Run Well

by Juliet McGrattan

  Real-life runners

  My nipples started chafing and bleeding when my runs increased in length and frequency. This didn’t bother me too much when I was running, but afterwards in the shower the water on the broken skin was painful. Sports lubricant only worked on short runs. The solution for me was tape. I just had to make sure it was the right length, so it didn’t stick to my chest hair and fall off.

  Jason Redman, marathon runner in training

  Q How can I take care of my breasts when I run? I’m worried running will make them sag.

  A Whether you are breast feeding or not, and regardless of your age, it’s important to look after your breasts when you run. Breasts are made of fatty tissue held in place by underlying muscles, overlying skin and a network of fibres called Cooper’s ligaments. Breast-sagging is largely determined by your genetics and how elastic your tissues are rather than by how much you run. Breasts move in a figure of eight motion during running and can move up to 10 centimetres. It’s important to reduce this movement as much as possible to prevent the ligaments becoming overstretched. A good sports bra is the best way to do this and it is worth investing time and money to find the right one for you. Women usually wear a chest band that is too loose and cup size that is too small. If possible, find a shop with an experienced bra fitter and variety of bras you can try on. Many online stores have free returns so you can order different styles and sizes, and send back what you don’t need. The bigger your breasts, the more support you will need. Opt for wide shoulder straps to distribute weight and a mix of compression to squash your breasts against your chest wall and encapsulation to support each breast individually. Don’t forget that bras wear out and lose their elastic support, so if you can’t remember how old yours is it probably needs replacing!

  Did you know?

  It’s quite a shocking statistic, but 70 per cent of women wear a bra that is the wrong size for them.

  Q I get chilblains every winter. Will running help them or make them worse?

  A We don’t really know why some people get chilblains and others don’t, but these red or purple lumps can be itchy and painful. They develop in response to the cold and are more common on extremities such as toes and fingers, but you can also get them on ears, noses, cheeks and even your legs. Anyone can get them, but people who have poor circulation, who smoke or have diabetes, tend to get them more often. They are also more likely to develop if you warm up cold skin too quickly, by putting your feet on the radiator or plunging your hands into hot water, for example. The good news is that they usually go away by themselves, within a couple of weeks. No treatment is necessary other than keeping them warm. Running may be triggering them if you’re out in cold weather and re-warming too quickly. Layer up to keep your body warm and invest in warm socks (merino wool is ideal) and well-insulated gloves. Exercise does, however, boost circulation generally and you may just be someone who is prone to chilblains. They often run in the family. They can be a pain, but aren’t harmful and you can generally keep running.

  Did you know?

  Double dipping, where you take some lubricant from a communal pot and apply it to your body and then put your fingers back in to take some more, is illegal. Well, actually it’s not, but it should be! Use a spoon or wooden spatula to take out what you need to prevent germs growing in the lubricant. Please don’t double dip!

  Q I get huge blisters. What can I do to prevent them?

  A Blisters form in or just under the epidermis. Friction and resulting skin damage from rubbing shoes and socks is the commonest cause for runners, but extreme cold, heat, chemical damage and medical conditions can all cause blisters too. Fluid (serum) fills the damaged space to protect the tissues underneath. The fluid is usually clear, it may be bloodstained if it’s a blood blister or, if the blister is infected, the fluid may be a thicker, discoloured pus. They’re incredibly common and annoying, but here are some things you can do to try to prevent them:

  • Get the right shoes. Go up at least half a size from your normal shoe to make sure there’s enough space for your feet to spread and swell a little when you run. Wear new shoes in before you hit the big miles.

  • Learn to lace. Everyone’s feet are different and you can help problem areas by altering your lacing. There are different lacing techniques for issues such as a wide forefoot or a high instep (see here).

  • Don’t forget your socks. The right socks are crucial for blister prevention and it can be a case of trial and error, with some runners favouring single layer socks and others double layer. A technical fabric that wicks away sweat and dries quickly will keep feet dry. Wet fabric and wet feet makes blisters more likely.

