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Friday
Nov072014

Post Marathon Recovery: How to make sure your last marathon isn't your last marathon!

By Dr. Marc Bochner

It’s November, and many runners have just finished a fall marathon. For some it may be their first, others may have raced to a personal best. Hopefully, you finished “feeling good” and that feeling has carried over into your recovery period. However, if you plan to jump right into heavy training again, you may be in for trouble in the months ahead, in the form of injury or “burnout” from running. Here is some information you can use to ensure that your last marathon won’t be your last marathon.

No matter if it’s your 1st or 50th marathon, a certain amount of time is required for our bodies, and minds (not to mention family and friends), to heal before the next race or season.

 

Understanding just what recovering means when it comes to exercise in general and actually a race of any distance, not just a marathon, can help with planning you’re next few weeks and months.  After any exercise session, our body systems- musculoskeletal, hormonal/metabolic, nervous, immune- are stressed and must adapt to be ready for the next bout of exercise.  Of course, a marathon will cause more damage and need a longer recovery time than a shorter race. Other stressors, such as lack of sleep, poor nutrition, work or family obligations- can also combine with the exercise session to stress these systems.  We must monitor our response to these stressors as well to exercise, when planning our post-exercise recovery. No matter if it is a hard workout or a marathon, the same principles apply. 

Post-race recovery can be broken up into 4 stages: the immediate hours after the race, the first week, the first month, and returning to regular training after the first month. This article will assume you successfully navigated the immediate post-race walk, hydration, and nutrition and the rest of your marathon Sunday and did not have an acute injury or medical condition.

For the musculoskeletal system, the monitoring during the last three recovery stages can be as simple as charting your post-exercise soreness levels during regular daily activity such as walking, and also ranking your tenderness to touch.  Often after exercise that stresses our bodies past current ability levels, the maximum soreness will not occur until about 48 hours after the exercise session.  This is called “delayed onset muscle soreness” or DOMS. However, by three or four days after the race, this soreness should be dissipating. Thus, if you are still experiencing significant soreness with daily activities (walking downstairs and bending your legs to squat, for example) after the third of fourth day post-event, you may be recovering slowly the first week. And, if you have soreness or tenderness to the touch that is only on one side of your body, this may be the first sign of a developing injury, as DOMS is usually bilateral and equal in intensity and duration on both sides.  If high impact exercise such as running is resumed too early in this healing process, the soft-tissues that are still in a weakened state will not have the strength to resist more muscle/soft-tissue damage and recovery can take longer and injury risk can be higher. 

 

To help athletes and patients in general self-monitor their recovery from regular workouts and from races such as the marathon, in addition to monitoring the post-injury return to exercise such as running,  I have developed an online training long and electronic health record system called traininghistory.com.  Training History includes an “Activity Readiness Score” which takes into account not only injury symptoms, but the underlying status of your muscles. Often injury will occur or re-occur if non-symptomatic muscle dysfunction in not identified and treated. The goal of training history is to provide a method for you to note when key areas that may lead to injury are dysfunctional, before the full injury develops.  For post marathon recovery, this score can be valuable as it can help you take some of the guesswork out of planning your return to exercise and running.  The self-monitoring muscle dysfunction ranking for the Activity Readiness Score is as follows:

Level 1:  None= little or no soreness to even heavy touch/stretching/motion.

Level 2: Mild= mild soreness to medium to heavy touch/stretching/motion.

Level 3: Moderate= moderate soreness to light touch/stretching/motion.

Level 4= Severe= severe soreness to even light touch/stretching/motion.

