Monday, April 20, 2009

How I Recover After A Marathon

Everyone is searching for the quickest route to recover from a long run or a strenuous race. The recommendations are found throughout the magazines and across the internet. I have my own special regimen that speeds my recovery, and once again has helped me progress to almost complete resolution of muscle pain and weakness after just 48 hours. Let me list the process I underwent after my marathon:

1. Cool Down
It is recommended in all research I can find that a runner should not stop to stretch or lie down after a strenuous exercise. The cool down can be a simple walk or jog after the race. I walk for at least 10-15 minutes without sitting or stretching to ensure the muscles have time to cool down with a light stretch from regular motion. Sitting or lying down will allow cramping. Stretching may overstimulate the stretch mechanism in an exhausted muscle and produce cramping or even injury. Stretching can be done after the cool down and is a good idea if done at the right time. If the cool down is done effectively, it will alleviate some of the after marathon recovery.

2. Refuel
Any amount of exercise utilizes the glycogen in muscles as an energy source, with blood glucose and free fatty acids. As the exercise level progresses to longer exercise or more strenuous exercise, these sources become depleted more quickly and "anaerobic" (without oxygen) mechanisms are utilized to produce lactate. The lactic acid in muscle fibers or even the muscle breakdown to obtain necessary energy can lead to muscle pain and stiffness. The speed of muscle recovery is determined by the amounts of lactic acid or protein (muscle) breakdown is required to repair the muscles (especially after an exercise is completed).

The University of Illinois did a study on rats in 1999 that showed quicker muscle recovery from this depletion with refuelling with foods containing Leucine (an amino acid) immediately after exercise. They showed muscle stiffness and soreness would subside more quickly. More recent studies have found 30 minutes to be the key time for muscle recovery. The foods eaten in the first 30 minutes after exercise help rebuild the muscles, while foods eaten later have less benefits for muscle repair.

Leucine is found in protein products such as meats and dairy products, as well as in protein bars and some sports drinks. It is not recommended, however, that pure amino acid supplements be taken, because the beneficial amount is not known. In the study, they made the following findings: "It [Leucine] stimulates muscle protein synthesis, provides fuel for the muscle and helps to maintain blood glucose. What really surprised us was that its activity is not seen when leucine or protein is consumed before or during exercise. Instead it has a dramatic impact on protein synthesis during the recovery period after exercise."

So how do I refuel after a race? After any run, and especially after this marathon, I drank a large glass of milk withing 30 minutes of completing the exercise. Fluids are also imperative as are some other carbohydrates to help further maintain blood glucose and reduce lightheadedness from low blood glucose. When I don't want to eat within 30 minutes after an exercise, I eat anyway, especially the large cup of milk and/or a yogurt to get the Leucine benefits.

3. Fluids, Fluids, Fluids...
Part of refueling is getting the necessary fluids to replenish the body. I have a tendancy to start sweating when I think about exercise. I therefore must replace a large amount of fluid after any form of exercise. This replacement is both for refueling and for providing the reservoir for flushing out waste products from the body and especially the muscles. It requires more fluid to carry all these waste products out of the muscles into the kidneys for excretion. Try to drink 6-8 ounces of water every 2-3 hours during the initial recovery period.

4. Hot or Cold?
Everything I have read recommends ice baths or ice massage after a strenuous exercise, and often they recommend avoiding the heat after exercise. I will say now that I aggressively treat my muscle soreness after an exercise (even after the marathon) with soaking in a warm bath or hot tub. Let me explain the scientific basis for my actions. (Note that for me this works really well and decreases my muscle soreness significantly within the first 24 hours and reduces it nearly completely by 48 hours.)

The body reacts to hot and cold by dilation or contracture of blood vessels. Cold (ice) will reduce(vessel contracture) the blood flow into the area or cause the body to pull the blood from the area. Heat will increase (vessel dilation) the blood flow to the area and allow increased blood flow through the area. Since muscle pain is often due to lactic acid in the muscles or other waste products of "anaerobic" muscle metabolism (contracture), heat will allow blood flow through the muscles that can remove these waste products. Heat is only recommended by me during the first 12-24 hours. Ice can be utilized at anytime, but is rarely necessary if I undergo my usual exercise recovery regimen.

I have found through the use of these 4 simple techniques that I can continue to run, recover quickly and not suffer for days - weeks after a strenuous exercise. I plan to continue to train and run marathons and will evaluate the benefits of this regimen after any strenuous exercise. The proof will be in my recovery. Currently I am basically painfree the Monday after a Saturday 26.2 miles...I hope this helps.

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Friday, April 3, 2009

Final Preparations For A Marathon

I am two weeks away from the Salt Lake Marathon, and I am once again reviewing my preparation. What am I doing to ensure that I am running the race correctly, to protect my health, avoid injury and compete at a good level? Here is the thought process I undergo as a physician specializing in foot and ankle health.

Physical Preparation
Physical preparation starts months to years before the marathon and must include regular running with increasing endurance. You can't physically prepare for a marathon if you are not consistently running and able to increase your distance to near marathon distances (20-22 miles are recommended). During the week, longer runs can be split between two runs in the same day (10 miles can be run as two runs of 5 miles in the same day), but at least one long run must be done each week. The advantage of splitting some longer runs into two is decreased chance of injury from stress fractures or other running related injuries.

As you move closer to the race, the training should continue, but be modified to allow full muscle strength and full body preparation for the run. A marathon, due to adrenaline and competition, will usually be faster and harder on the body than other runs. This is what brings the runners high from such a long run.

Therefore, at this time, I am ensuring regular runs with some modification of mileage to protect my body during these last 2 weeks. I am also doing what I can to eat right (regular, healthy, energy rich foods), sleep good at night and trying to avoid sickness that could interfere with the functioning of my lungs. I am doing what I can to be physically prepared.

Mental Preparation
I am still strongly of the opinion that the most important preparation for a marathon is mental. As part of the physical preparation, you get to the point where you believe you can complete a marathon. During any given run, there will be times that are hard and times that are less hard. If you believe you can do it, you will.

Often when I am running I will hit what many call "the wall" and just tell my body that it is not an option to stop running. I run because I can and mental preparation keeps legs moving when the muscles ache, the lungs are tired and the body is ready to stop. This mental attitude is the key to running distances, running hills and even starting a run when the desire may not be there.

I feel that I am mentally prepared, but it is a constant process. My goal is to "run and not be weary, walk and not faint." Mental attitude definitely helps.

Correct Equipment
With all the physical and mental preparation, injury can occur in a 26.2 mile run easily if poor equipment (or even worn out equipment) is utilized. Things to consider are the shoe, and what clothes will be worn for the run.

With shoes, mileage over 300 - 400 miles will wearout a shoe. A new shoe, however, should also not be worn without a breakin period. I plan to use a good shoe that has participated in about half of my training. This shoe, however, will be replace before my next marathon.

Clothing choice is more variable. What will the weather be like? How will you limit rubbing that can cause soreness throughout a run? What will you do to limit sunburn or other discomfort during the run? Will you wear a hat? Whatever the clothing choices may be, it is important to train with these clothes, even utilizing them on long runs to ensure that you are able to enjoy the 26.2 miles without interruptions from the clothing you wore (or didn't wear).

I can truly say that I am excited for this marathon and I am doing everything in my power to be prepared for this run. Besides I have already registered for other marathons that I must be ready for also...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com