Running 01 – Don’t run through the pain: preparing before, during and after a race

This article opens the series Run Long, Run Safe. The later articles go deeper into each topic: stress fractures, heat and fluids, what to eat while running, the common injuries one by one, and how to get back to running.

Three weeks to go before the race. After the weekend long run, a spot on the inner side of your shin starts to hurt. In the first week it only aches while you run. By the next week it stabs even when you walk down the stairs in the morning, and pressing a finger on one exact point on the bone brings it on. In the running group, the advice comes fast: “Take a painkiller and run, you’ve already paid the entry fee.”

Most pain while running is harmless. Some kinds of pain, though, are your body telling you to stop, and a painkiller only turns that warning down. This article covers two things: recognizing those kinds of pain, and preparing before, during and after the race so you reach the finish line safely.

What kind of pain means your body is telling you to stop

The pain in the opening scene has a few telltale features: it is focused on one point, it hurts when pressed, it gets worse run after run, and then it starts to hurt at rest and at night too. That is the pattern of a bone stress injury, often called a stress fracture. Sports injury textbooks (Joyce and Lewindon, 2016; Magee) advise stopping running and seeing a doctor; X-rays are often normal in the first weeks, and magnetic resonance imaging (MRI) is more sensitive. Pain spread along the whole lower part of the inner edge of the shinbone points more toward medial tibial stress syndrome (“shin splints”). Telling these two apart is the doctor’s job; it cannot be guessed from messages in a group chat.

The most worrying is pain in the hip or groin when you walk, because it may be a stress fracture of the femoral neck, a part of the bone that heals poorly.

Stop running and see a doctor if you have any of the following signs:

• Pain at one point on a bone that is tender to press, gets worse, and also hurts at rest or at night;
• Hip or groin pain when bearing weight or hopping on one leg;
• After twisting your ankle you cannot walk 4 steps on your own, or the ankle bones or the top of the foot are tender to press;
• Hearing a “pop” at the back of the heel and being unable to rise onto your toes;
• A lower leg that quickly becomes tight and hard, with numbness after a blow: go to the emergency department, and do not raise the leg.

By contrast, aching spread across the thighs a day or two after a downhill run is delayed-onset muscle soreness, which goes away on its own. For pain at the front of the knee, around the kneecap (patellofemoral pain), the Grieve physiotherapy textbook accepts pain of 0–2 on a 10-point scale (0 means no pain, 10 the worst pain) during exercise, and up to 5 out of 10 if it is only brief and is no worse the next morning.

The painkiller in your waist pack

The word-of-mouth tip “take a painkiller before a long run to make it easier” has been put to the test. Lipman and colleagues (2017) randomly assigned 89 runners in an 80 km race to take ibuprofen 400 mg every 4 hours or a placebo. Acute kidney injury occurred in 52% of the ibuprofen group and 34% of the placebo group. That difference was only a trend and not statistically significant, so it cannot yet be said for certain that the drug harms the kidneys; the authors still advise thinking carefully before taking it.

Anti-inflammatory painkillers (ibuprofen, diclofenac and other drugs in the same group) reduce blood flow to the kidneys, more so in hot weather, when you are dehydrated, or if you take blood pressure medicines such as ACE inhibitors or angiotensin receptor blockers (ARBs), or diuretics. They do almost nothing for muscle soreness after running, and should be avoided when a stress fracture is suspected (Joyce and Lewindon, 2016).

That is why the clinic advises against taking anti-inflammatory painkillers “to prevent pain” before a long run. For the runner in the opening scene there is one more risk, which is our own reasoning rather than something a study has measured: the pill silences exactly the signal that is warning that the bone is overloaded.

Why the rush, why the hurry

A Vietnamese folk verse says: “Why the rush, why the hurry, only to trip on a stone and get caught in a vine?” Before a race, runners often rush in two ways: increasing their distance too quickly in the last few weeks, and changing many things at once.

