The Marathon des Sables

The Marathon des Sables: A Test of Grit and the Power of Physical Therapy

Prologue

By Will Austin, PT, DPT, OCS

Are Ultra-Marathons the New Marathon?

Ultramarathons, defined as endurance events of 50 kilometers or greater, have never been more popular. With advances in sport science, training programs and gear, I would argue that for some, ultra-marathons are the new marathon. Our client, Matt, recently shared an account of his experience during the Marathon des Sables, a multi-stage 160-mile trek across the Northern Sahara Desert. Below is a brief commentary on how the body and mind can achieve such extraordinary feats followed by Matt's entertaining account of his experience of the 2024 MDS.

The Ultra-Adapted Runner

The human body is remarkably adaptable and resilient, especially when challenged by the extreme demands of ultramarathon events. These races, often exceeding 50 kilometers, push the boundaries of physical and mental endurance. With consistent training, the body undergoes significant adaptations: skeletal muscles increase mitochondrial density, improving energy production; the cardiovascular system becomes more efficient, enhancing oxygen delivery; and connective tissues strengthen to withstand repetitive impact.

One of the most profound changes is metabolic flexibility - the ability to utilize both carbohydrates and fats for fuel, essential for sustaining energy over many hours. The body also fine-tunes thermoregulation, becoming better at sweating and maintaining core temperature under prolonged exertion.

Beyond physiology, resilience emerges from neuromuscular adaptations and mental toughness. Runners learn to pace themselves, tolerate discomfort, and maintain focus through fatigue and adversity. Hormonal regulation, particularly of cortisol and endorphins, helps modulate stress and pain perception.

Recovery mechanisms also improve, allowing the body to repair and adapt after intense effort. While ultramarathon training stresses every system, it also teaches the body to respond and rebuild. This balance of breakdown and repair highlights the extraordinary capacity of the human body to endure in the face of extreme physical challenge.

The following article is by our ultra-amazing client, Matt:

I never considered myself a runner. In fact, I had a rather strained

relationship with running and heat - two things that define the Marathon

des Sables (MDS). Yet there I was last April, standing at the start

line of this multi-day, self-sufficient ultramarathon that stretches

across 160 miles of the Sahara Desert.

The event, which took place in Southern Morocco's serenely desolate

Sahara Desert, is a true test of endurance. Participants face harsh

conditions, long distances, equipment wear, and the discomfort of

being self-sufficient for eight nights in decidedly inhospitable

conditions. The race distances vary each day, and in 2024, they ranged

from 13 to 55 miles. Competitors must carry all their food, equipment,

and sleeping gear up to a limit of 15 kilograms - excluding water. The

organizers provide tents, basic ablutions, and a daily water ration,

leaving everything else to each participant's ingenuity.

The journey to the start line was as much of a challenge as the race

itself. After paying the entry fee, the instructions were simple: "Be

at Ouarzazate Airport in Morocco by 8 a.m. on April 12th with

mandatory equipment and medical clearances." The rest was up to us,

with a plethora of online opinions guiding our choices. I relied

heavily on podcasts during my training runs, blending advice from

seasoned runners with my instincts to plan my gear, hydration, and

nutrition.

Given my aversion to running and heat, preparing for the MDS was

indeed a daunting task. It wasn't a midlife crisis that led me here;

rather, a languishing bucket list check box left over from my 20's.

The decision came in late October 2023, and from November onward, I

was committed to fixing my body, getting running fit, and acclimating

to the heat - all within five months. I was not starting from a good

place despite considering myself an endurance athlete in rowing and

swimming. I remember the first training run, a mere 5km, where the

aftermath left me with hips that screamed in pain and felt out of

place and knees that did the same. My nagging SI joint injury from

over exuberance in a game of soccer in 2016 was biting me and

everything felt well worn. I reached out to Shawn for advice and he

promptly made an appointment to assess me.