  • Use a barrier. You can apply some lubricant to your skin to help protect it, or try a talcum powder if you think sweaty feet are a cause for you. Plasters tend to move or fall off and you may have more luck with specially designed blister tape.

  • Avoid chemicals to toughen your feet. By all means steer clear of the moisturiser and allow your feet to naturally toughen, but I’d advise against using alcohol or surgical spirit to speed up the process. You often end up with painful cracks and fissures which cause their own problems.

  Real-life runners

  I used to get terrible blisters, usually between my toes and on the balls of my feet, despite loads of lube before marathons. Strangely, though, once I stopped using it I had far fewer problems. I think the lube was just making my feet slide around in my shoe. I hardly get them now.

  Tara Cunnington, runs, sings and dances

  Q What’s the best way to treat my blisters? Is it OK to pop them?

  A I don’t recommend popping blisters. Even the tiniest hole can be a route in for infection. While the skin is intact the contents of the blister are sterile. The fluid is also acting as a cushion to protect the delicate skin beneath. If you’re mid-ultra and absolutely need to pop them to be able to continue, then the ideal technique would be to use a sterile needle and syringe to aspirate (draw out) the fluid. If this isn’t possible then use a sterile needle to make a small hole and gently milk it out. Follow with a sterile dressing and tape it down firmly. If you’re not popping or your blister has popped on its own, then the goal is to keep it clean, dry and cushioned. Warm soapy water is adequate to clean it. Pat it dry and then apply a padded dressing. I like the hydrocolloid ones. Small blisters will shrivel up on their own within a few days; larger ones may take a couple of weeks. See your pharmacist or GP if you think your blister is infected – there may be redness which is spreading further and further out from the blister or it may be filled with pus.

  TRY THIS

  AT HOME

  Heel lock

  One cause of blisters is your feet moving around too much inside your shoe. If you have a narrow heel and ankle and your feet aren’t secured properly, then this can create a lot of movement. You might find your toes hit the end of your shoes during downhill running when your feet slip forward. This can cause toenail damage as well as heel blisters. The handy ‘heel lock’ is a trick that many runners don’t know about – it’s why there is that extra hole for lacing at the top of your shoe which is usually ignored!

  1 Lace your shoes up in a criss-cross pattern, finishing with the laces coming out of the shoes in the top hole.

  2 Create a loop by taking the lace and threading it back in towards the shoe through that second spare eyelet on the same side.

  3 Cross the laces and pass them through the loop on the opposite side, from inside to outside.

  4 Pull the laces tight to lock the heel in place and tie the laces as normal.

  Q Is being outside a lot damaging my skin? How can I protect it and what signs of damage do I need to look out for?

  A It’s a good idea to protect your skin from ultraviolet rays as much as you can when you run, especially on sunny days. You can do this by wearing a good sunscreen (at least SPF 15), a cap or visor, and covering your shoulders and arms if you’re going to be out for some time. Wear good quality su
nglasses to protect your eyes. Runners often complain that sunscreen slides off when they sweat and ends up stinging their eyes, but there are many sweat-resistant ones available. Remember that you can still burn on cloudy days.

  The first sign of damage is an obvious one – sunburn. Don’t be the runner who forgot to put cream on before their marathon and has painful sunburn as well as DOMS to deal with! Ultraviolet radiation damages skin cells. The skin tries to limit damage and begin repair by dilating blood vessels to increase circulation to the area. That’s why skin turns red when it’s burnt. The skin then dries out and eventually the top layers peel off. The DNA of skin cells can be harmed and altered by ultraviolet rays, potentially leading to skin cancer.

  Another sign of damage is changing moles. Any mole which is growing in size or thickness, bleeds, itches or crusts, needs to be checked by a doctor. So do moles that are becoming darker, changing shape or appear to be spreading outwards into the surrounding skin. These are all potential red flags for the serious skin cancer melanoma, so don’t put off getting checked. You can take a photo on your phone of any moles you’re unsure of so you can see if they’re changing.