The “10% rule”, never increasing your weekly distance by more than 10%, was tested by Buist and colleagues (2008) in 532 new runners: 20.8% of the group following the rule were injured, versus 20.3% of the group on a standard plan, almost the same. What helps is increasing gradually and watching your total load, meaning everything that makes your legs carry more, not just the kilometers. New shoes, moving from road to trail (dirt paths and mountain tracks) or adding hill sessions all increase load, even when the distance stays the same. Tendons need 2–3 days to recover after a heavy session (Joyce and Lewindon, 2016), so don’t schedule two hard sessions back to back. Anyone injured in the past 12 months should increase load even more slowly, because a previous injury is the clearest warning sign of a new one (Saragiotto and colleagues, 2014).

A few other things have data behind them:

• Supervised hip and core strength training: a trial by Leppänen and colleagues (2024) in 325 new runners found about a one-third lower risk of lower-limb injury;
• Mountain races above 1,500 m: maximum running capacity falls by about 1% for every 100 m of altitude, so keep a slower pace than usual (Jameson and colleagues, 2018; Joyce and Lewindon, 2016).

Choose shoes that feel like a good fit and are comfortable (Nigg and colleagues, 2015), and if you change shoe type, change gradually. Trail runners should practice downhills starting with short stretches and build up, because one downhill run makes the next one less sore (Tallis and colleagues, 2024); put simply, the muscles get used to downhills a little more each time. If you usually train somewhere cool and your race will be hot, be active in the heat for 1–2 hours a day for at least 7 days before the race, according to the Wilderness Medical Society (WMS; Eifling and colleagues, 2024).

The next two lines of the folk verse praise the person who goes “unhurried”, for whom “no stone ever trips”. On trails, taking it slowly is not enough: if you haven’t practiced downhills or balance, you can still twist an ankle at a slow pace. What should be slow is how you increase the load; the training itself still takes effort.

The Su Wen (素问 / 素問, Basic Questions), an ancient Chinese medical classic, has the line “prolonged walking injures the sinews” (久行伤筋 / 久行傷筋, jiǔ xíng shāng jīn): walking too long harms the sinews, that is, the tendons and muscles. The line is a reminder about moderation, not a ban on going far. That is why a textbook on the basic theory of Chinese medicine (中医基础理论 / 中醫基礎理論) places it next to the advice of the renowned physician Sun Simiao (孙思邈 / 孫思邈): move lightly and regularly until you are slightly tired, and don’t push beyond what you can bear.

Who should see a doctor before signing up for a race

• Middle-aged people who don’t exercise regularly, or who have heart disease, diabetes or kidney disease, or chest pain or shortness of breath on exertion: the American College of Sports Medicine (ACSM; Riebe and colleagues, 2015) advises getting a doctor’s opinion before taking on a marathon or a trail race;
• People who are pregnant: in a normal pregnancy, exercise is still safe and should be encouraged (American College of Obstetricians and Gynecologists, ACOG, 2020). Data on altitude during pregnancy only go up to about 1,830 m, so the clinic advises against taking part in long-distance trail races or races in high mountains during this time. That advice is ours, on the side of caution, not a recommendation from ACOG.

What to eat before and during the race

Eating too little for long stretches during weeks of heavy training weakens the bones. The International Olympic Committee consensus (IOC; Mountjoy and colleagues, 2023) treats infrequent periods (cycles longer than 35 days), periods that have stopped for 3 cycles or more, and repeated stress fractures as signs of energy deficiency that need a check-up. Colebatch and colleagues (2025) found that injured female runners ate about 303 kcal less per day. Women who run a lot and whose periods become infrequent need to eat enough, reduce their training load and see a doctor, especially if they are trying to conceive.

In the days just before a long race, eat more carbohydrates (rice, sticky rice, bread, potatoes). Keto, or running on an empty stomach to “burn fat”, does not make you run better (meta-analyses by Gejl and Nybo, 2021; Koerich and colleagues, 2022).

