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HOW THE BODY RECOVERS FROM AN ULTRAMARATHONNew study reveals keys to recovery after long-distance endurance runs

Newswise — SACRAMENTO, CALIF. — Ultramarathon runners can expect an approximate five-to-seven-day subjective recovery post race, according to research presented this week at the Association of Academic Physiatrists Annual Meeting in Sacramento, Calif. The study also looked at factors that affect physical recovery and a runner’s ability to return to full running speed after participation in an ultramarathon.

Ultramarathons – footraces longer than the traditional 26.2-mile marathon – have grown in popularity, with some people participating in multiple races each year. These races most often take place on tracks, roads and trails with terrains and environmental conditions that challenge even the most seasoned runners.

“The exponential increase in the number of people running multiple ultramarathons each year, combined with the physical stress each race places on a runner’s body, has made it important to understand the factors that enhance recovery,” explains Joseph Chin, a second year medical student at SUNY Upstate Medical University. Chin served as a summer extern at the VA Northern California Healthcare System and member of the research team under the mentorship of the Principal Investigator, Martin Hoffman, MD; chief of PM&R at VA Northern California Health Care System and professor of PM&R at the University of California Davis. The team studied 72 participants in the 2015 Western States Endurance Run – a 100-mile trail race through the Sierra Nevada mountains of Northern California where runners climb 18,000 feet and descend 23,000 feet.

The team first established each participant’s baseline function with two separate 400-meter runs in the 21 days prior to the race, and this was repeated at days three and five after the race. The researchers also assessed subjective measures by participant’s lower body muscle pain – on a scale of zero (no pain) to 10 (unbearable pain) – and fatigue at race registration, immediately after the race, and each morning for the seven days immediately following the race. Finally, at completion of the race, the researchers collected blood samples from participants to determine plasma creatine kinase concentrations of each runner, which measures muscle damage.

While assessing the outcomes of these tests, the researchers also took into account other factors that might affect a person’s recovery. “Ultramarathons are challenging runs, and we expected a number of factors to affect recovery,” says Chin.



“In this study, we looked at those factors that seem to be the most important and most easily obtained; these included age, sex, race finish time, number of years of regular running, number of years running ultramarathons, number of 100-mile marathons completed, number of 100-mile ultramarathons started, average weekly running distance, highest week running distance, and longest training run or race during the three months prior to the Western States Endurance Run.”

Instead of the typical 24 to 72 hours it takes to recover from exercise-associated muscle pain and soreness, the participants required an average of five days to recover. This – according to Mr. Chin – is to be expected from such a physically demanding sport. However, despite recovery from pain and fatigue, speed does not return to baseline within that time frame.

The researchers noted that older runners reported slightly less muscle pain and soreness. Also, higher levels of post-race plasma creatine kinase concentrations were correlated with higher muscle pain and soreness ratings. However, Chin notes the muscle pain, soreness, fatigue, and change in run times are not good indicators of severe muscle injury (called rhabdomyolysis), and blood tests are best to capture this information.

“This study sheds light on the factors that impact a person’s physical and functional recovery from running an ultramarathon. As athletes continue to push the boundaries of strength and endurance, it becomes more important to study the effects of these activities as well as measures that could aid in recovery,” says Chin. “As a next step in this research, Dr. Hoffman will compare pneumatic compression with massage at another ultramarathon in New Zealand. The subjective and functional measures collected at this race will be used to study another recovery method at the 2016 Western States Endurance Run.


The Association of Academic Physiatrists (AAP) is the only academic association dedicated to the specialty of physiatry in the world. AAP is an organization of leading physicians, researchers, in-training physiatrists, and others involved or interested in mentorship, leadership, and discovery in physiatry. AAP holds an Annual Meeting, produces a leading medical journal in rehabilitation, AJPM&R, and leads a variety of programs and activities that support and enhance academic physiatry. To learn more about the Association and the field of physiatry, visit our site at and follow us on Twitter using @AAPhysiatrists. To learn more about the 2016 AAP Annual Meeting, visit

AbstractDeterminants of Recovery from a 161-km UltramarathonJoseph Chin, BS; Natalie Badowski, MD; Kristin Stuempfle, PhD; Carol Parise, PhD; Martin D. Hoffman, MDObjectives: This study examined short-term recovery from a 161-km ultramarathon through functional and subjective measures, and explored which factors determined the rate of recovery.Design: Participants of the 2015 161-km Western States Endurance Run completed two 400 m runs at maximum speed during the 21 days before the race and on days 3 and 5 after the race, underwent a blood draw for plasma creatine kinase (CK) concentration post-race, and provided lower body muscle pain and soreness ratings (10-point scale) and overall muscular fatigue scores before the race, immediately after the race and for the subsequent 7 days.Results: Among the 72 race finishers completing the study, 400 m run times were 26.3% slower (p=0.001) at day 3 and 12.4% slower (p=0.01) at day 5 compared with pre-race times. Muscle pain and soreness ratings and muscular fatigue scores had statistically returned to pre-race levels by 5 days post-race. Lower body muscle pain and soreness across the recovery period was modeled by time (decreased by 1.1 points each day), post-race plasma CK concentration (0.8 and 1.5 points higher for CK value of 10,001-27,999 and ≥28,000 U/L compared with ≤10,000 U/L, respectively), and age (0.4 points lower for each decade of aging).Conclusions: Post-race plasma CK and age are the main determinants of resolution of lower body muscle pain and soreness following an ultramarathon. Appropriate training would be recommended to attenuate muscle damage and optimize ultramarathon recovery.

Meeting Link: AAP Annual Meeting, Feb-2016

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AAP Annual Meeting, Feb-2016; American Journal of Physical Medicine & Rehabilitation, Feb-2016