The table below lists some of the possible problems you may encounter during an ultramarathon, along with possible causes, treatments and preventions. Continuing a race when you have a problem entails some degree of risk, and these problems can impair your judgment, so use caution. This list is not comprehensive, and is expected to change over time. With all these suggestions, never forget The Golden Rule of Racing, "Never do something in a race you have not practiced in training".

1 Diagnostic Test

Try the Jimbo Test. Picture three things in your mind; a cold drink, a cheeseburger, and a slice of cake.

If the cold drink appeals, then you're probably thirsty/dehydrated. (Remember, drink to thirst as over-hydration kills.)
If the cheeseburger appeals, then you're either after fat or salt.
If the cake appeals, then you'll probably have to some carbohydrate.

You can vary the items to suit your taste. For instance, if a doughnut generally appeals more than cake, then think of a doughnut instead of cake. This test is not foolproof, but it is a good, simple way of evaluating want your body probably wants.

2 Nausea or vomiting

See Nausea.

Possible Cause stripped	Action
Overheating	Slow down and cool off. Once you've become overheated, it can be tricky to cool off enough to recover. Slowing down or stopping is normally required to reduce your heat production. Cold fluids pored over your head, neck and body can help, as can ice. Lying down with your feet elevated can also help. Prevention Heat Acclimation Training. Running in the Heat.
Overeating	Reduce calorie intake and only eat what appeals. Ginger or mints may help. Prevention Eat what appeals.
Going too fast	Slow up, possibly dramatically until things improve. Prevention Better pacing.
Too little fluid intake Even without dehydration, if you're not drinking enough to maintain urine production then you may become nauseated. This is because the hormone that reduces urine output also causes nausea.	Rehydrate, but try to drink to thirst. Remember that over-hydration kills. Prevention Practical Hydration.
Excessive fluid intake/too little salt One of the symptoms of Hyponatremia is nausea.	Reduce fluid intake. Increase salt intake. If it appeals, a little salty broth may help. Prevention Drink to thirst. Take enough salt to maintain thirst.
Too much salt It's unclear how likely this is to happen in practice.	Restrict salt intake. Be careful with Electrolyte Capsules to balance them against fluid intake. Prevention Balance salt intake with fluid intake. Avoid Electrolyte Capsules.
style="background-color: #E7E8D8;" NSAIDs	Avoid NSAIDs
Infection	Sorry, better luck next time Prevention Careful hygiene, including keeping all your drinking containers sterile
Change in intestinal bacteria (due to traveling)	Sorry, better luck next time Prevention Travel earlier Avoid non-bottled water.
Constipation It's unusual for constipation to cause nausea, but it can happen.	Higher Fiber intake. Stay hydrated.
Tight waist band	Loosen anything around your waist or pressing on your abdomen. (Waist packs for carrying drinks are a particular problem.)

3 Fatigue and sleepiness

Possible Cause	Action
Low blood sugar	Take something sweet or a Gel Prevention Take carbs earlier
Low blood fat^[1]	Consume a high fat food, such as peanut butter Combine high fat and high carbs as this will not only boost both, but often these foods are easier to digest Prevention Eat fat earlier Have a higher fat pre-race meal Don't consume only fast carbohydrates
You're running an ultra (what did you expect?)	Caffeine Short nap (5-15 min)^[2]. Pick up the pace^[3].
Thinking about the time	Ignore the time of day and focus on the hours

4 Depression

Possible Cause	Action
Low blood sugar	style="background-color: #E7E8D8;" Take something sweet or a Gel Prevention Take carbs earlier
You're running an ultra (what did you expect?)	Music^[4]. Positive thinking. Keep moving and wait for it to pass^[5]. Have a good cry^[6]. Play mental games. Don't think about how far you have to go. Count the miles down rather than up. Mentally hook a runner in front and let them mentally 'pull you along'. Join up with another runner or group of runners^[7].

5 Headache

Possible Cause	Action
Low blood sugar	style="background-color: #DFF1F2;" Take something sweet or a Gel. Prevention Take carbs earlier
Tight hat	Loosen hat. Prevention The Golden Rule of Racing
Lack of sleep	Short nap. If you have a sleep deprivation headache, I've found that nothing other than a short nap will help.
Caffeine withdrawal	Take Caffeine. Prevention Monitor Caffeine intake Consider abstaining from Caffeine for 1-2 weeks before the race
Overheating	Slow down or stop. Remove excess clothing. See Running in the Heat
Dehydration (only if accompanied by thirst and dry mouth)	Drink more (but drink to thirst as over-hydration kills). Keep salt intake high. Slow down or stop. See Practical Hydration
Altitude sickness	style="background-color: #DFF1F2;" Viagra for Altitude. Descend. Prevention Altitude training Viagra for Altitude

6 Heartburn

Possible Cause	Action
Eating 'wrong' foods	Antacid tablets Eat what appeals Avoid what triggered the heartburn
Stress	Try to relax Prevention Visualization Preparation

7 Blisters

See Popping Blisters, Taping, and Blister Prevention.

