Ultra Running/Injuries

Injury Modifications

4 injury guides

Guidelines for safely modifying workouts when dealing with common injuries. Always consult a healthcare professional for specific medical advice.

Blisters

Friction blisters are one of the most common issues in ultra running. While often dismissed as minor, blisters can lead to DNFs by altering gait mechanics and causing secondary injuries. Prevention through proper footwear, socks, and training is far more effective than treatment. The key is managing friction, heat, and moisture before blisters form.

Warning Signs

  • ⚠Increasing redness around blister
  • ⚠Pus or cloudy drainage
  • ⚠Increasing pain
  • ⚠Red streaks extending from blister
  • ⚠Fever or feeling unwell
  • ⚠Deep blister not improving

When to Seek Professional Care

  • →Signs of infection (pus, spreading redness, fever)
  • →Deep blister involving multiple skin layers
  • →Blister not healing after 2 weeks
  • →Diabetic or immunocompromised
  • →Blood blister that's very painful
  • →Unable to walk without pain

General Principles

  • •Friction is the primary cause - reduce friction, prevent blisters
  • •Never race in new shoes or socks - test all gear in training
  • •Moisture increases friction - keep feet as dry as possible
  • •Hot spots are warnings - treat immediately before blisters form
  • •Prevention is far more effective than treatment
  • •Gait changes from blisters cause secondary injuries

Contraindicated Movements

Racing in untested footwearLong runs in new shoesRunning with wet socks when alternatives existIgnoring hot spots during runsRemoving blister roof (deroofing) unless necessary

Recommended Exercises

Foot inspection routine

1 sets × 1 reps

Check feet daily and after every run for hot spots

Taping practice

1 sets × 3 reps

Practice taping technique until perfect before race day

Gear testing

1 sets × 1 reps

Test all race day gear in training, including socks and shoes

Foot strengthening (towel scrunches)

3 sets × 15 reps

Stronger intrinsic foot muscles reduce friction points

Callus maintenance

1 sets × 1 reps

File calluses smooth - thick calluses can cause blisters underneath

Return to Full Training

Criteria:

  • ✓Blister fully healed (new skin formed)
  • ✓No pain when running
  • ✓Root cause identified and addressed
  • ✓Prevention strategy tested in training

Progression:

  1. 1.Day 1-3: Rest from running if severe
  2. 2.Day 4-7: Short easy runs with protection
  3. 3.Week 2: Gradually extend duration
  4. 4.Week 3+: Full training with prevention protocol

Muscle Cramps

Exercise-associated muscle cramps (EAMCs) are a common issue in ultra running, particularly affecting quads after prolonged downhill running. Research shows cramps are primarily caused by neuromuscular fatigue rather than electrolyte imbalance alone. Prevention through specific training and fatigue management is more effective than supplementation.

Warning Signs

  • ⚠Cramps occurring earlier in runs than before
  • ⚠Multiple muscle groups cramping simultaneously
  • ⚠Cramps at rest after activity
  • ⚠Cramps not responding to stretching
  • ⚠Associated weakness or numbness

When to Seek Professional Care

  • →Cramps with no clear trigger
  • →Cramps at rest unrelated to exercise
  • →Associated muscle weakness
  • →Numbness or tingling
  • →Dark urine after cramping episodes (possible rhabdomyolysis)
  • →Recurrent severe cramps despite prevention strategies

General Principles

  • •Cramps are primarily caused by neuromuscular fatigue, not just electrolyte loss
  • •Train specifically on terrain similar to your race - flat training won't prepare you for mountains
  • •Strength training reduces cramping by improving muscle fatigue resistance
  • •Carbohydrate depletion directly causes cramping - fuel adequately during long efforts
  • •Quad cramps are common after prolonged downhill running - train eccentric strength
  • •Studies show electrolyte status alone does not predict cramping

Contraindicated Movements

Racing on terrain you haven't trained onSignificant volume increases (>10% per week)Long runs without adequate fuelingSpeed work when already fatiguedSkipping strength training before ultra blocks

Recommended Exercises

Eccentric quad exercises (Nordic squats, slow step-downs)

3 sets × 8 reps

Builds fatigue resistance for downhill running

Calf raises (bilateral then single-leg)

3 sets × 15 reps

Calf cramps common in ultras; strengthening prevents them

Hamstring strengthening (Nordic curls, Romanian deadlifts)

3 sets × 10 reps

Hamstring cramps often follow quad fatigue

Hip flexor strengthening

3 sets × 12 reps

Fatigued hip flexors contribute to altered gait and cramping

Core stability work (planks, dead bugs)

3 sets × 30 reps

Core fatigue leads to compensation patterns that trigger cramps

Return to Full Training

Criteria:

  • ✓Complete long run without cramping
  • ✓Strength training program established
  • ✓Fueling strategy dialed in
  • ✓Terrain-specific training completed

Progression:

