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Caroline Jones
UWRT 1103-H
Campbell
10 November 2015
Are Long Distances Safe in the Long Run?
In the month of June of 2015, I had the pleasure of working with a physical therapist,
Michael Wright, in my home town of Eden, North Carolina. Michael was not only a physical
therapist as his daytime job, but as soon as he walked out of the clinic doors he was a
marathoner. After being informed of Michaels extreme hobby, I questioned his sanity. Fast
forward a month, Michael took on a third role as coach and convinced me to train with him and
run a half marathon. Fast forward another three months, I recently finished my first half
marathon, over 45 minutes before my goal time. Not only did I finish, but in three weeks I am
planning to start training for another half marathon! At some point during the hundreds of miles I
have run in the last three months, I have wondered, Is this safe? Is running this much, in this
short amount of time, safe for my body? Every ache and pain during training a runner thinks,
Can I run through it? Will it go away? Am I seriously injured or sore? Can I still run
tomorrow? These thoughts were alarming so I wanted to do a little more digging.
I first wanted to compare my feelings with that of a professional. Maybe these insecure
thoughts were of an amateur, so I compared my feelings to the feelings/thoughts experienced by
very established ultra-marathon runner, Nikki Kimball, through a documentary about her called
Finding Traction In order to clarify the establishment of Nikki a few of the major events
mentioned that Nikki Kimball has won include: Western States 100 miler (2004, 2005, 2007), 50

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Mile Trail National Champion at Crystal Mountain (2003, 2004, 2005), and 50 Mile Road
National Champion, State College, PA (2005). Nikki is by no means an amateur in the world of
running, and experienced the same lows in training and racing that I felt. Throughout her
documentary, Finding Traction, Kimballs mental and physical characteristics are documented as
she attempts to defeat a set record of running the Long Trail in upstate Vermont, a 273 mile
trek. Kimball is attempting to run this ultra in under four days to overtake a previously set record
by Jonathan Bashum. During a long distance runs above a 10k, races have what are called aid
stations. Aid stations are like a NASCAR pit stop if you will, providing food, water, first aid,
and whatever else the runner needs. It is every aid station, Nikki shows the same lows that I
experience. She questions whether she is hurt, if she can continue, and the spiraling thoughts that
follow. One can also see the intense pressure her legs and feet are under as she undergoes the
continuous taping, cleaning, Kinesiology tape (a type of tape to reduce the amount of stress on a
particular tendon or muscle), and PRICE (pressure, rest, ice, compression, and elevation)
(Jacobsen, Finding Traction).
Even though runners like myself and Nikki question our bodys capabilities in running,
there are some proven benefits to running the longer distances that we do. Dan Tunstall Pedoe,
the author of Marathon Medicine, writes about the multiple benefits of running longer
distances like marathons. Some of the musculoskeletal benefits of distance running include an
increase in size, strength, and endurance of muscles as well as in thickness and strength of
tendons and ligaments. In addition, the mineral density and strength of bones were shown to
increase (278). What does this mean exactly for those whom do not know anatomy? Tendons and
ligaments are both made up of cartilage that is produced in the body as we grow, and the only
way to strengthen these, like muscles, is to put stress upon them. If no or minimal stress is put on

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tendons or ligaments, they become more flexible, and weaker- and as a result eventually become
unable to support the muscles to which our joints are connected. Muscles are strengthened in the
same fashion. The stronger and larger our tendons, ligaments, and muscles are the more support
is provided to our body as a whole. CBS News reports that long distance running offers valuable
benefits such as weight control, stress reduction, improved blood pressure, better cholesterol, and
the potential for a longer life (Shallow). In fact, CBS cites a study done by the Journal of the
American College of Cardiology that questioned if runners lived longer; which did prove correct
by an average of three years (Shallow). Pedoe also argues that long distance runners age better!
Now thats a new one. As runners age, they remain active even beyond their sport due to the
greater sense of wellbeing that a runner has later in life. Pedoe states that older marathon
runners have a better quality of life, independence, mental wellbeing, increase in motivation,
increase in balance, and an increase in mobility (280). These are the statistics that I knew I
could find during my research, with my predetermined thought process of running is safe and
beneficial, nothing else.
However, even though there are positive outcomes from distance running, there are
certainly negative aspects that raise questions to the safe nature of running that I was not
expecting to find. When running a long distance like a marathon, CBS News touches on a few of
the extremes that may occur: dropping dead, heat stroke, dehydration, exhaustion, as well as
myocardial fibrosis (a build-up of excess scar tissue around the heart) (Shallow). One of the most
frightening negative outcomes of distance running is the danger the cardiovascular system is
under, which makes sense if anyone has ever run up Mallard Church Road in Charlotte, NC. For
example, CBS News reports dropping dead is only recorded to occur on average every 0.5 in
100,000, according to their cardiologist expert James H. OKeefe M.D. (Shallow). A still rare but

