Marathon Advice from Dr. Amol Saxena, DPM

Having run several marathons and having the fortune of treating some of the best marathoners in the country, I would like to offer some advice on achieving your goal without ending up in the doctor's office with an injury or other problem. Preparing for perhaps your longest and toughest race can be hard on your body and detrimental to your running health, and there are many common mistakes novice marathoners make.

Most of the top runners say it is not the marathon that will injure you, it's the training. I believe you should run a minimum of 40 miles per week, and three long runs of at least 75 percent of the time you plan to run or 20 miles (whichever is longer) to run the marathon healthy and without injury. Joan Benoit Samuelson and Jeff Galloway's books have good programs, particularly for novices. The Leukemia and Lymphoma Society's Team in Training group seems to have less than a 10 percent attrition rate if you would like to train with a group. Keep in mind, the marathon isn't for everyone. Seasoned marathoner Joe Rubio says the more miles you can run at race pace per week, the less likely you'll "crash." I also find a high percentage of runners get injured if they don't take at least one of their long runs on similar race terrain and surface as they'll be running in the marathon. If you don't do this, your legs go into shock absorbing mode during the race. If you're lucky, only your quads and glutes will cramp. If you're unlucky, you may get a stress fracture. Taking some gentle downhill runs helps develop these muscles.

Though it is often repeated, many novice marathoners don't heed to the advice "don't try anything new on race day!" This means socks, cloths, shoes, gels and other products. Wear acrylic fiber socks (as cotton socks get wet and can cause blisters faster than acrylic fiber socks) and use Vaseline on any areas prone to blisters.

Run at least 50 miles in the shoes in which you plan to race. Make sure you bring layers for race day, especially clothing you can discard, including a second pair of socks, gloves and a hat (See below).

It is important to get enough rest prior to the marathon. Mark Conover has a taper program of running successively less quarter-mile repeats at race pace on the days prior to race day, working from six miles down to two miles. A lot of elite marathoners like to run a race of 10 km or less one to three weeks prior to the marathon, while novices should run a race of 10 km or less two weeks before the marathon, with your last long run three weeks prior to the event. I advise taking off the two days before the marathon, and then jogging two to three easy miles the day before the marathon.

Getting a massage a few days before the event is also helpful, as is stretching more and staying well hydrated. Use ice to massage any sore spots for five to 10 minutes. Be wary of dramatic diet changes; not everyone does well on carbohydrate loading or fat/protein loading.
Remember to experiment with different foods on some long runs to find out what works best for you.

On the day of the race, don't dwell on race-day tips. Have confidence in your training.

Olympian Mark Coogan says you can't do much more to get yourself in shape during the last couple of weeks anyway. The recovery phase after the marathon starts immediately after the race. Re-hydrate and refuel.

Change your clothes! At the San Francisco Marathon, I treated many runners that were close to hypothermia because they didn't have warm clothes or a hat in which to change!

It is also wise not to pop your blisters until after you shower to prevent infection. Use a sterilized needle to pop two holes on opposite sides of the blister and leave the roof on. Lubricate the area with antibiotic ointment, and only cover them if you absolutely needed. (Second Skin, Compeed or Tegaderm work best.) Leaving the blisters open and soaking in Epsom Salts also dries them out faster. If you have black and blue toenails, drain them as soon as possible, and you may be able to save your toenails and avoid a lot of unnecessary pain. Keep moving around as much as possible in the days after the marathon. Alternate hot and cold soaks, and get a massage. Anti-inflammatory such as Aleve or Advil (as long as you are not allergic or have ulcers) will help ease your pain in the first post-marathon week. Getting a massage helps flush out all the waste products in your muscles. It may also be wise not to resume running until all of the soreness is gone from your legs. Use your judgment about when to resume running. Basically, if anything is swollen or bruised, or if you experience sharp pains when you resume running, stop!

If your symptoms don't improve in a week, seek medical advice. I recommend taking it easy for a month after the marathon, so you can make sure any lingering tightness won't lead to an overuse injury when you ramp back up your running mileage. Good Luck!