The clinic


How much rest time is necessary after a marathon? Why is it that rest is needed after a marathon but not after the 26-mile training runs leading up to it?

Michael Moran

Charlottesville, VA

The rule of thumb is a day of rest for each mile raced, which means basically an easy month after a hard marathon to allow your body a full recovery. I usually recommend an entire week off from running and then relative rest up to a month. Typically, your last long training runs leading up to a marathon are 20-plus miles at most, not the full race distance. Tapering, or reducing mileage and intensity, in the final weeks before the marathon usually reduces the final long run before a race to about 9 to 10 miles. Tapering builds rest time into your training schedule leading up to the race.

However, more rest is required after. the marathon than after a long training run because a race is usually run with greater intensity than your training runs. It is usually the goal to run the race at your best effort, testing yourself more, using less restraint than in practice. Harder effort requires more recovery.

Lee Fidler Ed.S.

Stone Mountain, GA


I am a 44-year-old runner, 5’7″ and 150 pounds. I have been running for 18 years and have run 35,000 miles in that time, including 12 marathons. I also have lost 100 pounds and have maintained that weight loss for 11 years. Due to irregular monthly periods (too often and too long) attributed to perimenopause, my doctor recommended that I use the birth control pill. Could you give me some advice and guidance on the effects of birth control pills in women over 40 who continue to run?

Caitlin Minnow

Boston, MA

The use of the birth control pill in women over forty has gained a great deal of popularity in the past three to four years. This is due, in part, to the continued need for contraception, but even more commonly, for the irregular cycles and the un-predictable and heavy bleeding many women experience during perimenopause (the years leading up to menopause). Low dose birth control pills that contain 20 to 30 micrograms of estrogen are the most commonly prescribed.

There are many known benefits other than effective contraception with low dose birth control pill use. It is known that women who use low dose birth control pills have lower incidence of heavy bleeding or irregular bleeding, endometrial cancer, several types of benign breast disease, ovarian cancer, rheumatoid arthritis, and pelvic inflammatory disease.

Oral contraceptives are also associated with a number of changes in the blood clotting mechanism in both sedentary and physically fit women, and can cause a slight increased risk for blood clots, particularly in the legs. Exercise training may offset the tendency towards these increased risks. Birth control pills containing estrogen and progesterone can also adversely affect cholesterol and lipid levels due to the progesterone. However, a recent study showed that runners taking oral contraceptives have lipid profiles similar to those of runners not taking hormonal medications, suggesting that exercise may offset the adverse effects of oral contraceptive agents on lipid levels.

Some recent studies have shown that there is no significant difference between athletic performance in women on birth control pills as compared to controls. Of course, the best effect on your athletic performance will be from the consequences of not bleeding excessively. Regulating your cycles and reducing the amount of menstrual bleeding will provide enormous performance benefits. Not only will you have the advantage of training without worrying about your unpredictable cycle, but you will also lower the impact of frequent and excessive blood loss on your iron levels reducing the likelihood of anemia.

Overall, for individuals without additional risk factors, the use of low-dose birth control pills to regulate cycles during perimenopause is a reasonable option. As long as you are in good health, continuing to train can actually counteract many of the potentially adverse effects of the pill.

J. Ron Eaker, M.D.

Augusta, GA


Will replacing the insole in my running shoes with expensive athletic shoe insoles extend the life of my running shoes? Will they help me avoid shin splints? I’ve had a history of shin splints.

Wendell Weustenberg

Eldridge, IA

Replacing an insole of a shoe is not likely to increase the life of the shoe. The midsole materials will begin to deform within 200 to 400 miles. Calculate your average weekly mileage and make a note in your calendar to buy new shoes within 400 miles or fewer. Depending on your mileage, this can mean several pairs of shoes a year and it is one of the most important things you can do to prevent injuries. Your insoles, on the other hand, will break down more quickly, roughly in half the time and should be replaced at least once during the life of your shoes. Many running shoes now come with replacement insoles.