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more frightening negative outcome is myocardial fibrosis that occurs in 12% of marathon
runners due to the constant strain of the heart under training, causing the build-up of scar tissue.
In addition, it is recorded that 30 to 50% of runners show an increase in levels of enzymes and
biomarkers that are typically released during heart attacks or are associated with heart failure
immediately after a marathon. The comparison of a heart attack to marathon runner, seemed so
farfetched with my initial predetermined thought process. However, the statistics do not lie!
Also, athletes heart, a thickening of the heart muscle and enlargement of the heart, an
asymptomatic, yet dangerous condition due to the overworking of the heart of athletes can occur.
An example to the amount of cardiac work done during exercise is one given within the article,
How much running is bad for your heart?: Sitting at your desk, your heart pumps about five
liters per minute, but during exercise it can pump up to 25 liters a minute. Thats a lot of cardiac
work to do for four hours at a time [in reference to the time it takes to run a marathon]
(OMara). With each of these cardiac conditions in mind, it is alarming the amount of options
if you will that runners have for cardiac conditions, which raise a large, waving red flag of the
safety aspect of running long distances.
Now not all negative outcomes of long distance running are deadly, such as dropping
dead or a cardiac condition, however life changing outcomes can still occur. For example, female
marathoners or distance runners often suffer from athletic amenorrhea. Athletic amenorrhea is
defined by the American College of Sports Medicine as a lack or exclusion of a period other than
pregnancy, thyroid or endocrine disorders, androgens, a pituitary tumor, polycystic ovarian
syndrome, or genetic abnormalities. Athletic amenorrhea is caused primarily when there is not
enough nutrients in a womens body left over to have her monthly period. Due to the intense
training periods of distance runners, this is a common disorder; and is recorded to affect 24 to

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26% of runners. Most women would think, Thank goodness! No Aunt Flow this month!
However, these condition can have some serious consequences. These consequences can include:
lack of productive estrogen which causes bone demineralization or premature osteoporosis,
increased risk of stress fractures, infertility, early onset of menopause, increase in blood lipid
levels, cancer of the reproductive organs, and an increase for premature cardiovascular disease
(American College of Sports Medicine).
When looking at negative consequences of long distance running, one may feel it is time
to throw in the towel and conclude than long distance running is not safe. However, a study of
Christina Haugaard Rasmussen, et. al from the International Journal of Sports Physical Therapy
correlates directly with my conclusion. It is all about the miles in moderation. Now, you may
think this is a crappy answer. However, it can be proven with risk related injury, which is the
related risk of injury for a given activity. The study observed 662 marathon runners, 68 of which
experienced a risk related injury that was directly correlated with marathon running. A
correlation with the amount of miles per week and the increase in injuries was found. The study
concluded overall that a minimum of 30 km/week before a marathon would reduce their risk of a
running related injury. However, runners with a weekly average below 30 km there was a 95%
increase for a running related injury (111-120).
After looking the this data, one can be conclude that if a long distance runner wants to
safely run he/she must do so in strict moderation and careful calculation of mileage. However,
within the overarching consensus of serious, lifelong runners in mind, moderation is extremely
hard to find. When I was told not to run due to shin splints in the middle of my training, the look
on my face was of pure horror. What did I do anyway? Run. What happened? It hurt. Every
runner I have met, Michael Wright included, has a similar story. However, this leads to a further

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question If a runner cannot moderate, as the research suggests, it would only be safe to stop all
together. The sport of distance running is found to be a gamble at the Roulette table. A lucky spin
could get you one of the greatest memories of your life, crossing the finish line of a marathon; or
could cause heartache and pain, such as infertility due to amenorrhea.

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Works Cited
Jacobsen, Jaime. Finding Traction. YouTube, YouTube. 26 June 2015. Web. 7 Oct 2015.
OMara, Kelly. How much running is bad for your heart? Competitor.com. 29 Jun. 2012. Web.
5 Nov. 2015.
Pedoe, Dan Tunstall. Marathon Medicine. The Royal Society of Medicine 1.1 (2000): 278-308.
British Heart Foundation and the Flora London Marathon. Web. 12 Oct. 2015.
Rasmussen, Christina Haugaard et. Al. Weekly Running Volume and Risk of Running-Related
Injuries Among Marathon Runners. International Journal of Sports Physical Therapy
8.2 (2013): 111-120. United States National Library of Medicine National Institutes of
Health. Web. 13 October. 2015.
Shallow, Parvati. Is running marathons bad for your health? CBS News CBSNews.com. 13Mar.
2015. Web. 12 Oct. 2015.