Recovery: What Every Runner Needs to Know to Stay Injury-Free
This exclusive interview with sports medicine specialist Dr. David Geier brings to light game-changing solutions for marathoners and triathletes alike. Learn how to appropriately increase mileage, beat dehydration, and avoid stress injuries. Pulling from Geier’s extensive experience with elite athletes, ProForm readers get the inside scoop on a healthy, injury-free season.
Welcome, Dr. David Geier
Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston, South Carolina. He has served as orthopaedic consultant for professional and elite sports teams, including the United States Women’s Soccer team and the Eagles USA Rugby National team, among others.
“EACH ATHLETE IS INDIVIDUAL. YOU HAVE TO KNOW YOUR BODY WELL.”
What should every marathoner know about post-race recovery?
The first thing you need to know about the marathon process is that it takes a tremendous toll on the body—even for experienced marathon runners. You can’t assume that you’re going to be fine two days later and be back to 100 percent. You have to let your body recover. It’s a tremendous amount of muscle breakdown, a lot of calories burned, and your energy stores are totally depleted. You have to make up for that. It isn’t something your body can do instantaneously with one big meal or one good night’s sleep. A lot of experienced runners are surprised that it is such a difficult recovery process.
What does a major race like that do to your body, specifically?
With marathons, you’re talking about long periods of time where you completely exhaust your energy stores. Your body is breaking down fat (and these people usually don’t have excessive fat stores) then you start to break down muscle. On top of that, you are putting your muscles through tremendous demands over hours—not 15 or 20 minutes—but hours.
Another factor involved is dehydration. No matter how much you drink throughout the race, you are losing a lot of fluids. That compounds your body’s ability to get rid of the bi-products of the muscle breakdown. All of this takes time to get your body back to a balance. And even for experienced runners and triathletes, it’s a lot to overcome. It’s not just something a first-time competitor has to deal with; it’s true for everybody.
How can we prevent dehydration during big races?
Part of the battle with hydration is that while there is a focus on it in the recovery phase, it is just as much a prevention issue as anything else. Everyone pretty well knows to drink throughout the race. The key is to come in hydrated. Drink plenty of fluids in the weeks beforehand because you are going to lose it.
If you start with optimal hydration status and then you do your best to keep up with your volume loss during the race, you won’t have to deal with post-race dehydration as much. The challenge after the race, especially for those who aren’t experienced with it, is that they try to put it all back right away—which doesn’t go that well in their stomachs after all that exertion. They can’t hold down gallons of water. At races that are well established with good medical staff, if you are feeling really dehydrated, it’s not the worst idea in the world in that hour after the race to go by the medical tent and get assessed. If you are significantly dehydrated they can do IV fluids, which can get a larger volume of fluid in more effectively.
How should a first-time marathoner prepare so the recovery process isn’t a surprise?
I would tell a first time racer to plan ahead and expect the first few days or longer to be rough. Don’t plan any strenuous, stressful, or heavy-exertion activity.
Each athlete is individual. You have to know your body well. After these long strenuous events, you need to figure out if you are experiencing just normal soreness and fatigue or is there potentially a mild injury. In the heat of the moment (and with the adrenaline rush) sometimes it can be tough to tell. That is yet another reason you shouldn’t turn right around and try to push yourself through a workout until you get a sense of where your body is.
Do you think recovery is just as important as pre-race training? Why?
From an injury prevention standpoint, they are both equally important. Obviously if you don’t do the pre-race training, you won’t be able to make the race. Then the recovery is a moot point.
As an orthopaedic surgeon, the focus in my practice is injuries. I think the recovery process, like the training process, has to be done in such a way that you get your body back to a baseline. You’ve pounded on your body. You’ve put it through such stress. You’ve got to give it a window of time to recover from that repetitive stress on the feet, ankles, and legs. If you ignore that, you are just going to accelerate your chances for injury.
What are some of the top injuries associated with running?
Running is a repetitive impact sport. By that I mean you are doing basically the same motion over and over, millions of times. And all of that stress is concentrated on the lower body: the bones of the feet, ankles, tibias, shinbones, up into your thighs, and the hips.
“Running is a repetitive impact sport. By that I mean you are doing basically the same motion over and over, millions of times.”