When you run for more than an hour, take in 30–60 g of carbohydrate per hour (Stellingwerff and Cox, 2014; International Society of Sports Nutrition, ISSN: Kerksick and colleagues, 2017; Tiller and colleagues, 2019). Beyond 2–2.5 hours, you can go up to 90 g, using gels or drinks that contain both glucose and fructose. Women and smaller people often do better with 30–50 g. In ultra races (distances longer than a marathon), favor real food and salty dishes. The 120 g per hour now being promoted has only been tested in professional mountain runners (Viribay and colleagues, 2020; Urdampilleta and colleagues, 2020).

Your gut needs training too. Every long run is a chance to try the gels, bananas or snacks you plan to use on race day. Nothing new on race day.

Coffee has good evidence behind it. According to the IOC consensus (Maughan and colleagues, 2018) and the ISSN (Guest and colleagues, 2021), taking 3–6 mg of caffeine per kg of body weight about 60 minutes before running helps you run longer; doses below 3 mg/kg taken with carbohydrate still help. Only use it if you are already used to caffeine, and never use pure powdered caffeine, which the U.S. Food and Drug Administration (FDA) warns can be fatal.

Drink when you’re thirsty

The advice of medical societies on fluids is short: drink to thirst. The international consensus on exercise-associated hyponatremia (Hew-Butler and colleagues, 2015) and the WMS (Bennett and colleagues, 2020; Eifling and colleagues, 2024) point the same way; the 2024 WMS guideline sets a goal of not losing more than 2% of body weight. Don’t force yourself to drink on a schedule, and don’t try to replace all the weight you have lost while you are still running.

Drinking too much water dilutes the sodium in your blood; this is called exercise-associated hyponatremia. At a 161 km race in hot weather, Hoffman and colleagues (2013) reported hyponatremia in 15.1% of runners, about 1 in every 7. Among those with hyponatremia, 35.6% (more than a third) were in fact dehydrated. So a runner with symptoms needs to be measured; you cannot tell by looking.

Salt tablets are what runners trust most. In a survey of 1,152 ultrarunners by Hoffman and colleagues (2019), 66.4% wanted races to hand out sodium tablets, and 65.5% believed these tablets prevent hyponatremia. The consensus statements advise the opposite, because salt tablets cannot prevent hyponatremia if you still drink too much water. For long races in hot, humid weather like ours in Vietnam, use drinks that contain sodium and eat some salty food.

Signs that mean stopping mid-race

Hot, humid races have two emergencies where bystanders can easily do the opposite of what is needed: heatstroke and hyponatremia. Both can make a runner confused.

What you see	Think of	What to do
Confusion, rambling speech, collapse, body burning hot	Heatstroke	Cool the person on the spot right away, call 115 (emergency)
Nausea, vomiting, headache, confusion after drinking a lot of water	Hyponatremia	Give no more water, get them to medical care
Chest pain, fainting while running, irregular heartbeat	Heart disease	Stop running, call for medical help
Urine as dark as cola, severe muscle swelling and pain, passing little urine	Rhabdomyolysis (muscle breaking down on a large scale)	See a doctor, test muscle enzymes and kidney function
In the mountains: short of breath even at rest, coughing, loss of balance	Severe altitude illness	Go down to a lower altitude right away
A wet, windy night in the mountains: shivering, forgetfulness, trouble speaking	Hypothermia	Keep the trunk warm, not just the hands and feet

For heatstroke, the WMS (Eifling and colleagues, 2024) ranks immersing the whole body up to the neck in ice water, or the coldest water available, as the first-choice way to cool down; immersion like this lowers body temperature almost twice as fast as covering with wet towels. If there is no tub, pour water over the person and fan them at the same time. Cool first, transfer to hospital after. Applying cool towels or ice to the neck, armpits and groin, along with Oresol (oral rehydration salts), as Vietnam’s Ministry of Health advises, suits mild heat illness; for anything more serious, call 115 and keep cooling while you wait. If it is unclear whether it is heatstroke or hyponatremia, let medical staff do the measuring.

