Ready, Set, Don’t Get Injured

The pattern is a familiar one for sports medicine doctors, orthopedic surgeons and physical therapists. Marathon season — usually a stretch lasting from mid-August to December — means more patients.

This year, of course, is the first time since the fall of 2019 that many runners are returning to start lines around the world, in hopes of feeling something resembling normalcy. They will be joined by a swarm of new runners: those who laced up their shoes in the past year and a half when running outdoors became the easiest, and sometimes safest, option for exercise.

And this year, there will be more major marathons packed into a fall calendar than ever before, with the Berlin Marathon on Sept. 26, the London Marathon on Oct. 3, the Chicago Marathon on Oct. 10, the Boston Marathon on Oct. 11, the Tokyo Marathon on Oct. 17, the Marine Corps Marathon in Washington on Oct. 31, the New York City Marathon on Nov. 7 and the Los Angeles Marathon also on Nov. 7.

The beginners and veterans will, as always, be united by a common goal: getting to the start line injury-free. But this year may make that a bit more difficult, as many runners have not entered an in-person race for more than 18 months.

“Your body right now is not the same body you had two years ago, so you’ve got to pay attention to that,” Dr. Jordan Metzl, a sports medicine physician at the Hospital for Special Surgery in New York, said. “I’ve been talking to patients about closing the gap between where you are and where your mind thinks you are.”

So how do you stay on track for a fall race — be it a 5K fun run or an ultramarathon — and keep yourself uninjured?

Here’s some advice for novice runners and elites alike:

Acknowledge the past year and a half. For the vast majority of us, there’s been a drastic shift in activity since March 2020, be it eliminating the walks to and from work or decreasing the intensity of workouts because of pandemic restrictions. Treat this training block accordingly, and fight the impulse to compare your runs with those from previous years.

Look at your past few months. Make sure you are not violating what Metzl, a 35-time marathoner and 14-time Ironman triathlon competitor, calls the “Rules of Too” — too much, too quickly. Drastically increasing your mileage or workout intensity can be a surefire recipe for an overuse injury. Most plans should ease you into longer runs and faster workouts.

Invest your time in strength training. “Every time you run, it’s a battle of man or woman against the ground,” Metzl says. “And the ground wins every time.” Two of the ways you can show up more prepared for that battle are strength training and cross training, which Metzl has long proselytized to his patients. And you don’t need a gym membership to find a good strength program for runners. Try this 9-minute, equipment-free workout to start.

Be a good “body listener.” If you use a training plan, you may be wary of switching anything up for any reason. That can come at the expense of your health. So if you are feeling off, listen to your body and change course. Knowing when to push and when to back off is perhaps one of the hardest things for a runner to do consistently. Fight the urge to do more if your body is telling you to do less. And don’t be afraid to adapt your plan — which should be thought of as a guide — based on what your body is saying you need.

Know how to identify types of pain. It can be difficult to determine when running pain is acceptable, even expected, versus when it will lead you down a treacherous road toward injury. It’s something that novices and elites alike struggle to identify. Metzl, who admits he has faced almost every injury his clients have, recommends thinking of your stride to start. A side cramp is one thing. A pain that causes you to shift your mechanics is something else. If you are no longer able to run properly, it’s time to see your doctor.

Learning how to listen to your body and recognize different types of pain is a lifelong process for athletes. So go easy on yourself if you are frustrated when different aches arrive on the road to race day. And when in doubt, check it out.

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