Trail Run Spain.

Multi Day Desert Racing - Medical Preparation Tips

Decent preparation will ensure you achieve your potential in Multi Day Events. It will also give you the best chance of avoiding medical problems and actually enjoying the race.  Most problems can be predicted, and they can often be prevented. Much has been learnt since the first Marathon des Sables over 20 years ago, take advantage of this knowledge.  What follows is based on personal opinions from experienced multi day runners, and experienced multi day medical directors, as well as sound evidence from textbooks.

Personal Health / Medicla / ECG
Make sure you are in good health before you leave. Often events specify getting a medical and sometimes ECG done within a month or two of the race. Get this done as early in this period as possible, so any problem can be identified and sorted. If possible, get your medical/ecg done by doctors experienced in dealing with athletes, so they can pick up and advise you on injuries and prevention, and because athlete’s ECG’s (heart tracing’s ) can often look abnormal and require proper interpretation. Marathon Medical Services do a tailored, reliable medical and ECG interpretation as all our doctors have all worked at ultras. That said your own GP has your old notes so may be best if you have had previous problems.

Common problems in athletes that may cause you to lose performance include :
Anaemia- (Low blood Count). Ultrarunners are not infrequently anaemic. Part of this is natural (“physiological”) as with regular exercise more blood pumps round the system. Therefore the cells are diluted and give you a slightly lower count without affecting performance. Runner’s performance will be worse if they are losing blood. We are more likely to do this through “foot strike anaemia,” and losses from the bowels and urine pretty much due to friction while running. If you feel consistently tired, or your performance tails off, it might be worth getting your doctor to check a full blood count, ferritin (iron level), and if necessary prescribe iron.

MEDICAL CONDITIONS/ MEDICATIONS. If you have a medical condition and it is not well controlled like asthma, then get it sorted way before your event.  Certain medications like Beta Blockers (common treatment for high blood pressure) can impair performance. Check with your GP if you have concerns about this

COMMON INJURIES. These include knee injuries, shin splints, ankle injuries, foot injuries and blisters. There are a multitude of different causes for these symptoms, and these are more fully discussed in Marathon Medical Services “COMMON INJURIES.”  Many are caused by overuse, or by a sudden increase in training.  Good principals include: Rest, or at least decrease intensity of training, consider a few swimming sessions as an alternative. Ice, to decrease swelling. Bandage if appropriate. Painkillers- Non Steroidal Anti Inflammatory Drugs type are painkillers and anti-inflammatories. Avoid if you have asthma (unless you’ve taken them with no problems before), or have had stomach ulcers. If you are a normal weight adult 400mg of ibuprofen 3 times a day is the recommended dose for adults. Paracetamol is a painkiller that can be taken itself, or with anti-inflammatories. It is not an anti-inflammatory. 1 gram Paracetamol 4 times per day is the maximum dose for a normal sized adult. You can get both these from the chemist. Elevate a leg if it is swollen.  If in doubt, consult a doctor or a sports physio.

Put Vaseline on any chafed areas while running, and consider nipple/ back chafing (if carrying a rucksack) and consider taping these areas for longer runs. Everyone has their own way of treating blisters, It’s discussed further in the COMMON INJURIES paper. Keep them clean and dry if you can though. Blisters, shin splints, and front of knee pain can often be helped a fair bit by better fitting shoes, consider going to a proper running shop. Another good tip is to run off road. Tarmac puts more pressure on the joints and feet so running on trails, or grass often helps prevents injury.

Nutrition Prior to an Event
It’s extremely important to arrive at the start line fit, and fuelled up. During training runs of longer than an hour, try to eat/ drink some calories every half hour or so. Directly after any training run/ activity, replace the calories you’ve used, and help repair your muscles by eating/ drinking some protein. A carbohydrate/ protein mix is ideal directly after training, the sooner after the session the better. Something like chocolate milk  has both and is way cheaper, and just as good as commercial products. Eat a normal, balanced diet, and eat plenty long acting carbohydrates like pasta, cous cous, potatos, or bread the night before a long run. The night before a long run you are best eating mostly carbs with less protein and fat for various reasons, but make sure you eat protein and carbohydrates after a long one.  Drink plenty fluids when training, fluid is absorbed quickest, and therefore least likely to give you a stitch if it is roughly isotonic.  Lots of people avoid drinking alcohol for months before an event. This is probably unnecessary, as the odd carb filled beer isn’t harmful, but more than a couple on any one night will have a negative effect.