Any one-day’s worth of running is not going to do long term damage because overnight and the next day your body repairs the microscopic stress on the bone. But when you train day after day with little rest, those microscopic stresses can become large-scale stresses on the bone—ultimately leading up to stress reactions or stress fractures.
That is what we see the most often in long distance runners. In fact, even first-time marathoners are often putting their bodies through too much repetitive stress without enough time for their bodies to recover appropriately. So they suffer from injuries that cause them to miss up to six weeks or three months.
When it comes to the arena of the triathlete, do you feel like they are more balanced as athletes, so you see fewer injuries? Or would they potentially have more injuries?
It’s a fascinating discussion and I don’t know that there is an absolute right answer. Yes, in theory by switching between the three sports, you distribute stress differently. Swimming puts a lot more stress on the upper body; with cycling there isn’t the repetitive impact even though there is stress on the lower body; and then obviously running we’ve talked about. Even within these three sports, athletes are still training a lot. So there is still potential for overuse injuries. But, in theory, there is less risk for stress fractures than for someone who just runs all the time.
But on the flip side, triathletes get their own host of overuse injuries. In swimming you see overuse injuries of the shoulders and with cycling you can get some of the tendinitis-type problems of the knee.
Both activities are prone to the personalities types that push themselves harder and harder. Sometimes these athletes will push through a fair amount of pain. They don’t want to take a day off or a week off.
We hear the popular mantra: “No Pain, No Gain” often during training. Is pushing through pain healthy?
It’s a tricky question. When is it ok to keep training, practicing, or playing in your sport when you are experiencing pain or discomfort? Is it just soreness or are you potentially risking damage?
I always ask a patient if the pain or the symptom is limiting your ability to do what it is you want to do. So maybe you’re a marathon runner still able to run, but you’re losing 20 seconds on your mile each mile. Or your knee pain bothers you going downhill but on flat surfaces it’s fine. The pain is keeping you from running as well as you would like.
I would also argue that if you’re competing for a big marathon or triathlon, you should pay attention to these complaints. Sometimes it can be better to find out what the source of the pain is and take some simple measures to fix it before it becomes a big problem. Because if you keep training on an injury, it could become a case where we have to shut you down for six weeks or you may even need surgery.
What can athletes do to prevent stress-related injuries?
I see more overuse injuries from people trying to do too much too soon than from anything else in running. For runners in general, there is a good rule of thumb for how quickly you should increase your training, and it’s fairly simple. Don’t increase your training more than 10 percent per week. For instance, if you are running 20 miles per week on average and you want to increase that, then you would only run 22 miles the next week. And then you’d increase 10 percent more the next week.
This basically allows you to give your body time to get used to the increased demands and helps minimize the chance of developing a stress fracture. Some people say that is overly strict. But this rule is especially true for new marathon runners and people that aren’t used to training at the volume of experienced runners.
“I see more overuse injuries from people trying to do too much too soon than from anything else in running. don’t increase your training more than 10 percent each week.”
So if you know your marathon is next month and you are only running 10 miles a week now, there is no way you’d be able to increase by 10 percent each week and get to where you need to be to run 26.2 miles. Instead, you should say, “I want to run a marathon New Year’s Day 2015. I need to be able to run 50 miles a week at that point.” You then work the map backwards to figure out when you need to start training.
I would also encourage athletes to cross train one or two days a week. Find non-repetitive impact exercises like swimming, cycling, or lifting weights. You can still get a good workout—and maybe even improve your performance. But more important, you are giving your legs and feet a day or two off. It’s a preventative strategy, and a very important one.
What resources would you recommend for those specifically training for their first triathlon or marathon so they can stay injury-free?
I would absolutely say it’s a good idea to find people in your town that have competed in the past or are currently training. Every town has people who have run marathons. Find a running club in your area—and many bigger cities have triathlon clubs. They are usually more than willing to help.
It’s also a great idea to find a coach. People usually hire coaches to improve performance, which is great, but I think there is a lot to be said for experience. A coach can get you ready mentally, help with nutrition, and plan your days off. Plus, coaches will be able to design a program that accelerates appropriately and isn’t overly ambitious. They will know when a first-time runner is likely to hit a training lull and face fatigue/burnout.
It’s important to find a coach—not a month before your event—but right when you start training in the first place. It’s nice to have that person you can call when you have setbacks or questions. It is absolutely critical. I don’t think nearly enough people do that, quite honestly.
As told to Erica Colvin, ProForm writer