Appointment one revealed that my hips and knees were indeed taking the

brunt of the abuse when running. The use of different muscles from

swimming and rowing was obvious to Shawn and he pointed out that the

SI joint weakness and the hip pain was simply due to an absence of

decent muscle in those areas. I'm someone who tends to research first

and ask questions later but as testament to Shawn's expertise I left

my first appointment with exercises that had immediate impact on my

instabilities and which were not in my existing repertoire, despite

personal efforts to address them with other physiotherapists and an

abundance of youtubing. With his advice and ongoing guidance in hand I

set to the task of fixing myself before undertaking any serious

distances on my feet.

Within 3 weeks of performing my physical therapy religiously I felt

good enough to undertake some serious distances, starting with 5 miles

and building to a series of weeks that covered 100 miles per week and

more than a few back to back marathon distances. With Shawn's guidance

I found myself pain free for the first time since 2016.

The Marathon des Sables is not just about running though, heat

acclimatization was another key component. To prepare for the

oppressive desert sun, I combined hot yoga with rowing sessions, using

room heaters, thermal underwear and a neoprene suit with hood to

simulate the conditions. This training helped me manage my core

temperature and perform well even in the extreme heat of the Sahara.

The 12th of April, a date highlighted in red on my phone's calendar

for the past 5 months arrived. The time was 8am and along with 900

competitors from over 60 countries we commenced the boarding of the

convoy of buses that would meander their way through the final 6 hour

leg of the journey to the desert. A mix of open desert, more of the

Atlas mountains and dwindlingly populated villages laid the path to

the start line and the enclave of black Hessian sack-like bivouacs

that would serve as our nomadic home for the next 8 days. There is a

day in camp to give competitors an opportunity to rethink and repack

gear as well as share stories and glean insight from old hands. Most

erring to save every ounce possible from their packs and ultimately

giving away or discarding all manner of items even food and clothing.

The native Berbers there as local support delighted at the donations.

The organisers were thorough in checks to ensure the minimum of 2000

calories of food and the mandatory safety equipment was present for

each entrant. This period of calm before the running also gave an

opportunity to appreciate the heat, dryness and general approach to

desert living. Often there was a choice while inhabiting the tent. One

could have a very gentle, but discernibly cooling, breeze of air that

carried with it a fine dust of sand that pervaded every opening, or,

drop the side of the tent facing the breeze, removing the cooling

effect and replacing it with a cloak of hot air. Getting each tent’s

eight occupants to agree to either stifling heat or sandblasted skin

was usually a game of diplomacy. Living was as basic as it comes. The

latrines were nothing more than a crudely fashioned seat over which

one placed a compostable plastic bag to catch and contain business

transactions before removing it and putting it in a trash can that sat

at the front of the inevitable queue nervously shuffling runners . The

privacy screens were a nice touch for when the wind was absent but

became a trial of wits when it was blowing and an outright menace to

toilet goers when it was blowing hard...which was frequent.

The camp atmosphere the night before the first stage was one of great

anticipation. Old hands with multiple MDS's under their feet could be

heard offering last minute advice as one mooched about the camp. Piles

of discarded kit was being rethought, questioned, packed and unpacked.

Food was circulating as everyone ate their last hearty meal before

resorting to leaner rations in the days ahead. Sleep came fast with

mental exhaustion reaching out and claiming the campground silence for

itself.

Stage 1 (20 miles): The first stage provides a taste of moving through

the desert but not before a mandatory 30-minute briefing where the

organisers and medical teams talk about the conditions and how to cope

with certain aspects of the route. After the briefing Patrick

Hernandez's 'Born to be Alive' and AC/DC's 'Highway to Hell' would amp

everyone up before crossing the start line. The terrain was mixed with

stretches of packed sand beneath feet yielding to soft shifting sands

that drained strength and impeded progress. There were three sizable

elevation gains, each one accompanied with a slog up a sandy gully

followed by an albeit too short descent. The air was hot, dry, not

stifling but still draining and provoking elevated heart rates which

if heat stroke was to be avoided, needed to remain below 140. The last

leg of this stage was long and hot but I was feeling good getting the

first stage done despite stumbling upon the skeletal remains of what

was once a camel. The evening conversations reflected the relief felt

at getting a stage under one's belt, the anxiousness giving way to a

certain level of excitement for the following day.