Be careful when using over-the-counter insoles with built-in arch supports. They are made to accommodate a wide variety of foot types and won’t necessarily be the best for your foot. Since you are prone to shin splints, see a sports medicine professional and find out whether you’d benefit from specially-fitted orthotics to use instead of regular insoles.

Steven Plotka, D.P.M

New York, NY

An unpublished study comparing the effects of insoles and running shoes on impact forces indicated that running shoes are the primary determiner of impact characteristics and that replacement insoles had little effect on impact forces measured at the tibia. Since running shoes are equipped with both shock absorbing and motion control features (both of which work to reduce shock forces), it may be that the marginal reduction of force due to the addition of insoles is slight.

In a published review of data from several other studies, authors concluded that shock-absorbing insoles do reduce the incidence of stress fractures in athletes and military personnel. Replacement insoles may provide an extra margin of protection in your running shoes. However, if motion control to prevent over-pronation or over-supination is a factor for you, check with a sports medicine professional before you add shock-absorbing insoles. Also, be sure that you have an accurate diagnosis of your shin pain. “Shin splints” is a general term that can cover a variety of injuries (see below). As with any recurring injury, you should make sure you have a clear understanding of the underlying causes so that you don’t continue a cycle of injury/rest/heal/injury. (CN)


I am 15 years old and run varsity cross-country and track I have had persistent problems with shin splints and continue to have pain despite icing, stretching and taking anti-inflammatory medications. I have continued to run with some success since my times have continued to drop. During the post season (January and February) I cut back on mileage, increased crosstraining and the pain had improved. Unfortunately, as soon as indoor track started, it was back. I got new shoes and over-the-counter orthotics but these haven’t helped. I don’t want to give up running during track season. Any suggestions?

Sarah Morrill

Chagrin Falls, OH

First, you need a precise diagnosis for your pain. “Shin splints” is a general term that can refer to shin pain from a variety of causes including exertional compartment syndrome, claudication, stress fracture, stress syndrome and periostitis. Evaluation includes a gait and biomechanical evaluation, a check for leg length difference, joint range of motion and flexibility, and a check for swelling, redness, and tenderness. You will need to be evaluated for osteoporosis if you have stress fractures. Young female runners can be at risk for Female Athlete Triad in which low estrogen levels contribute to loss of bone density.

Treatment should correct the training errors, biomechanical imbalances and tissue pathology. Prescription orthotics can correct biomechanical problems. Replace your shoes after 300 miles. Your coach should review and modify your training program. Always warm up completely, cool down, and stretch. Include adequate rest and recovery in your training schedule since overtraining can always be a contributing problem. You can apply heat prior to exercise and cold packs after. Use cold packs anytime for pain control.

You may need to evaluate your diet and consider hormone replacement therapy if you are not having normal menstrual periods. Be sure you see a sports medicine physician who can determine the source of your shin pain, solve the underlying problems, and get you back on track.

Mitch Goldflies, M.D.

Chicago, IL

Indoor tracks are usually constructed of wood and sometimes concrete. Both can be less forgiving than the materials used for outdoor track surfaces, which include rubber and cinder. Indoor tracks often have a smaller oval with more turns and less straightaway, which contribute to increased foot and ligament stress. Indoor tracks may also have canted curves, which work for you only at a defined speed and consequently create functional leg length differences for many runners. You may need to decrease your workout load and take more breaks. Pay close attention to overall training stress, hydration, and nutrition.

Marvin Bloom, M.D.

Burlingame, CA


Ask The Clinic, in care of The American Running Association. 4405 East West Highway. Suite 405, Bethesda, MD 20814, FAX (301) 913-9520. or e-mail at Write a letter Including as much relevant information as possible about you (age, weight. etc.) and your injury (type and location of pain), training schedule (typical weekly workouts, pace, surface). athletic and medical history, sole wear, recent changes in training. etc. Type or print your letters. Handwritten FAXed letters cannot be accepted. All letters, even e-mail, must include your name, address and phone number. Responses usually take three to four weeks, but can take as long as five.

COPYRIGHT 2002 American Running & Fitness Association

COPYRIGHT 2003 Gale Group

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