Race season is upon us. Many of the big marathons and halves are underway, and regardless of how smoothly your training went, or how closely you followed the protocol, chances are you will experience new levels of soreness after the big day. The culmination of smart race training is smart race recovery to assure a strong return to the sport once the body and spirit are ready.
My name is Dr. Allan Buccola, and I am a physical therapist and owner of Impetus PT in Greensboro, NC. Even though the availability of good training information continues to improve, our sport like many sports continues to be subject to the trendiness of what may seem like a good idea, or is endorsed by a particular athlete. Here are some popular recovery topics that continue to come up in my clinic, and what the most recent research has to say about them. Enjoy!
Muscle Soreness: Compression?
You'd be hard pressed to run a race of any distance these days without seeing a gaggle of runners in compression socks or calf sleeves. Only the hardcore nonconformist runner would fail to consider whether they personally would benefit from such a neon trend in running. As a whole, most of the research available supports the use of compression as a means of recovery after the race, but evidence of benefit from them during the event is less universal. Here are some highlights.
A 2014 study utilized calf compression garments for 72 hours post marathon, and revealed that even though subjects reportedly felt their recovery benefited, there was no significant improvement in muscle strength or metabolic markers when compared to a sham group.
Another study from 2015 played this from a more functional angle, applying compression socks for 48 hours after 26.2 and then compared running performance 14 days after the race. In this case, there was a significant but marginal improvement in running performance when compared to the participants who did not utilize compression.
A study in Sept 2016 had participants utilize compression socks between two hard effort 5ks 1 hour apart. Whereas the compression group experienced no real improvement in performance, the non compression group experienced a decline in performance. More interestingly, the participants with the strongest beliefs about compression seemed to have gained the most benefit. Just goes to show that the best intervention combines science AND placebo.
A more comprehensive review to be published in December 2016 takes a close look at lots of studies on compression garments. Their number crunching indicates that compression use during an event may be best served for longer endurance events, as they have been shown to improve time to exhaustion. The authors assert that these effects are mediated by compression's ability to improve biomechanics, running economy, perceived effort, and better regulation of muscle temperature.
Additionally, I would also throw in the importance of an active recovery, which is to say that lots of walking immediately after and the hours to days following a hard workout can be very beneficial. I often suggest some light stretching (see below) for particularly sore areas, and simple active range of motion and contraction of all other muscles for pain relief.
Don't Lose Heart!
After the big race day, don't forget about the high levels of stress imposed on the heart. Whereas there's a wide breadth of research that associates regular physical activity with cardiovascular wellness, some studies have identified that running marathon distance races is also associated with high levels of stress on the heart.
One study cited by this post found that close to 50% of participants in one particular marathon demonstrated elevated cardiac enzymes at levels high enough to meet the diagnostic criterion for a heart attack. After reviewing training and biometric data of these runners, the only predictive values for elevated cardiac enzymes were young age and total time to completion.
As the runners' age increased, their extent of cardiac damage appeared to be less. Older age was actually protective, according to their data, and contrary to similar reviews. However this study focused on a wide range of ages (21-76) and only runners completing a 26.2 mile race.
Data from a similar premised meta analysis that included data from multiple studies looking at different distances had slightly different findings. Post race enzymes seems to be high in runners taking part in shorter distance races, These same markers of cardiac damage also seemed to be lower in runners with lower BMI.
This being said, I find it difficult to extrapolate any specific guidelines from these studies. There is a bit of debate within the cardiology community as to whether these findings should be concerning. The question may stand, then: why, Allan, do you even bring this up? I think it's important to remind ourselves that training to run at this level is always a little stressful on the body, and that healing and recovery time should be given some serious consideration.
Some of the best ways to decrease additional cardiac stress after a big event are probably things you are already doing, like keeping close tabs on your electrolyte (salts) replacement, as well as remaining adequately hydrated after the event. Since encasing your heart in a compression sock isn't really an option, lets considers some other prophylactic measures.
Firstly, whereas there is a spike in markers associated with cardiac cell damage during the event, these metabolites continue to spike up to 48 hours after the race, a sign that perhaps the heart may still be under some stress even beyond the finish line. Nutritional studies aimed at improving outcomes after heart attack have shown some benefit from therapeutic supplementation of things like magnesium, L-carnitine, vitamins C, E, and some B vitamins.
