It is Marathon training season; at least here in New York City. Over 50,000 people are training for the New York City marathon that will take place on November 6 this year, and I am one of them! My name is Christina Ramirez, and I have been a recreational runner for about 3 years now, completing my first half marathon in the Fall of 2014. I have also been a physical therapist for a little over 3 years now, and I feel, being a runner, helps me empathize better with my patients and their experiences. I am very excited about my plans to complete my first marathon this Fall, and I hope my journey can help educate and encourage others to achieve their physical goals in a healthy and safe way.
I started my training for the New York City marathon in July; so, shame on me, I should have started sooner, and I am probably in the same boat as a lot of procrastinating athletes training up to the last minute. I have not been following any one official training regimen put out by the New York Road Runners or any other running organization or guru since I put off my training for so long; but, I do recommend, if you are running your first long distance race, do research on running schedules and strengthening exercises recommended for running athletes (some good resources are halhigdon.com, runnersworld.com, and nyrr.org). Counting down the weeks I had until the race in July, I did the math and decided I needed to increase my max distance by 3 miles every other week, in order to achieve my goal of training up to 21 miles before the marathon. Since I am increasing my mileage so quickly, I have experienced the pain of over-used muscles and delayed onset muscle soreness. I have also experienced some close calls with injuries which I was thankfully able to treat myself with my physical therapy knowledge. If you are planning on running a long distance race, it is a good idea to research physical therapy practices in your area, and even schedule an evaluation so you can get a baseline measurement of your strengths and weaknesses and learn a home exercise program to prevent injuries while you are training. If, God-forbid, you are injured, then you will already know a therapist, and can begin treatment to get you back to recreational activity quickly.
One of the treatments I have found to be most successful for sore muscles, aches, and shooting pain is foam rolling. Foam rolling is a type of self-myofascial release/massage that can help to return athletes to their desired activity quicker and prevent injury. In a study by MacDonald et. al, the authors show that foam rolling after exercise helps to reduce muscle soreness and improve passive and active ROM in the lower extremity when compared to exercising without foam rolling afterward. The authors also claim that foam rolling and connective tissue recovery may be correlated, as seen indirectly in this study. The authors hypothesize that foam rolling evokes these positive responses by increasing blood flow to exercise damaged tissues, increasing mitochondrial biogenesis, decreasing cellular stress and inflammation, and decreasing creatine kinase levels which allows influx of neutrophils to damaged tissues. In layman’s terms: exercise (especially intense exercise) can cause muscle and connective tissue damage; this causes the body to respond by sending many white blood cells to the damaged region to try and heal the tissue. The body often sends too many white blood cells which causes swelling and inflammation and decreases the ability of red blood cells to flow to the region. Foam rolling helps to push the excess swelling out of the region and back into the circulatory system which then allows red blood cells to return to the region, bringing oxygen needed for healing. Foam rolling also helps to push extra ions that have been stuck in the region along with the swelling and inflammation out the muscle tissue which helps with soreness.
Another article that focuses on the benefits of foam rolling is Pearcey et al. In this article, the authors show that foam rolling is beneficial, specifically for reducing delayed onset muscle soreness (DOMS for short). The authors hypothesize that DOMS is a manifestation of damage to muscle fibers, change in metabolic homeostasis, altered joint mechanics and muscle function which can negatively affect athletic performance. After putting the subjects through a DOMS-inducing exercise protocol and comparing the non-foam rolling group to the foam-rolling after exercise group, the authors found that foam rolling after exercise significantly lowered the pain threshold (muscle soreness) for the subjects’ quadriceps at 24 hours and 48 hours post exercise, but not significantly for 72 hours post exercise.
I make sure to foam roll after every running session for 3-5 minutes over each muscle group (quadriceps, hamstrings, iliotibial bands, calves, and gluteals). When I foam rolling any muscle group I make sure to rotate my hips side to side, if I am on my stomach/back, or front and back if I am on my side to massage the targeted muscle group and surrounding muscle groups. While foam rolling over an especially tender area, I shorten the length of my rolls, and may even just lay still over a painful knot to decrease my pain and allow for better tolerance of foam rolling. If you have tried foam rolling and still feel pain that will not subside with running, I would suggest meeting with a physical therapist to create a personalized plan of care and better evaluate and treat your pain so you may return to running.
I will continue to share my triumphs and obstacles that I encounter while continuing to train for the NYC Marathon. I will also continue to write about treatment techniques I find helpful for while you’re training for a big race, or just running to stay in shape. Remember to exercise in safe and healthy ways and if you can’t treat it yourself, go see a physical therapist!
- MacDonald, G. Z., Button, D. C., Drinkwater, E. J., & Behm, D. G. (2014). Foam rolling as a recovery tool after an intense bout of physical activity.Med Sci Sports Exerc, 46(1), 131-142.
- Pearcey, G. E., Bradbury-Squires, D. J., Kawamoto, J. E., Drinkwater, E. J., Behm, D. G., & Button, D. C. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of athletic training, 50(1), 5-13.