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Health & Exercise Forum

Recovering after the Steamtown Marathon

Oct 12, 2015

Dr. Mackarey's Health & Exercise ForumCongratulations to the close to 3,000 runners who finished the 20th Annual Steamtown Marathon yesterday. Most, if not all of you are waking up this morning with a little less jump in your step than you had yesterday.

As active people by nature, many of you will resist the logic of rest, despite the pain and stiffness in your muscles and joints. Therefore, I would like to offer some words of wisdom, based on science, to encourage you to adequately rest and allow your body to recover.



With adequate rest and recovery, an elite runner can quickly regain full form in 3-4 weeks, while an average runner may require 4-6 weeks. Meb Keflezighi, an elite American runner and winner of the 2014 Boston Marathon, is an excellent example of the merits of rest and recovery. However, he discovered it by accident…following the 2012 New York City Marathon, Meb developed a foot infection which required three weeks rest. With the Olympic Trials just 70 days away, Meb quickly regained his pre-injury fitness level to win the 2012 US Olympic Marathon Trials and join the US Olympic Team in London. It may be that his injury was fortuitous and allowed him adequate recovery time, (that he might not have otherwise allowed), preparing him for intensive training leading up to the trials.



The Effects of Running 26.2 Miles on the Body:  ( - Jim Peskett)

Muscle-Skeletal System:

 One of the most obvious effects of running a marathon is significant muscle and joint pain and stiffness. It will set in after you sit for a while and attempt to get up and move around. For most, it will be more pronounced the day after the marathon, as you get out of bed and limp to the bathroom. Studies show that the leg muscles, (especially the calf muscles) display significant inflammation and necrosis (dead tissue) in the fibers of the muscle. In other words, the trauma to the muscles is so severe that tissue damage causes muscle cells to die. Consequently, studies found that muscle strength, power and endurance is compromised and required significant time to recover… sometimes as long as 4-6 weeks!

Additionally, many runners report severe bone and joint pain following the race. Some studies report findings of microfractures or bone bruising from the repeated and prolonged pounding of the marathon. It is purported that the stress on the joints may be related to: weight and body type, running shoes, running style and mechanics. While not dangerous, again, it is important to respect the stress placed on the body and allow adequate healing…LISTEN TO YOUR BODY!

Cellular Damage:

 Creatine kinase is an enzyme found in the brain, skeletal muscles and heart. It is found in elevated levels in the presence of cellular damage to these tissues, for example, following a heart attack. Similarly, significantly elevated creatine kinase levels are found in the blood of runners up to 4 days post marathon, demonstrating extensive tissue damage at the cellular level. It is important to note, that these enzyme markers are present, even if a runner does not experience muscle soreness. So, adequate rest for healing and recovery is required, regardless of soreness.

Immune System:

 It is not a coincidence that the runners are more likely to contract colds and flu after intensive training or running 26.2 miles. The immune system is severely compromised after a marathon and without adequate recovery; a runner can become ill and ultimately lose more training time or will underperform.


  • If I don’t have pain, then I did not damage my body and I can run again soon after the marathon.
    • FALSE: As stated above, enzyme levels that indicate cellular damage to the tissues are present in the post-marathon runner, even in those without significant pain.
  • Energy drinks with caffeine are the best way to reenergize my body and speed up my recovery.
    • FALSE: In addition to rest, drink, drink, drink - 24 ounces of water for every 2 pounds you lose after the marathon. This is based on pre and post exercise weight. You just burned 2,600 calories so avoid diet soft drinks. You need the glucose (sugar) boost. Also, don’t drink alcohol and use minimal amounts of caffeine (the equivalent of 1-2 cups of coffee). First, drink plenty of water and sports drinks (Gatorade) to prevent a diuretic like caffeine from messing up your fluid balance.
  • If I don’t run, I will lose all of my conditioning in one week.
    • FALSE: Studies clearly show that the VO2 Max, (the best measurement of a runner’s endurance and fitness), is unchanged after one week of inactivity. And, after two weeks, the loss is less than 6% and can be regained quickly. Moreover, it is important to remember, without adequate rest and recovery, performance is comprised, not by the loss of VO2 Max, but by muscle-skeletal tissue damage, which renders the leg muscles of the runner weaker. Remember Meb Keflezighi! Expedite Your Recovery:
      • Rest – Take it easy for a few days. Let you muscles/body heal. Take short walks.
      • Elevate – Elevating your legs to allow blood/fluid in you muscles to return to the heart without using gravity.
      • Massage – This can be an effective method of relaxing muscle spasms, cramps and mobilizing fluids from your muscles to your heart after the marathon. It should be very comfortable. You may find even more benefit from massage 24-48 hours after the race to assist in the recovery of delayed onset muscle soreness from lactic acid build-up in your muscles.
      • Slowly Reintroduce Exercise and Running – Gradually introduce longer walks and slow jogging after a few weeks. Cross-training is good for less joint compression and allows the use of other muscles. (Elliptical, bike, swim)
      • Listen to your body!


This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email:

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at The Commonwealth Medical College.