Now, to the specifics of the post-marathon exercise plan for the first week and month. Light stretching and walking for regular daily activities is fine for the first few days and will help circulate blood with healing nutrients as well as remove waste products. If you have a foam-rolling and self-massage routine that you follow, you can use that routine as a self-monitoring tool. Just be careful the first few days post-race (those with low pain tolerances will not want to go near their rollers much the first week). For everyone, waiting at least one week before running again, or doing other lower body aerobic exercise (even the elliptical) is a wise choice.  Those who were either under-trained or over-trained, raced beyond their fitness level, or were fighting a specific injury before the race may need more recovery time than the more properly prepared and/or experienced runners. Using the self-monitoring system described in the previous paragraph, if you are still a 3 or 4 on the muscle rating scale, meaning you have moderate to severe soreness to just light touch or with light motion, you should not be doing running or other weight-bearing impact exercise yet no matter how many days have passed since the race. Just regular light walking during your daily activities should continue. Non weight-bearing exercise such as swimming may be OK. 

Once you score a 1 or 2 on the scale, which usually will be after about a week, then you can hit the elliptical or other non-impact exercise and try easy running. If your legs still fell heavy, lifeless, and sore after a week of light runs or workouts, continue to go easy or take some more rest days. If not, you can run a little faster and longer and more frequent the third week.  By the fourth week, you can run almost normal pace, distance and frequency for weekday runs, but you should not run a long run similar to your long runs in training or increase your mileage to “base building” levels.  Information on the return to regular training after the first month is given near the end of this article.

If after 7-10 days you are still experiencing any specific soreness with motion or tenderness to the touch, and are still a 3 or 4 on the muscle recovery scale, it may be wise to see your sports doctor for an exam to rule out a specific injury.  A post-race massage and/or chiropractic treatment is a good idea in any case at this point. Also, if you were injured during training and still did the race, or want to prevent future injury, scheduling a visit for a full sports chiropractic biomechanical analysis and treatment plan to correct any imbalances and altered movement patterns is essential. My Prepare to Compete© program has helped many endurance athletes use their “off-season” to work on their weakness and injury-proof their bodies.  It is difficult to correct imbalances during the intense training and racing parts of the year, so once you are past the one month recovery point after the marathon, such a rehab/prehab program can begin.

 

Finally, to plan the rest of your marathon recovery past the first month, and to avoid injury and recover fully, it may be helpful to think of the training year as a continuous circle, with the day after your last big race as the first day of the next season. This is because what you do now will determine what you can do over the winter months, which will then determine what type of shape you are in when your next race arrives. If you are planning to run some “off-season” winter races, even just for fun (which can be a good idea to help you avoid the post-marathon winter “blues”) you should keep some type of aerobic base. Most should decrease their weekly mileage and add some other forms of aerobic activity, such as swimming, cycling, deep water running, or cross-country skiing.  Those who enjoy downhill skiing or snowboarding can fill in the added non-running weekend days with those activities. And if you like to play a sport such as tennis, or even basketball, those can help maintain fitness as long as you are careful and gradually get used to moving laterally and with quicker movements. In addition, an weight-training program that includes upper body and core (from the hips to the shoulders) strengthening should be part of you winter fitness routine, and range of motion work such as yoga should be used as part of this routine. “Functional exercises” such as single leg squats, lateral lunges, single leg deadlifts and plyometric exercises can also be utilized once any weak links and imbalances are rehabbed with a program like Prepare to Compete.  Traininghistory.com also has a full prescription of recovery, correction, rehab and fitness exercises for each stage of recovery and for the racing season.

When should you start transitioning back to a more running-centered plan and increasing running mileage again? The answer depends on what your goals are for next year. Those who plan to “peak” for two marathons next year, one spring and one fall, such as Boston and New York, or have an early season triathlon, will want to start building a base earlier, such as January. But even if you are not racing “long” until next fall, don’t wait until July to start building back your base, as you will leave less room for error and more room for injury. Ideally, for a fall marathon, you should reach half-marathon distance by the end of May, no matter what your ability level.

 If you follow these steps, chances are you will avoid the common post-marathon injuries that often appear in the winter months, such as iliotibial band syndrome and stress fractures. Better yet, you will enjoy your winter racing or cross-training, and you will have both the body and the energy to “reach new peaks” next year.

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