Recovery After a Marathon
A marathon is one of the most exhausting trials an amateur can go through. After the finish, pride quickly gives way to pain in the legs, fatigue and a wish not to move for several days. Proper recovery determines whether you return to training healthy or pick up an injury or lingering fatigue. The editorial team examined what happens to the body after 42 kilometers and how to structure the return to running.
What a marathon does to the body
During a marathon a runner takes tens of thousands of steps, and each landing engages an eccentric contraction of the thigh and calf muscles. Warhol and co-authors (1985), in a classic histological study, found in the muscles of marathon runners after the race signs of fiber damage that gradually healed over the following weeks. That is precisely why the sensation of “wrecked legs” is no exaggeration.
Biochemical markers of muscle damage, primarily creatine kinase, usually rise sharply after a marathon and peak a day later. The review by Peake and co-authors (2017) describes how, after exhausting loads, an inflammatory reaction unfolds that simultaneously causes pain and triggers tissue repair.
The energy state also changes noticeably: glycogen stores in the muscles and liver are significantly depleted by the end of the race. Water and electrolytes are lost with sweat, and stress hormones, in particular cortisol, remain elevated for several more hours.
The heart, too, responds to a marathon. Neilan and co-authors (2006), in a study of Boston Marathon participants, showed that in some non-elite runners markers of myocardial damage (troponin) rose after the finish and temporary changes in ventricular function appeared. This was more pronounced in those with a smaller training volume. In most cases the changes are transient, but they underscore the importance of preparation.
Finally, the immune system. After prolonged exhausting loads, temporary changes in immune indicators are observed, and in epidemiological studies marathon runners more often reported respiratory symptoms after the race. Modern reviews (Nieman, Wentz, 2019) interpret this connection more cautiously than before, but hygiene and rest after the start remain sensible advice.
The first hours after the finish
Immediately after the finish you should not stop abruptly and lie down. A few minutes of calm walking help to gradually lower the pulse and avoid the dizziness associated with the redistribution of blood. If weakness, nausea or confusion appears, you need to see the medics at the finish.
Hydration should be sensible, not maximal. Go by thirst and the color of your urine, and prefer drinks with sodium. Excessive water intake during and after the race can cause hyponatremia — a dangerous drop in blood sodium. Almond and co-authors (2005) found hyponatremia in some Boston Marathon finishers, and the main risk factor was weight gain during the race from excessive drinking.
Nutrition in the first hours is aimed at replenishing glycogen and starting muscle recovery. The ACSM position on athlete nutrition (Thomas et al., 2016) recommends, when fast recovery is needed, consuming about 1–1.2 g of carbohydrates per kilogram of body weight per hour during the first hours, and also adding protein. After a marathon, when the next start is not tomorrow, strictly following these figures is not mandatory, but a full meal with carbohydrates and protein is important.
- calm walking for 10–15 minutes after the finish;
- drinking to thirst, with electrolytes, without “flooding” with water;
- a snack with carbohydrates and protein within the first hour;
- warm dry clothing to avoid getting chilled;
- a full meal and an early night's sleep in the evening.
Alcohol after a marathon is a tradition of many races, but it worsens rehydration, sleep and muscle protein synthesis. If you celebrate, do so in moderation and after you have restored your water balance and eaten.
The first week: passive and active recovery
The first 2–3 days after a marathon are the period of the strongest DOMS. Descending stairs is especially painful, because it is precisely what requires eccentric work of the quadriceps. During this time light movement without impact load is best: walks, calm swimming, cycling with minimal resistance.
Massage has the best evidence among methods for reducing DOMS, but deep intensive massage in the first days can be too aggressive for damaged muscles. It is better to choose gentle techniques or postpone deep work for a few days.
Sleep is the main recovery tool. After the race many people sleep poorly because of pain, agitation and an elevated pulse, so it is useful to create the most favorable conditions: a cool dark room, avoiding caffeine after lunch, a moderate dinner.
