How the hell does Matthew Marquardt do it?

If you’re walking like Frankenstein just 50 minutes into an Ironman, something has gone very wrong. Unfortunately, Matthew Marquardt is used to the sensation. 

Marquardt posted the third-fastest time in the 2.4-mile swim at Ironman Cairns. He was right next to his biggest competitors, exactly as he hoped. But almost as soon as he got out of the water, cramps seized his legs. His first thoughts were “shit,” followed by “here we go again.” Marquardt has cramped in every one of his four triathlon starts this year, each time during the first transition — post-swim, pre-bike. It’s been a curse on his campaign to stand on the overall podium of the Ironman Pro Series at the end of the season.

Something you should know about Marquardt, if you’re uninitiated, is that he is also a full-time medical student at Ohio State University. Being a pro triathlete is something he takes very seriously, but it’s also not his primary gig. Being a med student gives him some healthy emotional distance from the sport, in fact. He describes triathlon as stress relief from the rigors of rotations, research, lectures and exams. Most pro athletes spend their days recovering, and making sure they are taking in nutrition in carefully measured quantities. Marquardt is often on his feet for long stretches of time, and cramming in workouts and fueling in his spare time.

So though Marquardt had reason to panic or throw in the towel in Cairns, as so many others might, he just kept going. He took a process-oriented approach (you might call it “clinical”) to the situation. His third thought was “OK, I need to get to my bike.” Then he could soft pedal, stretch, get blood flowing again, and hopefully loosen the vicegrip taking hold of his legs. About 15 minutes into the bike, he was finally able to push his race pace again. He was roughly eight minutes out of first.

Marquardt, his coaches, and doctors have all been studious in determining the cause of his cramps. The fact that the issue occurs in the same way every time helped narrow it down. Factors like recovery, nutrition, hydration, and even wetsuit tightness could all play a role, but Marquardt and his team have focused on a nerve in the front of his upper leg that he believes is being agitated by his muscles during the swim. 

“When your muscles contract, your muscles move relative to the nerves. So in an ideal world, that nerve is gliding as the muscles contract,” Marquardt explains with the cadence of your trusted primary care physician. “But what can happen is that, over time, through working out, especially someone who’s a little heavier like me, you can develop scar tissue at the interfaces of those things. And so now, instead of it gliding smoothly, it’s almost like you have sandpaper on top of the nerve.”

Targeted stretching and active release techniques have helped release scar tissue from the nerves and ameliorate the cramps. When Marquardt entered Cairns, he thought the problem was gone for good. But while the cramp was an unpleasant surprise, the fact that it subsided quickly was still a relative gift. When he cramped at Ironman Texas in April, the pain lasted for two hours into the race, and he had to scrap his race plan and enter survival mode, willing himself to cross the finish line (and still finishing an impressive 15th given the circumstances.) When the pain finally went away in Cairns, he thought, “Oh I’m still in it.”

The next step in Marquardt’s process was to make it to the last 65-70 kilometers of the bike ride, where the headwind would be strong and he was well-suited to climb the field. He has a powerful build relative to many of his peers in triathlon. He was able to whittle his deficit to roughly three minutes when he began his run. 

Marquardt’s biggest frustration with the constant cramps has been his inability to express his training to the world. It’s hard enough for him to simply schedule his days, much less put in the time. When Marquardt was doing hospital rotations from January through April, he’d wake up at 4 a.m. to work out, see patients all day, then tack on another workout at 6 p.m. And despite imperfect recovery conditions, he felt he made real progress throughout the spring. Unfortunately, the competitive results didn’t show it.

He was particularly proud of how much he had improved his run, but it’s not easy to show that off when you’re well out of podium contention. In his three years as a pro, he had taken six Ironman or Ironman 70.3 podiums prior to Cairns, and in four of them he finished within 2.5 minutes of the win, often after leading off the bike. He had a reputation for nailing the first two legs of his triathlon before fading late. But in Cairns, his run took center stage. On the four-loop run course he gradually ramped up his speed. Entering the third lap, he heard that leader Nick Thompson was suffering, and passed him before the start of the final loop. 

