Posted by: Dean Hebert | August 26, 2008

Training: what’s wrong? A look at a long recovery period after a marathon

Here’s a question submitted by a reader named Barbara:

I have just ran my first half marathon back on May 4, 2008. I was fine after the race and some weeks after. I kept running at least 3x a week after taking a week off. It has been at least a month now since Iʼve run or even taken short walks. My lower back, hips and the outside of my thighs hurt so bad. I canʼt sit or stand too long without discomfort. Iʼm awakened or canʼt sleep because my thighs hurt. After laying down for the night and getting up in the morning I can hardly walk or stand straight because of the pain in my outer thighs, hips or lower back. Anti-inflammatories only last for 2-3 hrs when the doctors say they should last for 24 hrs. Iʼve never had any serious health problems and only the normal aches and pains most runners get. I am a 50 yr old female who has been running since high school. My doctor say I am in good shape for my age. This pain is a mystery to me and my doctor. Do you have any suggestions as to what else my doctor should be looking for considering my symptoms? Your thoughts are greatly appreciated.

No doubt this is truly a difficult and frustrating time for you. Though it is not uncommon for some runners to experience long recoveries from long races (usually marathons); extended recoveries and complications are typically seen after races which truly overextended themselves. That is, they ran further and/or far faster than what their current physical condition indicated. Often, these runs ended in what we call a “death march” because the last miles were just survival. Again, often these are seen in adverse weather conditions (usually extremely hot), which simply over-tax their bodies. And finally, extreme dehydration in a race does a lot of cellular damage which can prolong recoveries.

You do not indicate any of those conditions. You took a week off to recover, which is reasonble. You don’t detail how the three runs a week were going. So, I can’t tell if you had lingering soreness, etc. that was unresolved from the race and then was constantly aggravated by running – even if modestly.

Age can play a role in that it usually requires longer recovering from hard efforts. However, your symptoms still seem extreme.

Something commonly overlooked by physicians when working with fit populations is doing a complete physical work-up including blood tests. They come from a disease model not a fitness model. They often assume because we can do more than the sedentary obese “average” American, we must be ok. What they do not assess well is the loss in physical activity as a marker of something that is indeed “wrong”. As a result they are not biased to action and are not aggressive in getting to the bottom of it all. (Ok, enough editorializing.)

So, my advice is this:

I don’t know that running is the cause or even the continuing aggravating source. So recommendation #1 is to stay as active as you can in any way you can without overdoing it and staying within what you can tolerate. It’s not about torturing yourself. Given your time off from running, it is hard to believe it is the cause. So, until and unless physical activity is found to be the precipitating cause – modest amounts won’t hurt and may help long term. Try running in a pool to see if it’s gentler on your body and more tolerable until a cause and treatment plan is determined.

Get your doctor to do a complete physical. You need blood work, x-rays, urinalysis, etc. I’m not a doctor but in ancient times I was a nurse. Two simple examples of things to look for are iron levels (high or low) or protein in urine, amongst many other things. You can also have an EMG done. This can determine if your pain is neurological or muscular in nature.

It might be a disease process. The first one that comes across my mind is Lyme Disease (easily treated with antibiotics – but often misdiagnosed due to the symptomology). A test can determine this.

My physician resources tell me this: Push the medical community on this. Seek and expect answers. Find doctors with a bias to action. They can start treatments (such as a course of steroids or antibiotics) with little to no side effects and cover a lot of possible causes. Doing nothing is not acceptable.

Good luck and please update us on your progress. I send good thoughts for your quick recovery and return.

Coach Dean Hebert, Tempe Arizona
Contributing Editor, Running Advice and News


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