Beyond 26.2 Miles: Surviving an Ultramarathon

You just finished running a marathon -- your first or the maybe most recent of many. The finish line, the highs, the lows -- all of that's in your rearview now, and you think, "I want to go further."

You're about to join a devoted group of die-hards -- ultramarathoners -- whose profile has been raised by the niche sport's icons, like Scott Jurek, for example, who recently set the record for the fastest traverse of the Appalachian Trail, which he completed in July, covering 2,189 miles in 46 days, 8 hours and 7 minutes.

By comparison, you may be planning something more "moderate" -- say, starting with a 30- or 50-mile race -- although there's nothing "moderate" about running more than 26.2 miles. "The beauty of an ultramarathon is that it tests not only the body but also the mind," Jurek says. "The places I have to go to get through the challenges -- whether it's running 46 days on the Appalachian Trail or whether it's running 100 miles -- for me, I really have to tap into this primal, instinctual survival mode."

Pushing limits is what the sport is all about, but that doesn't mean its faithful adherents wish for injury or health problems that might keep them sidelined from running or other aspects of their lives. A study published last year in the journal PLOS One concluded that "compared with the general population, ultramarathon runners appear healthier and report fewer missed work or school days due to illness or injury."

Still, there's no denying the toll that going long can take, from stress fractures -- reported by 5.5 percent of the more than 1,200 active ultramarathon runners participating in the study, most commonly involving the foot -- to knee injuries. The injuries were reported for the prior year. Debate continues, too, about the potential effects on the heart of logging an extreme number of miles. However, while the negative effects of being sedentary, such as increasing one's risk of heart attack and stroke, are well-established, concerns on the opposite end of the spectrum -- regarding potential cardiovascular health related to participation in endurance sports -- remain unsettled. And studies typically find the risk to be low or the reverse to be true: A study published earlier this year in the Journal of the American College of Cardiology found that the highest levels of exercise measured were associated with a lower risk of mortality.

In addition, for those interested in going beyond a marathon, there are ways to maximize safety and performance. That doesn't guarantee you won't still face-plant after tripping on tree roots crossing the path of your weary legs. And pain, say the sport's devotees, is part of the deal. But you can run longer, feel better and recover quicker, experts say, by following some straightforward steps.

Build Up "Fatigue Resistance"

"I think the biggest thing is to pay attention to your body," says Jurek, author of "Eat & Run." He recommends gradually increasing miles during training, never more than 10 to 15 percent per week and not being afraid to mix in crossing-training, while also doing moderately long runs on consecutive days -- or so-called "back-to back" runs. "If you're getting ready for a 50K, maybe you do a 10- to 15-miler, and then the very next day, you do another 10- to 15-miler. What you're trying to do is create fatigue resistance -- get your body used to running on tired legs," he says.

This also takes the place of having to run even longer on one particular day, while also getting the joints, muscles and bones used to the kind of stress associated with the full mileage on race day or for multiday events, says Dr. Brian Krabak, an ultrarunner and clinical professor of rehab, orthopedics and sports medicine at University of Washington in Seattle. "Stress fractures occur when there's abnormal stress to normal bone or normal stress to abnormal bone," he says. "Most of our athletes are healthy, but we're running much longer distances." Quickly increase distances, Krabak explains, and you increase the stress on muscle, joints and bone, which also contributes to fatigue. "That is what's likely going to lead to injury," he says.

Instead, both in goal-setting and training, take time to graduate to the next mileage. "So if they were running a race of, say, 80 to 100 kilometers, they would nevertheless have run many 42-kilometer races and hopefully one or two of 64km or so," wrote Dr. Timothy Noakes, a retired physician and research scientist who taught exercise science and sports medicine at the University of Cape Town in South Africa, in an email; he is also an experienced marathoner and ultramarathoner who authored "Lore of Running." "Thus they are not entering the race without having already accumulated some substantial experience. One doesn't go from 10km to 80km -- one progresses step by step."

Stride Right: Put It in Granny Gear

Jurek says making sure to "stride right" is important for runners going any distance, and particularly for ultramarathoners.

"You want that to be at 85 to 90 strides per minute. A stride is a left, right, left. So, if you can imagine, it's a complete revolution of your legs," Jurek says, referring to the analogy of being on a bicycle. "You want to think about being in a 'granny gear.' Unless you're thinking about winning the race, you're not going to be taking these long strides that faster runners typically take or [that you would take] for shorter distances."

Don't make the rookie mistake of going out fast. "When it comes to injury prevention, if you're spinning in the granny gear, your foot and your body is not in contact with the ground as long," he says. "Any time your body or your foot is in contact with the ground, that's the most stressful time, from a running stride standpoint."

In fact, the study published in PLOS One found that it was the younger, less-experienced ultramarathoners who seemed to be more at risk for stress fracture. Skip that greenhorn right of passage by pacing like a pro: "There is really no hurry to get sore," Noakes says. "If you run at a slightly lower intensity than you think you should, it will be the safe and appropriate intensity." Furthermore, he says, this will put you in position to turn it on in the second half of the race and improve your overall time. "This has a great effect on one's mental state -- passing others becomes the focus rather than worrying about one's physical state," he says.

