It is that time of the year again, an influx of runners in my office, increasing the mileage as Comrades qualifiers approach and the month of June draws closer. As promised from my last blog “Sportsmen or women? This read is for you” I want to dive into different sports focuses over the next few months, with the Comrades Marathon being my first event of choice.

Based on my own private practice experience, which I know is only 3.5 years, this is my feedback, advice and hopefully helpful tips for you thus far, together with some input from some of my patients. Please note, this is just my broad-spectrum analysis. I am fully aware that during your Comrades’ journey you will receive advice from a hundred different people but FIND WHAT WORKS FOR YOU. These are just points to be aware of and to consider. And with that said, don’t read this and then go change everything, that in itself can lead to disaster. If these tips are helpful, start making the necessary changes over time.


The biggest ‘error’ I have personally noted is patients dropping every other activity just to increase running mileage. “I can’t surf anymore because I need to run instead.” “I don’t want to strength train because it makes me too bulky for Comrades.” Like I’ve quoted before, the best way to prevent injury is by staying diverse with your movement demands! We need to work through a wide range of physical literacy challenges in order for different systems and tissues to be stressed without being overstressed. Yes, I understand that you need running mileage, but what is the point of all the mileage if you develop a stress fracture or medial tibial stress syndrome? Running is a LINEAR sport, but the forces applied during running are not just sagittal or in a straight line. If you don’t incorporate movements that make you stronger in the frontal and transverse planes, you may just end up with an ITB (iliotibial band) syndrome. 

Balance practice, core endurance, and strength training will drastically reduce your chances of developing running injuries, especially whilst training for ultra-marathon distances. Why balance practice? Running is one foot at a time, and you are constantly changing loads, therefore this is a skill we need to develop and possess. Why core endurance? Most issues that occur deep into a run stem from hip and core stability mechanisms fatiguing. Why strength training? It really helps to have strong, activated gluteal and lower limb muscles. Resistance is key to ensuring that our joints can handle the repetitive stress from km’s of running. Did you know that running can create forces up to 3x your body weight with each foot strike? Your Achilles tendon, for example, is loaded 3.4x your body weight during walking but 7.7x your body weight when running. And this resistance training doesn’t refer to light weights and high reps. Another reason why lower body strength and trunk control (core) is important is that the majority of runners are heel strikers. Research shows that rearfoot striking increases stress on the body to a much greater degree than those who are mid, to forefoot strikers. The stronger you are, the harder you are to hurt. 

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If your friends dare you to do the Comrades marathon in a couple of months and you’ve never run more than 10km’s, maybe not the wisest decision you’ll ever make. Conditioning is of vital importance for reducing injury risk. As discussed above, running subjects the body to an increased, repetitive load with every foot strike. Be smart and realistic about your goals. Just because someone believes you can do the Comrades, doesn’t mean you have to enter the upcoming one and prove you can achieve it. It is a 90KM ROAD ULTRA MARATHON. Yes you might complete it, but at what cost? We all know there are some super humans that beat all the odds, run a dozen Comrades marathons with minimal preparation and still manage to avoid injuries or knee surgery, but those individuals are few and far beyond. 

So what do I mean by conditioning? According to the Britannica Encyclopaedia, “conditioning, in physiology, is a behavioral process whereby a response becomes more frequent or more predictable in a given environment as a result of reinforcement, with reinforcement typically being a stimulus or reward for a desired response.” So, if Comrades is your goal (and by that I mean a successful Comrades as injury-free as possible), then get a few half marathons under your belt first. Once you’ve done that, allow the mileage to climb again and then get very comfortable with doing a marathon, or two. And I don’t mean this happens all in a few months. Comrades is not running away (yes I know what I did there), you have plenty of years ahead to prep for an event of this magnitude. And besides, research shows that peak running performance occurs later in your 30s and/or with the correct conditioning over the years. With that said, if you are very conditioned in the marathon department, this is great, however, when picking your qualifier marathon, don’t pick 4. Too many people exert themselves 110% over a few marathons, instead of strategically planning for one or two. You cannot always expect your body to show up for that many marathons. 

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I decided to consult the beautiful Mariella Sawyer for this section, a top South African triathlete and dietician (e-mail her at for more information). Her pointers include:

  • Everyone is an individual and different things/food work for different people so stick with what YOU know. 
  • Race intensity influences how well your body can digest food. The higher the intensity, the less blood goes to your gut, meaning that digestion becomes a lot more difficult. This is why easily digestible carbs such as gels are often the go-to for those racing at higher intensities. 
  • Hydration is key! Electrolytes are important and dehydration is often the cause of cramps, stomach stitches, nausea, vomiting and a decline in performance. 
  • PRACTICE MAKES PERFECT! Practice your race-day nutrition during long runs and figure out what works best for you. 
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Of the thousands of individuals that run the Comrades Marathon, I always wonder how many see a chiropractor or get regular sports massages during their training, 10% maybe? And I don’t mean visits to either due to running injuries, I am just referring to maintenance care, maybe more like 5%? I always think it’s fascinating that when our shoes reach a certain mileage and are worn out (which happens pretty quickly when training for an ultra-marathon), we get new ones. In most cases, not because they are causing injuries, but because we have come to terms with the level of wear and tear they are exposed too. We do this, yet we fail to get our bodies treated regularly during this time. I am sure our bodies are the ones withstanding the constant impact of the weekly increased running mileage. Respect your body during this time, its training to achieve a huge goal. 

