Running the big one

Some tips for the post-Manitoba Marathon recovery

Running the big one
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Post-race recovery: tips for all marathon runners

Winnipeg Health Region
Published Friday June 17, 2011

Thousands of Manitobans will be pounding the pavement during the Manitoba Marathon on Sunday. Unfortunately, a number of runners may injure themselves during the course of the race. After all, 26.2 miles is a long way to run.

After an endurance test like the marathon, your body will need a little help rebounding from the run, says Stan Szumlak, an athletic therapist at the Winnipeg Health Region’s Pan Am Clinic.

“Minor injuries such as blisters and bruises won’t require attention, but you will need to see a health-care professional when symptoms last longer than 48 to 72 hours,” says Szumlack.

The good news is that most trained marathoners shouldn’t take too long to recover.

“There are a lot of good running clubs and clinics, stores and online resources, which talk to runners about how to train for marathons,” says Szumlak. “It’s the weekend warrior who did the five or 10 km run who might be having more trouble come Monday.”

Szumlak provided the following list of post-race problems and advice on whether you can self-treat your wounds or whether you need to seek further aid from a health-care provider. He also provided a list of tips on recovery for all marathon participants.

Mild injuries

Black toenails: Subungal hematomas, or bruising under a toenail, is caused when your toe strikes the tip of your shoe, or by improper fitting shoes. These throbbing injuries can be drained by a health-care professional. Or you can wait until they heal on their own.

Blisters: There’s always a question about blisters: To drain or not to drain? If you choose to leave them alone, apply padding around the blister. If you do drain, disinfect the area and keep it sterile so bacteria doesn’t have a chance to enter. Be sure to check your shoes, and get rid of any friction causing the blister to form.

Bruises: Use the PRICE therapy to heal them: protect, rest, ice, compress, elevate. Protect them from further damage, rest the area they are on, apply ice and compression and elevate the limb to reduce the blood flow to the area.

Dehydration: Severe dehydration can cause a medical emergency, so you should have taken advantage of the water stations along the marathon route, and carried your own water which should contain electrolytes. However, if your skin continues to be flushed and you feel clammy during the hours after the race, you should see medical attention. Health-care professionals may prescribe hooking you up to an IV for fluids.

Friction: This is caused by chafing around where clothing rubs, ie. at the arm holes of your t-shirt or the waist band of your shorts. This sort of skin irritation should be looked at by a doctor if it persists more than 48 to 72 hours. Next time you run, use a lubricant or padding to stop friction before it chafes your skin.

Hyponatremia: Also known as water intoxication, hyponatremia is an electrolyte disturbance in which the sodium concentration in the blood serum is lower than normal, when excess water accumulates in the body at a higher rate than it can be excreted. The symptoms of hyponatremia include bloating, a feeling of fullness in your stomach, nausea, incoherence and disorientation. Your race water should contain electrolytes which have sodium and potassium. If your symptoms continue, you should see medical help.

Muscle cramps: Painful cramps are your body’s way of telling you to stop what you are doing. But there is more than one reason why cramps attack: was it physical weakness, dehydration or a muscle imbalance? The cure is the same: stretch the muscle and rehydrate. Monitor your diet for electrolytes. Following a cramp, you can do massage, gentle walking and yoga to loosen the cramped muscle. 

Sunburn, windburn: Perhaps you forgot to wear sunscreen on race day, and now, your skin is burning and reddened. If it’s more than just a mild burn, and involves your skin blistering and peeling, you need to be checked by a health-care professional. Immediate first-aid includes cooling down the area with a cool bath.

Toe calluses: These are hardened areas on your toes caused by repetitive friction. Decrease friction and remove hardened skin with cream or pumice stone.

Upset stomach: The “runner’s trots” can be caused by anxiety, or an improper diet prior to the marathon, one which might include too much salt, sugar, fats or anything in too much quantity, such as fruit. Butterflies in the stomach should calm down after you have finished your race. Remember to rehydrate well, if you are losing fluids.

Minor injuries

Heart problems: Sadly, being in shape enough to run a marathon does not protect against coronary artery disease, heart damage or heart attacks. If you have any symptoms of heart problems, such as shortness or breath or chest pains, while running a marathon, stop at once and see your physician. Heart attacks can and do happen during marathons, often to runners who have underlying heart disease. If your symptoms continue after the race, you need to be transported to the hospital emergency room.

