Marathon training + the power of the period.
Sarah Milner - Physiotherapist @ Warrior Sports Clinic + Mission Therapy Clinic
Marathon season is fast approaching and we probably all know someone, or are ourselves training for a marathon this year. It’s such an amazing achievement to strive for, however incredibly difficult. If you’ve never run before it takes a lot of discipline to train, avoid injury and to get yourself out there when it’s as soggy outside as it’s been in London lately.
We’ve asked a guest to join us on the blog, someone who knows a helluva lot more about training for marathons than we do. She’s someone that has helped me make training plans for races in the past, advised me on various injuries and helped me prevent injuries in training. She’s also a great friend with a shared love of the dance floor - originally bonding at Dekmantel in 2019.
Sarah Milner, specialist sports and rehabilitation physiotherapist with over 12 years post graduate experience in private practice, NHS, professional and amateur sports as well as working with actors and circus performers. She works with a variety of different sporting populations including running, football, rugby, martial arts, winter sports and callisthenics.
She’s worked with a number of brands including Adidas and New Balance to deliver educational sessions to their athletes and running groups. A specialist in female health and performance, delivering presentations and on panels for several organisations including the English Football Association and New York State Soccer Association on how to improve participation and performance as well as coaching for women and girls in football. She also contributes to various publications including Women’s Running.
Previous semi-pro footballer turned runner with experience at marathon distances as well as a keen interest in strength and conditioning.
Sarah, you’re an avid marathon runner. How did you get into running?
I’ve always been involved in sport, whether that’s team sports like football or individual sports. To be honest I used to hate ‘just running’, I needed to follow a ball or be in a competitive setting to want to run. I ended a long term relationship 6 years ago and I wanted to get back into fitness. Running was the simplest way of doing this for me. I remember running 500 meters and feeling absolutely gassed on my first run with burning lungs and legs but over time and with consistency I saw real gains in my fitness and started to love the peaceful mind running gave me.
Why do you like to run?
As a health professional I can see how beneficial meditation and mindfulness is for people, I recommend it as a tool for my clients regularly however I always struggled myself to find a useful way of practicing this. I have tried apps, classes, self-directed practice but didn’t find them helpful. With running, I put on a podcast or an audiobook, no matter the distance, turn my notifications off and just run. It really helps me clear my mind of all the tasks I have to do and helps me decompress from a busy week or even prep for one coming up! I’ve built up enough fitness to feel comfortable running and have enough run routes around the whole of London that I can just really zone out and focus on whatever I’m listening to. I had a time in my running journey where I definitely ran because it was the easiest way to shed a calorie or two but I’m very happy and grateful to have worked my way out of that mindset and I think that’s kept my relationship with running really healthy.
How many marathons have you run now? Where were they?
I’ve run 3 marathons, London twice and Valencia once. I’ve signed up for my first Ultramarthon this year (crazy stupid) which will be along the Jurassic coast, 101km and over 2500 meters elevation.
Wow - an Ultramarathon, I can’t even imagine! Which has been your favourite marathon location & why?
You can’t beat a home marathon. My first London marathon was just so special to me. Not only is the vibe insane, with the best support in the marathon game, this day signalled the end of a year long running challenge for me where I ran 5km every day for a year for Cancer Research. My dad had sadly passed away 2 months before the end of the challenge and the marathon day but all my friends and family came to support along the course which was just such an incredible feeling to experience. Safe to say there were quite a few tears and beers after the race to celebrate!
How long do you typically take to train for a marathon?
I recommend 16 weeks but you’ll find many training plans stating 12. I’d highly recommend a bespoke plan that works for you with the guidance of a running coach or physiotherapist. I like the flexibility a longer training plan gives, professionally and personally, I recommend my athletes/clients include ‘deload weeks’ into their plan every 4-6 weeks. This involves dropping your weekly volume down and especially your long run to about 30-50% less than the previous week. It enables your body time to recover and avoid over stressing your nervous system. I also find that it gives you some life flexibility should you be away on holiday, super busy at work or if you’ve caught a cold. You can have a week off of the really long runs every now and then which you can shift to fit your schedule.
Do you have a strict marathon training schedule? Or does it fit around your lifestyle?
The hardest part about running a marathon for most people is the training. There has to be some element of consistency and plan to ensure that you are well equipped to run long distances without getting injured or if you want to achieve a performance goal. I always try to make plans that fit in with my work/life but sometimes you just need to compromise, especially when the training runs get to a higher mileage. You also need to factor in time for strength training, cross training and mobility/recovery so having a plan really helps you cover all bases.
