Yesterday, in my Grapevine, Texas office, I had a patient who asked me this very question. He raced Ironman Arizona, which was November 20th and wanted to know if I thought it was OK for him to "jump in and run with a friend" the White Rock Marathon? Really? When I started laughing, he then asked if I thought perhaps a relay leg was OK?

So, after I composed myself I said, "It depends....." So I thought I would give a better, more scientific answer than "Are You Nuts?"

What he really was asking is: How long does it take to recover from a marathon? How long does it take to recover from an Ironman triathlon? How much racing is bad for my body? These are all good questions posed in my office on a regular basis. The problem is that the answer is always, "It depends". Everyone recovers at a different rate. Age, experience and current fitness level are large variables in the equation. I know a marathon runner in town who ran 100 marathons in a less than 10 years; and of course, we have all heard of Dane Rauschenberg who ran 52 marathons in one year for charity and then wrote a book about it! The flip side is that I know runners who can only do one marathon a year without getting hurt and most triathletes only train for one Ironman a year.

So what is the magic formula? How much is too much? I think the first thing to think about is what is your goal? If you are just talking about finishing the marathons and not really having a time crunch, then feel free to do up to six a year but realize that having more than two quality runs in a year is very difficult. The Ironman distance should not be attempted more than 2 or 3 times a year regardless of time goals! Now, for those of us who are addicted to the watch, "racing" a marathon is something that should not be done more than twice a year. "Racing" an Ironman triathlon should only be attempted one a year.

Why is this true? Well, simple math. It takes a minimum of 4 months to train effectively for a marathon and 6 months for an Ironman. Then you need at least one day for every mile you ran and three to five days for every hour your triathlon took. That means a month of recovery before you start to train again after a marathon and at least 6 weeks after a 12 hour Ironman. Last time I checked, there were only 12 months in a year; hence, the common recommendation of racing no more than 2 quality marathons or one quality Ironman triathlon a year.

Why do some people recover faster? Age. My feeling is that youth is wasted on the young. I remember being able to run a marathon and get up and go to work the next day. Now I have to take at least one day off and often take two! Experience does help. Your body has been there before, so it knows it will live. Veterans often have a post-race routine down that helps them recover. (Often this includes the anesthesia known as beer!) If your fitness level is high and your nutritional status is good, you will recover faster.

What can you do to hasten recovery? Walk a cool down after the race. Do not sit down immediately even though your legs are begging you to! Take a 15 to 20 minute walk and stretch gently. An ice bath is best, but very few people I know are that tough. A cool bath followed by stretching before you go to bed is helpful. A large amount of carbohydrates and water also helps. Hence the beer phenomenon! A massage a few days after the race will help you recover. More than anything, do not start training again until you are fully recovered. Many injuries occur due to too much, too soon, too fast and too fatigued syndrome!

So how much is too much? Again, the answer is always, "It depends." Listen to your body. Really listen and stop being stubborn or stupid! If you start training and you are exhausted, you are doing too much. If you are spending too much time in my office and less on your bike, you are doing too much. The answer is really simple stupid. Listen to your body and it will tell you how much is too much.

Bottom line: Let your body fully recover from your races and quality times will be recorded. Race only one to two marathons or one Ironman triathlon a year. As for other distances, keep in mind that you need one day for every mile of a running race and at least 3 days for every hour you raced in triathlon. Anything shorter, you better take off your watch and go for the finish instead of the time and prepare yourself to spend some quality time with your local sports medicine physician!

Run Happy! And Recover Well! See You at White Rock!

Tip #1: Do not increase your mileage by more than 10% per week. The body grows stronger if it is stressed in small increments, but starts to break down if it is stressed too much. Studies show that increasing your mileage by no more than 10% per week will help you grow stronger without breaking you down. Avoid increasing duration and pace at the same time.

Tip #2: Always follow a hard workout with an easy one. The body’s like a cell phone. If you continue to use it without recharging, it will eventually wear down. By incorporating easy workouts or cross training into your program, you’ll allow your body a chance to rest and repair itself.

Tip#3: Add strength training to your workouts. Strength training is usually absent from most training programs, but cross training with weights is the only component that has been proven to reduce running injuries. Proper strength training can help you overcome muscle imbalances that lead to injury, as well as strengthen connective tissues that help support your joints.

Tip#4: Do regular self-checks. Tune into what your body is telling you. How do your muscles and joints feel? How does your breathing and heart rate feel? Are you straining to keep up your pace? Anything that doesn’t feel the same may be an early sign of overuse. Keep a training log of not only your mileage, but how you feel during and after each workout. Fatigue over a period of a few days is a huge red flag that your body is trying to tell you something.