  You may not have heard of actinic keratoses (also called solar keratoses). These develop over many years of sun exposure and are more common if you’re over 50. You might notice a dry, rough or scaly patch in areas such as the face, forearms or on a bald head. They vary in colour from a pale pink skin colour to deeper red and often have a white, crusty scale on the top. Actinic keratoses aren’t actually harmful and will often go away on their own, but because there’s a small risk they can turn into a type of skin cancer, called a squamous cell carcinoma (SCC), they’re usually treated. Treatment may involve freezing them off, applying cream or having the patches scraped away.

  Finally, older runners should be aware of basal cell carcinoma (BCC), another non-melanoma skin cancer that is related to sun exposure. Lesions are usually on the head and neck and more common in men than women. BCCs tend to start as a small, painless lump, just a few millimetres across, which is either pink or pearly coloured, and grows very slowly over months. Sometimes they can bleed, develop a crust or ulcerate. BCCs rarely metastasise – spread to other places in the body – so treatment is not as urgent as for a melanoma.

  In summary, because of potential high sun exposure, it’s wise to take steps to protect your skin, be skin aware, check moles regularly and see your doctor about any skin lesions you are unsure of.

  Did you know?

  According to Cancer Research UK, melanoma is the fifth most common cancer in the UK and over the last decade its incidence has increased by almost 50 per cent.

  Q Will running make my face sag?

  A It’s not unreasonable to think that the repetitive up and down movement of running might make your face sag, but there’s no evidence that runners have more droopy or wrinkled skin than non-runners. In fact, exercise can be anti-ageing (see here). It’s largely your genetics that determine the elasticity of your skin and how ready it is to bounce back after gravity has pulled it down. Ultraviolet rays will decrease the skin’s elastic properties, so follow the advice above about protecting your skin from the sun. If you use a daily moisturiser on your face, consider one that contains an SPF so you always have a degree of protection when you’re running outside.

  Skin infections

  Q I keep getting athlete’s foot. It seems to clear up and then just comes back again. What can I do?

  A Athlete’s foot is a fungal infection. Fungi love damp, warm, dark places, so where better than a runner’s sweaty shoe? It’s also known as tinea pedis, with ‘tinea’ meaning fungus and ‘pedis’ meaning foot. It can affect your skin in a number of ways. It may become dry and cracked or moist and split, especially between or under the toes. It can look white or red, it may peel or bleed, feel sore or painful, and it’s often itchy – sometimes intensely so. You can treat it with anti-fungal creams, sprays and powders from your local pharmacy.

  Examples of anti-fungal medications include terbinafine, miconazole and clotrimazole. Tea-tree oil is often suggested as an alternative treatment, although studies have shown mixed results. Don’t apply tea-tree oil directly to skin, dilute it in a carrier oil first and always carry out a small patch test to check for any reactions. If your athlete’s foot is very itchy then your pharmacist may suggest a product that has a small amount of hydrocortisone in it to ease the itch. Wash and carefully dry your feet twice a day and after running. Take care to dry thoroughly between your toes with a clean towel. Apply your chosen treatment and then put on clean socks or spend some time barefoot. It’s important to continue treating it for a few days after you think it has cleared, just to be on the safe side. If you run daily, then it might be worth having a second pair of running shoes and alternating so they have time to dry out properly. Never be tempted to wear running socks twice. If it really won’t budge, then see your GP who may take skin scrapings to confirm the diagnosis and will consider an oral anti-fungal medication to attack the infection from the inside out.

  Q I’ve been looking online and think I might have ring worm in my groin. Do I need to go the doctor?

