Post-race: your recovery plan

Ultra endurance events push athletes to the limits of their capabilities. They subject their body to a significant amount of stress, and it is important to consider muscle damage, inflammation, cardiac stress and mental fatigue in the recovery plan.

The length of recovery for each athlete varies depending on a range of factors

Severity of muscle damage: Not every athlete will experience the same degree of muscle damage. Factors like training adaptation, pacing strategy, nutrition, and hydration during the race can influence the extent of muscle damage.

Training load: Athletes who have trained appropriately and have conditioned their bodies for the demands of the event are likely to experience less muscle damage and recover faster than someone who may have been underprepared.

Post-race recovery strategies: Implementing recovery strategies immediately after the race, like proper nutrition, hydration, cool-down exercises, stretching, massage, ice baths, or compression garments, can facilitate faster recovery. Not all of these are backed by clinical evidence (i.e. compression garments) but many people anecdotally report feeling better when using these post event.

Individual variability: Just as individuals respond differently to training, they also recover at different rates. Genetics, age, overall health, and previous injury history can all play a role.

Type of damage: While soreness (often referred to as DOMS - Delayed Onset Muscle Soreness) typically peaks 24-72 hours post-exercise and then gradually subsides, more severe muscle injuries or strains may take longer to heal.

Nutrition and sleep: Proper nutrition and adequate sleep in the days following an event can significantly impact recovery speed.

Not that I anticipate athletes will be running out for blood tests post their events under the usual conditions of recovery, it’s interesting to think about biomarkers that are related to muscle damage to provide insights into the level of stress experienced by skeletal muscle tissues. These biomarkers can be detected in the blood and can increase after intense or prolonged physical activity, like an ultra-run or an Ironman triathlon. Here are some of the most commonly evaluated biomarkers of muscle damage:

Creatine Kinase (CK): One of the primary markers for muscle damage. CK is an enzyme found in the muscles, and its levels in the blood increase when there's muscle damage. A significant rise in CK is often observed after intense physical activities.

Lactate Dehydrogenase (LDH): This enzyme, involved in the conversion of sugar to energy in cells, is present in many body tissues but mostly in the heart, liver, kidneys, muscles, brain, and lungs. An increase in LDH can indicate general tissue damage, including muscle damage.

Myoglobin: This is a protein that helps transport oxygen in muscle cells. When muscle damage occurs, myoglobin is released into the bloodstream.

Alanine Aminotransferase (ALT) and Aspartate Aminotransferase (AST): These enzymes are primarily found in the liver, but they are also located in skeletal muscles. Elevated levels can suggest muscle damage, but they are more commonly associated with liver injury.

Troponin: Primarily a marker of heart muscle damage (like in heart attacks), but intense endurance exercise can also lead to a transient increase in troponin levels.

C-reactive protein (CRP): While not a direct marker of muscle damage, CRP is a marker of inflammation in the body. Muscle damage can lead to an inflammatory response, which can elevate CRP levels.

Ferritin: This is a marker related to iron, however it increases in response to inflammation. This is why we can’t rely on ferritin as a marker of iron in the presence of inflammation.

What do these biomarkers tell us?

Extent of muscle damage: Elevated levels, especially of CK and myoglobin, can suggest the extent of muscle damage. This helps athletes and clinicians gauge recovery needs and evaluate potential risks (like rhabdomyolysis with very high myoglobin levels).

Inflammatory response: Some markers, especially CRP, provide insights into the body's inflammatory response post-exercise. Inflammation plays a role in both the repair and adaptation processes but can also contribute to delayed onset muscle soreness (DOMS).

Potential complications: Extremely high levels of certain biomarkers, especially myoglobin, can be indicative of complications like rhabdomyolysis, which requires immediate medical attention. This is thought to be under-reported in endurance athletes.

These all provide information on inflammation and muscle damage, and I mentioned troponin as a marker of damage to the heart. It’s worth double-clicking on this for a bit, as it’s not often mentioned in the discussion of recovery, but it’s important especially for athletes who participate in an event where there is considerable environmental stress (such as the Kona Ironman), as studies show there are transient changes in the heart that require recovery.

