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It’s that time of year again when lots of us increase our resolve to get fitter. London Marathon training is kicking in and there is no better way than running, for many people, to get in shape – but that is only if your body can cope with the stress for long enough to see the results of the hard work. Sadly, a large proportion of people setting out to run one of this year’s many marathons or just participating in regular running activity will get inured in the first 6-8 weeks. The most common things that we see in our clinics are pains at the front and outside of the knees, the front and inside of shins and the Achilles tendons. One problem that lots of our patients encounter when starting a running programme is that they do ‘too much too soon’. The issue that we all face here is that our cardiovascular fitness improves very quickly; changes in muscle chemistry can be seen literally within hours after aerobic training and improvements in the actual microcirculation within muscle and the structure of our muscle proteins within days so that, within a relatively short period of time, our ability to push ourselves harder increases dramatically. This all sounds great but the trouble is that our tendons, cartilage, joints and bony tissues adapt very slowly in comparison often taking months and even years to adapt and strengthen in response to higher levels of stress. Our skeletal tissues are involved in a constant process of break down and repair; cells are dying and being replaced all the time. The net rate of these two processes dictates whether our tissues are generally maintaining a health status quo, building strength or quietly breaking down and becoming degenerative – we refer to the amount of exercise stress we can tolerate and maintaining this healthy state as our “envelope of function”. Do too much and our tissues slowly become less healthy and eventually fail. Do too little and we are perhaps not pushing ourselves as much as we could and so not seeing those training results as quickly as we might ideally like. So the fitter heart and lungs and new improved muscle chemistry are able to easily cause our joints and tendon damage if we are not quite disciplined in how much we do. Generally we need to ensure that, whilst we are pushing things along, we are probably feeling that we could push it harder if we wanted in lots of our training sessions. This is a difficult thing to manage and most runners learn this through hindsight as naturally competitive people inevitably try and progress their training a little too quickly. We end up learning the hard way about what our bodies are able to tolerate and what is too much. Around 10% increase per week is one anecdotal method that is followed and appears to work quite well. This is a slow increase e.g. 10 minutes runs this week are 11 minute runs the following week. Lots of runners follow published training programmes found in the various running magazines and race entry packs. One thing that we have observed about these is that they appear to take people through a training programme based on the physiological time scales required to change our aerobic capacity and some degree of muscle conditioning. Ramping up the training levels quickly will not trouble the heart and lungs – they will just get fitter but what these programmes sometimes fail to recognise is that, unfortunately, most people who embark on them are asking their bodies to experience very large increases in physical stress when compared with their normal levels. For most of us a typical 24 hour period is spend sleeping and sitting for around 20 hours, a small amount of walking to and from the office and the train or tube and only 1 hour a day 3-4 times a week for example when we actually do something physically strenuous. Asking our muscles and our heart and lungs to adapt to marathon distances in 4 months is doable. Unfortunately asking our joint surfaces, cartilage, tendons, ligaments and bones is often not. Good luck with your running training. Get in touch if you have any questions or want to have your running action examined. If you have pain and injury you can usually get treatment covered through your medical insurance. We also offer discounted rates for cash payers who are entered in the 2013 London Marathon

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