Cardiac arrest during marathons and half marathons is rare, about 0.5–0.6 per 100,000 runners (Kim and colleagues, 2012 and 2025), and middle-aged men are at the highest risk. Cardiopulmonary resuscitation by bystanders and automated external defibrillators save lives. Fainting just after the finish line that clears within 30 minutes of lying down with the legs raised is usually harmless; fainting while still running needs a heart check-up.

If you get a cramp mid-race, stop and gently stretch the cramping muscle. The data do not support the belief that dehydration and loss of electrolytes are the main cause (Miller and colleagues, 2022), and a Cochrane review of the research (Garrison and colleagues, 2020) found no trials of magnesium for exercise-associated cramps.

The meal after the finish line

After you finish, eat carbohydrate together with protein: rice, or bread with eggs, milk, meat or fish. The ISSN (Kerksick and colleagues, 2017) suggests 0.5–1.2 g of carbohydrate per kg of body weight together with 10–25 g of protein, and spreading protein across several meals over the day.

Rehydrate gradually as thirst guides you, with some salt. If weighing yourself before and after running shows a real loss, the book Performance Nutrition by Austin and Seebohar suggests about 1.5 liters for each kg lost, spread over several drinks. If you sweat heavily and feel a little overheated, mix Oresol at the dose on the packet. Don’t plunge yourself into a full-body ice bath to “recover faster”: Joyce and Lewindon (2016) warn about the heart risks of doing this, which is entirely different from emergency cooling for someone with heatstroke.

Delayed-onset muscle soreness sets in about 24 hours later and can last up to 10 days. It is most noticeable in the front of the thighs after a long downhill section, and then it goes away on its own. The signs in the first section of this article still apply after the race.

Getting back to running, starting with one minute

After a break for shin pain, Sahrmann only allows a restart once you can walk for 30 minutes without the pain getting worse. The first session is walk 4 minutes, run 1 minute, repeated 4 times. After that, move to walk 3 minutes, run 2 minutes, then walk 2 minutes, run 3 minutes, with rest days in between, on soft surfaces first. If pain or swelling lasts more than 48 hours, go back one step; if there is sharp pain, stop.

For a stress fracture at a site that heals well, Joyce and Lewindon (2016) wait until you have been pain-free for 10–14 days before returning to running at half intensity, then increase by 25% at each step over 3–6 weeks. Stress fractures of the femoral neck, the navicular (in the middle of the foot, on the inner side) or the 5th metatarsal (on the outer edge of the foot) need follow-up by a specialist, and running resumes only when imaging confirms the bone has healed.

When to come in for a check-up

Back to the runner in the opening scene: three weeks to the race, pain at one point on the bone, getting worse run after run. The right move is to stop running and get checked, with imaging when the doctor orders it. You may miss this year’s race. If the problem is found early, there is already a return plan like the one above. If you keep running on that bone, no one can say in advance when you will be able to run again.

Some other pains keep coming back even though you have rested and reduced your load. For that kind of pain, the clinic also looks at how the nervous system controls each muscle, using Applied Kinesiology (AK). A muscle may not be wasted or undertrained, yet when the doctor tests it by hand, it cannot hold the position. AK calls this a muscle working below threshold. The tendon and the muscles around it have to compensate, so the pain may keep coming back on long runs (Cuthbert, 2013, p. 108).

Sometimes the root of this is an old injury. Walther, who wrote the foundational AK textbooks, noted that the proprioceptors in joints, muscles and tendons, the tiny nerve endings that tell the brain what position your arms and legs are in, may still send wrong signals after an old sprain or fall (Synopsis, p. 60). The doctor tests muscles to find the one working below threshold, treats the spot where the signal is still off, and then retests that same muscle to see whether it can now hold the position. A later part of this series will go into more detail.

