After competing in New York City Marathon, ice can be a runner’s best friend when treating sore muscles

Dear Running Doc:

I just ran the NYC Marathon Sunday and set a personal record finishing in 3 hours 58 minutes. My whole body hurts! Is this normal? Should I use ice or heat?

– Joseph G., Port Washington, NY.

Thanks Joseph. Congrats on your PR. Thinking about that must ease the pain.

Yes, hurting after a marathon is normal. In fact, my friend Frank Shorter, one of America’s most famous marathoners, once said that everyone, including him, hurts after marathoning. “And if you don’t hurt, you aren’t getting your money’s worth,” he said.

If he can hurt, so can all of us. Muscles and soft tissues are strained and healing. Be sure you are eating protein to give you basic amino acids to build back the damaged tissues and take cool showers to reduce inflamed tissue.

Your question about heat vs. cold is a good one; I am asked that daily. There really isn’t much controversy about heat vs. ice. Most who treat athletes on a regular basis agree that from the first day through the first 24 hours, ice is the treatment of choice. Heat tends to further injure friable blood vessel walls thereby promoting leaking of fluid and increasing swelling. Ice, on the other hand, also vasodilates and does not injure the vessel wall, and, in fact, helps its integrity. Ice is truly a great vasodilator. Although initially vasoconstricting in the first few minutes, it then promotes vasodilation, as evidenced by the red area on the skin after icing.

After 24 hours we want to continue vasodilation to bring in blood flow with nutrients and cells to promote healing. The vessel wall has regained its integrity and both ice and heat work – after a 20-minute treatment, both result in an area that looks red due to increased blood flow. Which should you use? I prefer ice because it temporarily deactivates receptors in the vessel walls, thereby keeping the vessels open for an additional 45 minutes following a 20-minute treatment. When heat is applied, as soon as the heat comes off, the vessel area begins to cool the receptors and the vessel walls are reactivated to normal blood flow. Therefore, ice gives you a longer treatment for a 20-minute application. Contrary to grandma’s old advice of applying ice then heat, ice works better, three times a day for 30 minutes each time. You can ice up to six 20-minute treatments a day for the most effect.

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Recovery Tips from Sunday’s NYC Marathon

Dr. Maharam: I am running the NYC Marathon. Any tips to be less sore the next day? Nancy K. White Plains, NY

Thanks Nancy. Post-event muscle soreness is an issue everyone complains of the next day. Follow these tips to lessen the ache:

* Do not get a post-event massage until a minimum of two hours after finishing the race. The lactic acid needs a chance to buffer to a neutral pH before it gets moved around. And even then, do not allow any “deep tissue” work for a minimum of 72 hours since the muscles/ligaments/tendons are all still inflamed and friable.

* Make sure you include protein and carbohydrate in your post race diet. Chocolate Milk is a great recovery drink.

* Do not try any new stretches or have someone stretch you out again until 72 hours have passed to allow for those soft tissues to heal and not be injured more.

* Non-steroidal anti-inflammatories (again: Advil, Motrin, Alleve, Ibuprofen, etc.) that we told you not to take during the event, can be taken after you finish and have urinated once. By then you are no longer at risk for hyponatremia that these meds can help cause. These meds do reduce inflammation and if they don’t bother your stomach can be taken as recommended on the bottle.

* If you feel really sore the next day, besides cool showers and NSAIDs, see your sports doc for an inection of Torodol. This is an injectable NSAID that is so powerful, it has the pain-relieving effect of morphine without any narcotic side effects. It is a miracle injection; you will feel great within two hours of the injection.

Give yourself two or three days of rest before starting your training again. Try a nice swim in these days, but allow yourself some recovery time. You will feel better for it.

Again, congratulations. We hope to see you at many events in the future.

Lewis G. Maharam, MD

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As New York City Marathon approaches, readers ask why runners collapse at a certain point in the race

Dr. Maharam: I have noticed that most half-marathon and marathon deaths seem to be happening before the finish. I understand there is discussion about research on this but do you have any thoughts as to why runners are collapsing at this specific spot? – LeeAnn, Wheeling, W. V.

