More information on post-race recovery

After Your Race - Post Marathon Recovery
Posted: February 12, 2004
From Lore of Running-4th Edition by Timothy Noakes

After a marathon, the immediate priority is to drink sufficient liquid to correct any dehydration and sodium chloride losses that may have occurred. This ensures that the kidneys increase their urine production as soon after the race as possible, and it is especially important for faster runners. Slower runners who have drunk adequately during the race and who may be slightly overhydrated need to be careful about not drinking too much after the race, thereby becoming water-intoxicated (hyponatremic). Unconfirmed reports suggest that there have been at least two deaths in marathon runners who drank too much both during and after races because they believed they were dehydrated. The increasing frequency of this condition, especially in recreational women runners who take more than 5 hours to complete marathons, has been emphasized repeatedly.

You should be able to pass urine within six hours of completing a marathon. If you are not able to, it is possible that you may have developed acute kidney failure, an extremely rare condition in marathon and ultramarathon races. However, if you have not passed urine within 12 hours of completing a race, contact a doctor, preferably a kidney specialist. If you are developing acute kidney failure, the earlier you seek a medical opinion, the more likely it is that the severity of the failure can be lessened and the need for blood dialysis prevented.

A runner’s appetite is usually suppressed for a few hours after a marathon. When it returns, there is usually a mild craving for high-fat or high-protein foods, such as steak. According to Bruce Fordyce, the only time he eats steak is during the first three days after ultramarathons. It is probable that the protein in the steak is needed to repair the racing-induced muscle damage.

The day after the race is usually characterized by varying degrees of mental and physical fatigue and, in some, mild depression. Typically, your legs will be stiff on account of the muscle damage, and anything except sleeping will seem to sap all your available energy. This usually lasts for 48 hours after a standard marathon and for 7 to 10 days after a short ultramarathon.

Little can be done about these feelings, except to accept them as normal, to sleep more, and to avoid excessive physical and mental activity. I suspect that the depression is due to depletion of brain neurotransmitters—an exaggerated response of the same type that in a milder form explains the ability of running to reduce anxiety.

From the second day after the race, there is an increased likelihood of developing symptoms of infection or inflammation. In a study of the incidence of symptoms of upper respiratory tract inflammation or infection (sore throats, nasal symptoms, cough, or fever) after the 56-km Two Oceans Marathon, Edith Peters and Eric Bateman (1983) found that 47% of runners who ran the race in less than 4 hours developed such symptoms in the first 14 days after the race, whereas only 19% of those finishing the race in between 5:30 and 6:00 developed these symptoms. The frequency of these symptoms in the slower runners was the same as that of members of their households during the same period, whereas that of the faster runners was much higher. These symptoms were not trivial, and in 47% of runners they lasted for more than seven days. Taking vitamin C, both before and after these races, may reduce the probability of developing these symptoms (E.M. Peters et al. 1996). Other studies have confirmed that there is a greater risk of contracting these symptoms after ultramarathons (E.M. Peters et al. 1992; 1997) and marathons (D.C. Nieman et al. 1990) than after shorter-distance races of 5 to 21 km (Nieman, Johannsen, et al. 1989). Similarly, runners that train heavily are also at increased risk of developing these symptoms.

At present, we do not know whether these symptoms are due to a bacterial or viral infection or whether they represent an inflammatory or allergic response to the high rates of ventilation sustained for many hours during the races. Thus, there is uncertainty about whether to treat the symptoms with antibiotics or with anti-inflammatory or antiallergenic medications.

However, the best form of treatment is rest. My bias, first suggested to me by my colleague Wayne Derman, is to believe that these symptoms are probably of an allergic or inflammatory origin and are not due to infections. This seems especially likely given the increased probability that athletes will suffer from allergies.

After about one week, when your enthusiasm for running starts to return, it is a good idea to analyze the race in detail to find out what errors you made both in the race and in training. If you ran well, it is probable that your training was appropriate and that you paced yourself well during the race. If you ran badly, it may be that your training was not appropriate, that you raced too much in the previous 12 months, or that you ran too fast too early in the race. The most common errors made by runners are overtraining, training too hard too close to the race without a decent taper, or racing too frequently and too recently. You should also pay attention to the balance between speed and distance training. Was the balance correct in your training? Did you carbohydrate load effectively, or did you become hypoglycemic during the race because you failed to carbohydrate load properly, to eat the correct prerace meal, or to ingest sufficient carbohydrate during the race? If you quit mentally during the race, analyze your responses. Did you start having negative thoughts at some point in the race? There is also the possibility that you did in fact run to your genetic potential (chapter 2) but that you are not yet willing to accept the reality.

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