"Rock Doc's" Marathon Tips

Elite Racing, Inc. and The Marathon Medical Team want you to have a safe race. Please read the important information below and have a great race!

Download Medical Brochure (853KB PDF*)

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Medical Director:

Lewis G. Maharam, M.D., FACSM

The Medical Team is a group of volunteer multidisciplinary medical personnel dedicated to acting as a team to provide rapid assessment of medical needs and to administer acute first aid and immediate services to the runners. The team is made up of volunteers from virtually every medical institution within your city to assist you in every way possible to finish the event. The following tips, services and guides are presented here to help you achieve a healthy and safe race.

Course & Finish Medical Stations

There will be medical stations on the course and at the finish. Look for the Medical Station sign and sports medicine volunteers wearing RED T-shirts for complimentary help before, during and after the race.

Post-event massage will NOT be offered in the finish area. Medical studies have found post-event massage within the first two hours after running/walking an endurance event to be harmful; it does not prevent post-event muscle soreness. Research has also shown that at least two hours after you finish the race is the most effective time for post-event massage. While our finish line medical teams will have massage therapists incorporated within the teams to assist in relieving cramps and to assist in first aid measures, they will not be giving post-event massages. If you care to schedule a post-event massage privately after you have left the finish expo, it is your individual responsibility to do so, and we suggest you do this ASAP since massage therapists will become booked for race day evening quite quickly!

Dropping Out of the Race

You know your body best. If you feel like you cannot finish or your doctor has advised you against participating in this event, we suggest that you do not toe the starting line. If you want to drop out of the race (for non-injury reasons), visit the nearest medical station on the course. Shuttles will be located at the following medical stations and will transport you back to the finish line:

• Marathon: Mile 10.6, 17.9, 19, 20.1, 22.3 and 23.7
• Half Marathon: Mile 8.6 and 10.3

You will not be shuttled back to the finish line until cleared by the Medical Team Captain at the above-listed medical stations. If you check into a medical station that does not have a shuttle on duty, you will be directed to walk to the nearest station with a shuttle. Alternatively, you may wait for the sweep vehicle tailing the last participant, or you may call a friend, relative or taxi to pick you up.

Start Line Medical Services

Should you have any last minute needs, a full medical staff will be at the start available for you. Please do not hesitate to ask questions in between warming up and stretching. Complimentary pre-event massage will also be provided. Keep in mind, this massage is done in 5-minute sessions to help loosen you up but does not replace your warm-up and stretching before the race. No creams or oils will be used that might clog pores needed for sweating.

The Rules About Fluids

You need to drink. But how much? The International Marathon Medical Directors Association (IMMDA) published guidelines which we suggest you read and use to remain healthy and safe on race day:

How Much Fluid Should I Drink During Endurance Events? It is IMMDA’s desire to educate and ensure that participants consume proper amounts of fluids during endurance events to remain healthy and perform well. Too much or too little may bring about health concerns and/or poor performance.

What should you drink? If your event or workout is longer than 30 minutes you should drink a sports drink instead of water. The added carbohydrates and electrolytes speed absorption of fluids and have the added benefit of energy fuel and electrolytes. There is actually decreased benefit to watering down or diluting sports drinks or alternating sports drinks with water.

How much should you drink? Drinking too much or too little can be of risk to health and performance. Hyponatremia (low blood salt level due to abnormal fluid retention from overdrinking) and dehydration (due to net fluid losses from under drinking) are conditions easily adverted by understanding your individual body needs. Just as you have a unique face and fingerprint, your body’s need for fluid is individual as well. Body weight, gender, climate and sweat rate are just a few variables that individualize your needs. It is normal to lose a small amount of bodyweight during a marathon: bodyweight will re-equilibrate over the next 24 hours through the consumption of sodium and fluids with meals. A weight loss of more than 2% or any weight gain are warning signs that justify immediate medical consultation and indicate that you are drinking improperly.

