ASK FLASH: “Get me to the starting line!” (Tapering and Cortisone Shots)
Posted April 2nd, 2007 at 3:00 PM by Joshua Flash Gordon
Section: Running & Training, Injury & Rehab, Columns, Training Tips, Ask Flash
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Since the Boston Marathon is just around the corner (about two weeks), let’s deal with a couple of time-sensitive questions about getting to the starting line on the big day.
Q. I have been training for the Boston Marathon for the past few months and during a 20 mile run last week I developed pain on the inside of my right knee. I was diagnosed with Pes Anserine Bursitis and told to take anti-inflammatory medication, ice, and stretch. I was also offered a cortisone shot, but, did not get one because I don’t know too much about them. Could you please give me your opinion on cortisone shots? The marathon is in two weeks and I would love to run it pain free!
~ Just Shoot Me in Wounded Knee, South Dakota
A. So, you got yourself a case of the Goosefoot Bursitis, huh? I must confess that in the past I have always refused offers for cortisone shots. So, I am probably a little biased against them. Maybe I’m just afraid of the needles.
Another concern that I have is the stated risk of weakening the tendon. However, many studies and articles seem to support cortisone shots as a safe and highly effective option for the type of inflammation that you are battling.
The most common side effect is “steroid flare” - a condition where the injected cortisone increases the pain levels prior to relief. The shot itself can also be uncomfortable. My brother has had a number of them over the years and has more than a few stories of the mild torture.
From what I understand, they use a lot less of the steroid then they used to and have been able to minimize any side effects. Ultimately, this is a personal choice for you. Your doctor is well within the boundaries of appropriate treatments for treating the Goosefoot. If you do decide to go ahead with it, try to limit them in the future because the more you use them - the greater the chance that later on trouble will once again rear its ugly head.
The more important issue is why did this happen? Did you suddenly increase mileage? Do you have tight hamstring muscles? Too many miles on your shoes? Are you doing some functional or core strength training? Two weeks before Boston is not the time to make changes - but please keep these concerns in mind.
Good luck and keep me posted!
Q.when should I stop running before my marathon? A few days before to give my body a very good rest. Or should I just continue to run as I am now with no breaks? I am doing this 100% on my own and I’m not really sure what miles I need to either do or stop doing to better prep me for the big day.
A. You want to taper. Read and follow this article by Coach Pfitzinger. Ideally, you should taper 19-22 days before a marathon, 11-14 for a 1/2 marathon, and 7-10 days for a 5-10k.
Tapering is not something you can do for every race (if you race with some frequency) or you would never get in shape. But if this is a target event (like most marathon are for most of us), then a taper is highly recommended. Basically, you will want to reduce your mileage by 20%, then 40%, and finally 60% in the weeks preceding a target marathon. You also will probably want to slightly increase your intensity to prevent you from feeling too stale.
Refine the strategy that works best for you and your body over the years (keeping a training log will be helpful) and learn from your own experiences, as well. Don’t get too alarmed if you start to feel strange aches creeping in as you reduce mileage. This is very common and to be expected as your body repairs itself.
Additional reference article: http://www.thefinalsprint.com/2006/10/tapering-101-my-approach-the-conventional-wisdom/
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Joshua ‘Flash’ Gordon is a runner who is never shy to give his opinion. Flash has been running competitively since 1989 and can be found training hard on the roads and trails of Boston. Flash continues to compete in distances from 5k to the Marathon as part of the Boston Athletic Association (BAA).
Sometimes Flash runs fast. Sometimes Flash runs slow. But neither rain nor snow nor heat nor gloom of night can keep Flash from the swift completion of his training regimen.
Have a question? Please feel free to ASK FLASH and TheFinalSprint.com’s team of experts by submitting your question via the form below.
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Tags: advice, Ask Flash, bursitis, cortisone injection, cortisone shot, goosefoot, Joshua Flash Gordon, knee pain, marathon, mileage, taper, tapering
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