"I was popping vitamin I like they were M&Ms"... said one ultra runner.
NSAIDS: THE SHORT STORY...
You may be aware of the controversy surrounding the use of NSAIDs (non-steroidal anti-inflammatory drugs) during ultra marathon training and racing. Categorically, NSAIDS are drugs that may be OTC (over-the-counter) or prescription strength, are pain relievers, fever reducers, and also reduce inflammation. NSAIDs are particularly effective for treatment of mild-to-moderate pain due to inflammation associated with tissue injury. Common OTC NSAIDs are aspirin, ibuprofin, Advil and Aleve.
The most common side effect of NSAIDs is dyspepsia aka "stomach upset". GI (gastrointestinal) complications associated with NSAID use include stomach cramps, nausea, vomiting, diarrhea, gastric erosions and GI bleeding. Some NSAIDS are associated with increased risk of heart attack, heart failure and stroke. In particular, NSAIDs are known to be "anti-prostaglandin". By reducing levels of prostaglandin in the blood, pain levels are decreased but negative effects may result in the kidneys where prostaglandin plays a vital role in kidney profusion (blood flow). Low prostaglandin levels may result in constriction of renal (kidney) blood flow. This constriction of renal blood flow combined with other stresses associated with endurance running (dehydration, electrolyte imbalance, adrenal fatigue, hyperthermia, muscle damage), are associated with increased incidence of acute renal failure, secondary to rhabdomyolysis (a condition in which damaged muscle particles are released into the blood stream). In recent years, there have been numerous documented cases of hospitalizations due to acute renal failure among ultra runners who have used NSAIDS during training and racing.
THE LOW DOWN...
Not only are NSAIDS a health risk for ultra runners, they actually interfere with our natural ability to manage pain. Here's how it works... You run, run, run. It starts to hurt. You have no real "fear" of this pain because your brain knows that it is "normal" to hurt when you run 25-miles, 50-miles, etc. As you keep going, your pituitary gland starts to produce endorphins that flow through your bloodstream. According to Wikopedia, endorphins "are produced by the pituitary gland and the hypothalamus in vertebrates during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce analgesia and a feeling of well-being". The more you train (run, run, run), the more adept you become at pumping out endorphins. Endorphins are "endogenous morphine" to an ultra runner and probably is the reason that ultra running is so "addictive"! The constant flow of endorphins throughout the running activity causes pain levels to "ebb and flow" and to become more manageable as the athlete becomes highly conditioned. But when NSAIDs are added to the picture, the body never becomes efficient at producing endorphins because the NSAIDs temporarily mask the pain. The problems with this are that (1) the pain levels eventually come back up again and require repeat doses of NSAIDs, (2) NSAIDS create dependency and higher than normal doses are soon required to relieve pain, (3) Pain levels increase through the cycle because the endorphin response is being blocked by the NSAID use (4) Side effects of NSAIDs begin to set in causing increasing distress to the runner.
The solution to the NSAID dilemma is to "get clean"! Teach yourself to train without using NSAIDs or pain relieving drugs. When you encounter discomfort, pain, or fatigue, tell yourself "this is normal". Tell yourself "the more you hurt now, the less you will hurt later". Slow down or shorten your mileage a bit; pain is after-all, a message from your body telling you to ease up! Each time you return to the trail, you will come back stronger. For post-run soreness or pain, elevate the legs, use ice or heat, take a bath with Epsom salts get a nice massage. The result is that you will soon be training without taking pain meds at all and you won't suffer the medical problems associated their use.
In 1997, I ran my first 100-miler without taking any pain meds; a fact that I'm sure helped get me to the finish line. Fast forward to 2003 when I ran the Badwater 135-Mile Ultra Marathon and on the second night, I had a terrible "tweak" in my neck and felt like a hot knife was stuck in my shoulder blade. Someone asked me when I last took ibuprofen and I answered "six years ago"! After a good laugh, they popped a single" Vitamin I in my mouth and about an hour later the pain was entirely gone!
Of all the things that can throw a wrench in our ultra running plans, the blister tops the list for me! Blisters are one area where "damage control" really makes a difference and improves your chances of making it to the finish line of a long distance race!
First... think "prevention"!
