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Ultra Endurance Running

Ultra-endurance (UE) is classified as any endurance event lasting more than the usual event distance (i.e. marathon >42.195km) where athletes seek to push themselves (and their bodies) to the absolute limit. Ever increasing in popularity are ultra-marathons (UM) which are unique in that the preparation and management before, during and after each event can differ substantially depending on which event is undertaken. UM events can be undertaken in various settings, ranging from thermo-neutral, to desert, to arctic and can last anywhere from several hours (i.e. single stage), to several days, weeks and even months (i.e. multi stage). The events can be fully supported, semi-supported (where athletes are required to carry just food), or unsupported (where athletes are required to carry both food and equipment). Examples of UM events include the Marathon Des Sables, the Badwater Ultra Marathon, the Ultra Trail Du Mont-Blanc and The Yukon Ultra.

UM athletes are subjected to an abundance of stressors which not only have the ability to impact upon performance over several hours or consecutive days of competition, but may also have implications on health – both in the short and long term. Such stressors include an inability of athletes to match intake to expenditure, micro and/or macro nutrient malnutrition, increased risk of musculoskeletal and/or superficial injuries and/or infection, reduced immune function, increased circulating stress hormones (i.e. cortisol), accumulated fatigue, poor sleep quality, gastro-intestinal symptomology (i.e. appetite suppression, nausea, vomiting), disturbed recovery periods, exposure to extreme environmental conditions such as cold (<0ºC) and hot (>30ºC) temperatures and the necessity to carry a pack (as is the case in unsupported events) which can range from 5-15kg.

If you are considering taking up Ultra-endurance sports, particularly UM, there are several considerations that you need to make, including investing in a good allied health support team. In the following blog piece, you will see considerations from both the athlete (Richard Bowles) and the support team; the Physiotherapist (Scott Hancock), the Podiatrist (Steven Singh) and myself – the Dietitian (Rebekah Alcock).

The athlete:

What is ULTRA-running? The dictionary states that the word "ultra" means:

“Going beyond what is usual or ordinary; excessive; extreme”

And I feel we all understand the term running? It’s like walking but faster!

So, ultra-running is all about going beyond what is considered normal when running. I believe there is an ultra-runner in all of us, because running in general takes you past your normal limits every time we lace up and leave the front door; a few kilometers for one is past what they may consider normal.

The official distance of the ultra-runner however is anything longer than the marathon distance of 42.2km. Yes, there is a whole bunch of people who like to run races longer than the almighty marathon; from 50km to 100km and beyond.

Ultramarathon running, as it is sometimes called, is more of a mind over matter sport than it is physical. There is only so much mileage you can train your body to run, after that is met, you run with your head and your heart. It’s about blocking out the pain and hurt that comes with taking your body to extremes. For this reason, ultra-running can be competitive for both male and females, with some of the longer races seeing ladies on the podium over men.

If you want to join the crazy world of the ultramarathon runner, then don’t take the “ultra” word lightly. Running further means that every other thing in your life becomes extreme and excessive. Diet, stretching, sleep, physio, strength training and anything else you have to do as the ordinary runner, just got ultra-too. The demands of the sport are not just come race day, training itself takes up a huge amount of time and with all the other duties on top including a very large shopping bill each week due to the ultra-appetite, means priorities have to change. And you thought you were struggling with a work-life balance before?

Running this way has to be your life and not a part of your life, it’s not a hobby, it’s a way of living. If what you have heard so far still gives you a desire to run further, then you already have what it takes to make it a success.

Richard Bowles
Consultant & Professional Speaker.

The Physiotherapist: 

World Class BioMotion Movement Analysis System

As previously mentioned UM athletes are subjected to an abundance of stressors on both race day and throughout an appropriate preparation. These physical and psychological stressors dramatically increase the risk of musculoskeletal and overload injuries. The most common of which are:

In order to reduce the risk of such injuries occurring it is imperative that you follow a progressive overload program, which is optimal and tailored to your needs and allows musculo-skeletal adaptation to occur. It is important that your progressive running program is diverse, varied and incorporates hill training, speed/interval training and cross training.

In conjunction with such a running program, an appropriate strength and conditioning program incorporating flexibility and mobility exercises and recovery techniques should be performed to improve performance and minimise the risk of injury.

An appropriate strength, flexibility and recovery program may include:

  • Massage, myofascial and trigger point releases such as foam rolling.
  • Stretches and specific mobility exercises.
  • Strength exercises aimed at strengthening inactive and weak muscles and improving performance.
  • Pilates
  • Running technique drills
  • Alter-G Training

Finally it is important to have your running technique and biomechanics assessed by an appropriate professional. Your running technique has a large influence on the direction and magnitude of load which is applied to the body. Through a Running and Biomechanical assessment, abnormal or inefficient movement patterns can be observed and highlighted and an appropriate plan including cues, running drills, strengthening or mobility exercises may be prescribed to improve your running efficiency, performance and to reduce the risk of injury. Such Running Assessment may be conducted at our Richmond clinic in our state of the art Bio-Motion Laboratory.

Scott Hancock
Senior Physiotherapist
Recover Sports Medicine
AHAPRA, APA, SPAM, M. Physio, B. ExScRehab

The Dietitian:

This past year, I was lucky enough to be covered in blood, sweat (but not tears – I’m not that cruel!) engaging in research on the optimal nutrition provision for ultra – endurance runners (where the literature is currently scarce). One requirement was that I completed a literature review looking at what we know about current athlete practices across both single and multi-stage events i.e. are they meeting their energy requirements, and are they following the current guidelines for ultra-endurance athletes? A summary of current guidelines can be seen below:




General: 5-12g/kg

BM/day Loading: 10-12g/kg

BM/day(2 days) During: Up to 90g (Glucose:Fructose; 2:1 ratio)

Post: 1.2g/kg BM/day

General: 1.3-1.8g/kg

BM/day Distribution:  0.2-0.3g/kg BM (which equates to ~20-25g serve*) every 3-4 hours

Post: 20-25g*

Not of priority due to lack of performance improvements and displacement on CHO intake.

