Review
Medical problems of marathon runners

https://doi.org/10.1016/j.ajem.2006.01.023Get rights and content

Abstract

Several organ systems can be affected by marathon running. Acute musculoskeletal injuries are common, but running does not result in increased rates of musculoskeletal disability. Gastrointestinal complaints are also common among runners; some of these complaints are explained by the decreased mesenteric blood flow during exercise. Although cardiac events are rare, they can be devastating. Symptomatic hyponatremia is another serious but mostly preventable problem.

Introduction

In the United States, there are now approximately 375 marathons and in 2002 approximately 450 000 participants completed one. The largest US marathons now have more than 30 000 participants, with women constituting 40% of the field and runners older than 40 years (masters), 43%. The median finishing time is now 4 hours and 20 minutes for men and 4 hours 56 minutes for women [1]. Of marathon participants, 2% to 8% will seek medical attention during or immediately after completing the race [2], [3].

In cities that host one of the large marathons, marathon day can seem a preplanned mass casualty incident for the event medical tents and nearby EDs. The rigors of training and the stress of the race itself place great demands on the marathoner and frequent runner. We will discuss problems that can affect marathoners during and immediately after the race.

Section snippets

Musculoskeletal

While running, the repetitive impact of each foot strike transmits forces to the body estimated to be 2 to 3 times the body weight of the runner [4]. During a 12-year period at the Twin Cities marathon, musculoskeletal problems accounted for 17% of visits [3], most commonly, muscle cramps, blisters, and acute ankle and knee injuries [5]. Most of these complaints are addressed at the race medical tents. Knee injuries are more common in road racing, and ankle injuries predominate in track races

Conclusions

Most of the abnormalities present in the immediate postmarathon period are related to the event itself and resolve after a few days of rest. Testing asymptomatic patients during this period with several screening examinations may precipitate unnecessary workups for laboratory abnormalities such as for GI bleeding or hematuria. Testing in the immediate postrace period should be done with a specific question in mind and the understanding of how the endurance event can affect laboratory

References (66)

  • D.S. Miles et al.

    Changes in pulmonary diffusing capacity and closing volume after running a marathon

    Respir Physiol

    (1983)
  • N.A. Shadick et al.

    The natural history of exercise-induced anaphylaxis: survey results from a 10-year follow-up study

    J Allergy Clin Immunol

    (1999)
  • A.J. Siegel et al.

    Effect of marathon running on inflammatory and hemostatic markers

    Am J Cardiol

    (2001)
  • USA Track and Field Road Running Information Center: Annual USATF RRIC Marathon report. Running USA Wire 32, April 23,...
  • B. Crouse et al.

    Marathon medical services: strategies to reduce runner morbidity

    Med Sci Sports Exerc

    (1996)
  • W.O. Roberts

    A 12-yr profile of medical injury and illness for the Twin Cities Marathon

    Med Sci Sports Exerc

    (2000)
  • J.S. Dufek et al.

    The evaluation and prediction of impact forces during landings

    Med Sci Sports Exerc

    (1990)
  • M.A. Caselli et al.

    Lower extremity injuries at the New York City Marathon

    J Am Podiatr Med Assoc

    (1997)
  • G.W. Bishop et al.

    Musculoskeletal injuries in a six-day track race: ultramarathoner's ankle

    Clin J Sport Med

    (1999)
  • A. Koller et al.

    Effects of prolonged strenuous endurance exercise on plasma myosin heavy chain fragments and other muscular proteins. Cycling vs running

    J Sports Med Phys Fitness

    (1998)
  • A. Kratz et al.

    Effect of marathon running on hematologic and biochemical laboratory parameters, including cardiac markers

    Am J Clin Pathol

    (2002)
  • C.A. Macera

    Lower extremity injuries in runners, advances in prediction

    Sports Med

    (1992)
  • C. Riddoch et al.

    Gastrointestinal disturbances in marathon runners

    Br J Sports Med

    (1988)
  • S.N. Sullivan et al.

    Runners' diarrhea. Different patterns and associated factors

    J Clin Gastroenterol

    (1992)
  • J.P. Clausen

    Effect of physical training on cardiovascular adjustments to exercise in man

    Physiol Rev

    (1997)
  • A.E. Schwartz et al.

    Endoscopy to evaluate gastrointestinal bleeding in marathon runners

    Ann Intern Med

    (1990)
  • M.A. Porter

    Do some marathon runners bleed into the gut?

    BMJ

    (1983)
  • M.E. McCabe et al.

    Gastrointestinal blood loss associated with running a marathon

    Dig Dis Sci

    (1986)
  • R.S. Baska et al.

    Gastrointestinal bleeding during an ultramarathon

    Dig Dis Sci

    (1990)
  • N.J. Rehrer et al.

    Biomechanical vibration of the abdominal region during running and bicycling

    J Sports Med Phys Fitness

    (1991)
  • S.C. Choi et al.

    The role of gastrointestinal endoscopy in long-distance runners with gastrointestinal symptoms

    Eur J Gastroenterol Hepatol

    (2001)
  • R.S. Baska et al.

    Cimetidine reduces running-associated gastrointestinal bleeding. A prospective observation

    Dig Dis Sci

    (1990)
  • F.M. Moses et al.

    Effect of cimetidine on marathon-associated gastrointestinal symptoms and bleeding

    Dig Dis Sci

    (1991)
  • Cited by (60)

    • Cecal volvulus in long-distance runners: A proposed mechanism

      2019, American Journal of Emergency Medicine
    • Characterization of medical care at the 161-km western states endurance run

      2015, Wilderness and Environmental Medicine
      Citation Excerpt :

      The findings from this study provide an opportunity to compare the medical needs at a 161-km mountain ultramarathon with what has previously been reported for marathons and staged multiple-day ultramarathons. The present consultation rate of 8.2% falls within the range of 2% to 12% that has been reported for marathons.17,24 However, it is substantially lower than what has been reported for a 5-day staged 209-km ultramarathon in which 56% of participants were seen with a medical problem5 or for 7-day staged 250-km ultramarathons in which 85% of participants were indicated to have been evaluated for at least one illness or injury.4

    View all citing articles on Scopus

    This article has not been published previously and is not being submitted elsewhere. The manuscript is the original work of the authors and there are no conflicts of interest to disclose.

    View full text