To begin, examine your feet. Areas of concern to look for are (1) callouses or thickened skin and (2) thick toenails. Failure to eliminate these two "issues" will increase your chances of blistering and will make repairing the blisters more problematic.
Next, get yourself a "Ped-Egg" for sanding down callouses when your feet are damp.
Then, get a large emery board for sanding down callouses when your feet are dry. These are about 8"-12" in length and have two sides (a smooth side and a rough side). You can often find these in spa salons or maybe the drug store.
About every other day, you will need to spend a couple of minutes working on your calloused areas to wear them down and maintain them to keep them away. The object is to sand your callouses gently at frequent, regular intervals versus getting too aggressive on rare occasions. Using the callous tools to regularly maintain your feet will keep callouses from re-developing each time you run. While feet without callouses may still blister, the blisters are not as deep, are easier to drain and less likely to become infected.
You also want to work on your toenails. Toenails that are thick tend to develop pressure blisters under the nail, which are very painful and very difficult to drain. For your toenails, you will need a regular 6" emery board (the kind to use on fingernails). About 3-4 times each week, you want to just sand down the thickness of each nail for about 30-seconds. The whole process should take about 5-minutes. You probably will need to put your thumb on the top of the file to move the file over the nail bed. After about 4-weeks of regular filing, your toenails will become thin and pliable and will be less likely to blister against pressure from the toe box. You know how good it feels after a black toenail falls off and there is no toenail there at all? Filing your nail surface down to paper-thin causes the same result. Just do it "gradually" and do not get too aggressive or it will cause pain. Keeping your nails thinned will reduce the likelihood of toenail blisters and if they do form, they will be much easier to drain. Keeping your nails trimmed straight across and very short will also help; suggest trimming the toenail length approximate bi-weekly.
There are several prophylactic measures one can take during a race to prevent or minimize blisters.
Wear moisture wicking socks: These tend to be 100% polyester that allow the material to dry more quickly than cotton material thus helping to keep your feet dry. Some runners like to wear a thin polyester sock liner under a heavier running sock; the theory being that the thin sock will wick moisture away from the feet into the heavier sock. Be sure your socks have smooth seams if any, so as to reduce friction. To prevent blisters involving the toes, Injinji makes a toe sock that has passed the tests by runners, including myself at the Badwater 135-Mile Ultra Marathon. I personally endorse Injinji as the #1 sock for ultra running and I especially like them for runners who need to lube or tape toes http://www.injinji.com.
Lube Your Feet: Applying lube to your feet and/or between the toes can reduce friction that leads to blisters. If you switch to Injinji, you might need to size up your shoes ½ size. A popular lube used by ultra runners is called "Hydropel". Some runners prefer "non-petroleum" lubes. Wearing Injinji toesocks also helps make applying lube easier by inverting the sock to put a dab of lube into each toe pocket.
Powder Your Feet: While some prefer lube, others prefer powder. Powder users generously powder their feet and then invert their socks to apply some powder to the inside. If you plan to try powdering your feet, I recommend you get a good medical powder such as Zeasorb https://www.google.com/search?q=zeasorb&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a.
Tape Your Feet: I am a big fan of pre-taping for blister prevention and treatment. It is a good idea to attend a foot taping clinic or read "Fixing Your Feet" (http://www.fixingyourfeet.com/) before you start because foot taping gone bad is really bad; you can actually cause more blistering with a bad taping job! Taping should always be done with a good product called Kinesio-Tex. Kinesio-Tex is the same colorful tape you often see on runners knees however we use the beige tape for feet; it comes in widths of 1", 3" and 4". You will also need a barrier type skin prep to help the tape stick. Some runners use "tincture of benzoin" and I have used "Skin-Prep" protective wipes made by smith&nephew.
Likewise, if you have a "problem toe" that needs taping, you can safely tape that one toe and put on the toesock resting assured that the tape will not cause friction on the toes on either side.
If you are prone to blisters, it’s a good idea never to go to a race without your pair of trusty scissors or a sharp box cutter. You can use them to trim away the piece of insole under an annoying toe blister or even cut out the offending part of the shoe. There are several prophylactic measures one can take before a race to prevent or minimize blisters.
AFTER THE RACE: