Wrapping an Injured Ankle

Wrapping an Injured Ankle


A Race Too Far

by  Laura Morgenthau

I have never looked worse. Clearly, it was the perfect time for a network news camera to be trained in on my miserable face. That warm April afternoon, I became the 6 o’clock news’s poster child of anguish and despair for the 105th running of the Boston Marathon—I was the leg-weary marathoner whose heart had been broken on Heartbreak Hill.

My misery began, innocently enough, exactly one year earlier. A recent Boston immigrant, I showed up in Copley square on marathon morning starry-eyed and eager to find out what all the marathon buzz was about. I stood in the throngs of spectators, soaking in the sounds of clanging cowbells and the waves of cheers that crested as personable runners strode by. Straining to see these sinewy paradigms of athleticism, I vowed that next year, I’d be on the other side of the steel gates. I wanted to taste the sweet victory of a blue and gold finish line for myself. Evidently, the adrenaline-laden air had gotten to my head.

People run marathons for many reasons. Mostly, it is a challenge—a physical and mental achievement that many desire, but few attain. A common line item on life’s list of Things To Do Before I Die, many think of marathons as epic journeys, the pinnacle of physical fitness. But, marathons punish the human body in a myriad of ways. There is so much potential for injury, that it seems illogical to even think about running one. And yet, in 2002, 450,000 people completed marathons in the United States. We can’t all be crazy. Or can we?

Finished Before Starting

Marathon casualties start piling up even before the starting gun is fired. The New York City Marathon accepts 50,000 runners every year expecting that only about 35,000 will show up in Staten Island on race day. Richard Finn, the spokesperson for the ING New York City Marathon, speculates that injury, illness, and conflicting personal commitments explain, at least partially, why 15,000 of the initial entrants never toe up at the start.

A 30% attrition rate is not surprising considering the physical, mental, and time demands of training for a marathon. A typical beginner training regime builds over a five month period, and requires running 4-5 days per week, with an additional day of cross training such as biking or swimming. Once a week, marathon trainees complete a long run that gradually builds from about 5 miles to somewhere in the 20-mile range. According to Christine Roy, a physical therapist at Spaulding Rehabilitation Center in Wellesley, MA, this long run is essential as it accustoms the mind and body of the marathoner to high-mileage running.

Preparing for Pain

As it turns out, injury would mar my own training regime. On December 26, 2000, I laced up a new pair of Nikes, zipped up a fleece-lined running jacket, and stepped out into the cold. Miles and miles of running followed, as the winter months dragged on. My weekly long runs, two- to three-hours of mind-numbing monotony, were quickly chased with a quart of Fruit Punch Gatorade and an equally long nap. And then, something unfortunate happened. Somewhere in the winding, hilly madness of Commonwealth Ave, two-thirds of the way through an 18-mile training run, I felt my hamstring twinge. When I finished my run, I realized that the “twinge” was actually an injured muscle. With the race a little over a month away, I scaled back on my training, desperately hoping to heal quickly.

Musculoskeletal injuries, like my injured hamstring, are common in marathon runners. The constant pounding of each stride, a force equal to about two or three times the runner’s body weight, can wear on a runner’s muscles and bones. In fact, at the Twin Cities marathon, which runs from Minneapolis to St. Paul, MN, 17% of medical visits during a 12-year time period, were due to musculoskeletal injuries.

In addition to muscle pulls, stress fractures sideline many prospective marathoners. These tiny cracks in a runner’s bones, most commonly in the lower legs and feet, are caused by the perpetual pounding of distance running. Distance running can also cause the kneecap to move incorrectly inside the knee, eventually wearing away at or irritating the knee’s cartilage. This condition, called runner’s knee, plagues many marathon runners. But runner’s knee isn’t the only marathon injury that causes knee pain—iliotibial band syndrome does as well. If a runner’s iliotibial band, a band that runs from the hip to the knee, is tight, the friction as it rubs against a bone projection on the outer knee can cause intense, burning pain.

But musculoskeletal problems such as these are just the meat and bones in a devil’s brew of marathoning injuries. Blisters, chafing, bloody nipples, dehydration, and exercise associated collapse are a few of the many other potential marathon ailments. And with a recipe for disaster like this one, running a marathon, from a health perspective starts to sound crazy.

Then again, marathoners are all a little insane. The last thing a marathoner wants to hear is someone telling her to stop running. Since some pain, such as muscle tightness, is a normal part of running, some runners have a difficult time differentiating between normal pain and injury, notes Roy. And, at times, the desire to continue training can cause a marathoner to keep going when she shouldn’t. Roy calls this the “runner’s mindset.” A marathoner herself, she found she was not immune. While training for her first marathon, she acquired what she thinks was a stress fracture in her pelvis three weeks before the race. She ran the marathon anyways. Even though, as a physical therapist, she knew she shouldn’t.

Racing to the Infirmary?

My injury eventually healed, but my training regime suffered. So it was with a little trepidation that I showed up in Hopkinton on April 16, 2001. Nervously fidgeting at the back of line, I found myself at the point of no return. It was Boston or bust.

Race day is a peculiar event for marathon runners. Months of mental and physical training boil down to a runner’s condition on that single day. Because of this, runners may ignore sub-optimal running conditions that can place their health in peril, such as hot weather that increases dehydration risks, or a dodgy muscle ache. “It’s one day of pain. You just kind of push through it,” says Lisa Murray, a Boston University Athletic Trainer who finished her second marathon this past April.

During or just after the race, 2–8% of marathoners receive medical help according to a 2006 review article in the American Journal of Emergency Medicine. This article also reports that as many as 81% of marathoners may complain of gastrointestinal issues, such as bloating, cramps, nausea, vomiting, diarrhea and fecal incontinence either during or training for the race.

My stomach of steel, thankfully, held out for me that day. I strode confidently through the first half, passing the 13-mile mark in under two hours. And then, at mile 15, I started to realize that I might have a problem. The weather was unusually warm, and I had not prepared for it. Dressed in my winter leggings, I was hot and couldn’t shed another layer. At mile 18, I hit the wall.

I can only describe hitting the wall in one way: pain, pain, and more pain. Every muscle in my body ached and was screaming at me to stop. I just could not, could not, take another stride forward. I started walking. I slogged my way through the rest of the course, dragging an ego as badly bruised as the rest of my body behind me. My cycle of misery was complete. Almost.

From the security of the sidelines this year, I once again watched thousands of runners proudly cross the finish line in Boston. And I realized that my marathoning days are not yet over. I know there will be pain. Likely, there will be injuries. But there’s a part of me that still yearns to stride confidently into Copley with my head held high and my muscles intact. Next year is my year, I think.