8 Are we there yet?

In ultras it's common to get the sense of not making progress, or that the miles have become longer. This is because they have, at least in time terms.

Possible Cause	Action
It's an ultra	Run to the next aid station, not the end and avoid thinking about the overall distance. Run to the next landmark, such as a tree, road sign, rock, etc. (repeat). Think about time not distance^[8]. Convert to 'effective distance' ^[9]. Listen to music, focusing on it rather than letting it play in the background. Rest your mind, aiming for Stillness in Motion. Mental energy is a precious thing in an Ultra, so conserve it. Put your head down and keep moving.

9 Bloating or gas

Possible Cause	Action
Overeating	Reduce calorie intake Gas-x Prevention Eat what appeals
Eating beans or other gassy foods	Gas-x Prevention Change diet before and during the race
Antibiotics	Gas-x Prevention Take yoghurt to help compensate

10 Diarrhea

See Running and Lower GI Problems.

Possible Cause	Action
Infection	Consider Imodium^[10] Prevention Careful hygiene
Gastrocolic reflex^[11]	Some foods are a stronger stimulus of this reflex, so avoid those foods
Too much Fiber	Consider Imodium^[10] Prevention Carefully reduce Fiber intake before the race
Change in intestinal bacteria (due to traveling)	Consider Imodium^[10] Prevention Travel earlier Avoid non-bottled water.
Too much isolated Fructose	Stop Fructose intake
Dairy (lactose intolerant)	Stop dairy intake (read the ingredients)
Ischemic colitis	Stay hydrated
Antibiotics	Sorry, better luck next time Prevention Take yoghurt to help compensate
Magnesium supplements	Don't take any more during the race Prevention Magnesium Oratate does not generally cause diarrhea, unlike other forms of magnesium. Limit magnesium in the 24 hours before the race.
Excessive fluid intake^[12]	Drink to thirst (also helps prevent Hyponatremia and death)

11 Weak or painful legs

Other pain – ITBS, shin splints, cramps

Possible Cause	Action
style="background-color: #E7E8D8;" DOMS	Caffeine Prevention Downhill Running
style="background-color: #FEFFF2;" Glycogen depletion	style="background-color: #FEFFF2;" Take something sweet or a Gel Increase carbohydrate intake Caffeine to increase carbohydrate absorption Prevention Carbohydrate Loading
Muscle spasm	Massage can work wonders, even in the middle of a race
Low blood fat^[1]	Consume a high fat food, such as peanut butter Combine high fat and high carbs as this will not only boost both, but often these foods are easier to digest Prevention Eat fat earlier Have a higher fat pre-race meal Don't consume only fast carbohydrates

12 Cramping

See Cramps

Possible Cause	Action
Sodium Deficiency	Add salt to your drink Eat something salty Drink pickle juice Fellrnr's Go Juice DIY Electrolyte Drink
Muscle fatigue	Stretching Massage (even mid race massage can make a remarkable difference) Relaxed Running Form

13 Chafing

Possible Cause	Action
Skin on skin	Wear something form fitting so the clothing rubs, not the skin Tape both surfaces so the tape is rubbing, not the skin Lubricants may help if used early enough, but often make things worse
Skin on clothing	Wear something form fitting so the clothing rubs, not the skin Tape the skin Lubricants rarely work
Monkey butt^[13].	style="background-color: #E7E8D8;" Clean the area using moist wipes, making sure it's really clean. Any unwanted residue will act as an abrasive. Diaper (nappy) treatment can help relieve the pain. Desitin (or a generic Zinc Oxide ointment) is recommended by some runners, but does tend to leave white marks. Smothering the area with Desitin can help if things are bad. Lubricant can help if used early enough, but if the skin is damaged and rough it doesn't help as much. One of the best lubricants for this area is 2Toms Sport Shield. You either need a roll-on dedicated to this area, or preferably use the Sport Shield Wipes. Prevention Cleanliness is critical. Make sure the areas is thoroughly clean, using wet wipes if you have to go mid-race. Lubricate before the race, clean and lube after you go and periodically through a longer race. Compression shorts or tights that are too tight around the buttocks can hasten the Chafing