Marquardt said he felt his legs begin to falter in the last two miles, but by then he’d put so much distance into the competition that it didn’t matter. He won by nearly three minutes over Thompson, who took second. At the end of the race, his face was tingling from exhaustion, and he knew he had given the full-throated performance that best represented him. His marathon time of 2:39:47 was a personal best.

“That was another reason why Texas hurt so much is because I really wanted to be able to show the world, ‘Look, you can have a job outside of triathlon and still be competitive against the best in the world,'” Marquardt says. “I’m doing all the things that in theory you’re not supposed to do, and I still was able to make it work. I really wanted to show the world that this can be done. And so to have the cramping take away those races was hard. But to be able to do it in Cairns gets the point across, I think.”

Ambition is a funny thing. Often we think about it as someone’s all encompassing pursuit of one shiny goal. No one would ever dare argue that Marquardt isn’t ambitious, but by maintaining two high-pressure pursuits, he is more zen about outcomes. He often talks about triathlon as being in service of becoming a doctor, citing a study that showed that the only reliable predictor of future success in the profession “is if you’ve been elite at something else other than medicine.” 

Marquardt estimates he spoke with 20 people when determining whether to pursue a pro triathlon career three years ago. The decision came down to whether he felt he could be one of the best in the world, and he has set out to prove that at every opportunity, taking on Ironman World Championships twice and Ironman 70.3 World Championships once in his first two years. Chasing small wins didn’t interest him; the difficulty was the point. 

“Knowing how to become great is what matters. Because then, in medicine, you know what it takes to become the best, and you’ll apply yourself,” Marquardt says. “[People] were like, ‘If you end up being really good at triathlon while still nailing school, that will show who you are more than anything else.’ So I was like, ‘OK, well, like, let’s take this risk and give triathlon a shot.’ But it’s been year by year. This was never my grand plan. I never thought that I’d get this far, honestly.”

The idea that training for, and occasionally winning, Ironmans could be a “release valve” for someone who is also effectively working an overtime job might be surprising and mildly infuriating to some of Marquardt’s peers. But he has learned his lesson about boxing himself in, physically and emotionally, for competitive greatness. He’s only 27, but when you pack so much into your day-to-day, your wisdom quickly grows beyond your years.

Marquardt won three Ohio high school state swimming titles in 2016, and went on to compete on the Princeton swim team. He felt he approached collegiate swimming too rigidly, and missed out on formative experiences — or at the very least, a bit of fun — so that he could stay at home and maximize his recovery from one workout or competition to the next. 

When Marquardt decided to take the dual med school/triathlon path, he vowed that he wouldn’t live life like that. In triathlon terms, that meant not sweating the details. In many ways, the choice is made for him — he has to do research, attend lectures, take exams, and stand on his feet for hours on end during rotations to complete his medical school degree. He, quite literally, has no time to worry whether his nutrition has been perfect, his saddle is not quite right, or his sleep score could be higher.

The old him certainly wouldn’t have taken a cruise in the middle of one of his biggest competitive blocs of the year. 

About a year ago, his girlfriend and her family brought up the idea of going on a cruise to celebrate her graduation from med school. Marquardt knew it would take place in May, an important time period in his run-up preparations for Ironman Lake Placid on July 20. But he also knew that the trip was important to people he cares about. “So I was like, ‘Well, this is like a once in a lifetime opportunity.’ And, yeah, triathlon is also kind of a once in a lifetime opportunity, but not to the same extent.”

Cruising in the Caribbean presents a few challenges to a pro triathlete. Initially, Marquardt had planned to limit his training to running on board the ship, then fitting in open water swims whenever the ship docked. But after his rocky start to the racing season due to cramps, Marquardt added Cairns to his racing schedule just four weeks out from the race so that he could test his legs, and his girlfriend’s family encouraged him to bring his bike so that he could rack up the miles he needed (or close enough) to be ready.

“I was like, ‘I don’t want to bring the bike. That’s going to be a huge burden for everyone, and I’m a guest.’ But they were like, ‘No, you should bring it,'” Marquardt says. “My coach and I talked about it. We’re like, ‘Look, really, we just need to keep the volume up. You don’t have to do anything super crazy while you’re on the cruise.’ And that’s pretty much all we did. And then I came back and did a week of good training, and then headed to Australia. 