Tip#5: Respond to pain immediately. If you experience pain during or after a workout, follow the rule of R-I-C-E (rest-ice-compression-elevation). Use an ice massage or cold pack for 10-15 minutes every 4-6 hours to relieve inflammation and swelling. Elevation is also quite helpful in the first 48 hours. Apply a compressive wrap and hang out on the couch for a few hours and rest. After 48-72 hours, if the inflammation has subsided, apply heat to help promote healing.

Tip#6: Do not take pain-relief medication to finish a workout! Non-prescription anti-inflammatory medications can reduce inflammation and pain, but they do not speed healing. Taking anti-inflammatories prior to a workout may decrease your discomfort and allow you to finish a workout, but they also allow you to overstress already damaged tissue. This can prolong the healing process. Pain is a sign you should not ignore!

Tip#7: Choose relative rest over inactivity. Active rest, or easy exercise, is better than inactivity because it stimulates blood flow and promotes healing. If slow running is painless, but picking up the pace is painful, then stick to slow running until you feel better. Or do other activities, like swimming, cycling, or aqua running until you can run pain-free.

Tip#8: Don’t wait too long to seek professional help. If your pain does not respond to a week of R-I-C-E and cutting mileage by at least 50%, see a sportsmedicine specialist. Not only can a professional help you diagnose and treat the condition, but they may also help you determine and biomechanical abnormalities that can lead to recurring injuries.

Tip#9: Try to maintain a positive attitude.  You immune system fights injuries with a complex army of nutrients and special cells. But, you immune system doesn’t work alone. Your mind also has a voice in what goes on. Attitudes and feelings are organized in your brain to communicate with your immune system with chemical messengers. A positive attitude can go a along way to help speed healing.

Tip#10:  Ease back into your regular training program. Remember, too much, too soon, too fast is what hurt you in the first place. It’s tempting to jump right back in where you left off, but your injured tissue may not be fully recovered. It’s during the first few weeks back that most runners get re-injured. Use the 10% rule to ease back into mileage….

Above all, have fun! Marathon running is a challenge that is mental as well as physical. The miles between 20 and 26.2 take determination, stubborness and probably a tiny bit of inner insanity! Whether you finish in 2 hours or 6+, you are still a marathoner forever after you cross the finish line!

Run Happy! And Injury Free!

Today was the White Rock Marathon in Dallas. This is an annual event that I usually participate in with many of my patients and peeps. Wonderful event with a full marathon, a half-marathon, and a 5-person-relay. This year had record participation of 17,000 people with almost 7,000 runners in the full marathon. Unfortunately, today it was 68 at the start and warmed up to about 75. Did I happen to mention the 30 mile an hour head wind that was in our face for at least 14 miles of the marathon.

This should be the tale of two half-marathons. Most of us were doing great at the half. I personally hit the 13.1 mile marker exactly as predicted in my pre-race planning at 1:52 which would have brought me in at 3:45 with the negative split I was planning. I've always said that a marathon is a fast 10K with a 20 mile warm-up, so I always try to bust it in with a negative split. Unfortunately, the weather was not cooperating! I turned the corner at 14 miles to go on the lake access road and was hit by gale force winds. Being small of stature, I was blown all over the place! I felt like a small kite for at least 10 miles.

At 16 miles, my day was done! I was putting forth the effort for an 8 minute mile and crawling at somewhere between 10 and 11 minute miles. My goal was shot, but my wonderful brother (who on the spur of the moment last night thought he would pace me in the marathon - crazy!) would not let me quit (I really wanted to because the wind was positively evil!)so we persevered on against the wind.

My friend Mike Horton was a sight from God that jumped in at 19 miles and ran us through the worst of the hills (Thanks Mike!) We did some walking, then decided it would be faster to finish if we were running.

My awesome BFF office administrator Lori Cerami jumped in at 23 (at this point my brother jumped out since this was the most he had run in 2 years) and yelled at me to get my butt moving....she stayed with me giving me gummy bears and Accelerade until the 25 miles marker. At that point I figured I was almost done so I ran a quality 1.2 miles to the finish.

My assistant Penny, associate Dr Mollye Karp and pedorthist Janet were at the finish, but had already drank all the beer :) So salty pretzels and some Starbucks were my reward, but I loved seeing them with signs cheering me on.

Only one of my peeps was even close to her goal today, so it was basically a PW (personal worst) for almost all of us, but I think my finishing time of 4:13:45 deserves an astericks next to it for the weather.

To put it in perspective, only 3,878 people finished out of almost 7,000 and I was 1,339 overall, the 329th woman, and 58th master woman (yes, I am that old). Not what I had hoped for, but the course humbled all today due to the crazy conditions. The winner finished in 2:22 in comparison to the 2006 winner who ran 2:12; so I think we can all comfortably subtract 20 minutes from our time for conditions. :)

We survived to run again.....and should rejoice that we can....