Dr Marliese Symons
Aug 28, 2017 · 8 min read

Marathon Tips: Week 8: Alignment, Posture & Stories from the Sahara

The human being is bilaterally symmetrical. Or at least that is the ideal, from an anatomical and functional point of view. The skeleton is there to protect the central nervous system, the most important system in the body. It also serves to hang muscles, tendons and ligaments from. As a general rule, in the neuro-musculo-skeletal system, what we have on our left side, is replicated on our right side: beautiful symmetry. This allows for optimal functioning of the body. By contrast, if one or other side of our body’s musculature is tighter than the other side, it causes a pull in that direction, which changes the dynamics of the body and its functionality. Basic biomechanics. The effect of a lack of symmetry can be far reaching, as I observe in clinic every week. It has an impact on patient’s mobility, physiology and ultimately their ability to function, in the broadest sense. This is why alignment and posture is so vital.

Patients in clinic are a self-selecting group: generally they are people who value their health and well-being, albeit with varying degrees of willingness to participate. Regardless of what their presenting complaint is, I always check patients’ alignment and posture because it will, to a greater or lesser extent, have an impact on their particular complaint. Just this week a patient with shoulder pain presented. Her alignment was out of balance and was almost certainly having an impact further up and down the kinematic chain. In her particular case it was the shoulder that was presenting with pain and reduced range of movement. Bearing in mind that the body’s centre of gravity is around the third lumbar vertebra, if there is a mis-alignment in the pelvic region (which begins at L3), it will impact joints, ligaments, tendons and muscles throughout the body.

As we go about our activities of daily living, the body (neuromusculoskeletal system) is a master at compensating for asymmetry and misalignment (all in an effort to ensure that our head, and more importantly, our eyes, remain level — to allow us to assess potential danger and take evasive action). However, should this become too pronounced, or remain for too long, our ability to compensate reduces and eventually symptoms arise, as non-postural muscles become involved in maintaining our posture or we become asymmetric. This last point is an interesting one because I observe that as patients become increasingly in tune with their bodies, they begin to feel when there are ‘out of balance’ before they even experience any symptomatology. They come into clinic with no symptoms to report, other than “feeling out of balance”. And lo and behold, when checked, they are indeed misaligned, to a greater or lesser extent.

Posture contributes enormously to the body’s alignment. We sit on sofas, in cars/trains/buses/planes, we send our children to school, to sit on chairs for years. Followed by college or an office job and so it goes on. The musculoskeletal system was not designed for prolonged periods of inactivity. As such, posture becomes an important part of managing alignment. Oftentimes we have limited control over how much activity we can have. Office jobs usually involve lots of sitting (although some offices are encouraging staff to stand at higher desks). By taking care of how we sit and stand, we can influence our body. Tight hip flexor muscles and important postural muscles such as the iliopsoas muscles are almost always checked in patients, as they play a crucial role in maintaining alignment. Simple exercises can increase the flexibility of one side or other to encourage more symmetry of movement.

Whilst a small misalignment may not be an issue for most people as they go about their daily lives (because the body is beautifully adept at compensating), those training for a marathon, or undertaking anything that pushes the body to perform more than usual (eg. pregnancy), alignment becomes more important. Clinical experience has shown that those patients who undertake regular exercise, such as preparation for a marathon, will be affected much more quickly from being misaligned than those who are not demanding more from their bodies. As such, and in order to avoid injury, it becomes more important to ensure alignment is as good as it can be. And take action if required. Simple adjustments to one’s daily habits and movements can make the difference between the body functioning as well as possible and one that struggles to meet the demands that we ask of it. Oftentimes the flexibility, or otherwise, of the sacro-iliac joint plays a part. Patients ask if this is because of something that they have done, specifically. Whilst that may contribute to a certain extent, it cannot be the whole story, as I see many babies, newborns, in clinic and they often have one sacro-iliac joint which is tighter than the other side. Could it be their position in utero? Or the misalignment of their mother’s pelvis?

The effect of alignment and symmetry can influence the body in many ways, not least of all is gait — the particular way in which each one of us walk and run. This is crucial for the marathon runner because of the long distances involved in both training and race day. A little time invested in alignment can have far-reaching benefits in the run-up and including race day.