  1. 1.Week 1-2: Establish strength routine, shorter runs
  2. 2.Week 3-4: Gradually extend long run with walk breaks
  3. 3.Week 5-6: Accumulated fatigue training
  4. 4.Week 7-8: Terrain-specific long runs
  5. 5.Week 9+: Full training with maintained strength work

Overtraining Syndrome

Overtraining syndrome (OTS) is a serious condition resulting from accumulated stress exceeding recovery capacity, leading to persistent performance decline and systemic symptoms. It's distinct from normal training fatigue or functional overreaching (which resolves with short rest). Ultra runners are particularly vulnerable due to: - High training volumes - Long events with extended recovery needs - Racing multiple ultras per year - Type-A personalities that push through fatigue Related condition: Relative Energy Deficiency in Sport (RED-S) - inadequate fueling relative to training demand, which can present similarly.

Red Flags - Seek Immediate Care

  • ●Persistent depression or severe mood changes - seek mental health support
  • ●Amenorrhea for 3+ months (females) - evaluate for RED-S
  • ●Significant unexplained weight loss - medical evaluation
  • ●Recurring stress fractures - evaluate for RED-S/bone health
  • ●Exercise intolerance (symptoms with any activity) - medical evaluation

When to Seek Professional Care

  • →Symptoms not improving with 2-4 weeks rest
  • →Any red flag symptoms
  • →Signs of RED-S (females: missed periods; both sexes: stress fractures, low energy)
  • →Depression or anxiety
  • →To rule out other medical conditions (anemia, thyroid, etc.)

General Principles

  • •Overtraining is a systemic condition - rest alone may not fix it
  • •Prevention is far better than treatment
  • •Training stress + life stress = total stress
  • •Recovery is a training component, not a weakness
  • •HRV monitoring can provide early warning
  • •Adequate fueling is essential - don't undertrain and underfuel

Contraindicated Movements

High volume trainingIntense intervals or speed workRacingRunning through fatigue signs

Recommended Exercises

Easy walking or yoga

1 sets × reps

Light movement for recovery without training stress

Sleep optimization

1 sets × reps

Sleep is the primary recovery tool

Stress reduction practices

1 sets × reps

Meditation, breathing exercises to reduce total stress load

Return to Full Training

Criteria:

  • ✓Energy levels normalized
  • ✓Enthusiasm for training returns
  • ✓Easy running feels easy
  • ✓Sleep quality restored
  • ✓Resting HR and HRV normalized
  • ✓No recurrence with gradual return

Progression:

  1. 1.Week 1-2: Easy walking or light activity only
  2. 2.Week 3-4: Very easy short runs (20-30 min)
  3. 3.Week 5-8: Gradually build volume (10% per week)
  4. 4.Week 9+: Slowly reintroduce quality sessions
  5. 5.Racing: Not until fully recovered and training consistently

Plantar Fasciitis

Warning Signs

  • ⚠Pain increasing during runs (stop immediately)
  • ⚠Limping after runs
  • ⚠Morning pain getting worse
  • ⚠Pain spreading to heel or arch

When to Seek Professional Care

  • →No improvement after 4 weeks of conservative treatment
  • →Severe pain limiting daily activities
  • →Numbness or tingling in foot
  • →Visible swelling or bruising

General Principles

  • •Reduce overall weekly volume by 20-30% initially
  • •Prioritize soft surfaces (trails > roads)
  • •Strengthen the intrinsic foot muscles daily
  • •Address calf tightness - often the root cause
  • •Consider zero-drop to low-drop transition (gradually)
  • •Ice and roll the fascia after every run

Contraindicated Movements

Steep downhill running (increases plantar load)Barefoot running on hard surfacesSpeed work until pain-freeBack-to-back weekends during acute phase

Recommended Exercises

Calf stretching (gastrocnemius and soleus)

3 sets × 30 reps

Tight calves are often the root cause of plantar fasciitis

Toe yoga (spread, lift, curl)

3 sets × 10 reps

Strengthens intrinsic foot muscles for arch support

Tennis ball rolling

2 sets × 5 reps

Releases fascia tension - do morning and evening

Night splint use

1 sets × 8 reps

Maintains stretch while sleeping to reduce morning pain

Low-dye taping (for runs)

1 sets × 1 reps

Provides arch support and reduces fascia strain during running

Return to Full Training

Criteria:

  • ✓Pain-free walking for 1 week
  • ✓Pain-free easy running for 2 weeks
  • ✓No morning pain for 1 week
  • ✓Full calf flexibility restored

Progression:

  1. 1.Week 1-2: Walk only, do rehab exercises
  2. 2.Week 3-4: Easy running 20-30 min, flat terrain
  3. 3.Week 5-6: Gradually increase duration, still flat
  4. 4.Week 7-8: Reintroduce hills slowly
  5. 5.Week 9+: Resume normal training if pain-free