LeeAnn: I am so glad you asked. We at the International Marathon Medical Directors Association have been discussing this. Given the recent death at the LA Rock n Roll Half Marathon last weekend, I now get a chance to explain what medical directors are doing. The race course is really the safest place to be on a race day unless you are standing in the middle of an Emergency Room. We are all stationing paramedic units at that very spot – what we call the “X-Spot” where runners first see the finish line and know they are going to finish.

The prevailing theory about sudden death (fatal cardiac arrhythmia) in healthy patients in an endurance event, as we have discussed here before, is that either a caffeine load of more than 200 mg has caused enough decreased blood flow to disrupt an ischemic area’s electrical rhythm, or the release of muscle byproducts has caused a small plaque to activate platelets and a small clot to form in a coronary artery. Either of these things can cause a fatal arrhythmia. Limiting caffeine and taking a baby aspirin should help eliminate these possibilities.

The X-spot is where a runner knows he (or she) is going to finish the race, or where he can see the finish line and push to a hard sprint finish. This adrenaline rush, we think, might push the electrical system of the heart to an arrhythmia if the muscle is ischemic by one of the two mechanisms described above or if the participant has underlying heart disease. Not pushing yourself that last mile and taking it as you have the last few miles might make participating safer. So would encouraging announcers not to goad runners by saying things like, “If you can hear my voice you can break 4 hours!”

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Tips for running in cold weather as New York City marathon approaches

Dr. Maharam: This winter I plan on running races in Central Park put on by the New York Road Runners just about every weekend. I find myself shivering after the races, and am afraid I may eventually get hypothermic. As you have been at these races for years giving medical care, do you have any tips for us to stay healthy running in the cold? – Chad M., New York City

Thanks, Chad. I had been thinking about writing a cold-weather post since our Rock ‘n Roll Las Vegas marathon and half-marathon are coming up the first weekend of December, bringing cooler, evening temperatures, not to mention Sunday’s New York City Marathon.

Your question now gives me the perfect set-up to go over cold weather running for this race and for the coming winter runs.

I do have some basic cold-weather tips. Please follow these guidelines for staying safe if race day is unusually cold and/or damp, and especially if there is wind. (All temperatures listed are Fahrenheit.)

* Stay warm before the race. If race morning is cold and/or wet, you should arrive just before the start of the race. This way you’ll avoid standing too long in the cold. Wearing extra clothing, such as long pants, a long-sleeved shirt, and a wind-resistant jacket. Wearing layered clothes that you don’t care about and can discard along the route can be a good idea. Spend a little extra time jogging in place to warm up your muscles before starting.

* As always, respect your limits. Cold temperatures restrict blood flow, which can cause muscles to contract and even cramp. You will feel stiff and tight, especially in the early miles, if you don’t warm up. If you try to force the pace, you may pull (tear) a muscle. Adjust your pace to allow your body a little extra time to warm up. You may have to slow down from your projected pace to get to the finish line safely.

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As NYC Marathon nears, resuscitation and caffeine levels are hot topics among race doctors

A recent discussion amongst IMMDA (International Marathon Medical Directors) physicians described the following recent cases of successful resuscitations at different races around the world:

* A 35-year-old healthy firefighter died 500 yards before the finish at the 2011 Chicago Marathon.

* A 33-year-old male running a half-marathon dropped at the 12-mile mark, 3:10 into his race. The morning of the race, he had drunk two energy drinks and a grande coffee, and used two caffeinated gels. Cardiac catherization revealed a small lesion (less than 20%) but otherwise clean coronaries.

* A 42-year-old woman running a marathon dropped at the 24.5-mile mark, 4:10 into her run. She had drunk two large coffees and had three caffeinated gels. Her cardiac cath also showed clean coronaries.

* A 26-year-old male also running a marathon dropped at the 25.5-mile mark, 3:25 into his run. He had taken two caffeine pills plus coffee the morning of his race, and also had clean arteries on cardiac cath.

More cases were discussed. We also noted that the press always goes to the deaths at these events, not to the many more numerous successful resuscitations. And with these successful resuscitations, we can interview the patient and find out what they did that might have contributed to their collapse.

More and more of these runners have clean arteries and report having consumed more than the 200 mg recommended limit of caffeine (that is the amount in about two cups of diner coffee.)

Coincidence? We think not.

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