Nutrition in the first week should be energy-adequate. The desire to “lose weight right away” after a marathon is counterproductive: damaged muscles need protein and energy. The guideline for protein in athletes is roughly 1.4–2.0 g per kilogram of body weight per day, distributed throughout the day.
Returning to training
Among coaches a rule of thumb is widespread: one day of an easier regimen for each mile of the distance, that is, about 3–4 weeks without intense work after a marathon. This is not a scientifically precise formula but a practical guideline that fits well with histological data on the duration of muscle healing.
| Period | What to do | What to avoid |
|---|---|---|
| Days 1–3 | Walks, swimming, light cycling, sleep | Running, intense exercise, deep massage |
| Days 4–7 | Short easy jogs possible, by how you feel | Speed work, long distances |
| Week 2 | Light aerobic running, gradually increasing volume | Intervals, competitions |
| Weeks 3–4 | Return to usual volume, first strides | Rushing to plan the next marathon |
During the return, go by how you feel: if easy running causes pain that intensifies, or remains as hard as at the finish, it is worth adding a few more days of rest. Pay especially close attention to local pain in the bones of the foot or shin — this can be a sign of a stress injury.
Mental recovery is no less important. After months of preparation, many runners experience a drop in motivation. It is useful to give yourself a few weeks of training without a rigid plan and to choose the next goal without haste.
Warning symptoms after the race
Most of the unpleasant sensations after a marathon are a normal part of recovery. But some symptoms require immediate medical care. It is important for both runners and the loved ones who meet them at the finish to know them.
- Hyponatremia:headache, nausea, vomiting, swelling, confusion after the race, especially if the person drank a lot.
- Rhabdomyolysis:tea-colored urine, very strong and growing muscle pain and swelling, reduced urination.
- Cardiac symptoms:pain or pressure in the chest, shortness of breath at rest, fainting, pronounced heartbeat irregularities.
- Heat stroke:high body temperature, confusion, cessation of sweating.
The consensus on exercise-associated hyponatremia (Hew-Butler et al., 2015) stresses that symptoms may appear even several hours after the finish. Therefore a person with a growing headache and confusion must not be “given water to drink” — a doctor's assessment is needed.
You should also see a doctor with bone pain that intensifies under load, with lingering fatigue over 3–4 weeks or with frequent infections after the race.
Editorial conclusions
A marathon causes significant muscle damage, glycogen depletion and temporary changes in the work of the heart and immune system. Full recovery takes weeks, not days.
In the first hours, a gradual stop, sensible hydration with electrolytes and food with carbohydrates and protein matter. Excessive drinking is dangerous.
The first week is light movement without impact load, sleep and adequate nutrition; the return to usual volume is gradual, over roughly 3–4 weeks.
We also recommend reading our materials on DOMS and ways to reduce it, on the signs of insufficient recovery, and on stress and cortisol in the athlete.
References
- Warhol MJ, Siegel AJ, Evans WJ, Silverman LM. Skeletal muscle injury and repair in marathon runners after competition. Am J Pathol. 1985;118(2):331–339.
- Peake JM, Neubauer O, Della Gatta PA, Nosaka K. Muscle damage and inflammation during recovery from exercise. J Appl Physiol. 2017;122(3):559–570.
- Neilan TG, Januzzi JL, Lee-Lewandrowski E, et al. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation. 2006;114(22):2325–2333.
- Almond CS, Shin AY, Fortescue EB, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005;352(15):1550–1556.
- Hew-Butler T, Rosner MH, Fowkes-Godek S, et al. Statement of the Third International Exercise-Associated Hyponatremia Consensus Development Conference, Carlsbad, California, 2015. Clin J Sport Med. 2015;25(4):303–320.
- Thomas DT, Erdman KA, Burke LM. American College of Sports Medicine joint position statement. Nutrition and athletic performance. Med Sci Sports Exerc. 2016;48(3):543–568.
- Nieman DC, Wentz LM. The compelling link between physical activity and the body's defense system. J Sport Health Sci. 2019;8(3):201–217.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