If someone were starting training from scratch, what top tips would you give them?
Following simple apps like couch to 5k to build steadily into running is a really great way of avoiding doing too much too soon and opening yourself up to injuries.
Be patient with progress, it will come, just give it time.
Find shoes that are comfortable for you, don’t worry about sticking with big brands or someone telling you to buy THICC soled shoes, if it feels good for you when you walk and run then it’s generally ok!
If you’re not confident going alone then run with a mate or join in one of the many many run clubs that are now popping up around London/the UK. There are some great ones which are suitable for all abilities like Adidas Runners or Outrunners.
What are some of the most common injuries you see from marathon runners? Are there any tips to avoid them?
Runners knee (pain at the front of the knee)
Pretty much all of the running injuries are from poor biomechanics – something is being overloaded and something isn’t pulling it’s weight and taking the load. Often I find that people are weak around the glutes and calves and super tight in their quads, ITB (side of thigh) and calves.
Try to strength train consistently before starting your marathon plan and ensuring that there are strength sessions planned at least two times a week during your training plan. Always warm up dynamically before all runs and factor in recovery/mobility/foam rolling time into your week.
How do you motivate yourself to run when it’s cold, dark, wet and wintery outside?
If the weather is just ridiculously bad I’ll try to run inside on a treadmill and do a sprint interval session (I’ve done a 24km run a treadmill once before and I think my soul came close to leaving me, never again).
If I’m being a big brave girl and running outside in not ideal conditions then I’ll always make sure to be wearing the right kit – suitable clothing, head torch etc. I find a cap very helpful in the rain (all too frequent in the UK). Some people find joy running in the rain, I haven’t found the love for soggy feet yet and I’m not sure I ever will!
What would be your key advice to anyone training for the marathon?
Follow the process, have a plan, get guidance or advice if you need from a coach or specialist. 1000% train with whatever nutrition you will use on the day, whether that be gels, electrolyte drinks, food etc. Do not leave this to marathon day, you need to train your gut as much as you train your lungs and legs!
People always stress about times and how fast they can run it in, it always amazes me where people get the magical milestone of a sub 4 hours or 3:30 when they’ve never run a marathon before! I always say to my clients to have three goals –
Goal 1 – complete the training program injury free
Goal 2 – complete the race and enjoy it.
Goal 3 – this can be a time but make sure it’s realistic and your training plan reflects this!
The training is the hardest part, when the big day comes enjoy it. You’ve done all the hard work and the marathon day is the reward.
& Finally, any key nutritional & kit specific advice to avoid injury & dehydration?
I always caveat any nutritional advice I give with – it works for me but may not work for you! You need to trial things and see if your body is good with it or not. Same with footwear and clothing.
Nutrition wise some of my favourite brands for gels/electrolytes/chews are Maurten, Veloforte, SIS (electrolyte tabs only, their gels give me nightmares after my first marathon). Always check who the sports drink sponsor of an event is, for example, London is Lucozade. If you know you may need an energy boost towards the end of the race and will grab anything in sight to give you that, then maybe take a few sips of Lucozade when you’re on some of your longer runs to make sure your stomach is ok with it!
Make sure you are hydrated – no matter how many carbs you put in your body, if you’re not suitably hydrated then they will all go to waste! So that means making sure in the week leading up to the marathon and on the morning of race day, drink up – water, water with an electrolyte tablet, my personal fave is a non-alcoholic beer or two the night before the race (it’s basically just carby water!).
Please please please train in the footwear and clothing you’re planning to use on race day. Your worst nightmare would be wearing a new top or shorts/leggings on the day and succumbing to the dreaded chafe… Same with footwear, nothing new on the day, if you’re switching to a carbon plated shoe for that go faster feeling on race day make sure you have a few training runs in them (I know they’re expensive, I know they have a small shelf life when it comes to mileage, but trust me, practice in them a few times!).
One big piece of happy advice for race day – get your name printed on your bib number or write it on your shirt somewhere very visible. Marathon spectators are wonderful people. They will shout your name and act like close family when you look like you’re down and out after mile 20. Don’t underestimate the boost hearing people cheer you on will give you.
You’ve previously done a campaign with Adidas focused on playing sports and women’s menstrual cycles - can you tell us a little bit more about this and why you got involved?
I was honoured to be involved in a campaign for the release of adidas’s new period proof clothing. The campaign was run by a small creative agency called INMOTION which is a collective made up of women, for women. The production team, directors, stylists, videographers were all made up of hyper talented women who wanted to create a campaign which de-stigmatised menstrual cycles and facilitate increased participation in movement/sports by launching a product which helped women on their period feel more confident to be active.