Hypertension: Hypertension, or high blood pressure, could be caused by the anxiety and stress of running the marathon. Or it could be congenital, which means you had the condition prior to racing. Either way, you need to see a health-care professional if you experience persistent headache, dizziness, blurred vision, nausea and vomiting, chest pain and shortness of breath after the marathon.

Sprains, Strains, and Stress Fractures: These can be mild, moderate and severe in symptoms. For mild symptoms, use the PRICE method: protect, rest, ice, compress, elevate. If you continue to be in pain for more than 48 hours, seek medical attention, including an x-ray of the affected part. You may need to use a sling or crutches to help rest the area until it can heal. Some of the specific strains include:

  • Hamstring pulls: Did you try to sprint up hill? The hamstring muscles run down the back of the leg from the pelvis to the bones of the lower leg. An injury to this group of three muscles can range from minor strains, a pulled muscle or even a total rupture. Rest, then conditioning will prevent further problems.
  • Plantar fasciitis: Strain to tissue on sole of the foot, which holds the arch up. The tissue gets strained and tears and erupts as a sharp pain in the heel. For immediate relief, roll a frozen water bottle under the arch. In more nasty cases, you may end up on crutches. Physiotherapy or orthotics can also be called for.
  • Hernia: Hernias could be caused by an imbalance of your muscles. Or you could be getting older and more prone to problems in this area.
  • Achilles tendinitis: Assess your footwear. Put too many kilometres on the shoes and they break down.  Use the PRICE therapy method. You might want to consider installing heel cups and lifts in your shoes.
  • Morton's Neuroma: This is an irritation to the nerves between long bones of your toes, caused by ill-fitting shoes. Symptoms include tingling and numbness between the toes. Rest is prescribed, along with better shoes.
  • Metatarsalgia: This is an irritation to the long bones of the toes, which results in pain and swelling. Use the PRICE method. Then pad the area to take stress off the metatarsal pads. Modify your shoes.
  • Anterior and Posteral Medial Tibial Stress Syndrome: This is an irritation to bones of the shin that provide attachment for the muscles that run down to the arch of your foot. The muscle breaks down, and can cause stress fracture of the bones. Find the cause; shoes, muscle strength or imbalance. It may require a cast or removable cast boot or just rest.
  • Iliotibial Band Friction Syndrome: The Iliotibial Band runs from pelvis to shin on outside of thigh, and causes irritation on outside of the knee, which can be very debilitating. Use the PRICE method, and increase flexibility with massage to the thigh. Get your inner and outer muscles balanced and stronger. You can also use a brace to take stress off the band.
  • Patellofemoral Syndrome: Irritation around kneecap where it glides on thigh bone. Decrease pain, swelling and friction. Increase flexibility and strength of the thigh muscles which attach to the knee cap. You can use braces, or adjust your footwear to control stress.
  • Patellar Tendinitis: Inflammation of the tendon from kneecap to the shin. Control inflammation with PRICE method. Decrease forces to the area by using crutches or a brace to support the area.

Post-race recovery

Immediately after the race, you should: Keep moving for 10 to 20 minutes until your heart rate returns to normal. When 30 to 60 minutes have passed, have a small meal with carbohydrates, protein and sodium, such as bagels, a peanut butter sandwich, bananas, chocolate milk or yoghurt. Get up and move 10 minutes for every hour for the rest of the day. Have a cool shower or bath, and you can add ice to the bath. No hot tubs! Do some gentle stretching. At the marathon, there are some massage therapists who can do light therapy. Get a good rest that night, and don’t drink alcohol or caffeine.

A day after the race, you should: Do yoga, light walking and book a massage. Eat small frequent meals and sip fluids with electrolytes. Your urine should be pale in colour; not too dark or clear. If you are in pain that lasts more than 48 to 72 hours, see your family doctor or sports med specialist, to talk about pain medication. Ice your sore areas again.

How to ease back into training: Take a day off of aggressive running for every mile you ran in the marathon. For first week post-marathon, do a reverse taper, with light stretching the first day, then a 15 minute walk the next, followed by a light run on the third day. Do more stretching and easy training for the next 3 to 4 weeks. Listen to your body! Don’t beat yourself up by entering another marathon too soon, as this could jeopardize your health.

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