Some key points

Cardiac biomarker elevation: After long endurance events, it's not uncommon for athletes to show elevated levels of cardiac biomarkers in the blood, such as troponin and B-type natriuretic peptide (BNP).

Transient cardiac dysfunction: Some studies have shown a temporary reduction in right and left ventricular function post-endurance events. This is typically assessed using echocardiography. The right ventricle, which pumps blood to the lungs, may be more affected than the left ventricle, which pumps blood to the rest of the body. Fortunately, these changes tend to be temporary and typically resolve within a week.

Cardiac remodelling and "swelling": The term "swelling" might not be the most accurate description, but there is evidence of cardiac remodelling – structural changes in the heart's chambers – in response to prolonged endurance training. This is often considered a normal adaptation to the increased demands placed on the heart. However, immediately after an event, some degree of dilation (or enlargement) of the right ventricle has been observed. This typically returns to baseline within a week.

Other cardiac concerns: Athletes, especially those over 35, should be aware of the risks of atrial fibrillation, a common irregular heart rhythm, which appears to be more prevalent in long-term endurance athletes. While the exact mechanisms aren't entirely clear, it's believed that the combination of the heart's structural changes, autonomic nervous system alterations, and inflammation might contribute.

Athletes participating in extreme endurance events should undergo regular cardiac monitoring, especially if they have risk factors or a family history of heart disease. This can help detect potential issues early and ensure that any observed changes are indeed benign adaptations and not indicative of an underlying problem. That said, at the conference I attended last week, family history isn’t a good indicator as to who may experience heart-related issues.

Outside of the physical fatigue and damage that occurs, we can’t forget the mental fatigue that occurs when you participate in these long events. The apprehension of a long event, with slight-extreme anxiety of the lead up to the race, coupled with actually being out and engaged for a prolonged period of time takes it out of us mentally. The brain gets tired. Things feel hard. Maybe not initially. A lot of people feel obviously weary the 24h post-race but then get excited to get back into it later in the first week. However, the mental fatigue is still underlying and can come back with a vengeance. Being mindful of this and taking stress load off mentally as well as physically will allow you to recover mentally in a timely fashion, so you feel real motivation when you are ready to get back to it. This doesn’t mean you can’t train, but do so without expectations or goals, as this can quickly lead you to feel demotivated

Recovery plan for weeks 1-4

I know you will want to eat all of the things. Do this for the first 24 hours post-race of course. Have the relaxed day you are after. Ultimately though, the more you put quality protein and phytochemicals and good dietary fats back into your body, the quicker you will heal. A few notes on diet, sleep, recovery, training
 

• Keep alcohol low / absent from your diet in the first week
• Use exogenous ketones which have been shown to reduce inflammation (SFuels Revival contains these in their recovery product, they are also available as a standalone product).
• Greens powder such as a Good Green Vitality that contains organic greens to help reduce oxidative stress and remove free radicals and oxidative metabolites from your system
• Ensure protein intake is on point and quality. Meat, eggs, protein powder, dairy (if you tolerate), fish – aim for at least 2g/kg body weight of protein, distributed across the day
• Creatine: 3-5g/day
• Smoothies with dark greens and berries for their phytochemical content. Can also add turmeric and ginger to this
• Salmon, sardines, mackerel for their omega 3 content (omega 3s help reduce inflammation) – can take fish oil supplements here
• Loads of salads and fresh greens
• Sleep. The body needs to recover and this is the best recovery tool. Ideally no alarm set
• Offload mental stress load wherever possible
• Sauna and/or ice bath to with blood flow and reducing inflammation
• Body work if possible after the first week to help recovery. Lymphatic-massage work in the first week 2-3 days post event should be fine. Topical cream to help reduce swelling or has the feel of reducing swelling can help. Thinking Arnica style cream.
• Keep active but no structured training in the first week-10 days. Swimming, spinning with no resistance, yoga or body balance for gentle stretching, no weight bearing activity. Think zone 1-low 2
• After 10 days, light jogging if legs
• On week 3, bring in scheduled training, bring back some strength work, and think about bringing back in some tempo work in the non-weight bearing sports if you feel recovered and your body feels good.
• Week 4 can be a good time to start consider training specifically again, keeping a check on how you are feeling post sessions, being flexible about pulling back if need be, and being honest about how everything is feeling.