'Too Far, Too Fast' -- Physician Q&A on Health Issues Among Runners During Pandemic

During the COVID-19 pandemic, both experienced and newbie runners have hit the roads and parks to offset the effects of spending more time at home and limited access to gyms. The end result: More visits than normal to doctors treating muscle or joint distress or injuries from falls or overuse.

“If you’re used to a treadmill or an elliptical machine at the gym, which cause a very light impact, and you’ve been forced to switch to road running, then that can result in a big shock to the runner’s body,” explains Michael Swartzon, M.D., primary care and sports medicine physician with Miami Orthopedics & Sports Medicine Institute.

Dr. Swartzon was co-medical director of last year’s Life Time Miami Marathon and Half Marathon along with orthopedic surgeon Thomas San Giovanni, M.D., a foot and ankle specialist with Miami Orthopedics & Sports Medicine Institute. Baptist Health South Florida is a sponsor, and for years has been the official medical provider for the event, providing assistance at the various first-aid and medical stations along the full course.

This year, the COVID-19 pandemic forced organizers to go virtual for 2021. The event usually occurs in late January, when about 20,000 runners take on the 26.2-mile course through sections of downtown Miami and Miami Beach. This year, the race was a “first-ever digital rendering of our world-renowned event that took place January 10 – 31, 2021,” organizers state. Runners could choose their distance – 5K, half marathon (13.1 miles) or full marathon, and whatever safe course they could find, adhering to social distancing practices and possibly wearing face masks if anyone else is nearby.

Dr. Swartzon says it’s a good idea to keep the tradition going “virtually” among serious and beginning runners, but there are safety concerns for individuals or small groups that take on the challenges this year of long-distance running.

“There a many behind-the-scenes challenges for safety s and logistics that go into a large, outdoor mass participation event like a marathon, ” Dr. Swartzon said. “There’s a reason why we have a medical tent every two miles, water stations, and careful coordination with the cities of Miami and Miami Beach, Miami-Dade County, fire rescue, police departments, Miami transit authority, and even Homeland Security. We provide safety to the course by blocking off roads and facilitating quick transport to medical facilities when needed.”

There are health issues that apply to anyone running long distances without the support network that is typical of the actual marathon event. That includes dehydration from lack of sufficient liquids or overheating, and runners who continue at a swift pace even if they feel soreness or pain, he added.

“When I typically see people in the office, it’s when they try and go too far, too fast,” he said.

Here’s more from our Q&A with Dr. Swartzon on running and fitness during the pandemic and this month’s virtual running event:

Q: Are you seeing more patients during the pandemic because they started running for the first time or intensified their routines to offset being stuck at home or not going to the gym?

Dr. Swartzon: “This is certainly happening because people were used to going to the gym and that was their entry-way to the exercise world. A lot of the marathoners were a part of running clubs or running groups, many of those have disbanded, and that really left a lot of people without a home for their exercise or running. Certainly, running is a great form of exercise. It doesn’t require a lot of equipment. It can be done outdoors, which is relatively safe from COVID and you can do it alone. We’ve noticed a definite increase in running, which leads to an increase in injuries — very proportionately. We see some road injuries from people falling, and for people who were used to running on a treadmill the asphalt on the roads can be a lot less forgiving on the body.”

Q: What type of running injuries are you see during the pandemic?

Dr. Swartzon: “Exercise is usually safe and it is very helpful. Unfortunately, like everything else in life, accidents happen. As much as we try and prevent all accidents, that’s never going to happen. So, you may slip and fall or trip and get injured. These are things that are going to happen, even in the best cases. We try and tell people to run with a buddy if they can, but with COVID people are reluctant. We try and ask people not to have headphones that block outside noise so that they can hear oncoming traffic and can hear someone honking. There are ways that people can make themselves safer. If you run at night, wear reflective clothing so that other people can see you. Try and run in a park, as opposed to actually on the road. At least try the sidewalks, although some neighborhoods don’t have sidewalks and so people are running in the streets. We want runners to give some thought into their running to minimize the risk of injury.”

Q: Isn’t it true that many health issues with running long distances are the result of overuse injuries or overdoing it without proper conditioning or training?

Dr. Swartzon: “Certainly, runners can get that ‘runner’s high.’ And as soon as people get used to it, they want it more and more. They start enjoying it. The brain and personal will can  go past what their body can accomplish. In the spirit of trying to improve, they keep pushing when they really should be listening to their bodies and going through a slow progressive rate of increase. One of the beauties of the running groups or running clubs is that they help you with a schedule that’s built for you to succeed over time and gradually increasing distances. If you’re running on your own, you may run to your heart’s content.  Maybe you are running for the calories.  You start looking at your fitness watch and you say: ‘I want to eat a bigger dinner tonight so I’m going to run more to burn more calories.’ When I typically see people in the office is when they try and go too far, too fast.”

Q: What injuries did you commonly treat during last year’s marathon event?

Dr. Swartzon: “People would fall and so we got some scrapes and those type of injuries. Toward the end of the race, when it gets hotter, there was a lot of cramping. Whether it was because of inadequate hydration or lack of preparation, their muscles seized up on them, especially toward the end. The most serious are usually runners with heat-related injuries. They were just too hot and we had to cool them down with ice, fans and sometimes intravenous fluids. Even though last year’s event wasn’t that hot, it gets on the warmer side at the end of the race. Then there are those people who knew they had an injury and tried running the race anyway because they had their goal or mission to start and finish the marathon — at all costs. They kind of knew going into it that it would be difficult, they took that risk, and then they ended up having issues.”

Q: Can you talk about the challenges of running this year’s “virtual” marathon?

Dr. Swartzon: “It can be challenging to find a 26.2-mile track that you can run safely. If you do get into trouble, there are smart watches and smartphones that can help you call for assistance. People can run in small groups and there are parks that are certainly open. There are ways for tracking their mileage and being safe. It’s not the same safety that we can provide (during the actual event) so be careful. The camaraderie and trill will be virtual, but these are the times that we’re in. People still want to do things, and we want to keep our Miami tradition going. Making the best out of this situation, and run Miami anyway, is our collective challenge.”