Come in for a check-up when pain lasts a long time or keeps coming back even after you have reduced your load, when you stay tired long after the race season, when cramps keep recurring, or when you want your medicines and supplements reviewed before a race; remember to bring everything you are taking, including Chinese herbal medicines, salt tablets and rubbing ointments. The doctor first checks for any sign that needs imaging or referral to a specialist, and only then discusses treatment.

If you miss this year’s race, there will still be a race next year.

Worth keeping

• Pain focused on one point on a bone that gets worse run after run, or hurts at night: stop running and see a doctor;
• Don’t take anti-inflammatory painkillers before or during a long run;
• Don’t schedule two hard runs back to back, so your tendons get 2–3 days of rest;
• For runs over 1 hour, eat 30–60 g of carbohydrate per hour, and try that food on your long runs before the race;
• Drink when you’re thirsty; don’t force yourself to drink on a schedule;
• If a runner is confused and burning hot, cool them right away with cold water and call 115;
• After an injury, wait until you can walk for 30 minutes without pain, then restart with walk 4 minutes, run 1 minute.

References

Sources in Vietnamese

• Bộ Y tế (Cục Quản lý Môi trường y tế). 2023. Hướng dẫn chăm sóc sức khỏe mùa nắng nóng cho cộng đồng và người lao động (ban hành kèm văn bản số 356/MT ngày 19/5/2023). Cổng thông tin Bộ Y tế, đăng ngày 22/5/2023. https://moh.gov.vn/tin-lien-quan/-/asset_publisher/vjYyM7O9aWnX/content/bo-y-te-huong-dan-cham-soc-suc-khoe-mua-nang-nong-cho-cong-ong-va-nguoi-lao-ong (trang gốc nay không mở được; bản lưu ngày 7/12/2025: http://web.archive.org/web/20251207001617/https://moh.gov.vn/tin-lien-quan/-/asset_publisher/vjYyM7O9aWnX/content/bo-y-te-huong-dan-cham-soc-suc-khoe-mua-nang-nong-cho-cong-ong-va-nguoi-lao-ong).
• Hoàng đế nội kinh Tố vấn. Nguyễn Tử Siêu dịch. Tr. 195.

