It's been just hours since thousands of runners crossed the finish line at the New York City Marathon, and for many of those people, the experience most likely ranks up there as one of the most exhilarating of their lives.
But, what happens with that natural high wears off? In most cases, pain and soreness set in.
"Most people have pain everywhere," said Dr. Kevin Eerkes, who works in Primary Care Sports Medicine at New York University School of Medicine. "You figure, there roughly 1,000 steps every mile and you ran 26 miles, so that's a lot of wear and tear."
A lot of wear and tear on the muscles may lead to a condition known delayed-onset muscle soreness or DOMS. It's caused by microscopic damage to muscle fibers and the surrounding connective tissue. It usually starts to set in eight to 12 hours after activity and can last several days depending on the severity, according to Eerkes.
Other prevalent marathon-related injuries include shin splints, and post-race knee pain, often called "runner's knee."
"In the immediate time frame, rest from running," said Eerkes. "Stay away from activities that aggravate the pain like stairs and let yourself have plenty of sleep, you're going to be really tired."
Nutrition and hydration are also key factors, he said.
"It's important in the first 24 hours to replenish the fluids you lost during the race," said Eerkes. "You also want to make sure you start eating as soon as you're able to. The diet should be balanced with plenty of carbs and protein."
This is not the time to count calories. Runners need carbohydrates because they've depleted their glycogen stores and protein because it helps rebuild muscles that have been damaged. Depending on the size of a person — 2,500 calories a day is recommended.
After pounding the pavement for 26.2 miles, eating, drinking and sitting on the couch probably sounds like heaven. While resting tired limbs, it's a good idea to take a trip to the nearest drug store, said Dr. Sean McCance, co-director of spinal surgery at Mount Sinai Hospital.
"We recommend taking over-the-counter anti-inflammatory medications on a regular basis for up to two weeks," said McCance.
He said runners with pre-existing stomach conditions should check with their doctors before taking pain relieving and anti-inflammatory medications, such as ibuprofen or aspirin.
If post-race pain persists, it might be time to take a trip to the doctor's office, said McCance.
"If it's an ongoing chronic issue, see a specialist to get a proper diagnosis," he said. "We always recommend physical therapy so they can come up with a work out regimen that's going to be best."
Getting Back on Track
For, people counting the days to their next marathon, jumping back into a rigorous training regimen may not be the best idea, at least in the immediate future.
"Take a break from running and opt for something that's going to be less stressful on your body," said McCance. "Mix up your workout, spend time doing weight-training, abdominal exercises, reflex training and swimming which is non-impact."
There's no firm guideline — but it's often suggested that the average person should only run two marathons per year. If that next one for you is running up Heartbreak Hill at the Boston Marathon in April, McCance offered this advice.
1. During the training period, maintain proper nutrition. If you don't maintain a proper diet your muscles get more stressed.
2. Get enough sleep.
3. Make sure you stretch properly before every work out. Take the time to warm up with light aerobics.
4. Cross-train. Don't do the same thing five days a week.
5. If you feel an injury coming on, take a break from running and focus on low-impact exercises.
"Not everyone is designed to run a marathon," said McCance. "For example, if someone is normally running five miles, three times a week, then ramping up to 15 miles three times a week, that's when people push their barrier and the weak link of their body starts to yelp."