14 Fainting

Also near fainting (light headed, dizzy)

Possible Cause	Action
Heart problems	Fainting or near fainting can be a warning sign of a serious health problem and it may be the only symptom that precedes a sudden cardiac death^[14].
Dehydration (only if accompanied by thirst and dry mouth)	Drink more (but drink to thirst as over-hydration kills) Keep salt intake high Slow down or stop See Practical Hydration
Stopping suddenly^[15]	Slow up before coming to a stop
Hypothermia	See Hypothermia.
Altitude sickness	style="background-color: #DFF1F2;" Viagra for Altitude Descend Prevention Altitude training Viagra for Altitude

15 Trouble staying warm

Possible Cause	Action
Exhaustion^[16]	Take calories, starting with some fast carbohydrates. Warm soup or other fluids.
Sweating through^[17]	Change into dry clothes. If possible replace all clothes, including underwear. If you're not too cold and you don't have the option of dry clothes then remove outer layers to allow inner layers to dry. Prevention Avoid trying to stay comfortably warm, aiming to be cool enough to avoid excessive sweating while avoiding becoming chilled. (This is as tricky as it sounds.) Wear layers with zippers that can be opened and closed to control your temperature.
Sunset^[18].	Prevention Be prepared for sunset by carrying some extra layers in the late afternoon.
Sunburn^[19].	Make greater allowances for the cold, wearing more clothing than you'd usually need. Don't rely on sunscreen, which does not block all the UV^[20] and their safety is unclear^[21] Prevention Be careful to avoid sunburn, covering up with UV resistant fabrics.

16 Sore feet


Continual pounding	Swapping to more cushioned shoes may help. Alternatively, going from a highly cushioned shoe like a Hoka to something more moderate can also provide some relief. Prevention Practice walking in training.
Muscular fatigue	Massaging the feet and calves (focus on the calf muscles that stabilize the foot). Try to run more (walking seems to be harder on the feet than running). Prevention Strengthen the foot muscles by doing balance exercises. Massage the feet and calves thoroughly before the race.
Stone bruises	Swap to shoes with more protection in the midsole

17 Notes

↑ ^1.0 ^1.1 Low fat availability is less well researched than low blood sugar/Glycogen depletion, but there is some anecdotal evidence that ultrarunning can deplete the available fat sources. This is not to say that you run out of body fat, just that you can't mobilize those fat stores quickly enough, combined with depleted intramuscular triglycerides.
↑ Some runners recommend napping in a chair, others lying down with your feet elevated. I like the lying down option as it helps my legs recover more. It can be helpful to have something to eat and/or drink before you take a nap
↑ I've consistently found that if I'm moving at a good pace, I don't suffer from sleepiness. Picking up the pace might help with sleepiness, though this is often impractical
↑ There's a difference between having music playing in the background and actively focusing on music. Focusing on the music can be more effective than just having it in the background.
↑ I've found that in most ultras there are various low spots. Often it's enough to just keep moving and wait for it to pass.
↑ Sometimes crying can be cathartic and release some of the mental pressure.
↑ Other runners can provide moral support and a well needed distraction. I've had some wonderful experiences running with others on races. Pacers can also help, especially as they'll focus on your race. Company can be especially beneficial at specific times on a race. The latter part of a race is an obvious time, but also sunset is another critical time.
↑ If you have 20 miles to go, and you're moving at a 15 min/mile pace, think about the 5 hours rather than the distance.
↑ If you have 20 miles to go, and you're moving at a 15 min/mile pace rather than your usual 9 min/mile, convert to time (5 hours), then work out how far that would be at your usual pace (about 33 miles). This can be depressing, but it creates a more realistic expectation.
↑ ^10.0 ^10.1 ^10.2 Imodium (Loperamide) is an anti-diarrhea mediation, but it works by slowing the progress of material through the digestive tract. Some runners find this makes the problem worse, acting like a cork.
↑ The Gastrocolic reflex is the urge to defecate after eating. This is not normally diarrhea, but the strong urge to defecate
↑ Drinking more than your intestines can absorb will produce inevitable diarrhea
↑ Monkey butt is a euphemism for chafing between buttocks. This condition is more serious than you might expect as it can be surprisingly painful. This is also sometimes called "the ring of fire."
↑ See http://www.aafp.org/afp/1999/1101/p2001.html and http://www.jfponline.com/Pages.asp?AID=5146
↑ The calf Muscle helps pump blood, so stopping suddenly can exacerbate low blood pressure.
↑ When you're exhausted, it is much harder to stay warm.
↑ If you wear too many clothes you will sweat and once your sweat has soaked your clothes you will become chilled.
↑ Hypothermia is a particular risk at sunset. In most ultras you've been running all days and you're depleted. When the sun goes down you lose the direct warmth of the sun and the air temperature drops. If you also slow up then you have the perfect storm for hypothermia.
↑ Sunburn prevents the capillaries in the skin from contracting to conserve body heat, making the cold worse.
↑ Amaya Viros, Berta Sanchez-Laorden, Malin Pedersen, Simon J. Furney, Joel Rae, Kate Hogan, Sarah Ejiama, Maria Romina Girotti, Martin Cook, Nathalie Dhomen, Richard Marais, Ultraviolet radiation accelerates BRAF-driven melanomagenesis by targeting TP53, Nature, volume 511, issue 7510, 2014, pages 478–482, ISSN 0028-0836, doi 10.1038/nature13298
↑ Dr. Gabe Mirkin, Sunscreen