Sources in English

• American College of Obstetricians and Gynecologists (ACOG). 2020. Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 135(4):e178-e188. doi:10.1097/AOG.0000000000003772. PMID: 32217980.
• Austin K, Seebohar B. 2011. Performance Nutrition: Applying the Science of Nutrient Timing. Champaign (IL): Human Kinetics. p. 93–95, 112.
• Bennett BL, Hew-Butler T, Rosner MH, Myers T, Lipman GS. 2020. Wilderness Medical Society Clinical Practice Guidelines for the Management of Exercise-Associated Hyponatremia: 2019 Update. Wilderness Environ Med. 31(1):50-62. doi:10.1016/j.wem.2019.11.003. PMID: 32044213.
• Buist I, Bredeweg SW, van Mechelen W, Lemmink KA, Pepping GJ, Diercks RL. 2008. No effect of a graded training program on the number of running-related injuries in novice runners: a randomized controlled trial. Am J Sports Med. 36(1):33-9. doi:10.1177/0363546507307505. PMID: 17940147.
• Colebatch EA, Fuller JT, Mantzioris E, Hill AM. 2025. Diet, risk of disordered eating and running-related injury in adult distance runners: A systematic review and meta-analysis of prospective cohort studies. J Sci Med Sport. 28(7):542-552. doi:10.1016/j.jsams.2025.02.001. PMID: 40000283.
• Cuthbert S. 2013. Applied Kinesiology: Clinical Techniques for Lower Body Dysfunctions. Gangasas. p. 108.
• Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, et al. 2024. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med. 35(1_suppl):112S-127S. doi:10.1177/10806032241227924. PMID: 38425235.
• Garrison SR, Korownyk CS, Kolber MR, Allan GM, Musini VM, Sekhon RK, et al. 2020. Magnesium for skeletal muscle cramps. Cochrane Database Syst Rev. 9(9):CD009402. doi:10.1002/14651858.CD009402.pub3. PMID: 32956536.
• Gejl KD, Nybo L. 2021. Performance effects of periodized carbohydrate restriction in endurance trained athletes – a systematic review and meta-analysis. J Int Soc Sports Nutr. 18(1):37. doi:10.1186/s12970-021-00435-3. PMID: 34001184.
• Guest NS, VanDusseldorp TA, Nelson MT, Grgic J, Schoenfeld BJ, Jenkins NDM, et al. 2021. International society of sports nutrition position stand: caffeine and exercise performance. J Int Soc Sports Nutr. 18(1):1. doi:10.1186/s12970-020-00383-4. PMID: 33388079.
• Hew-Butler T, Rosner MH, Fowkes-Godek S, Dugas JP, Hoffman MD, Lewis DP, et al. 2015. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med. 25(4):303-20. doi:10.1097/JSM.0000000000000221. PMID: 26102445.
• Hoffman MD, Hew-Butler T, Stuempfle KJ. 2013. Exercise-associated hyponatremia and hydration status in 161-km ultramarathoners. Med Sci Sports Exerc. 45(4):784-91. doi:10.1249/MSS.0b013e31827985a8. PMID: 23135369.
• Hoffman MD, White MD. 2019. Belief in the need for sodium supplementation during ultramarathons remains strong: findings from the Ultrarunners Longitudinal TRAcking (ULTRA) study. Appl Physiol Nutr Metab. 2020;45(2):118-122. doi:10.1139/apnm-2019-0238. PMID: 31163112.
• Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. 2018. Harrison’s Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Education. p. 3286, 3379–3392.
• Joyce D, Lewindon D, editors. 2016. Sports Injury Prevention and Rehabilitation: Integrating Medicine and Science for Performance Solutions. London: Routledge. p. 213, 229–234, 356, 416–421.
• Jull G, Moore A, Falla D, Lewis J, McCarthy C, Sterling M, editors. 2015. Grieve’s Modern Musculoskeletal Physiotherapy. 4th ed. Edinburgh: Elsevier. p. 573.
• Kerksick CM, Arent S, Schoenfeld BJ, Stout JR, Campbell B, Wilborn CD, et al. 2017. International society of sports nutrition position stand: nutrient timing. J Int Soc Sports Nutr. 14:33. doi:10.1186/s12970-017-0189-4. PMID: 28919842.
• Kim JH, Malhotra R, Chiampas G, d’Hemecourt P, Troyanos C, Cianca J, et al. 2012. Cardiac arrest during long-distance running races. N Engl J Med. 366(2):130-40. doi:10.1056/NEJMoa1106468. PMID: 22236223.
• Kim JH, Rim AJ, Miller JT, Jackson M, Patel N, Rajesh S, et al. 2025. Cardiac Arrest During Long-Distance Running Races. JAMA. 333(19):1699-1707. doi:10.1001/jama.2025.3026. PMID: 40159341.