Book a sports massage TODAY if you haven’t had one. Flush out those toxins, give the body some TLC and celebrate it for all the efforts it has achieved thus far. If you haven’t seen a chiropractor, make an appointment with one TODAY too. “But why do I have to see a chiropractor if I don’t have any reason too?” Well, why do you service your car every 15 000kms if there’s nothing wrong with it? Here are a few pointers taken from my previous blog regarding the benefits of chiropractic care for you.

Chiropractic care improves movement, on a spinal and joint level, as well as overall body movement. Imagine training for the comrades with ankles that don’t move properly? That directly affects the whole gait cycle and can lead to numerous lower limb enthesopathies, like ITB syndrome and shin splints. 

Better Balance and heightened body awareness. Chiropractic care restores balance to the entire body through correcting nervous system disturbances and allowing signals to flow freely between the brain and the body. Upper cervical adjustments have a direct influence on the brain stem. Do you know what the function of the brainstem is? It controls the flow of messages between the brain and the rest of the body and also controls basic body functions such as breathing, heart rate, swallowing, blood pressure, consciousness, whether one is awake or sleepy, and maintains healthy brain function and balance/coordination.

Increased flexibility. When joints and spinal bones are in proper alignment, you are able to manoeuvre with ease. 

These benefits, therefore, contribute greatly to preventing injury, relieving body stress inflicted by strenuous training regimes, increases strength and enhancing performance. Seeking chiropractic care is not only about injuries, but it’s also about body function and overall optimal performance. 

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And finally, celebrate the small victories. Celebrate the fact that you are training for an ULTRA MARATHON, and that fact the most of you have probably already successfully completed one, or multiple Comrades marathons. This is a massive achievement and you should be proud of yourself. Too often we fail to celebrate the things we achieve, the things we are capable of conquering, the goals we keep knocking out the park. Too often we forget that many people aren’t able and well enough to achieve something of this caliber, despite deeply desiring too. “Health is a crown that the healthy wear on their heads, but only the sick can see it.” 

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If you want some more perspective, here are a few patient testimonies for you.


“There will be times in the race where you feel great especially at the start but hang back. Then there will be times in the middle where you will feel like the finish line is incredibly far away and all you can think about is how much everything hurts. But then you will see someone you know or you have a snack or you walk for a bit and you will eventually start feeling a bit better, just hang in, you will get there. 

On the up run, I felt so ill in the first half and couldn’t eat anything and could only drink water. I got to halfway and wanted to cry, it just seemed so far, but I had a rehydrate and just kept going only drinking water and what I felt I could stomach. I took some walk breaks and eventually felt better and was able to start eating again in the second half and my latest km of the whole race was the last one because I couldn’t believe I was actually finishing. Once I got to the top of Polly shorts, I knew I would make it. 

The down run is much more of a mental battle about the distance. Running over 90kms in mentally insane. I got to 60kms and it felt impossible that I still had another third of the race to do. But because there is quite a bit of downhill in the last part, you just have to keep moving forward, and running into Durban is amazing! So much support and you are running home. Best advice – lots of vaseline and remember to take in the experience instead of just focusing on the time on the clock.”

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Everyone is different, you will get so much advice on pacing, nutrition, etc, but no one knows your body better than you, listen to it. You will hit a wall or two and you will get over it. Your mind is powerful and if you can get over the wall, you will finish the race (if you have put in the work). Find inspiration from your surroundings – there are some boring bits and long hauls – look around and find distractions, take part in traditions and talk to people around you, even if you get nothing back, encouraging someone else may be the encouragement you need. 

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My Comrades marathon journey in 2018 started as a daunting experience, stepping into the unknown and venturing into a sport and distance I know very little about. The best advice I received was to listen to one person’s advice and stick to one training plan. Thanks to my coach, Glen Gore, I was able to follow a manageable training plan and get as much advice from him as I wanted, as often as I wanted it. Throughout my 5 month build-up to Comrades, I did no other training besides running and swimming. I was incredibly conscious of the amount of physical work I was putting my body through so I made sure I booked a chiropractic appointment with Dr. Bezuidenhout every second week and sometimes every week depending on my training load. Due to the fact that I have a physical job where I am sometimes on my feet for up to 9 hours a day, I was very aware of the load I was placing on my legs. I didn’t do any form of gym or weight training during my 5 month training period, so I relied on swimming as my cross-training. It definitely helped massively with recovery, with getting rid of lactic acid after big runs, kept my core and upper body strong and gave me an opportunity to rest my legs. Being in the water also has a massage effect, so swims helped me to feel relaxed and physically relieved after running, at no extra expense. Although I have been injury-prone my whole life, I did not get injured once throughout all of my Comrades training and I suffered from no pain or injuries on race day. If I can give one piece of advice, it’s the advice I received – choose one plan and stick to it. 

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Big love,

Doc Lol x