[fat-1] 1.0 ^1.1 Low fat availability is less well researched than low blood sugar/Glycogen depletion, but there is some anecdotal evidence that ultrarunning can deplete the available fat sources. This is not to say that you run out of body fat, just that you can't mobilize those fat stores quickly enough, combined with depleted intramuscular triglycerides.

[2] Some runners recommend napping in a chair, others lying down with your feet elevated. I like the lying down option as it helps my legs recover more. It can be helpful to have something to eat and/or drink before you take a nap

[3] I've consistently found that if I'm moving at a good pace, I don't suffer from sleepiness. Picking up the pace might help with sleepiness, though this is often impractical

[4] There's a difference between having music playing in the background and actively focusing on music. Focusing on the music can be more effective than just having it in the background.

[5] I've found that in most ultras there are various low spots. Often it's enough to just keep moving and wait for it to pass.

[6] Sometimes crying can be cathartic and release some of the mental pressure.

[7] Other runners can provide moral support and a well needed distraction. I've had some wonderful experiences running with others on races. Pacers can also help, especially as they'll focus on your race. Company can be especially beneficial at specific times on a race. The latter part of a race is an obvious time, but also sunset is another critical time.

[8] If you have 20 miles to go, and you're moving at a 15 min/mile pace, think about the 5 hours rather than the distance.

[9] If you have 20 miles to go, and you're moving at a 15 min/mile pace rather than your usual 9 min/mile, convert to time (5 hours), then work out how far that would be at your usual pace (about 33 miles). This can be depressing, but it creates a more realistic expectation.

[Imodium-10] 10.0 ^10.1 ^10.2 Imodium (Loperamide) is an anti-diarrhea mediation, but it works by slowing the progress of material through the digestive tract. Some runners find this makes the problem worse, acting like a cork.

[11] The Gastrocolic reflex is the urge to defecate after eating. This is not normally diarrhea, but the strong urge to defecate

[12] Drinking more than your intestines can absorb will produce inevitable diarrhea

[13] Monkey butt is a euphemism for chafing between buttocks. This condition is more serious than you might expect as it can be surprisingly painful. This is also sometimes called "the ring of fire."

[14] See http://www.aafp.org/afp/1999/1101/p2001.html and http://www.jfponline.com/Pages.asp?AID=5146

[15] The calf Muscle helps pump blood, so stopping suddenly can exacerbate low blood pressure.

[16] When you're exhausted, it is much harder to stay warm.

[17] If you wear too many clothes you will sweat and once your sweat has soaked your clothes you will become chilled.

[18] Hypothermia is a particular risk at sunset. In most ultras you've been running all days and you're depleted. When the sun goes down you lose the direct warmth of the sun and the air temperature drops. If you also slow up then you have the perfect storm for hypothermia.

[19] Sunburn prevents the capillaries in the skin from contracting to conserve body heat, making the cold worse.

[VirosSanchez-Laorden2014-20] Amaya Viros, Berta Sanchez-Laorden, Malin Pedersen, Simon J. Furney, Joel Rae, Kate Hogan, Sarah Ejiama, Maria Romina Girotti, Martin Cook, Nathalie Dhomen, Richard Marais, Ultraviolet radiation accelerates BRAF-driven melanomagenesis by targeting TP53, Nature, volume 511, issue 7510, 2014, pages 478–482, ISSN 0028-0836, doi 10.1038/nature13298

[21] Dr. Gabe Mirkin, Sunscreen

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Fixing problems in Ultramarathons

Contents