Managing pain following a marathon

What’s the best treatment for pain following a long run?  In the absence of any major health concern, the primary issue of pain following a long distance event will be how well your body controls acute inflammation.  What is acute inflammation?  This is a non-specific and normal response to trauma which will clear away injured tissue, protect against local infection and allow the immune system access to the damaged area so that healing can take place.  All of this is mediated via blood vessels, which dilate and become more permeable during this state.  Signs of inflammation will therefore include redness, heat, swelling, loss of normal function and, later, once this swelling starts to irritate certain nerve endings, pain. 

We should stress that this acute inflammation is a normal reaction to running a marathon.  In fact, it’s the running of the marathon that is quite abnormal.   This might lead some to suggest that the best approach to managing your condition would be council with a good psychiatrist, psychologist or priest prior to the event.

So, being pragmatic, how do we best manage pain after ignoring all advice the run the marathon in the first place?  In 2012, researchers from the Cochrane Collaboration published a review of the best available evidence and found that cold-water immersion, or going for a soak, at or below 15 degrees Celcius provided significant, self-reported relief following exercise. 

The same group published an analysis of stretching, both before and after exercise. They concluded, somewhat surprisingly, that it made no difference whatsoever to perceived perception of pain.

The Cochrane Collaboration is a group who synthesize the results from multiple studies, and therefore, pull from a larger sample to discover some useful trends.  An important distinction here is that they studied generalized exercise, not necessarily marathon runners.  Again, it is very likely that the psychologists, psychiatrists and anthropologists necessary to conduct such a study simply could not be sourced.  Or, if they had conducted such a study on marathoners, they focused on the more pressing psychological concerns instead of physiological measures.      

Other, theoretically useful measures to control inflammation include elevating the feet, wearing compression garments, using kinesiology tape, contracting the muscles lightly with a TENS machine, or some form of manual therapy.  However, these interventions are often lacking in evidence, meaning they have not been studied sufficiently to advise either for – or against – their application.

One word of warning: NSAIDs, Non-steroidal Anti Inflamatory Drugs, such as nurofen, advil, voltaren, naprosyn, naprogesic, aleve and celebrex can be very dangerous to runners, especially females, following a marathon.  Even though the inflammation could be stopped by their appropriate administration, NSAIDs increase the risk of hyponaetremia, and can gravely affect the kidneys.  Therefore, NSAIDs should be avoided 24 hours before the event, and immediately following the event.   A safer first line of medication for the management of pain is acetaminophen.

What’s definitely in post marathon: ice, ice baths, swimming in the ocean, an ice pack on sore joints and muscles.  If pain is an issue right away, acetaminophen is a good first line medication.  Other considerations are consulting a psychiatrist, psychologist or priest regarding the issues that led you to run the race initially, and to assure it does not become a habit.

What’s definitely out pre and post marathon: NSAIDs (Voltaren, Nurofen, Naprogesic etc)

What’s seemingly pointless: stretching (But it may have other therapeutic effects, and I find it  useful.  Apparently, this is a pagan’s ritual, and not orthodox scientific practice.)

What some people find useful, but is not well studied: Compression gear, kinesiology tape, TENS at a motor level, light contraction of the muscle of the feet, elevation of the lower limbs, manual therapy such as massage or chiropractic.

But, hey, you can tell a runner but you can’t tell them much.  So, go out and experiment, find what works for you and enjoy. 

Written by Matthew Bulman

Matt Bulman is a runner and chiropractor.  He owns The Runner’s Clinic, a premier sports and spinal injury centre in the Inner West.  He loves getting questions about your injuries, it makes him feel useful.  He can be reached via www.therunnersclinic.com.au or at a Woodstock training session (most Thursdays and every Saturday).

Bleakley C et al. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008262. DOI: 10.1002/14651858.CD008262.pub2 - See more at: http://summaries.cochrane.org/CD008262/cold-water-immersion-for-preventing-and-treating-muscle-soreness-after-exercise#sthash

Davis et al. Exercise-associated hyponatremia in marathon runners: a two-year experience.  The Journal of Emergency Medicine July 2011

Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD004577. DOI: 10.1002/14651858.CD004577.pub3 - See more at: http://summaries.cochrane.org/CD004577/stretching-to-prevent-or-reduce-muscle-soreness-after-exercise#sthash.ObgTZpbq.dpuf