Crawling to finish line can be risky Some runners push through symptoms that warn of imminent organ failure

Jill Barker, Postmedia News 

Crawling to finish line can be risky 
 Some runners push through symptoms that warn of imminent organ failure

Cardiologist Patrick Garceau says rather than being encouraged to continue when they appear to be in a state of Foster dynamic collapse, athletes should perhaps be stopped and given medical assistance.

Allen McInnis / The Gazette


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.

Fortunately the majority of 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.




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, and can happen during training.

The reason behind these medical emergencies is varied. 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 heat stroke, 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, it 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.


Described in an article titled Crawling to the Finish Line; Why do Endurance Runners Collapse? published in the April 2013 issue of the journal of 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.”

For most people, such a traumatic event would be enough for them to stop and take stock of their condition. But 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 beginning training.

As for the tradition of encouraging or helping athletes reach the finish line despite their exhibiting behaviour characterized by the Foster collapse positions, the authors of the paper outlining the phenomenon question the practice that’s performed not only by fellow runners, but by race officials as well.