If alignment is important for a marathon, then it is even more so for those involved in an ultra-marathon. When I took part in Marathon des Sables. the 245km self-sufficient foot race in the Sahara Desert, I knew that if I was to be successful in completing it, I had to ensure I prepared as well as I could, given that I had never taken part in even a half marathon before, leave alone one in a desert. After a day or so into the race (which takes place over a number of days), I became more accustomed to the intense heat and was getting used to carrying a heavy rucksack with everything I would need for desert survival for the coming week. I had developed a daily routine in the Sahara: breakfast, preparing for the day ahead and so on. There was a point at which I settled into the race. As long as I was heading in the right direction and I was confident with my bearings to the next check-point, I could focus on each step and being in the moment. It was like a meditation at times. Blending into my desert surroundings, at one with the task in hand, no-one else around and forging forwards. There were times when the sheer isolation was terrifying and in the main I walked with one or two others.

At the start of each day, the makeshift camp was a hive of activity. Competitors carefully packing their rucksacks to ensure minimal effort was needed to access whatever they might need for the day ahead. We quickly learnt what the desert inhabitants already knew — that one does not stay out under the searing sun longer than needed. Packing the rucksack became an artform. As did securing our footwear to ensure we minimised any adjustments during the day’s ahead.

Once content with the basic preparations, the competitors made final checks on their race numbers — ensuring the pins were secure etc. and then headed to the start line — in reality a couple of poles swiftly erected in the sand, with a large banner above. With fewer than 200 participants in the year that I took part, it was relatively small cohort. Those people searching for a good race time jostled to the front of the pack, whilst I, on my maiden marathon, was jostling for a position at the back. It was a curious ritual, within the vast expanse of the Sahara…. as if space were an issue. I guess for those competitors searching for a particular ‘time’ to complete that day’s stage of the overall race, every second counted. For me, I was still partially in shock to find myself amongst a group of hardcore athletes in the middle of one of the largest deserts in the world. Surreal really was the word. Having successfully completed day one and navigated my way back to night camp, I began to grow in confidence, despite not understanding a word that the French organisers were saying at the briefing every morning. Bearing in mind that the Marathon des Sables began with a single, solitary Frenchman pitting himself against the unforgiving Sahara, all instructions and communications were in French. Words sprung to my mind from my childhood and I heard my parent’s say “You never know when you might need French….” or whatever language they were trying to persuade me to learn! I desperately tried to retrieve something of the school French that my cheery teacher, Madame Howat, had so enthusiastically tried to teach us. But sadly, to little avail.

It was around day three, when everyone seemed to settle into a routine. Competitors had got a measure of each other, we began to see familiar faces from other countries and had a feel for the organisation and logistics. So there I was, watching, as most of the runners broke into a sprint as the foghorn sounded out loud into the dry desert air. My aim had always been to simply finish the race, but I soon established a new aim — and that was not to be the very last competitor to finish every day. Never having taken part in a marathon before, I was convinced that I would be the last person every day. Luckily, that was not to be the case.

I happily took my time and broke into a stride, albeit a fairly fast paced and determined one. Within a short period of time the field had dispersed very widely. I was grateful not to be bringing up the rear and this dubious position encouraged me to walk as fast as I possibly could, with my rucksack and two litre water bottles tightly strapped onto my back.

My pace was usually steady throughout the day. This was what I had trained for in the preceding autumn and winter, albeit it on a damp and muddy towpath along the Thames. I knew that my stamina was good in a UK climate — I had no idea how I would fare in the Sahara. I was determined not to expend too much energy by breaking into a run, especially with the rucksack. What transpired surprised me. As the days unfolded, I realised that runners who had sped off into the distance at the starting line, were beginning to slow down considerably as the day worn on. I recall a group of Japanese women who were running together, or rather, jogging. They were clearly exhausted by the sheer effort of jogging for hours on end, day in, day out with the weight of a rucksack plus litre bottles of water. Another surreal moment was about to transpire. It was mid-afternoon and the heat was oppressive. I had been surprised and excited to see the small group of runners ahead of me. Not expecting to catch them up, my pace remained steady and constant. After a while, I realised that the group was getting ever closer. I still maintained my comfortable pace but had an added bounce in my steps, as I started to catch up with the three or four women ahead of me. And then the moment materialised. I strode past them and stared in disbelief as I realised that my walking pace was faster than their jogging pace. It was a sweet, satisfying moment and gave me the impetus and confidence to keep doing what I was doing. The hare and the tortoise came to mind.

Next week: Managing the Race

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Dr Marliese Symons

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Healthcare professional. +++ Wellness, sport, yoga. One of three English women who were the first to take part & complete the ultramarathon, Marathon des Sables