Pre-race sniffles: Is it safe to medicate?

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Molly asks: I came down with a cold right before my marathon. I wasn’t sure if it was safe to take a cold reliever if it was something I didn’t train with. What’s your advice on this?

Coming down with an illness just before a race is always a dilemma for any athlete. The two questions that every runner faces in this situation are:

1) To run or not to run?

2) To take medications or not to take medications? (Apologies to Shakespeare.)

The first question is usually addressed using the “neck check.” Is the illness a head cold (confined to the head) with nasal congestion and a runny nose? If that is the case, many experts would say it is okay to run. If you have symptoms below the neck (sore throat, cough, fever, or muscle aches), you should not run.

However, there is no real data to say the neck check is really reliable for runners; this recommendation is a best guess. It is always important to remember that viral illnesses cause an inflammatory response, and we do not know the effects of this inflammatory response on the body systems during exercise. Body aches are likely a physical manifestation of the inflammatory response in the muscles, and the heart is a muscle that does not need inflammatory scarring - a reason not to run.

The second question, and your primary question, addresses the use of cold medications. I am not a big fan of over-the-counter cold medications, and generally I do not recommend them for anyone as time will usually do the job. If you need ibuprofen to relieve symptoms, you probably are failing the neck check and should not run. Medications that “dry up” the nasal passages may affect other systems and may not be safe during exercise. I also agree with your observation that is not good to try new things on race day.

So my advice is not to take new medications on race day and not to race if you fail the neck check. I am always looking at what lands runners in the medical tent. Illness in the week leading up to the race is a common finding and too often associated with exertional heat stroke, even on cool days with start temperatures between 4 and 10ºC.