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Crawling to the Finish Line: Why do Endurance Runners Collapse?

Implications for Understanding of Mechanisms Underlying Pacing and Fatigue

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Abstract

Effective regulation of pace enables the majority of runners to complete competitive endurance events without mishap. However, some runners do experience exercise-induced collapse associated with postural hypotension, which in rare cases results from life-threatening conditions such as cardiac disorders, cerebral events, heat stroke and hyponatraemia. Despite the experience of either catastrophic system failure or extreme peripheral muscle fatigue, some runners persist in attempting to reach the finish line, and this often results in a sequence of dynamic changes in posture and gait that we have termed the ‘Foster collapse positions’. The initial stage involves an unstable gait and the runner assumes the ‘Early Foster’ collapse position with hips slightly flexed and their head lowered. This unstable gait further degrades into a shuffle referred to as the ‘Half Foster’ collapse position characterized by hip flexion of approximately 90° with the trunk and head parallel to the ground. At this point, the muscles of postural support and the co-ordination of propulsion begin to be compromised. If the condition worsens, the runner will fall to the ground and assume the ‘Full Foster’ collapse position, which involves crawling forwards on knees and elbows towards the finish line, with their trunk angled such that the head is at a lower angle than the hips. Upon reaching the finish line, or sometimes before that, the runner may collapse and remain prone until recovering either with or without assistance or medical treatment. The Foster collapse positions are indicative of a final, likely primordial, protective mechanism designed to attenuate postural hypotension, cardiac ‘pump’ insufficiency or cerebral blood flow deficiency. Continuing to attempt to reach the finish line in this impaired state is also perhaps indicative of a high psychological drive or a variety of neurological and psychological pathologies such as diminished sensitivity to interoceptive feedback, unrealistic situational appraisal or extreme motivational drives. A better understanding of the physiological, neurological and psychological antecedents of the Foster collapse sequence remains an important issue with practical implications for runner safety and theoretical understanding of collapses during exercise.

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Acknowledgements

The term Foster collapse position is used in this manuscript to describe dynamic collapse ambulatory positions for what we believe are for the first time, and named in honour of Dr Carl Foster as a mark of respect for his groundbreaking work in the pacing research field over the last three decades, and because he was one of the original authors that identified these dynamic collapse positions. The concepts described in this manuscript were first described by the authors during two symposiums at the American College of Sports Medicine Annual Conference in Denver, Colorado, USA, in 2011. There are no potential conflict interests for any authors with regard to the contents of this article. Financial assistance for the development of this manuscript and presentation of the concepts at the above described conferences were supplied by the University of Northumbria Research and Development Fund.

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Authors and Affiliations

  1. Department of Sport and Exercise Sciences, Sport, Exercise and Wellbeing Research Centre, Faculty of Health and Life Sciences, Northumbria University, Northumberland Road, Newcastle upon Tyne, NE1 8ST, UK

    Alan St Clair Gibson

  2. MOVE Research Institute Amsterdam, Faculty of Human Movement Studies, Vrije Universiteit, Amsterdam, The Netherlands

    Jos J. De Koning

  3. Discipline of Sport Studies, University of Canberra, Canberra, ACT, Australia

    Kevin G. Thompson

  4. Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA

    William O. Roberts

  5. School of Biological Sciences, University of Essex, Colchester, UK

    Dominic Micklewright

  6. Department of Kinesiology, University of Indiana, Bloomington, IN, USA

    John Raglin

  7. Department of Exercise and Sport Sciences, University of Wisconsin La Crosse, La Crosse, WI, USA

    Carl Foster

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  1. Alan St Clair Gibson
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Correspondence to Alan St Clair Gibson.

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St Clair Gibson, A., De Koning, J.J., Thompson, K.G. et al. Crawling to the Finish Line: Why do Endurance Runners Collapse?. Sports Med 43, 413–424 (2013). https://doi.org/10.1007/s40279-013-0044-y

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