ST: Minimising risks in running

This article was first published on Sunday Times on 7 July 2018.

Dr Malcolm Mahadevan – When a runner is forced out of action, more often than not, it usually involves minor issues such as muscle injuries, sprains, skin lesions such as blisters and abrasions. Acute injuries are rare. More than 8 in 10 running injuries are caused by overuse, often a mismatch between the strength and resilience of the connective and supporting tissue and the demands of running. How can we avoid them?

Follow a training plan

In my area of practice, I have seen many poorly prepared athletes suffer from swollen joints and muscle injury. I remembered a patient who was sedentary most of the time and had decided to participate in a mass run. She overstrained herself to the extent that her leg muscles swelled and broke down. The pressure resulting from the swelling of the tissues was so great that it impeded blood flow to both legs. She needed emergency surgery to relieve the swelling and save her legs. The damaged muscle had also released proteins and other by-products from the breakdown that clogged and failed her kidneys, thus necessitating dialysis treatment. While she recovered eventually, it was a traumatic experience that could have been avoided with proper training.

Thus far, research has turned up contradictory conclusions on the risk that running imposes on developing joint and muscle injuries per se. However, it has been recognized that running is one of the fastest ways to fitness and associated benefits such as health and longevity. A good gradual training plan (like #runwithmok) leading up to a race can help participants minimize their risks of running injuries. When I wanted to return to running, I too, approached my colleague, Dr. Mok Ying Ren for a training plan, so that I can ease in progressively.

Mok and Malcolm
Dr Malcolm follows the RunONE training plan himself and came back to running through a #runwithmok session. Photo credits: ONEATHLETE

Condition to dissipate heat

Heat stroke is a severe form of heat-related illness that happens under extreme and rare circumstances, usually a result of several contributing factors. The majority of us do not overheat as our bodies are able to balance and regulate heat generation through bodily dissipation, such as through skin. However, if either side of the equation is tipped over then that’s when we have a problem.

Under hot humid conditions like in Singapore, race planners generally plan races early or late in the day to mitigate the effect of heat and weather on runners.

What runners can do to help themselves, is to condition for the race through structured race preparation and training. This is just as in a car where the engine cooling system depends on coolant fluid for heat transfer and dissipation, our body depends on water to play the similar role. As we run, most of the water is lost through perspiration and respiration. Keeping ourselves well hydrated before, during and after a race is, therefore, the key to ensuring that our bodies are able to cope with the heat stress of exercising on top of the hot humid conditions we face.

Hydrate during the run

While training for my half marathon in Gold Coast, I have had the first-hand experience of the likelihood and risks amateur runners like myself face in dealing with heat-related illness.

While I was away in the Netherlands,  the chilly weather meant my long runs were comfortable affairs and I was afforded the illusion of luxury of not hydrating myself  Upon return to Singapore, the difference was apparent when my heart rate was significantly ramped up during a similar effort long run. I also quickly felt thirsty and had to stop often to rehydrate myself to prevent heat-related illness. The stark difference was a somber reminder of how easily the humidity and heat can dehydrate us while exercising under our hot tropical conditions

As most of our races in Singapore are well planned with hydration points spaced out at regular intervals, let’s make the best use of them to replenish our dehydrated and depleted bodies.

Participate in pre-race screening

While mass events such as run races are well organized with good first aid posts, emergency ambulance services and evacuation plans for contingencies, there have been unfortunate incidents where runners collapsed due to undiagnosed pre-existing cardiac conditions.

Recently a runner in his 40’s collapsed while running  While the security guards reacted quickly to start cardiopulmonary resuscitation, the paramedics arrived soon after to deliver the life-sustaining electrical shock to treat an otherwise potentially-fatal arrhythmia. He arrived in the emergency department where my colleagues and I worked to resuscitate him before sending him to the cardiac catheterization lab where our interventional cardiologist opened up his blocked coronary artery. Fortunately, he survived the whole episode. An older runner should get a proper check with their regular doctors who may refer them to a cardiologist for further evaluation.

Malcom at GCM 18
Dr Malcom’s flatlay before participating in the Half marathon at Gold Coast Marathon 2018 last sunday. Photo Credits: Dr Malcolm

Acclimatise to the race location

Proper training building up a solid base prior to a race, as well as proper acclimatization, are all essential elements for a runner’s safety. I recall having read about a young athlete who had just flown in from a temperate region and did not had enough race preparation and sleep before his race in Singapore. In the end, he overstretched himself only to collapse near the finish line. Unfortunately, he did not survive.

As runners, we need to respect the race we participate in, be mindful of our own bodies and know our limits whether we are young or not.

Practice good race discipline

Dr Malcolm looking spiffy during his half marathon at Gold Coast last sunday! Photo credits: Dr Malcom

Unlike competitive cycling where cyclists are bunched up together and a tumble can easily set off a chain reaction collision, It is rare to see runners collide and sustain injuries in this manner.

However, in some of the mass runs/races that I have participated in, I did notice that slower runners tend to congregate and walk abreast, blocking up a large part of the route. As a result,  faster runners had to swerve to overtake which can lead to collisions and injuries. Sprains and strains, or even more serious injuries like a fractured bone, are also possibilities arising from such accidents. This is where participants should exercise good race discipline by moving to the side and allowing others the opportunity of clear passage.


Generally, mass runs/races are safe. It is encouraging to see that more Singaporeans are participating and it is in line with all our efforts to stay healthy. A healthy dose of common-sense, graduated training, and preparation, as well as adherence to race guidelines, will go a long way in ensuring safe and enjoyable races for all of us.


Dr Malcolm
Associate Professor Malcolm Mahadevan is a Senior Consultant and Head of Emergency Medicine Department at National University Hospital. He undertook the RunONE training plan to get back into running.


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