The countdown to the Dublin City Marathon is on, but how can you avoid the pitfalls of overloading injuries/ tendinopathies?

Believe it or not, it is just over 11 weeks until the Dublin City Marathon. At this stage, most of the contestants who hope to complete the marathon will have ran close to the distance required to complete a half marathon. The body should be feeling good and there should be a very minor difference between completing a 10 or 12-mile run. Your undoubtedly excited and can see the finish line in sight as the autumn months approach.

Unfortunately, however every year I must give people the awful news that their Marathon journey has come to an end before the race has even began.

A huge percentage of the participants believe that the key to completing a marathon is to simply build up your mileage over a set number of weeks. Although some people get away with this approach there is however, a large percentage of participants that do not.

The simple reason is we are no longer hunter gatherer’s in our daily lives, we are now more sedentary slaves to our desktops. As a result, our tissue is no longer able to cope with the excessive loading which is required to complete the holy grail of 26.2 miles. The result of this sudden onset but gradual increase in load is the occurrence of overloading injuries in our tendons known as tendinopathies.

So, what is a tendinopathy and more importantly how can I avoid getting one if I am training for a marathon?

For many years tendinopathies were often diagnosed as tendinitis. The simple difference is a tendinitis is a chronic inflammatory issue which also occurs acutely at the early stage of a tendinopathy (reactive tendinopathy) whereas, a tendinopathy occurs when the healing rate following the initial inflammation is slower than the injury reoccurrence thus leading to tendon disrepair and subsequent deterioration and degenerative changes in the tendon.

This is characterised by collagen degeneration in the tendon due to repetitive overloading. These are quite difficult to manage and are very painful in nature. The most common tendinopathies that occur when training for a marathon develop in the Achilles tendon, Tibialis posterior tendon or occasionally the tibialis anterior tendon of the lower leg/foot.

The best way to avoid getting a tendinopathy is to perform a preseason/preventative strengthening programme and a mid-season maintenance strengthening programme. This programme should be designed by your physiotherapist and should focus on strengthening the muscle attached to these vulnerable tendons. The strengthening of these muscles increases the tensile load that the tendon can withstand which subsequently reduces the risk of developing an overloading issue.

Is it too late to begin strengthening?

It is certainly too late to begin your preseason strengthening programme involving plyometrics and high load eccentric exercises however, it may still be possible to strengthen moderately before the event. The grey area is that your programme of strengthening needs to incorporate the mileage you are also aiming to complete on a weekly basis. Therefore, if this programme is not designed correctly it may increase your chances of overloading and developing a tendinopathy.

Physiologically it takes anywhere between 8 & 12 weeks to strengthen muscular tissue dependant on the muscle.  So technically it is possible, my advice would be to see your physio and have a prehab assessment to identify the specific areas that need strengthening and lengthening. The strengthening is then much more focussed and unlikely to disrupt your training regime.

If a more generic strengthening approach is required Reformer Pilates may be the perfect solution to coincide with your running programme.

Although the reformer carriage provides resistance it will not allow you to overload vulnerable tissue and will certainly help your preparation by improving your foot strength and proprioception.

If I have overloaded a tendon and subsequently have pain how do I resolve it?

Once again see your physio. Tendinopathies are multi-factorial issues and require a multi-factorial approach. The sooner the issue is diagnosed and treated the sooner you can return to completing your training for the marathon.

It is also important to make sure you are performing foot strengthening exercises and that your trainers are appropriate for your foot posture. Please don’t try to keep running in pain and hope the pain will go away. My experience in treating all kinds of professional and nonprofessional athletes suggests this approach never works. This approach is in fact detrimental to your chances of completing the marathon.

Practically all the would-be participants that I have declared unfit to run in the marathon over the years fall into this category. They began to develop lower leg/foot pain at the 12-15-mile mark and believed they could get to the 21-22-mile distance before tapering off their training, thus giving the injury a chance to rest & be treated.

This never works and if it does the damage is already done by the time you see your Physio, making it virtually impossible for them to get you ready and to declare you fit.

Be proactive and ahead of the curve by booking a prehab assessment with Platinum Physiotherapy. It will not only allow you to reach that holy grail of 26.2 miles in late October, it will also allow you to enjoy the build-up to the event and the event itself without having the added worry of injury/pain/dysfunction.

Pre and Post Natal Pilates this Autumn

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