Try to drink to thirst. This advice seems way too simple to be true; however, physiologically the new scientific evidence says that thirst will actually protect athletes from the hazards of both over and under-drinking by providing real time feedback on internal fluid balance. If you are not thirsty, try to refrain from drinking. Do not feel compelled to drink at every fluid station nor follow the cues of other runners - their fluid needs are probably very different from your own. If you are “over-thinking” and feel you cannot rely on this new way of thinking, experiment in your training with one of these other ways realizing each has it’s own cautions as well.

Approximation of Fluid Replacement
There are individual variations: "one size does not fit all." IMMDA members endorse thirst as the best scientifically supported method for you to use. These alternate methods may not take into account changes in ambient conditions, running speed and terrain, which can change your level of thirst.

Runners and walkers who are interested in the endurance “experience” rather than pursuing a “personal best” performance, must resist the tendency to over-drink. Runners/walkers planning to spend between 4-6 hours or longer on the course are at risk for developing fluid-overload hyponatremia and usually do not need to ingest more than one cup (3-6 oz: 3 oz if you weigh approximately 100 lbs and 6 oz if you weigh approximately 200 lbs) of fluid per mile. Athletes should avoid weight gain during an event.

Some participants may find that adjusting their intake to pace or time is easier for them as shown below but remembering thirst is the best method:

Adjust the rate of fluid intake to race pace: slower race pace = slower drinking rate; maximum intake of 500 ml/hr (4-6 oz every 20 min) for runners with greater than 5 hour finishing times (10-11 min/mile pace). Weight monitoring is also important: if you gain weight during your workout or event, you are drinking too much!

For a more highly motivated runner/walker who desires a numeric "range", a fluid calculator can provide an estimate of body fluid losses as a generalized strategy for fluid replacement. Participants concerned about peak performance are advised to understand their individualized fluid needs through use of this fluid calculator but ALWAYS defer to physiologic cues to increase fluid intake (thirst, concentrated dark urine, weight loss) or decrease fluid consumption (dilute or clear urination, bloating, weight gain) while participating. It is also important to recognize that if you use this method in one climate and then travel to a different climate for your event, the humidity will change your sweat rate and therefore your fluid needs.

Fluid calculator to calculate sweat rate:

1. Weigh nude before the run.

2. Run/walk at race pace for one hour. (One hour is recommended to get a reliable representation of sweat rate expected in an endurance event.)

3. Track fluid intake during the run or walk; measure in ounces.

4. Record nude weight after the run/walk. Subtract from starting weight. Convert the difference in body weight to ounces.

5. To determine hourly sweat rate, add to this value the volume of fluid consumed (in Step 3).

6. To determine how much to drink every 15 minutes, divide the hourly sweat rate by 4. This becomes the guideline for fluid intake every 15 min of a run.

7. Note the environmental conditions on this day and repeat the measurements on another day when the environmental conditions are different. This will give you an idea of how different conditions affect your sweat rate.

Good luck in your training. Experimenting with your fluids can be a fun exercise. Remember to keep in mind that the consumption of beverages and foods containing sodium or carbohydrate should be guided by the goal to minimize loss of body weight and prevent weight gain.

Tips For Race Day

• Check your urine ½ hour before the race...if clear to dark yellow (like light lemonade)...you are well prehydrated...if dark and concentrated (like iced tea)…drink more fluids!
• During the race drink when you are thirsty...and no more.
• DO NOT take any product with ephedra in it. Ephedra increases your risk of "heat illness". It should not be used while training or on race day!
• Stay away from dehydrating agents such as cold medicines, anti-diarrhea products, sinus meds and caffeine which all can lead to dehydration; you may take them again a few hours after finishing the race.

Too Much Fluid Can Be Harmful

Most athletes understand the importance of drinking fluids, but some don't understand that drinking too much can be harmful as well. Overhydrating can lead to a dangerous condition known as hyponatremia (low blood sodium). Runners or walkers out on the course for long periods, losing lots of sodium in sweat, are at risk. Overzealous drinkers who drink lots of water in the days prior to the race and then stop at every fluid station along the course also may risk hyponatremia. This condition can lead to nausea, fatigue, vomiting, weakness, sleepiness, changes in sensorium and in the most severe instances, seizures, coma and death.