  A Tinea cruris, is the medical term for a fungal infection in the groin. In men it’s often called jock itch. Jock is the slang term for American college athletes and the warm sweaty groin of an athlete is the perfect environment for a fungus to grow. It’s very similar to athlete’s foot (tinea pedis) and it can be the same fungus causing the infection in both areas. This itchy and sometimes sore rash appears on the inner thighs and groin and around the scrotum in men. It is usually pink or red in colour and has an obvious and often slightly raised outline, distinguishing it from neighbouring normal skin. The treatment is the same as for athlete’s foot mentioned above. It’s crucial to shower straight after exercising to wash away sweat. Then pat the rash dry with a clean towel and lightly apply the anti-fungal cream. Where possible, keep the area exposed to the air rather than covering it. You may find applying a barrier cream before you run will make it more comfortable. You can treat it yourself with advice from the pharmacist. If it isn’t clearing, then do see your GP.

  Did you know?

  Our skin is home to thousands of microorganisms called commensals. They include bacteria, fungi and viruses, and are an important part of the skin microbiota or microbiome, which helps to keep skin infections at bay.

  Q I get recurrent thrush. Could it be due to running?

  A In the same way that athlete’s foot and jock itch fungi can thrive in the warm, moist folds of runners’ skin, so can thrush, but thrush is common anyway, so running might not be to blame. Candida albicans is the yeast-like fungus which causes thrush. You might find it under breasts, in armpits or groins. In these locations it’s classed as intertrigo, which includes a range of infections and inflammation occurring between skin folds.

  The vagina is the commonest site for women to experience thrush. The lining of the vagina and surrounding skin become inflamed, sore and itchy. There’s often a white, slightly lumpy vaginal discharge. Men can get thrush on their penis, where redness may develop on head of the penis and foreskin. It can be uncomfortable to pass urine or retract the foreskin and there may be an associated itch and discharge. If you’ve never had these symptoms before then it’s wise to see your GP or go to a sexual health clinic to get the diagnosis confirmed, particularly if you’re a man. If you’re confident that it’s thrush because you’ve had it before, then you can get treatment from your pharmacist. If the thrush is purely on the skin, then an anti-fungal cream should be effective, but if it’s inside the vagina, then a pessary (tablet that is inserted into the vagina) or an oral anti-fungal tablet will be necessary.

  Thrush usually clears within a week of treatment, but it has a habit of coming back. To help avoid this you can continue using the cream for a few days after it has seemed to clear. It’s also important to avoid things that disrupt the skin’s natural bacteria. This is particularly relevant to runners
who often shower multiple times a day. Over-washing, especially with strong or perfumed shower gels and soaps, can strip away the healthy bacteria and allow overgrowth of thrush. It’s best to avoid these products in sensitive areas and just use water or an emollient soap substitute, such as E45, Oilatum or Doublebase. Make sure skin is completely dry and not left damp. Cotton underwear is better than synthetic materials to avoid recurrent genital thrush. If your thrush isn’t clearing or it keeps returning, then do see you GP.

  Q I get lots of infected hair follicles in my arm pits. I know sweating when I run isn’t helping. What can I do?

  A The medical term for inflamed or infected hair follicles is folliculitis and it often affects armpits, groins or the beard area. Hair removal by waxing, shaving or plucking makes you more susceptible to folliculitis. It’s usually caused by bacteria, particularly staphylococcus aureus, which normally lives harmlessly on the skin. Typically, you’ll see red bumps and pustules which can be a bit sore, sometimes mildly itchy, and might weep some clear or pus-coloured discharge. You can try treating it at home by washing the area in salty water or using an antiseptic wash or cream. If this doesn’t help, then see your GP who will prescribe an antibiotic cream or tablet. You should generally keep the area as clean and dry as possible, so showering straight after running is important. You can protect sore or inflamed skin while you run by using a barrier cream. Occasionally an infected follicle can turn into a boil or abscess. Top spots for this, especially in active people, are near the anus (perianal abscess) or near the vagina (Bartholin’s abscess). These can get extremely painful and you won’t be able to run. You might even struggle with walking. See your GP as you will likely need antibiotics and possibly surgical drainage.