This report examines the injuries and health problems that were treated using physical therapy at the Splash FM/ICPC Integrity marathon races in 2009 and 2010 in Ibadan, Nigeria. More males participated in both events and they had more injuries than the females. Both events recorded injuries in nearly one fifth of the runners. A broader comparison of our data could not be made with previous marathons in Nigeria or any other African country because published reports on these were not available. However, it was interesting to note that the prevalence of injuries and marathon-related health problems was significantly higher in first-time marathon runners than the elite runners. The predisposition to greater risk in the first-time marathon runners has been attributed to the fact that they are not elite athletes. Most of these first-time runners lacked awareness of and proper body conditioning necessary for a marathon race . Some of them may have been overweight or underweight and may have over-trained without adequate strength training and probably lacked core muscle strength . This underscores the importance of consistent participation to adequate conditioning of athletes for such events.
Marathon events have been described as fashionable endurance competitions in which thousands of participants from all age groups compete, some even after relatively little training . Hence the 2009 Splash Marathon being the first of its kind in one of the largest cities in West Africa, attracted many participants. However, by the second event, the number of participants dropped by almost 50%. This may be due to the fact that it was no longer a novel event.
Reports of injuries at the finish line were significantly higher than during the race. This may be because most of the injured runners did not want to lose any time, since the winner of the race would have hefty money prize. However, most of those who reported injuries at the finish line confirmed injury onset during the course of the race. They probably were able to reach the finish line by sheer perseverance.
The exceptional capability of humans to run long distances under hot arid conditions has been linked to the use of a suite of anatomical, physiological and behavioural features which are uniquely found in humans. The specialised ability of cardiorespiratory endurance system permits humans to store and release energy effectively during a race and helps to keep the body’s centre of mass stable and overcome the thermoregulatory challenges of long distance running through sweating, evaporation and cooling .
Considering the site and type of injury, the part of the body that was reported the most was the thigh while the nature of discomfort mostly reported for both years was muscle cramps. The thigh as the commonest injury site could be due to chafing usually caused by repetitive rubbing of one area of skin against another or against an article of clothing. This occurs mostly in the upper thigh during running . Considerable amounts of injury were also reported in the knee, calf, ankle and feet. This is in line with the report of a previous study, in which more than 90% of injuries in runners are recorded in the lower extremities, equally affecting the regions of the knee, shank, and foot . This may be because of the weight-bearing nature of the joints and the repetitive movements that are involved in a full marathon race. Running has been shown to load the joints of the lower extremities with vertical forces that are 4 to 8 times greater than when walking . For instance, a 70-kg runner sustains an average vertical force of 2800 tons acting on the hip, knees, and ankle joints over a marathon distance of slightly more than 42 km . In addition, when muscle fatigue sets in near the end of the race, the bones and joints sustain an even greater proportion of the load . Most of the foot injuries reported were presented as blisters and abrasions. The blisters could be due to friction resulting from tight-fitting shoes. Nearly half of the injured participants in 2009 and more than half in 2010 reported heat exhaustion. The lower occurrence of heat exhaustion in the 2009 race may be due to a relatively lower ambient temperature which probably reduced the effects of dehydration and electrolyte imbalance as it had rained heavily the night preceding the event. Running in a marathon has been reported to jeopardize fluid balance and exercise-induced dehydration alters fluid-electrolyte homeostasis, cardiovascular functions and thermal balance . The fact that heat exhaustion was relatively low in 2009 could also have had a bearing on the reduction in the incidence of muscle cramps because of low incidence of dehydration and hyperthermia. Muscle cramps are mostly caused by mineral loss and dehydration as a result of profuse sweating .
Cryotherapy was the most utilized single mode of physical treatment. It was used for about one fifth of the injured runners in the two races although most of them had combination treatments which included techniques such as bandaging, cooling, stretching, massage and bandaging among other possible combinations. Previous studies indicate that the application of massage manoeuvres alone after racing events does not appear to alleviate the physiological symptoms of endurance activities such as muscle strength loss, swelling or soreness much faster than the no treatment condition [11, 12]. Although this report is not in a position to uphold or dispel this assertion, it is worth noting that for most cases in this study a combination of therapy procedures was utilized thereby improving the chances of alleviating the discomfort felt by the runners.
A major weakness of this report however is that it was not possible to follow up on the participants to establish how many of them developed post-participation health problems such as muscle soreness, swelling and general body aches. It was noted that some injuries and other health problems may not have been reported and this could have resulted in an underestimation of the actual injuries and other health problems. However, all reported cases were recorded and attended to.