To avoid hyponatremia follow these easy guidelines:

• Follow the fluid recommendations.
• Try not to drink more than you sweat.
• Include pretzels or a salted bagel in your pre-race meal.
• Favor a sports drink that has some sodium in it over water, which has none.
• In the days before the race, add salt to your foods (provided that you don't have high blood pressure or your doctor has restricted your salt intake).
• Eat salted pretzels during the last half of the race.
• Carry 2 small salt packets with you, eat one just before starting and the second during the last half of the race.
• After the race, drink a sports drink that has sodium in it and eat some pretzels or a salted bagel.
• Stop taking non-steroidal anti-inflammatories 24 hours before your race and do not start again until a minimum of 6 hours after finishing the race.

During Training: Weigh In Daily

Step out of bed every morning and onto the scale. If you're anywhere from 1% to 3% lighter than yesterday, re-hydrate by drinking 8 ounces of fluid for each pound lost before training again. Over 4% lighter, re-hydrate and back off that day’s training intensity and see a doctor.

And After Workouts?

Weigh yourself right before and after workouts. For every pound you lost, drink a pint of electrolyte replacement fluid that has carbohydrate and protein in it. Carbohydrate replaces your glycogen (stored glucose) and the protein aids in muscle recovery. A good recovery drink has a ratio of 3-4:1 (carbohydrate:protein).

Prep For the Heat

Take ten days to two weeks to get used to hot weather, building workout intensity and duration gradually. Favor more intensity in cooler morning hours over easier work during the heat of the afternoon. Monitor core body temperature, which should stay below 102.2º F immediately after a workout. Higher than that, your performance is going down. Unfortunately, an oral thermometer isn't precise enough, and doesn’t take the right reading. Core means core. Get out the rectal, and get used to it. Avoid lengthy warm-up periods on especially hot and humid days. No supplements with ephedra during training or on race day; taking ephedra increases your risk of heat illness.

Pain Relievers

Recent medical research has shown that non-steroidal anti-inflammatories (NSAIDs) like Advil, Motrin, Aleve, ibuprofen, aspirin, naproxen, etc. may be harmful to runners' kidney function if taken within 24 hours of running; only acetaminophen (Tylenol®) has been shown to be safe. These NSAIDs are thought to increase the possibility of hyponatremia while running long distances due to their decreasing blood flow to the kidneys and interfering with a hormone that helps the body retain salt. Therefore it is recommended that on race day (specifically beginning midnight before you run) you do not use anything but acetaminophen (Tylenol®) if needed until 6 hours after you have finished the race, are able to drink without any nausea or vomiting, have urinated once, and feel physically and mentally back to normal. Then, an NSAID would be of benefit in preventing post-event muscle soreness.

Finish Tips

During the race, blood has been re-directed to your legs, away from your internal organs. This is "normal" physiology that you should know about. YOU MUST CONTINUE TO WALK AFTER FINISHING YOUR RACE. MOVE FOR AT LEAST 20 MINUTES! If you don't walk and stop or sit down, the blood flow to your internal organs will not rapidly be re-directed to the pre-race state. You would then feel nauseous (not enough blood flow to the stomach) and throw up, as well as feel very dizzy and weak! Walking helps to re-direct your blood and bring you back to your "everyday" physiology. Drink fluids slowly at the finish and certainly not until you have adequately "walked it off!"

Medical information label

On the back of your race number, there is a "Medical Information" form. PLEASE fill that out now. This will help us to help you should the need arise. Thank you.

Questions?

The Medical Team is here to help! The Medical Booth at the Expo is being staffed by our Sports Medicine Advisory Team to answer individual questions. Stop by. We're here for you! At each and every medical station on race day will be sports medicine professionals to help you along the way.

About Our Medical Director

Lewis G. Maharam, M.D., FACSM is a sports medicine specialist practicing in New York City (212- 765-5763). He is also the Medical Director of the Rock ‘n’ Roll Marathon®, Country Music Marathon™ & 1/2 Marathon and the NYC Marathon®. He is a past President of the Greater New York Regional Chapter of the American College of Sports Medicine and currently serves as Chairman of the Board of Governors, International Marathon Medical Directors Assn.