Stage 2 (26 miles) was close to the full marathon distance and we

were warned at the early morning briefing that temperatures would be

higher than the previous day. The start led into a long hard climb for

around 4 miles in loose sandy conditions. Many resorted to using poles

to maintain traction and reduce leg exertion, and while it helped, it

was also going to sap arm strength early in the day. Overall the stage

was stunning with many elevation gains through dunes and spectacular

views being the reward for some mighty efforts overcoming the unstable

sand. There were some long stretches that forced water rationing and a

feel for real heat with it climbing to over 115’F in the shade....of

which there was none. It wasn't uncommon to pass some sparse outcrops

of low vegetation and find a competitor or two huddled into a dark

patch of ground that barely passed as shadow. At the end of this stage

everyone was feeling the same nervousness. The day was hard, it was

hot, it felt long and many were on their last legs when crossing the

finishing line. To think about doing more than double the distance in

around 12 hours' time was more than some could take and it prompted a

number of withdrawals.

Stage 3 (55 miles) brought with it a deep trepidation. This was going

to be a distance further than many competitors had ever covered with

55 miles broken over 7 checkpoints. The early part of the route

included 3 big climbs up some formidable Jebels and around 3000ft of

elevation gain. This suited me and I found my 'rowers legs' powering

up and then maintaining a good pace along the rocky, near vertical

ridges, many years scampering through the craggy Scottish Highlands

paying dividends as I rock hopped through a field of competitors much

less accustomed to the terrain. This stage was going to prove to be my

best day and my worst day rolled into one. I felt strong throughout

but was plagued from Checkpoint 2 onwards with ever worsening

blistering on my feet. I was to later find out it was simply trauma to

both forefeet from the hot rocky conditions. The blisters were not

from friction, but from impact and when they burst, they burst deep

within my foot, first one, then the other; separating the pad of skin

from the rest of the foot. When they popped I thought I had stepped on

a long thorn initially. There was nothing that could be done. It was

going to be very painful from this point forward and the best

description I can provide is to ask the reader to imagine around 40-50

very short tacks under the front of each foot. No matter how gently

you placed your foot down, the tacks were there and they would press

into the foot. I had around 100 miles to the finish at this point and

I reasoned I would have to endure this torture for another 180,000

steps.

I completed stage 3 in good time, managing, much to my surprise, a top

50 finish. It took me a little over 16 hours to complete and with it I

drank 29 liters of water (7.5 gallons) without peeing at all until the

following day.

Stage 4 (28 miles) should have brought some joy. The hardest day was

theoretically over but my journey, my test, had only just begun. On

the previous day adrenaline got me through but in its absence getting

going with my feet screaming at me was as big a test of willpower as

I’ve ever had. The first mile I needed to be in my head, partially

stamping my feet down into the sand to force my brain into accepting

the pain and then dealing with it from there. I could feel the watery

fluid build up and squidge around as my forefoot slid back and forth

in loose sandy conditions. I invented new profanities, screaming them

loudly in my head. I would at times take a loose strap from my pack

and place it between teeth out of fear of damaging them through

clenching. The only real upside to the pain in my feet was that it

took my attention away from the searing heat. Stage 4 was a real

humdinger with one competitor claiming to read 125F on his thermometer

while sitting in the shade. This was my toughest day. I knew I

wouldn’t quit. My little heroes at home and their messages of

encouragement seared into my brain would see to that. In my mental

state I would find my kids a little distance ahead teasing me and

joking about having an itsy bitsy teenie weenie little blister and

telling me to get a move on. Sometimes my cute little mirages just

needed to say ‘you can do it dad’ and I’d summon what was necessary to

get to the top of the next dune or press on to the next water stop.