Summary of current guidelines for ultra-endurance athletes. *Recommendation for 70kg male

Source(s): Jeukendrup AE. J. Sports Sci. 2011;29(sup1):S91-S9. Phillips SM, Van Loon LJ. J. Sports Sci. 2011;29(sup1):S29-S38. Beelen M, Burke LM, Gibala MJ, Van Loon LJ.. Int J Sport Nutr Exerc Metab. 2010;20(6):515-32.

Of upmost importance is carbohydrates; the body's predominant and in most cases preferred fuel source. It is broken down into glucose which is either stored in the muscle and liver, or immediately used as fuel (i.e. to produce ATP). However, the body only has a limited capacity to store glucose (AKA glycogen) which is essentially enough to fuel approximately 90 - 120 minutes of continuous activity at a high intensity – which is obviously much shorter than the length of an UM. If glucose is not replaced, then endogenous stores of glucose can become depleted, which is thought to be a major contributor to fatigue. In addition, carbohydrate has recently been shown to play a role in attenuating the negative immune response that can occur post exercise (honourable mention to my Honours supervisor Dr Ricardo Da Costa for establishing this in his research). The guidelines for carbohydrate in UE currently recommend up to 90 grams per hour, with a glucose to fructose ratio of 2:1 as the different carbohydrates are absorbed through different pathways, thus essentially allowing more carbohydrate to be available to the working muscles, and cognitive function.

Protein has been well established for its role in recovery and repair, the reduction of muscle soreness (particularly important in events run over consecutive days i.e. multi-stage) and can also assist in the replenishment of glycogen stores. Whilst fat has failed to show any performance benefits, thus is not a current recommendation/ priority. However, many athletes increase the fat content of their diet during an UM event in an attempt to meet their energy requirements whilst keeping their pack weight low – which may have a detrimental effect to performance.

So, back to whether or not athletes are meeting their requirements and/or the recommendations. In short, no, and there are several reasons for this, one such reason is that there is not enough planning and preparation, or the help of the nutritional professional is not enlisted (whereas, it would appear that athletes who have nutrition support have a better ability to meet requirements and/or meet recommendations). Indeed, adequate planning is essential (AND TRICKY), as it can be a challenging to simultaneously meet requirements, whilst also meeting recommendations and (where applicable) keep pack weight as low as possible.

My top tips for nutrition preparation for an UM event include:

  • Never trial anything on the day – use your training to trial different nutrition strategies to determine what works for you – GI upset is common in runners, trialing something new on the day may just results in a DNF (Did not finish).
  • Trial different products – there are SO MANY options i.e. gels, lollies, drinks and even home-made options – switching between foods will reduce the risk of flavour fatigue (believe me, by day 5 you will be screaming for a salty, savoury food!)
  • The current research suggests that drinking to thirst or “ad libitum” prevents not only dehydration, but over hydration (known as hyponatraemia), which may be of concern to UM runners (particularly those competing in cold weather OR multi-stage events in the heat).
  • DO NOT compromise nutrition for a lower pack weight as you may end up compromising on your performance, as I mentioned it is challenging simultaneously meeting requirements whilst keeping pack weight to a minimum, and this is one of the areas that I can help!
  • If enlisting in the help of a nutrition professional DO NOT leave it until last minute to seek assistance – training for an event is the best time to trial nutrition strategies (and also gives us time to adjust nutrition plans as appropriate).

Rebekah Alcock
Accredited Practicing Dietitian
Provisional Sports Dietitian
Recover Sports Medicine
BPH, MnutrDiet, BNut(Hons), Cert III and IV in Fitness.

The Podiatrist:

Preparation prior to running in an Ultra-marathon is key. I'm going to list 6 key essentials that you must to do to ensure that your feet come out in one piece on the other side of the Ultra marathon:

  • Always have 2 sets of the CORRECT runners. One for training purposes only and one used intermittently during training to be primed for the UM run.
  • Know your wear patterns - Correct biomechanical wear for a heel striker should start on the outside of the shoe and move in and under the arch towards the big toe. For a forefoot runner it should be evenly spread between where the balls of the feet would sit in the shoe. Knowing this information allows you to know if, or when you need to buy new shoes before shoe wear starts affecting your biomechanics (which can potentially lead to injury). Sometimes in-shoe modifications such as a wedge or foot bed can also assist with the longevity of the shoe.
  • Know your technique! For novice runners it is very important to know the most efficient cues for you turn your legs over with minimal effort. For some runners it’s a cue to keep their body in front of their feet. For others it may be lifting your toes during swing phase in running. Whatever it is, having your running technique assessed pre and during fatigue is important.
  • Develop a progressive overload program. Although your body may be able to tolerate training loads for one to two weeks, to avoid breaking down with injuries always have a plan of how to load your body progressively leading into the event.
  • Learn how to tape, bandage, and prevent blistering and callous formation. The skin of your feet being healthy is integral to ensuring you don't subconsciously compensate your load elsewhere on the foot.
  • Know a good podiatrist!
Dr. Steven Singh
Recover Sports Medicine
B. Pod, Cert III and IV in Fitness

If you have any questions regarding this post, or wish to book in to see one of our practitioners, please call us on 1300 858 774 or email contact@recoversportsmed.com.au

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