Marathon Training: Two Steps Forward, One Step Back (repost)

Two Steps Forward One Step Back: Marching To Marathon Success

The 10% rule of limiting weekly increases in mileage to no more than ten percent is widely quoted as the sin qua non of incremental training. In many cases even this may be too much. An invariably rising load of 10 percent marathon-APeach week may not give your body time to recover from the stresses of running.

In marathon training, I believe that for beginners, the long run is the key to successful completion of the marathon. Many years ago, in a very early survey, it was found that if an individual had completed 3 long runs of  18 miles or more (for example two 18 mile runs and one 20 mile run) the chances of completing the marathon were well over 90 percent.

Good questions are: 1) how to get to those long distances and 2) how long should your longest run be. The reason we ask these questions are to both be successful in completing the marathon and to limit injuries and enhance recovery.

I like what I call a “two steps forward, one step back” approach. I recommend this as a guide to the long run, up to about 17 or 18 miles. What this means is that you move up gently in your long distance running mileage for two weeks, than have a considerably easier and shorter long run. Once you have reached a long run of about 18 miles, you take two easier weeks to allow your body a good recovery.  And the long run only has to top out at about 20 miles for a successful completion of the marathon. Two to three other days of running and one to two days of cross training would work well with this approach to the long run. There are some programs that advocate an approach like this, while a good many just keep moving up the mileage. For beginners, I favor this gentle approach with recovery that is built into the schedule.

Weeks until Marathon : Long Run Distance

19: 8

18: 9

17: 10

16: 6

15: 12

14: 13

13: 8

12: 15

11: 16

10: 10

9: 18

8: 10

7: 12

6: 18

5: 10

4: 12

3: 20

2: 12

1:  8

Marathon: 26

Running Sports Medicine Tendinopathy

Achilles Tendinopathy: 2010 – Disappointing Results with PRP (repost from 01/2010)

Update: The results are still controversial and contradictory on PRP and Achilles tendinopathy. This is a repost of a blog from 2010. (The primary reason for the repost is moving material of archival interest to a site which functions better.)

A study published in the Journal of the American Medical Association, Jan. 13, 2010 gave disappointing results in using plasma rich protein to treat non-insertional Achilles tendinopathy. It showed no difference between using a sham injection of saline and combining it with a painful eccentric stretching protocol  in comparison with an injection of plasma rich protein injection along with the standard painful eccentric stretching protocol.

The authors note that previous studies did not have good control groups. In this small study, 27 patients were in the placebo group and 27 in the treatment group. The VISA-A score was used to assess improvement. Both groups improved somewhat without a significant difference between the two groups.

The study was called a “preliminary communication” which is often done with small studies. Other studies on similar topics with fewer than 30 individuals studies have also been billed as “preliminary studies”, but when they are talked up afterward, the “preliminary study” status is usually forgotten. As far as study design goes, the design, blinding, and performance of the study seems just right. I am not entirely convinced of the efficacy of the painful eccentric stretching protocol and would have not minded another study group omitting that treatment. Apparently it is not a panacea (or there would not be studies looking to add to the results), although the initial preliminary study made it sound as though it would be. Follow up journal articles by the primary author of the first study have been positive and are referenced below. Others have expressed reservations on the methodology. (see Woodley et. al. 2007 and Kingma et. al. 2006) Eccentric stretching and overload for tendinopathy has mixed results at best in other body areas.

Note: VISA-A is the Victorian Institute of Sports Assessment-Achilles


Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy: A Randomized Controlled Trial
Robert J. de Vos; Adam Weir; Hans T. M. van Schie; et al. JAMA. 2010;303(2):144-149 (doi:10.1001/jama.2009.1986)

Alfredson H. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med. 2003;22(4):727-741.

Alfredson H and Cook J (2007), A treatment algorithm for managing Achilles tendinopathy, new treatment options, British Journal of Sports Medicine, 41, 4, 211.

J J Kingma, R de Knikker, H M Wittink, T Takken. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med 2007;41:e3 ( doi: 10.1136/bjsm.2006.030916 (concludes: Studies on the effectiveness of eccentric overload training in patients with Achilles tendinopathy show many methodological shortcomings)

Woodley, B.L., R.J. Newsham- West, and D.B. Baxter, Chronic tendinopathy: effectiveness of eccentric exercise. Br J Sports Med, 2007. 41: p. 188-199.

Additional Information:

Pribut, S.M.,  Top 5 Running Injuries. Podiatry Management, 2008

Blog on: Heel Lifts and Achilles Tendinitis

Dr. Pribut on Achilles Tendinopathy

Dr. Pribut on The Science of Tendinopathy