In the week before an event eat plenty. For the last 48 hours concentrate largely on eating as many carbohydrates as possible. There is a technique called carbohydrate stripping which can be beneficial, but is a bit risky if you’ve never done it before.   Avoid eating anything risky prior to the race start, the last thing you need is a dose of diarrhea in the sahara or similar.  Avoid re-heated food, unpeeled fruit avoid, and probably safest with bottled drinks. Wash your hands after going to the toilet. Start the race well hydrated so your pee is clear.  Nutrition plans are quite personal and a professional opinion can help.

Your personal weight will be important, as this is what you will be carrying round the course. Also body fat is an insulator so makes it harder to lose excess heat in the body.  If it is soft underfoot ie sand, you will sink in more with each extra kilo. It’s a fact heavier people get more blisters. It’s really important to turn up on the start line in good shape, all the “racing snakes” are pretty slender.

Be organized. As a medical director it’s a common sight to see competitors turning up with equipment not fit for purpose.

SHOES - Wear in your shoes. The average shoes are ok for about 250 miles, and thoroughly mangled after about 400 miles. A brand new pair of shoes will probably give you blisters. Consider running 30-70 miles in your event shoes prior to the start, and consider wearing a pair a size or 2 too large, as your feet will swell. I  personally go 1 size up. It’s not a bad idea to have trained in a second identical pair. Go to a proper running shop to get your shoes, as they will tailor them to your particular foot type. Proper running socks are a good idea.

GAITERS - Most people wear sand gaiters, as if sand gets in your socks this increases your chance of getting blisters greatly. Get these gaiters stitched in properly, glue often melts in extreme heat. The parachute silk ones sold by “sandbaggers” are easily the best of the four I’ve used. I used poor quality gaiters the first time and my feet were massacred.

RUCKSACK - Again be used to running with your race equipment, and race rucksack. This will help you avoid back injury, chafing etc. Get a rucksack the correct size, and with a waist belt. Make sure you can easily access your water without having to take your pack off.

MEDICATION - take all your prescribed medication with you, carry it in your hand luggage. Think what you will need for a personal med kit. There is a “MED KIT FOR ULTRAS” ARTICLE AVAILABLE.

OTHER - Get used to the food/ drinks you will use during the race, and to drinking while you are running. Know where everything is for example toilet paper, painkillers, food, tape, Vaseline, and carry these for long training runs days.

Training - walking
Each competitor will have a different training programme. From a race doctor point of view, many people regret not practicing walking more. Many go with the intention of running the whole way, but the heat and the terrain means most people do a bit of walking. Walking uses different muscles so it might be worth doing a bit of walking as part of training.  Fast competitors may run the whole way, so consider what your aims are.

Training - for the heat
Unless you live somewhere hot, then this is very difficult. Consider going on a “hot climate” training camp like the TrailRunSpain ones in Spain, to work out potential problems and see how you adapt. Everyone acclimatizes differently to the heat, it would help to go to the place you are racing a few days early to get used to the conditions. Try training in a hot gym or on a hot day. You could consider layering up by wearing thermals under your running clothes to try to acclimatize, it’s not been accurately studied if this works or not. It’s definitely not as good as training in the race environment.  Using waterproof clothes can mimic humid jungle conditions well. (See Heat Acclimatization, Article archive on

There is no substitute for training. Train smart, and specifically for what you want to do. Get advice from people that have done the same or similar challenge before. Specifically if you are doing a multi day, then do a few consecutive days of training. Taper down, and run less in the week or two before the event so you have enough energy supplies for the big one. If you have an injury that’s not improving, see a doctor.

As mentioned earlier, there are a great number of brilliant resources out there. At most of these events the cammeraderie is superb and competitors often share tips and help each other.  Some top class resources include. competitors and veterans always happy to share tips. Probably the most useful website for desert ultras expedition, ultraracing seminar, jungle/ desert/ british ultramarathon organizers. Shop with fit for purpose gear only. Home of the famous Online Equipment. Passionate Ultramarathon specialists, with first class service and no quibble money back guarantee Team Axarsport/TrailRunSpain offer excellent training camps in Spain, as well as workshops and the al andalus ultra. Site launched in 2009. Good international race/info resource.

Dr Andrew Murray
( Co-founder Marathon Medical services, and ultrarunner. )

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