Ultra running is a sport with relatively little information available about it to the beginner, or indeed the expert practitioner. This will change as the sport grows, but for now very little is understood about it. There is even less known and spoken about the recovery from long (100 ish mile plus) races. This stretches to the medical profession too.
The reason I thought this was worth a mention is that I am in the recovery phase of my first long ultra and so this is all new and in some ways eye-opening. For those also about to do their first longer race it may be of interest too.
Now, let me start by saying that I am new to this and I have only been running consistently for 20 months or so. I am sure that over several years, one can recover quicker than this. I am also over 40 and large (by distance running standards) at about 12 stone. Recovery is a very personal thing and will differ between us all and at different times of life and levels of fitness. Nonetheless there are some things which are also common to us all.
The Double Cateran 110 was my ‘A’ race of the year. I prepared pretty well, and I ran pretty well, but I had no goals beyond it. A few small events that fit in with other stuff but nothing major. I had roughly planned a month of low level activity to recover, but essentially I left a big void, with nothing more than the thought of preparing for the West Highland Way Race 2015 as a motivating factor.
So, best I go back to the Spittal of Glenshee Hotel at about 7pm on 17 May. I finished and after pinching myself to wake me from the dream, I tried to sip a Lime and Soda (not the malt I had envisaged pre-race) and immediately felt nauseous and went outside to vomit. I then limped, shivering to the shower and after peeling off my clothing (not changed since race start), I endured a cold shower, the shivering now becoming uncontrollable. I knew that with plenty of warm clothes and some food I would be fine so wrapped up in a down gillet, compression tights, woolly hat, etc and hobbled to the bar for the prize giving. I managed a bowl of lentil soup and a soft drink but little more. I couldn’t face standing for very long and couldn’t really focus enough to hold a conversation, so I got horizontal and listened to everyone else. I was pretty done in. Every bit of my body was in pain. During the race I had experienced a sharp pain in my right shin (in the muscle) during the last 30 miles of and I had a painful pulled deltoid sustained when I arrested a fall just before half way. Everything else just hurt as much as I expect it should do after running for 25 hours. I had pushed hard and didn’t really have anything left.
The next day I woke to find my right calf swollen, run, hot and painful to the touch. Various anecdotal tales of Cellulitis, DVT, stress fractures and more were enough to warrant a visit to A and E, so after breaking camp we headed for Perth Royal Infirmary. Coincidentally, St Johnstone FC had won their first trophy in their history so the whole town was out to celebrate along with pipe bands, so there was a bit of a carnival atmosphere. I parked the car and limped (I could barely put any weight on the leg) to A and E. The triage nurse mistakenly put ‘run for 25 miles’ on my form, which I corrected to 25 hours, and I started a 3 hour wait to be seen.
The junior doctor had clearly never seen anything like it and quickly called the orthopaedic surgeon, who had also clearly no idea and she called the consultant who it seems was also not too sure and admitted me in case it was Compartment Syndrome. Luckily I had lots of kit in the car and embarked on my first ever stay in hospital since I was a few days old. I shared a Ward with some delightful old chaps aged from 80-98, so I was something of a youthful novelty. Lucy grabbed my kit and took an obligatory hospital-bed-with-trophy photo and left me with my new companions. I hadn’t planned on this bit.
My leg was iced (well sort of cooled) from time to time and elevated. In the morning I was given crutches andI showed the physio the prowess gained from hobbling around on them at Lympstone years ago. You don’t lose these skills and I set about racing an alarmed physio back to the Ward. The consultant did his rounds and I decided I was ready for discharge, arguing my case strongly. With an 11 hour drive back to work, he told me that if I drove in that condition, I could reasonably expect an emergency fasciotomy (slicing open the length of the muscle sheath, leaving it open before grafting skin back on from the thigh) on arrival. It’s not often I listen to advice, but he sold that one it to me.
So it was more RICE, and an X-Ray which showed evidence of previous stress fractures that had healed during training but no current fracture. Although I’d need another X-Ray at a later date to fully determine that.
Interestingly, given the other possibilities there was no form of scan (too expensive?), and no bloods taken. The next day I was released on the proviso that I didn’t drive for more than 2 hours without elevating it. The swelling had reduced and I was keeping theweight off it. Before leaving hospital both the Consultant and the Senior Physio gave me some shit advice; ‘Stop running long distances’. Typical medical advice which fits the masses. For most people it gives a handy excuse to not run and become obese. Stop doing it and you won’t have a problem. Well I can stop driving and then I won’t get killed in a car crash, but it kind of misses the point! I gave a wry smile and thought “f**k you’ as I plotted future WHWR, L100, SDW100, UTMB, Hardrock, etc!. Like so many things, the answer isn’t to give up when you reach a hurdle, but to work out a way round or over it.
I did no more exercise that week. I wasn’t inclined and my leg was painful. I saw the doctor at work who booked another X-Ray and declared me fit to fly (DVT?) but not fit to go to sea. The next week I started swimming and cycling although nice and steady. I also saw my Sports Therapist as the standard medical channels seemed intent on the standard approach. This is something like:
‘Rest and take anti-inflammatories until we get you an X-Ray (note; one scan at a time to minimise cost, rather than covering every base). During the wait the supporting muscles waste away but the pain cessates. We will pin the blame on whatever activity you were doing and the diagnosis will be the first fault we can find.’ Thus the cause is never found and your body becomes weaker and more susceptible to further injury.
So the Sports Therapist looked at me and instantly saw my back alignment was out (it often is when I have an injury elsewhere), and they set to work. After some manipulation the pain in my calf had eased and so they continued and it eased more. They said I could and should run if there was no pain, but take it easy as I wouldn’t have fully recovered from the stress of the race.
I did a short easy 3 miler and no pain. Possibly too soon I did a hard 10 miler which saw me tail off in the last 2 miles but generally felt ok. And so running re-commenced, at nothing more than ultra pace or on consecutive days, interspersed with swimming, running, stretching, core and light strength work.
The legs felt sluggish and still do 3 and a half weeks later. I think the muscle damage is repaired, but I don’tfeel too perky either. From what I’ve read this is because long after the muscle has repaired the Endocrine System is still laid low. I too thought that this was a Star Wars reference to the location of the rebel base. But no, it appears that it is the control of all our hormones which I now know play a big part in ultra distance running. By not resetting the system we are setting ourselves up for a big physical collapse. I will soon test the body out at the ‘Dirty Thirty’, but not pushing hard, just to see how far along the road to recovery I am.
It does strike me that ultra runners use the length (or shortness) of their recovery as a badge of honour. You often hear people throwing in intervals a few days after an ultra. I think this is folly and will do more harm than good. I am in awe of Ian Sharman and his ilk, completing the US ‘Grand Slam’ of 3 x 100 milers in 3 months. It must be at the limit of human restorative powers. Maybe the inability to recover completely is what limits many ultra runners performances and prevents them improving year on year?
I have found it hard to watch others training and racing while I am taking things easy but I keep focussed by looking back at the success of my 2 big ultras this year as well as planning my goals for next year. I have set an ambitious WHWR target and I know I need to play the long game if I want to achieve that. The big lessonduring this period has been to minimise recovery time. I am paying more attention to diet, eating lots of greens and beans and lean protein. I am also trying hard to build more sleep into my recovery. I think recovery will play a big part in my plans for next year. Maybe as athletes we should refer to recovery periods as growth periods? Surely it is how we recover to train hard again that will ensure we keep improving?