Also, it may be a run, but walking is OK, too. "For the novice who is pretty fit but uncertain if he or she can go the full distance, I suggest a run-to-walk ratio of 9:1," or running 9 km, then walking 1 km, Noakes says. The less fit could make this a 6:1 ratio, he adds. "Frequent walking makes it so much easier to complete the full distance, and if you do this from the start, most will be amazed that they finish in a very good time and much better than if they had tried to run the full distance, only to have to walk the last 10 miles, for example," he says.

Figuring Hydration and Eating on the Run

Drinking too little fluid -- and too much -- are both very real threats for ultrarunners, who can suffer from dehydration and hyponatremia, when too much water intake leaves sodium levels dangerously low.

Evolving science and thinking on hydration and food consumption on the run finds that it's neither a good idea to simply eat and drink constantly and mindlessly without regard for hunger or thirst, nor is it wise to wait until you're parched or you're starving -- as that can sap precious energy and lead to even bigger health problems.

Jurek, who typically eats and drinks several times an hour when running, also says he's in tune with his body's cues regarding hydration and food consumption, and pays attention to those cues. He recommends a sweat test, to get a sense of the amount of fluid you're losing while exercising and how much water you'll need to replenish. Incorporate food consumption, like hydration, into training -- and, yes, you're running far enough that you can eat real food, not just suck down energy gels and snack on sports bars, experts say. Jurek notes the importance of carbohydrates to keep energy levels consistent.

Runners' preferences vary widely, but most agree that gels and drinks you can get down on the go are still a priority, though real food becomes an increasingly important part of the strategy, even on the go. Jurek likes everything from bananas to avocado maki sushi rolls, and ultrarunners say mixing up what they consume can break up the monotony for longer events. Just don't wait until race day to think about food and drink. "I can't stress enough. One of the biggest tips is you've got to eat and drink during training," Jurek says.

Practice Self-Reliance

Here's another reason you'll want to do your homework, train and know your course and race ahead of time: You might be bi-pedaling through some sparsely populated stretches of trail.

Even the smallest details matter, like having a working light source, such as a headlamp, batteries and a backup light source, particularly for all-day events, says Pam Reed, ultramarathon extraordinaire and race director of the Tucson Marathon. Like Jurek, Reed has twice won the 135-mile Badwater ultramarathon that stretches from the parched earth of Death Valley to Mountain Whitney, an event self-described as "The World's Toughest Foot Race."

"If you're out on a trail and you can't see, you can't see where you're going, you could totally fall and hurt yourself," she says. Besides tripping, getting lost and even hypothermia, depending on the location, are very real possibilities for runners who get off track. Don't rely on a full moon to light your way either, she says.

"Ultramarathons aren't set up like the grand marathons. They aren't set up in big cities. There's not thousands of volunteers helping you out," says Hal Koerner, author of "Hal Koerner's Field Guide to Ultrarunning." More often, the racecourse follows trails that weave through woods and up and down terrain, such as mountains, so getting a map and learning the course ahead of time is essential, he says.

Speaking of self-reliance, accomplished ultrarunners are obsessive about research, talking with others about their methods and sharing tips -- including on shoes -- which Krabak says should be replaced every 300 to 500 miles. Socks are also key, and Koerner discourages buying cheap cotton varieties that will leave your feet soaked by sweat and more blister prone. "Runners need to look for synthetics, wool, nylon, bamboo, anything other than cotton," Koerner says, adding that it's important to buy the correct size and look for pairs of socks made to specifically fit the left and right foot to further improve their hold and reduce friction. "Snug arch bands, natural compression and no-seam toes are some of the selling points." And there are other matters of foot care and blister prevention -- Jurek rubs Un-Petroleum Jelly between his toes and all over his feet before he runs. (Read: You've still got a lot of homework to do if you're planning on running your first ultra, and there's no CliffsNotes shortcut, this article notwithstanding.) That's in addition to all the miles you'll log.

So why do all this work in the first place?

"The reason I do it is not because I have a gift to run particularly fast," Jurek says. "I think the reason I do it is because I love to be in the mountains, I love to be in the woods exploring my surroundings and exploring the potential of my body and what it can do."

He recalls a moment when he was in the Appalachians recently, and his wife, Jenny -- who had been among those supporting his effort with food and other supplies -- joined him down the homestretch. "I had a couple new friends I'd met in New Hampshire that were helping me and we were up on the top of this ridgeline in the Mahoosuc Range in Maine, and just watching the sun set over the horizon as we were finishing off the last five miles that day, moving ... super slow," he says. "As rugged and as hard as it was, being on that ridgeline, watching the sun go down was just pure magic, and it just had a simple beauty. Even though I was gutting it out, digging deep, hurting like crazy after covering almost at this point 2,000 miles, just being out and watching that sunset was an unreal feeling."

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.