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How to stop your marathon patient running into difficulties

Patients who are planning to run a marathon will benefit from the support and advice of their GP, writes Dr Steve Brown – who speaks from experience.

Patients who are planning to run a marathon will benefit from the support and advice of their GP, writes Dr Steve Brown – who speaks from experience.

Case history

Jane Green, 38, comes to you asking for advice on running the London Marathon in seven months' time. She has run a couple of 10-mile races, which was five years ago. She wants your help to get started.

Should I encourage her to run?

As somebody who has run five marathons now, I would encourage her to go for it. The benefits are numerous and I would advise her of these: getting fitter, losing weight, achieving a difficult goal and potentially raising money for charity.

What initial advice should I give?

I would encourage Jane to work out a timetable for the next seven months, and get her family to support her in her training as they will be affected by the time spent pounding the streets, a higher food bill, more washing and moaning about injuries!

Excellent training schedules are available online from Runners' World or The London Marathon. Marathon News, which is published by London Marathon, contains an entry form as well as advice on training, fluid balance and injuries. This is available from sports shops in the autumn before the race on 22 April. I would encourage Jane to stick rigidly to the schedule as the training plan will be gradually more demanding and if done properly will enable her to complete the 26.2 miles.

I would also encourage Jane to do at least three half-marathons in her training so she can monitor her progress and also see how hard a full marathon is.

What about equipment?

The best advice you can give your patient is to get the right pair of shoes. Shoes are the only piece of equipment that can protect the body from the impact of 30,000 steps in the race itself and hundreds of miles in training. I once had the wrong pair of shoes and developed shin splints, which I have never had since. All the main sportswear manufacturers analyse gait now with either a foot scan or videoing you on a running machine.

There are different running shoes depending on whether you have a neutral running posture or overpronation (in very simple terms, the inward roll of the arch and heel) or supination (the foot not rolling in enough). It is worth spending money on the right shoes, because most injuries are because of overuse, and any slight biomechanical abnormality will be found out by training. I would advise a consultation with a good sports physiotherapist or a podiatrist if Jane has any pre-existing lower limb problem or a previous injury.

What about a medical before running?

It would probably be a good idea to check her blood pressure and listen to her heart just in case there is an abnormality that has been undetected. For women who may be anaemic a full blood count may be appropriate. I would also ask Jane about her periods as exercise can stop periods and potentially lead to osteoporosis. Calcium supplementation if the diet is low in dairy products and the combined contraceptive pill may be advisable to provide extra oestrogen.

Sudden deaths do occur in running (such as in the recent Great North Run), but unless all runners undergo full cardiac investigations before running it is virtually impossible to prevent such events. However, I would advise Jane that on the day of a race if she is acutely unwell she should withdraw. In addition, I would advise Jane that she should listen to her body during the race itself, and there is nothing wrong with walking for a few minutes if recovery time is needed.

Is fundraising a good idea?

I have been very lucky in that I have had great support from family, friends and patients and have raised about £5,000 each time. If Jane was keen to be sponsored for a medical charity I would ask the partners if she could put a notice on our board in reception. I would also encourage her to arrange a meal in a local restaurant. I have found that it is easy to sell tickets with the restaurant giving a donation to your charity, and I am sure a lot of new business is created for the restaurant. I find that the support and interest is amazing when people find out you are doing a marathon.

What other role does the GP have in this type of situation?

GPs are not usually sports experts but there is a role for advice, which in my experience is to advise injured runners to rest from running rather than developing chronic problems. In this case a change to swimming or cycling for a short time may be good. I would also be able to advise Jane on simple stretches for minor problems.

Dr Steve Brown is a GP and trainer in Beaconsfield, Buckinghamshire

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