The dramatic stumble, lean and fall to the finish line
Some runners push through symptoms warning of imminent exercise-related collapse
Watching runners finish a marathon is always dramatic. There are those who cross the line with bravado, those who cross in tears and those who arrive on legs so wobbly they barely make it.
But by far the most dramatic of finishes is the runner who crawls across the line. A marathoner’s worst nightmare, it’s no way to end the final stages of a 42-kilometre race.
Most runners cross the finish line upright and in good health, yet some form of post-marathon collapse affects 1.4 per cent of finishers and accounts for 59 per cent of all medical interventions in the finishing area of marathons. Also rare is a fatal collapse, which, despite making the headlines more than once during marathon season, affects fewer than one in 50,000 marathoners.
The majority of both fatal and nonfatal collapses occur in the last quarter of the race and are far more common in marathons than half-marathons. Most occur after the runner crosses the finish line, though they also occur as the runner approaches the finish line.
According to Patrick Garceau, cardiologist at the Montreal Heart Institute, those last five to 10 kilometres are harder than most runners think, especially since marathon training programs traditionally cap at 30 to 32 kilometres. He also warns that exercise-related collapses aren’t limited to race day; they can also happen during training.
Reasons for these medical emergencies vary. Heart disorders ranging from cardiac anomalies typically found in young athletes and heart disease or cardiomyopathy (an enlarged heart) in the over-40 crowd are some of the causes. Other, non-heart-related reasons for collapse include dehydration, over-hydration, heat illness and heatstroke, asthma, an extreme allergic reaction to exercise, low blood sugar, a sudden drop in blood pressure and hypothermia.
Typically, when an athlete collapses and dies during an athletic event it’s likely due to a cardiac event. But there’s another form of distress in runners that is characterized by the inability to run, walk or stand without help. Referred to by a group of exercise physiologists as the Foster dynamic collapse positions, they were was identified after watching numerous video clips of athletes falling to the ground during endurance events.
Named after Dr. Carl Foster, who was one of the first to identify a pattern of behaviour synonymous with an athlete’s collapse, it includes a sequential series of movements that occur as the athlete moves from being upright to prone on the ground. The sequence includes the early Foster, half Foster and full Foster.
The early Foster is characterized by unsteady gait and leg movements and a dropped head position. The half Foster follows, with runners leaning forward until their head and trunk are in a horizontal position. The full Foster describes the collapse to the ground followed by a crawl forward on knees and elbows.
Described in an article titled Crawling to the Finish Line; Why do Endurance Runners Collapse? published in the April 2013 issue of the journal Sports Medicine, the authors offer their opinion on the cause of the Foster collapse.
“An athlete who develops imbalanced gait and subsequently collapses to the ground, has reached a point where homeostatic reserves have been ‘overwhelmed’ and has no further capacity to continue the event using normal ambulatory musculoskeletal patterns of movement.”
Runners often fall into that particular breed of athlete who possesses an inner psychological drive to finish what they started, which in the opinion of the authors, “operates to a level that may potentially harm the individual.”
Ignoring bodily discomfort, outside of the normal muscular fatigue experienced during most endurance events, in order to reach the finish line can have potentially fatal consequences. Garceau claims almost all runners who experience a cardiac event have symptoms prior to their collapse. Chest pain that resolves when exercise stops, dizziness and higher-than-normal heart rate given the exercise intensity are signals that something is wrong.
And while it’s not always possible to identify cardiac disorders prior to a fatal event, Garceau advises anyone over 40 to discuss their goal with their physician before undertaking the training necessary to complete any endurance event including a marathon, century cycle or triathlon. This preventive measure is particularly important for exercise fanatics of any age with high blood pressure or a family history of heart disease.
As for the tradition of encouraging or helping collapsing athletes?
“Given that the Foster collapse positions are perhaps evidence of physiological system or organ failure, rather than encouraging collapsed athletes to continue, they should perhaps be stopped immediately and receive medical assistance as soon as possible,” says Garceau.