• Koerich ACC, Borszcz FK, Thives Mello A, de Lucas RD, Hansen F. 2022. Effects of the ketogenic diet on performance and body composition in athletes and trained adults: a systematic review and Bayesian multivariate multilevel meta-analysis and meta-regression. Crit Rev Food Sci Nutr. 2023;63(32):11399-11424. doi:10.1080/10408398.2022.2090894. PMID: 35757868.
• Leppänen M, Viiala J, Kaikkonen P, Tokola K, Vasankari T, Nigg BM, et al. 2024. Hip and core exercise programme prevents running-related overuse injuries in adult novice recreational runners: a three-arm randomised controlled trial (Run RCT). Br J Sports Med. 58(13):722-732. doi:10.1136/bjsports-2023-107926. PMID: 38724071.
• Lipman GS, Shea K, Christensen M, Phillips C, Burns P, Higbee R, et al. 2017. Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial. Emerg Med J. 34(10):637-642. doi:10.1136/emermed-2016-206353. PMID: 28679502.
• Magee DJ, Manske RC. 2021. Orthopedic Physical Assessment. 7th ed. St. Louis (MO): Elsevier. p. 1018, 1270, 1371.
• Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al. 2018. IOC consensus statement: dietary supplements and the high-performance athlete. Br J Sports Med. 52(7):439-455. doi:10.1136/bjsports-2018-099027. PMID: 29540367.
• Miller KC, McDermott BP, Yeargin SW, Fiol A, Schwellnus MP. 2022. An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train. 57(1):5-15. doi:10.4085/1062-6050-0696.20. PMID: 34185846.
• Mountjoy M, Ackerman KE, Bailey DM, Burke LM, Constantini N, Hackney AC, et al. 2023. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med. 57(17):1073-1097. doi:10.1136/bjsports-2023-106994. PMID: 37752011.
• Nigg BM, Baltich J, Hoerzer S, Enders H. 2015. Running shoes and running injuries: mythbusting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. Br J Sports Med. 49(20):1290-4. doi:10.1136/bjsports-2015-095054. PMID: 26221015.
• Riebe D, Franklin BA, Thompson PD, Garber CE, Whitfield GP, Magal M, et al. 2015. Updating ACSM’s Recommendations for Exercise Preparticipation Health Screening. Med Sci Sports Exerc. 47(11):2473-9. doi:10.1249/MSS.0000000000000664. PMID: 26473759.
• Sahrmann S, et al. 2011. Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines. St. Louis (MO): Elsevier Mosby. p. 392–393, Box 7-1.
• Saragiotto BT, Yamato TP, Hespanhol Junior LC, Rainbow MJ, Davis IS, Lopes AD. 2014. What are the main risk factors for running-related injuries? Sports Med. 44(8):1153-63. doi:10.1007/s40279-014-0194-6. PMID: 24809248.
• Stellingwerff T, Cox GR. 2014. Systematic review: Carbohydrate supplementation on exercise performance or capacity of varying durations. Appl Physiol Nutr Metab. 39(9):998-1011. doi:10.1139/apnm-2014-0027. PMID: 24951297.
• Tallis J, McMorrow C, Shelley SP, Eustace SJ. 2024. Repeated Bout Effect of Downhill Running on Physiological Markers of Effort and Post Exercise Perception of Soreness in Trained Female Distance Runners. Sports (Basel). 12(6). doi:10.3390/sports12060169. PMID: 38921863.
• Tiller NB, Roberts JD, Beasley L, Chapman S, Pinto JM, Smith L, et al. 2019. International Society of Sports Nutrition Position Stand: nutritional considerations for single-stage ultra-marathon training and racing. J Int Soc Sports Nutr. 16(1):50. doi:10.1186/s12970-019-0312-9. PMID: 31699159.
• U.S. Food and Drug Administration (FDA). Spilling the Beans: How Much Caffeine Is Too Much? [Internet]. Available from: fda.gov.
• Urdampilleta A, Arribalzaga S, Viribay A, Castañeda-Babarro A, Seco-Calvo J, Mielgo-Ayuso J. 2020. Effects of 120 vs. 60 and 90 g/h Carbohydrate Intake during a Trail Marathon on Neuromuscular Function and High Intensity Run Capacity Recovery. Nutrients. 12(7). doi:10.3390/nu12072094. PMID: 32679728.
• Viribay A, Arribalzaga S, Mielgo-Ayuso J, Castañeda-Babarro A, Seco-Calvo J, Urdampilleta A. 2020. Effects of 120 g/h of Carbohydrates Intake during a Mountain Marathon on Exercise-Induced Muscle Damage in Elite Runners. Nutrients. 12(5). doi:10.3390/nu12051367. PMID: 32403259.
• Walther DS. 2000. Applied Kinesiology: Synopsis. 2nd ed. Pueblo (CO): Systems DC. p. 60.

Sources in Chinese

• 王新华, 主编. 中医药学高级丛书 · 中医基础理论. 第 721 页.