“I think it was a great lesson for me and hopefully for others too, that you don’t have to be perfect going into a race to still put together a good race.”

“Just get it done” has been something like a mantra throughout Marquardt’s journey as a pro athlete/med student. He documented his training on the cruise on his Instagram page (which you should very much follow), and it was an excellent look into his problem solving process. Fortunately there were treadmills on board, because the on-deck track was only 200 meters long and had “more turns than an F1 track.” His bike and trainer fit neatly in his room (or on his balcony for some heat training), and for the swim, he purchased a bungee cord off amazon, strapped it to a sturdy pole, tied the other end around his waist, and swam until his mind went “numb” early during the mornings while the rest of the ship was asleep.

“I remembered from COVID and from college, we would have bungee cords and you could use that to swim in place. And so like two nights before we left for the cruise, I went on Amazon and bought a bungee cord,” Marquardt says. “I think that’s an extreme example of, like, sometimes you literally just figure stuff out just in time.”

Marquardt’s approach to training may be unorthodox in pro triathlon, but it’s writ large in med school. Preparing for unplanned or imperfect conditions is part of the everyday job. When something goes wrong, wallowing is just wasted energy for a doctor. Their first thought should be “OK, what do I do next?” 

Conversely, racing Ironman has reinforced Marquardt’s process as a doctor. Long triathlons almost never go according to plan. The very best at sport are often those who mitigate the damage best when something inevitably goes wrong.

“That January to April period when things were really constrained, I think people would expect me to not necessarily do well. But sometimes constraints can be freeing,” Marquardt says. “It’s just less things that we have to think about. It’s like, ‘OK, this is my only opportunity to work out today, so I’m going to do my workout then.’ You’re in survival mode.”

Marquardt is rightfully proud of what he’s accomplished. He gets recognized by fans now, which means a lot to him. It shows that he’s coming across as an example to others, even when, until Cairns, he wasn’t standing atop podiums. He didn’t want to have to win to be considered “elite.” The effort that he’s putting forth in two very different and demanding fields, and what it illustrates about his discipline and character, is the goal, and gratifying to Marquardt on its own. 

That said, none of this is easy for Marquardt. Sometimes it seems that way. He’s a sunny talker with an easy laugh who is motivated by a higher calling — not just proving he has the mettle for the medical profession, but raising money for cancer research after coming to know many people who have been touched by the disease. It’d be easy to explain Marquardt as someone who is simply wired differently than the rest of us.

But the last six months have taken an undeniable toll. He’s had brushes with burnout, as has anyone who has pushed themselves too hard with too little rest. Maybe he’s one of the few humans on Earth who can do what he’s doing, but he’s still human. And he admits there may finally come a moment when he has to give medicine his full attention. Medical residency is one of the last stages of medical school, and it usually consists of 80-hour weeks (and often more time unofficially) of clinical practice under supervision. Marquardt’s plan is to race during residency, but the schedule will almost certainly look different — more selective racing, more maintenance time, etc. — because patient care will always come first.

Marquardt’s day-to-day life is a constant juggle. Maintaining an even emotional keel means exercising perspective. When he sat down with his sports psychologist to talk through his mental and physical exhaustion ahead of Ironman Texas, it was helpful to remind himself that “this race doesn’t matter.” That’s not to say that he didn’t care about his performance. But as someone who works with sick and injured people, he is constantly reminded of the privilege he has as a pro athlete who can use his body in ways that most could only dream.

“The outcome of the race doesn’t matter, because I’m healthy and I can push my body to the limit, whereas other people are pushing their body just to do normal day to day activities,” Marquardt says. “We’re over here stressing about what tire to use, or if I got first or fifth or 15th. And obviously, those are valid. But then I’m in the hospital, and there’s a kid who’s dying of heart failure. And that just provides a lot of perspective of what to be grateful for, and what to really be upset about.”

No matter what path Marquardt’s career takes next, he’s grown tremendously from even attempting the maniacal triathlon/med school split. He’s already “elite” by any definition, and he’ll figure out the future how he does best: One step — one often labored, often painful, but inevitably forward step — at a time.