Improving Marathon Performance

Chronic Pain and Marathon Training


History (Catalyst/Cause of Issue)

L.M., a woman in her mid-twenties, presented with chronic lumbar pain between L3 and L5 vertebrae at a constant pain level of 3 on an ascending 10 scale with spikes of stabbing and radiating pain down the front of her right hip at level 6. She also complained of frequent headaches and hip pain with prolonged periods of sitting or driving. Despite her chronic pain, she went for frequent runs and yoga classes. She reported that staying active helped to mitigate the pain symptoms in her back and hip, however her headaches were unaffected. She wanted to prepare to run a full marathon and sought therapeutic medical massage to complement her regular training regimen.



During her initial evaluation, I noted a forward-head position, a slight elevation in the right hip, and twenty degrees of external rotation of her right foot. I suspected a minor forward shift in the right ilium and confirmed by finding the anterior superior iliac crest via palpation on both sides and comparing their positions relative to each other. After conferring my thoughts with the client, I discussed a plan for the initial evaluation that included observations during her first session before creating a comprehensive therapeutic plan. During the initial massage, I found several trigger points, fascial adhesions, and hypertonic muscles—especially severe along multifidus, quadratus lumborum, and the entire length of the erector spinae group. Her iliopsoas muscles were in spasm on the right, and her hamstrings, gluteal group, and piriformis muscles were hypertonic as well. I noted internal rotation of both shoulders along with slight elevation.



After the assessment and initial treatment, I outlined and implemented a plan: ninety-minute therapeutic massages weekly, to be received the day after her longest runs, for the following three months before the day of her full marathon. Each session began with a brief intake on pain levels following the previous massage, the duration of relief (If any), and performance relative to her training. During the massages, I opened with long fascial holds to create enough plasticity in her tissue to allow the muscles to release, as well as passive stretching to test range of motion limits and find any painful areas that may have arisen during the course of her runs. Though the focus of each session lay on her lumbar spine, hips, and legs, the duration of each massage allowed me to devote time to trapezius, rhomboids, pectoralis major and minor, scalenes, sternocleidomastoid, anterior deltoid, and the long-head biceps-tendon attachment to address headaches and forward head posture. For the shift and elevation of the ilium, traction, deep-tissue cross-fiber friction and contract/relax neuromuscular retraining were the main methods of treatment.



The first three weeks of her treatment plan saw the most progress, with presentation of low back pain reducing from 100 to 40 percent of the time, and the pain ceased to radiate. After the first three weeks, progress continued, however at a slower pace. After six weeks, the pain did not spike above a level 4, and frequency dipped to a 20% occurrence rate. She recovered more rapidly from both long and short runs compared to her past runs prior to receiving regular massage. She also reported less frequency and intensity in her headaches and neck pain.



L.M. came in for her last session four days before the marathon. During her final verbal intake, she reported rarely feeling pain while running, was able to sit and work for the full duration of her shifts without feeling pain, and reported her recovery after runs to be quicker and more comfortable than before. After successful completion of the treatment plan, L.M. experienced less overall pain despite an increase in physical activity, improved athletic performance, and avoided injury beyond expected soreness from a strenuous exercise plan. L.M. returned for a follow-up session a week after her marathon and shared that she had completed the full event at a faster pace than a previous-best 5k, and—though her pain had returned and spiked—that she would not have been able to finish without massage treatment. L.M. received regular sessions on a maintenance schedule of one to two sessions monthly as part of her new maintenance routine.