Dear Sports Doc,
In the days after running a marathon, half marathon, or similar distance race, I am sore for a few days. Is there a difference between delayed onset muscle soreness (DOMS) and rhabdomyolysis? How can I be sure to recover properly in the days following a race?
Can you discuss some recovery techniques?
Good questions for the week of Thanksgiving when many may be trying to run off some extra calories.
Delayed onset muscle soreness (DOMS) is thought to be caused by overstretching of the muscle fibers following “unaccustomed” and/or eccentric exercise like a marathon or half marathon race. The pain and stiffness usually occurs 1-3 days after the event. It is not associated with severe muscle damage and usually goes away within a week. In contrast, rhabdomyolysis is breakdown of the cell walls and leaking of cell content into the vascular system. This is found by measuring the creatine kinase (CK) enzyme levels in the blood. If the muscle cells also leak myoglobin, the kidneys can be “clogged” causing renal failure. This most often occurs with heat stroke or with sickle cell trait crisis, but some people seem to be genetically susceptible to rhabdo with high exercise loads or with heat exposure. There are reports of rhabdomyolysis occurring with the use of anti-inflammatory medication like ibuprofen and naproxen during marathons and ultra’s; this is the reason few medical teams stock NSAIDs in the medical kits. So most everyone has some DOMS after a marathon, most will also have a rise in CK levels; however very few get rhabdomyolysis.
The key to marathon recovery is time. Much more time than many are willing to take away from running. Running a marathon damages cells to some degree, especially in the muscle. Letting muscles heal is a major part of recovery. Some recent literature implies that the heart muscle might also sustain some “damage,” so recovery may be more than just resting the legs. I do not think we have a perfect answer for how long to refrain from running after race day, but somewhere in the 7-14 day range is probably adequate. The most common concern is loss of fitness, but there is little loss of conditioning in the couple of weeks you take off to recover and you will be better a couple of months down the road if you invest in a solid recovery program. If you train year around, this would be a good time for your “month off” from training.
There are likely three phases in marathon race recovery: immediate post-race, one day post-race through day 7-14 (DOMS days), and ramping up toward your regular training runs. In the immediate post-race phase, get into warm clothes if it is cool, walk 15-20 minutes to keep the blood flowing and help reduce the metabolic waste removal. Replace fluids with recovery drinks like chocolate milk and eat your favorite foods to begin the process of replenishing the glycogen stores and providing the nutritional building blocks to restore damaged cells. Some people swear by an ice bath following the run, but I am not sure there is a lot of science to back up the practice. Water coming out of the cold water tap may be cool enough to accomplish muscle cooling, if that is your goal. Make sure you are able to move around well and your blood flow is good before you take a hot shower as the vasodilatation of your skin blood vessels may “steal” blood from your central circulation and cause lightheadedness or collapse.
Days 1-14 should focus on rest early and gradual return to some running late in the phase. Looking at different expert return protocols, it is difficult to say what the ideal return would look like, but it likely varies from person to person. The first few days should be mostly rest and some light walking and near the end of the time block, some low intensity, short duration running may be OK. You really have to listen to your body and hold back if you are still having muscle soreness as you advance through this period of relative rest. Eat well during this phase to ensure your body has the nutrients to rebuild tissues damaged during the run. A hot tub or warm water soak may relieve some of the muscle stiffness you feel in the early days following the race.
After day 14, start a 2 to 4 week gradual increase in your weekly mileage and long runs to your baseline training level. If you have muscle pain, back off to the last pain free level and wait a few days to increase your training volume. Your race pace for shorter distances will be off for a bit while you reboot your muscle memory and retrain your legs for shorter and faster runs.
For most of us running is a hobby and is mainly for health and fitness. From a health perspective, you are best to advance slowly after a marathon run to allow your body to heal completely and to avoid injury from running in a “hobbled” state.
I hope this helps.