More interesting, a 2012 study that looked at training history and cardiac enzymes of runners in the London Marathon made an interesting discovery. Runners who maintained a higher average weekly mileage over the course of the preceding 3 years were found to have fewer markers of cardiac damage after running 26.2, so there is definitely something to be said for having a strong training base.
If you are someone who is more often 'racing' these events rather than running them, or even someone who participates in ultra-distance events, I would suggest connecting with a registered dietitian for optimal post-race recovery nutrition. All in all, after the celebration food, I typically try to focus on a post race diet full of nutrient dense fruits, vegetables, and grains. This is a key component in the new holistic approach to reversing cardiovascular disease, and would probably have great application to us running types.
Going off the Deep End: Ice Baths
The tradition of ice baths and the science of ice baths are not best friends...which is to say that they have little to do with one another. In light of the religious use of ice baths for recovery, researchers continue to seek ways to determine efficacy. Results are all over the place. The most difficult task is in determining what we should measure.
Some studies aim to look at this from the metabolic/physiological perspective. These studies have tried to assess whether ice baths can change certain metabolic markers after vigorous exercise. Others look at changes to blood flow or oxygenation. Researchers and other human performance gurus alike don't exactly know whether these are truly ideal effects in the first place. They often fail to uncover any long term effects of the baths, which is problematic because adaptation to exercise is somethings that takes place over time, gradually.
There have been others that are performance based, wherein they seek to assess how ice baths can change performance. These studies too, are often difficult to extrapolate meaningful advice. There have been a handful that have shown brief improvement in performance, but we already know that lowering core and or muscle temperature is an effective means of optimizing physiological parameters by preventing overheating.
All in all, I stand with the current evidence available, which is that there is no clear answer out there. If an ice bath is a means to avoid the aches and pains after a hard effort, I'd say stop running away from your harvest. The microtrauma resultant from hard effort workouts and races is responsible for the physiological adaptation that comes next.
If you are sore the next day, its because you did something right...and your body is responding in a truly awesome way. So be patient and let your body do its thing. In time, you'll likely be stronger and faster regardless. If you do end up giving in to your curiosities, don't make the mistake I made several years back: ice baths are not intended to be anywhere near 32 degrees. REALLY big lesson learned that day.
Obligatory commentary on stretching
I've written a couple pieces on stretching now, and done some talks to running groups as well. Stretching is a complicated topic to cover, with no real simple answer. I'll make a few comments here as guidelines, but largely, I encourage most athletes to listen to their bodies and go with what makes them feel better.
First off, vigorous forceful stretching applied to fatigued and over worked muscles could actually be harmful to some extent, so be very cautious with immediate post race stretching. Secondly, in the presence of an acute muscle cramp or spasm post race, I think we can all agree that bringing some tissue lengthening to that problem is likely the only short term solution to the problem.
Thirdly, those first few days after the race, pay particular attention to those muscle groups that are particularly sore. These areas, often for myself, respond really well to regular repeated gentle stretching. I imagine that as post race soreness begins to seem quite similar to 'injury,' an abundance of scar tissue will be laid down in the recovery process and scar tissue tends to contract as it matures. This being said, also pay attention to any particularly sore areas that feel as though they continue to tighten up over the course of that post race week.
If you can identify a subacute or chronic injury that continues to flare up with races, I'd recommend seeing me or another soft tissue injury specialist to resolve those issues. Regular stretching will likely be a part of the solution, but often will not be sufficient in and of itself. Consider the efficacy of your stretching to be found in the consistency and regularity, not the forcefulness.
Above are just a few of what I've seen to be most trendy as of late. If you have additional questions regarding race recovery strategy please contact me via email. Largely, learning successful race strategy is more so related to keeping track of what things work best for you personally...but having a good research basis to find a starting point is always helpful.
Please bear in mind that this article is intended to serve as educational only, but not as medical advice. Without having personally met you or evaluated you, I cannot give blanketed advice that will be effective and safe for you. Thanks for reading. Learn more about my practice here. You can call for a free consult or book an appointment on our site. Find out more here about what makes Impetus unique among PT practices in Greensboro, NC.
Until next time, don't stop moving!