Ultra-Marathon Training and Treatment

Ultra-Marathon- How to make it race day

I recently took on my biggest challenge to date. I just completed my first Ultra-Marathon. However, it wasn’t a flat road race or even a trail run through the woods. I completed the Tafraout Atlas Trail, a 72k ultra-marathon through the anti-Atlas Mountains in Morocco. But hey you either ‘go hard to go home’ as they say, and I can honestly say it was the hardest thing I have ever done in my life. 72k of blood, (fell over twice and got attacked by a cactus) sweat (Morocco is still quite hot in November) but surprising no tears (although I did come close) went into completing the race. I literally didn’t have any more to give in the end. I finished in a gruelling 9 hours and 31 minutes………but I did finish! The furthest distance I have ever run in my life, but also the highest incline I have covered. The mountains maybe have been pretty but they were tough.

Race day itself was obviously a massive mental and physical challenge. However, getting myself to the start line was the start of the challenge. I have run on and off most of my life, and been distance running for the past 7 years or so. I can put my hands up now and say I completely underestimated what was expected of my body to complete my first ultra-marathon. I thought ‘I’ve trained for marathons before – how much harder can it be?’ The answer……..much harder.  I have been lucky enough (and I hope not to jinx myself further) that I have never had a serious injury that has stopped me from running. I have had niggles and tightness due to volume of training, but nothing that has required me to stop. Maybe because of my job as a rehabilitation specialist I know what to look out for in terms signs and symptoms of injury. Also, by trying to practice what I preach and do my strength/rehab work and have regular Sports Massages, I have managed to avoid being injured myself. That is until I started ultra-marathon training!

Training and Injuries

Maybe I was being a bit naïve or maybe I was just being a bit cocky, more likely I was being both. I managed to progress through most of my training before it started to take its toll, and my body started to break down. I have treated many runners training for distance events. Runners commonly pick up injuries due to the increased stress they put on their bodies by increasing their volume of training. Then suddenly it was happening to me! How can this be? I should know better right? (I guess I am only human) I assumed training for an ultra-marathon would be like training for a marathon. Interval training and speed work sessions in the week and long runs on a weekend. And it is overall, except the sessions are much longer and you do two long runs on a weekend. Apart from it taking up a lot more of my free time, my body was feeling okay with the increase training initially. I was waking up on a Monday morning having run 30+ miles on the weekend, and could still walk up the escalator on the tube on my way to work. This I soon learnt was not a realistic indicator that my body was in tip top condition.

Suddenly doubling the number of miles I would usually do in training, alongside massively increasing my hill training, (Box hill became my second home) I managed to give myself a hip flexor tendinopathy. My hip flexors have always been quite tight. Most runners would probably tell you the same. Increasing my hill training meant I was working harder trying to drive my legs up these ridiculous hills, then also trying to decelerate myself on the way back down. (I’m a massive wimp running downhill so I was decelerating a lot) This increase, compounded by the fact that my pelvic-lumbar stability wasn’t as strong as it should be = me picking up my first serious injury. A few weeks later after having a heavy training weekend consisting of racing a full marathon on the Saturday, and a half marathon on the Sunday. I then pick up a foot injury on the same leg. Go figure, right?! I had a slight suspicion they were connected somehow? This initially was a suspected stress fracture as I couldn’t put any weight on it pain free. Luckily for me it wasn’t and was my foot jamming up as a stress response to the volume of running I was doing at the time. That REALLY scared me as that would have been the end of my journey before I had even got on the plane.

I don’t want to seem too cheesy but owe the success of me finishing the race, to my colleagues who kindly helped me get to the start line in the first place. It was quite a different experience being the patient rather than the therapist. I’m sure I was probably a nightmare patient. Having too much knowledge in an area is not always helpful when that causes you to over analyse everything. Our Chiropractors Caroline, Emma and Ben assessed my hip, pelvis and lower back and ruled out it being a hip joint issue (great news) and concluding it was more of a tendinopathy (Not so great but could be worse). However, my pelvis was rotated putting excessive strain on my hip flexors. My mid to upper lower back was also very stiff and jammed up probably causing me to compensate when I was running and contributing to my hip issues. I suffer from mid back stiffness anyway; as I don’t have much rotation. This was made worse from running with a bag to practice carrying my supplies and water. Hunching over for hour after hours at a time didn’t help either. The stiffness and lack of mobility in my back was causing me to have to work harder through my pelvis, and this along with the ant tilt in my pelvis caused me to overwork and strain my hip flexor. We also worked out that my adductors were ridiculously tight. Probably from trying to help the hip flexors out to stabilise when they started to get tired. Caroline said I had the most developed adductor she had ever seen. (I don’t think this was a compliment)


I started a course of treatment which involved manipulations to my pelvis to help re-align me, and to my mid to lower back to free up my joint to get better range of motion. I instantly felt better as I could put weight on my hip without getting a sharp pain or it catching. I could almost run pain free, it would ache to start then ease off a bit. (This is very typical of tendon issues) I also felt a lot taller and able to take in deeper breaths now my mid back wasn’t so jammed up. However, I knew I was on a journey and that one session was not going to ‘fix’ my pain. Emma is trained in Graston technique, a soft tissue technique using instruments to help ‘iron out’ the tight muscle and break down any adhesions. This helped my hip pain as my adductors finally release. (Although they were so tight I almost had to ‘tap out’ of the treatment at one point) It was totally worth it. Caroline was also treating me with some manual therapy and acupuncture weekly to work on the tension in my tight muscles. She was also taping me using rock tape to help support my muscles while I was running. This all made a massive difference and I could keep chipping away at my training. Although I was being much more conservative, I had learnt my lesson that I wasn’t invincible. I was also trying to practice what I preach a bit more and concentrate more on my rehab exercises.


I always continue with strength exercises throughout my training blocks. Yet, I am probably like every other classic runner. When life gets busy it’s the first session that gets dropped. We tend to focus so much on getting the miles in we neglect the strength work. I preach to my clients all the time the importance of prioritising the rehab work. It was time for me to fix up and follow my own advice. I concentrated to doing a lot of standing hip stability work and trying to get my glutes to engage more to stop my hip flexor from over dominating my hip movement when running. I also returned to my Pilates training, concentrating on doing some low-level extension control work. Making sure I had some basic control and wasn’t cheating my using my global muscles. I was also doing some general core endurance work; my body was obviously telling me I was getting tired in training. I needed to make sure I was as strong as possible for race day. It was a combination of the different manual therapies kindly provided by my colleagues and my own commitment to completing my rehab that helped piece me back together again.

I learnt a lot from training for an ultra-marathon. The first being that you are not invincible no matter how much knowledge you have. I preach it to my patients all the time, but I learnt first hand the importance of doing my rehab. Without working on my weaknesses and muscles imbalances I wouldn’t have made it to the start line. I would have still been plodding along with niggling pain and would have ended up in a worse state and probably further injury. Just because you are pain free does not mean that there are no underlying issues that could be manifesting.

If you are a runner and struggling with injury and would like to speak to someone about getting help. Please call us on 02073742272 or email Em Manaton at emanaton@body-motion.co.uk. Or click here to book an appointment today.