Stage 4 was brutal.

The final two stages (20 miles and 13 miles) echoed the trials of

stage 4. The distances were shorter, the heat just as oppressive, the

terrain just as curse inducing and neither could be enjoyed to the

extent they deserved due to the pair of Spanish Inquisitors still

trying to get confession out of my rather pitiful looking slabs of

feet. I wasn’t alone, others were in a similar condition and I was

grateful it wasn’t muscular or chafing from the pack. The wear and

tear of the prior 5 days left many nursing blisters, aches, muscle

strains or a compromised physical condition due to flirting with heat

stroke. The desert had become something familiar at this point. When

it blew hard you barely noticed, pulling the shemagh or buff over your

mouth and nose and barely breaking stride. Check points by this point

had become choreographed affairs as water bottles were filled and

stored with familiar movement and words of encouragement "not far to

go now" are heard as backs turn and faces once more point to the

finish line, and oh what a finish line. It's hard to describe the

emotions that flood your brain as you cross over, hugs from the

organisers who have pushed and encouraged everyone through each

checkpoint along the way. The knowledge it is over, that I'd finished,

that the past 6 months had culminated in this single defining moment

and I'd achieved what I came out to do. I'd like to say that I didn't

care about my position but that wouldn't be entirely true. Before I

left my sister asked where I hoped to place and I said in the top

half, so around 500th. I came in 318th, dropping from 187th after day

three due to the inability to put my pace into the ground and instead

embarking on flamboyant hobbling over the last 100 miles. I was happy

with it and try not to think about what might have been had I selected

different footwear.

The journey back from the desert was very different to the one made 8

days earlier. Everyone felt like they knew everyone else. There was a

feeling of intense solidarity and deep regard for hearing each other's

stories. An awards ceremony back in Ouarzazate capped the event off

perfectly with the highlight being a short movie that captured the

event as a whole perfectly. I was pleased to provide a couple of

cameo's though I look mad as a hatter during one particular clip. I'd

also love to say that the pain in my feet went away but sadly it did

not until some significant healing had taken place over the following

3 weeks. I lamented the return gate at Logan being at the far end of

the airport from immigration and looked most peculiar as I performed

my hobbling at an excited pace, urging expediency to be home with my

family and back to a sense of normality.

Epilogue

It is my firm belief that anyone who is reasonably fit and able can

accomplish this endeavour. I won't say I recommend it, but for those

seeking a life changing event, this is one for the books. Looking back

on myself before and after I can say that I regained a deeper

connection to myself. I reminded myself what I am capable of and what

many others are capable of. The sand and the heat is a leveler, it

forces you to confront discomforts that are very hard to attain within

life's usual parameters. In my youth I read of turn of the century

polar explorers such as Captain Scott and Shackleton. I was inspired

by their accounts of daring-do but found their level of discomfort,

marching with frostbitten feet across hundreds of miles of ice

somewhat unrelatable. I now have an inkling of what they endured and

how our minds bend to the tasks at hand and the challenges before us.

I intend to maintain at least some level of the physical conditioning

this adventure brought. From November to the end of April I lost

nearly 30Ibs, some from releasing stored energy supplies but much from

reconfiguring my musculature away from being a rower and swimmer, to a

runner. I had incredible support from friends and family as well as my

local community who donated to my two chosen charities, Sobell House

Hospice that supports end of life care in the UK and the US arm of

Doctors without Borders. I give particular thanks to Shawn Sprague who

never doubted my sanity and provided me with advice, knowledge and

encouragement to finish. None of this would have been possible without

my family who trusted me to come back and to my wife who held everyone

together in my absence. Asked whether I would do it again my answer is

yes but it would need to be for a good reason because there is no

doubt the commitment to the Marathon des Sables is necessarily high

and there are not insignificant sacrifices made along the way.

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