I was approached to be involved as I’ve been a vocal advocate for women and girls around menstrual cycle health, education and participation in sports. I’ve presented to multiple groups on the subject including the English football Association as well as being open and honest about my experiences with my own menstrual health. When they asked me to be involved and explained the concept behind the campaign as well as the product I couldn’t say yes fast enough! We need more visibility, especially from big brands on this incredibly important topic!
Does your cycle impact your ability to exercise? How does it affect you?
Ok so this is a big topic. Yes and no, it’s all rather individualised. I will always be a vocal advocate of women tracking their cycles, using apps like FitrWoman or just putting the dates in your diary. This way you can get a good gauge of what stage of your cycle you’re in and you can really get to know your body and what it needs.
Every woman will respond differently to what their hormones are doing through their cycle. The main two female sex hormones are oestrogen and progesterone. Levels of these will rise and fall during your cycle and will affect all your bodies systems.
We have a rough idea that women perform best in the few weeks after their period has ended (phase 2 of your cycle) because of high oestrogen levels and low progesterone levels. This is typically the time where people aim to achieve PB’s in their training as we tend to have higher energy levels, increased anti-oxidant release, more stable blood sugar levels, increased feel-good hormone release (serotonin) and improved recovery and repair of muscle tissue.
The opposite of this is in phase 4 of our cycle (a couple of days leading up to your period). During this time both oestrogen and progesterone levels decline to their lowest point. This triggers an inflammatory response in our bodies, often thought to be part of the cause of PMS symptoms. This increase in inflammation may reduce your ability to recover after sessions. There is also a change in insulin sensitivity at this stage which can drive cravings and increase your appetite, altering your blood sugar levels. Your ability to fall asleep may be affected and you may wake more frequently which can leave you fatigued and reduce your ability to train/perform.
However, this is all very science-y. One woman may be affected as per the above and another be completely different throughout their cycle. I know personally on day one of my period I feel fantastic and can train really well where some others may need to be curled up in a ball with a hot water bottle! Main message – knowledge about your own cycle is the most powerful tool you can have, use it.
Do you find that women’s periods are actually powerful and helpful rather than a hindrance?
The term Bio-hacking sounds very cool and very laboratory BUT it’s an incredible tool that every woman can use. We have this resource called a menstrual cycle that men don’t have and we have been ashamed of it and taught to hate it for so many years. Whilst everyone has a different relationship with their period, we need to start thinking of it as a gift.
Now, I am very aware there are many women who really struggle with endocrine issues like endometriosis which make having a period unbearable, so I will speak from a privileged position of not having such a life affecting condition and not for these women’s whose needs are consistently ignored by our health care system.
Knowledge is powerful. Periods are powerful. Fact. It all starts with tracking. If you can keep a note, a diary, use an app (like Apple Health, FitrWoman, Garmin, WHOOP) to monitor your period dates, you can get a good idea of how long your menstrual cycle is (remember this is individual to each woman). Typically, we think of a ‘normal’ cycle length as 28 days but I’ve always had a slightly longer cycle so if I followed conventional phase length timelines then this wouldn’t be specific to me.
From studies, we know how the levels of our two primary sex hormones, oestrogen and progesterone, rise and fall throughout your menstrual cycle and what affect these changes have on all your bodies systems (heart, head, muscles, bones, liver etc!). If you can workout how your body responds to these hormonal changes, then you can theoretically program your training load and general lifestyle to adapt to these fluctuations and therefore peak your performance, improve your recovery, avoid injury and illness and control mood changes as well as a number of other factors.
We are seeing more female athletes and elite sports teams use specialists and tracking methods to gain further sporting excellence giving them the edge over other competitors, it’s about time women everywhere start seeing this and using it to benefit their day-to-day life.
A big thank you to Sarah for such in-depth advice. So a lot of that ^^ was incredibly ‘science-y’, as Sarah put it. But while it might be wordy and a lot to digest, it remains incredibly important that we know our bodies (all genders), not just to try for PBs and to train better, but for the impact that all of that has on our mental health.
I personally [Monica] love running and love to push myself, but sometimes my body just isn’t up for it. And that’s okay. And I really hate running on the treadmill, I find there’s nothing better than running in nature. But sometimes that’s not possible (weather, energy, location) and I’ll revert to yoga or pilates instead. I’m not currently training for any big race days, but for all of those who are, I hope this post was useful to you + good luck! Have FUN!!
Written by Monica Innes, Co-Founder of Re Cabins - Friday 1st March 2024
