The Pure Pod Ep. 6 - London Marathon: Preparation and Recovery

We’re deep into Marathon prep season. The London Marathon, at the time of recording, is just six weeks away. 

We know many of you will be on top of your training plans, but you’ll likely still want to know all the tips and tricks for finishing the race at your very best. That means nailing your running routine, your strength and conditioning programs, your diet, your hydration, and maybe most importantly, your motivation for getting miles in your legs. 

That feeling when you cross the finish line is the culmination of months of hard work. But what comes after is often overlooked. How do you mitigate the immediate risk of injury after 26.2 miles? Looking at the medium, or long-term recovery should you push on or scale back? What comes after the adrenaline dump? 

This is our second podcast on Marathon prep, and it will look in detail at the last-minute prep, race day itself, and the aftermath. Consider it your companion to the next month of effort, and the fitness journey that comes after your amazing achievement. 

To guide us through this process, we’ll be talking to physio and running injury specialist John Daly, and podiatrist Alex Townsend. Both men are long distance runners themselves, so can draw on personal and professional expertise to help with your prep and recovery. 

You can listen to the podcast in full below, or read on for some of the best bits from the conversation. 

Here’s what we covered: 

• Where runners should be in their programme at this stage (4:15)
• How to stay motivated with marathon training (7:15)
• Nutrition tips for the buildup, and on the day of the race (10:00)
• How to mitigate injuries, in particular lower limb ailments (16:45)
• Why recovery is a priority at this stage of prep (25:00)
• When you should start tapering your programme (26:30)
• The ideal routine for the week before the race (31:30)
• Tips for enjoying the day and maximising performance (35:45)
• Post-race recovery (39:30)
• How a podiatrist and physio might collaborate to help a patient recover from an injury post-marathon (44:30)
• Words of advice and motivation for runners taking part in the marathon (51:15)

We’re a month or so from the London Marathon, where should runners be with their training at this stage? #

John Daly: At this stage, your fitness is where it’s at. I wouldn’t really be looking at adding a whole lot of different variables. 

As a running injury specialist, seeing runners all day every day, I often see people when they’ve all of a sudden changed something. They’ve added in hill running, or speed work. We want to try and keep as many variables the same, focus on the basics and do them well. That’s sleep, rest, repair, recovery; absorb the training you’ve done. 

Strength and conditioning has a lot of benefits and can improve running economy and efficiency. But at this stage, it could be hurting. It can bring on delayed onset muscle soreness that could impact your running. The week before the marathon, I would cut all weight training. 

Alex Townsend: We don’t want to be adding in too many extra sessions, or too many high intensity sessions. That means long runs; many people have the thought: ​‘Oh, I’ll add in one more 35k run just to reassure myself.” That can lead to injury. Trust your plan coach, trust your coach and trust your physio. 

What would be your advice to a runner that’s lost motivation or struggled to find consistency in their preparation? #

AT: We’re coming out of winter, it can be really hard to keep going in those darker, winter mornings. I always tell patients to add it to their social life. A running club can surround you with like minded people with the same goals. 

JD: Running in a group we can spread the workload. You can learn from other people. Marathon training can be tiring, it can be taxing. It’s not the end of the world to look at your plan and change your harder intensity session to a lower one. 

The plan is a piece of paper. It doesn’t tell you how your body feels, how your sleep has been. 

What are common injuries at this stage, and how can runners mitigate these risks? #

AT: It’s very bone stress injury heavy. We call it medial tibial stress syndrome, or more commonly, it’s known as shin splints. We see a lot of plantar fasciopathy, so the connective tissue across the bottom of the foot. Achilles tendinopathy is also very common. 

JD: About a third of the injuries I’ll see are relayed to the calf. That can be achilles and plantar fascia-related too. The calf is probably the most important muscle for runners. 

There’s a lot we can do there. We look at shifting the load. If you’re presenting with knee pain too we can look at putting the treadmill on a bit of an incline so we can shift load onto the glutes. 

AT: We can only optimise load. We can deviate forces into different areas; we can’t remove it entirely. We can rehab someone on the treadmill, and look to strengthen the muscles in the gym. 

I’m a big fan of people using a footwear rotation. If someone’s coming in with achilles tendinopathy and we notice they’re calf dominant with their running form, we can suggest a shoe that has a higher heel to top drop, which can offload things to a certain extent. 

JD: Running related injuries are multifactorial, but the most important thing is to keep the easy days easy. If you can hold a conversation while you’re running, that’s a good sign that you’re in Zone 2 cardio; we don’t need to push the pace harder than that. 

How about recovery? #

JD: Recovery is a vital part of the process. Training breaks the body down, and we’re causing microtears in the muscles, but it’s when we’re recovering that we see the full benefit from the work. 

Risk of injury when you have two weeks of less than seven hours sleep has been associated with a 1.7X greater risk of injury. 

Mixing in other forms of low impact aerobic fitness; cross training on the bike for example. Focus on sleep, hydration and recovery.

What are your tips for race day? #

AT: Don’t add anything new. 

JD: The biggest one is don’t go out too fast. You’ve tapered your training, you feel fresh, there’s crowds, there’s the adrenaline. I spoke to so many people that said they felt great but went out too fast and started losing time as the race went on. Stick to the blue line, that’s the shortest route. I’ve seen some people add a K to the run by not sticking to that route. 

What are your post-race recovery tips? #

AT: It’s the basics. Good hydration, good nutrition and good sleep. One thing I will say, if this is a big deal for you: good company, good drink, good food. 

JD: It’s a great opportunity not to be as clean on your diet. You’ve just burned 1000s of calories, pushing the hardest you ever had. You don’t need to live like a monk. Better to be in a surplus and consuming so you can heal, rest and repair. 

Maybe on Thursday or Friday I might get on the bike. Low resistance, very gentle spin. This is active recovery, so again it should be in that Zone 2 range. That weekend, maybe I’d consider doing a gentle 5k to help you loosen up. You can actually run to recover from running, as contradictory as that may sound. 

How might you collaborate on treating a patient with an injury from long-distance running? #

AT: I’ll obviously take the first step from a podiatry perspective. Is there something going on biomechanically that I want to assess? Is it an acute injury? Are we looking at chronic overload? Do we need ultrasound, MRI, or doctor involvement? After that triage, we can collaborate with sports and medicine consultants, rheumatology, endocrinology; the list is endless. 

JD: Being from different disciplines we can work together to get the best outcome for the patient. We can do joint sessions, and have done after marathons. 

The first thing I want to rule out is a bone stress injury. If the patient reports any kind of sharp pain along a bone we want to get that screened right away. That investigation can also consist of a blood test to see if there’s a calcium injury. It can also mean looking at diet. Are they under-fueled? Are they not strong enough; do they need to see a strength and conditioning coach?

AT: The reason our clinic exists is to treat people who have specific sporting injuries so they can get back to what they need to. There’s no point going to a GP who will tell you to stop running or that running is bad for you. Runners will always get a second opinion when they hear that.