Part 2b of 2, The Final Kick: What is Happening to me?!?! What happens to your body during a marathon, ultramarthan, ironman, or other ultra distance races of silly proportions.

Here we enter the final stretch to discuss what happens after your race, and how you can best prepare for it. Picking up where we have left off...'ve just displayed a phenomenal kick by sprinting the last 30 seconds (or LESS!!!) of your race. You are hands-on-knees, gasping, and beaming with happiness. You're finally done with your ultra event. 

It's easy to feel a sense of unexpected and overwhelming loss once you have cross the finish line. You've raced for hours, you've trained for months, and you've consumed enough honey-stinger energy gels to be directly responsible for the disappearance of the bees. Now what? How can you possible return to a normal life? What will you post about on Facebook?

Do not despair, ultra-child. Your race isn't truly over yet, or at least the repercussions of it are not. You can count on a few things to occur in the next 24hrs as a direct result of your feat:

1. A notable compromise in immune function. 

Moderate levels of exercise actually helps to boost our immune system. So if a little is good, more is better, right? Isn't that the American way? Unfortunately for ultra distance athletes, this is not the case. Prolonged exercise increases the level of cortisol and other stress hormones, which compromises our immune system. Risk of acquiring a cold, virus, or other illness decreases with moderate exercise, but begins to rise linearly with increasing intensity and duration (demonstrated below). 

On a personal note, I have literally started a race feeling well and finished knowing I have a cold. It's uncanny. Past a certain level of exercise my body just gives me the big

 Leah's immune system after races that are 3-4hrs or longer.

Leah's immune system after races that are 3-4hrs or longer.

An abundance of evidence suggests that consuming carbohydrate (glucose) during exercise may attenuate immunosuppression. Research also suggests that a diet that is rich in antioxidants (vitamin C, for example) may also help avoid illness. Put more simply- reduce your chances of getting sick by eating enough carbs during your race and by including plenty of produce in your regular diet. Consider looking into an antioxidant supplement if getting sick post ultra racing is a problem for you.

 A simple summary of the above paragraph. 

A simple summary of the above paragraph. 

Should this dissuade you from pulling the trigger on your next Ironman? No way. Just be aware that your body's defenses will be low during periods of heavy training and/or after your race. Be that guy- wash your hands 20+ times per day, wear a mask to work when your co-workers start to sniffle, refuse to share a drink with anyone, and get a ton of sleep. Your immune system may be compromised, but that doesn't mean you have to get sick after a race. 

2. Post exercise increase in oxygen consumption, AKA the afterburn.

Your body likes homeostasis, or more simply, your body likes consistency. Remember all of that glucose you used during your race, and all of the oxygen your body required in order to exchange it? Once your event is over, your body will begin its own race to replenish fuel stores, normalize hormone levels, and repair damaged tissue. This will of course require more energy. Even if you spend the next 24hrs in the horizontal position, your body will be using its fat stores like crazy. Did you eat dinner 45min ago but you are sure that you just felt your stomach rumble? Is run-ger real?

 "Are you gonna eat that?"

"Are you gonna eat that?"

Oh yeah. Run-ger is real, folk. 

3. Delayed onset muscle soreness, AKA, THE DREADED DOMS!!!

Some of you may be wondering...what do you mean delayed onset muscle soreness? I'm sore as soon as I cross the finish line! That, my friend, is acute onset muscle soreness and describes discomfort which is felt immediately after exercise. It is attribute to muscle fatigue, an increased concentration of hydrogen ions in the muscle tissue, and tissue swelling due to increased blood flow through the muscle. Notice that I didn't say "an increase in lactic acid in the muscle". Lactic acid itself does not cause muscle soreness. In fact, lactic acid can actually be exchanged and used as fuel for muscle contraction. Hydrogen ions as a biproduct of our metabolism, NOT lactic acid, makes us sore. 

Typically acute onset muscle soreness dissipates in a few minutes or hours. If you have raced an ultra distance, you can bet that it will be replaced by delayed onset muscle soreness or DOMS at some point. 

DOMS type soreness and pain starts to peak around 24-72hrs after a strenuous effort. DOMS is what makes you so comical to watch as you try to go down a flight of stairs the day after a 50k. What causes DOMS? To answer that, let me first describe how muscles contract. Muscles can contract in three different ways:

1. Isometrically. This is when a muscle is doing work, but the length of the muscle is not changing. Imagine pushing against a really solid wall. Your muscles are certainly working, but nothing is changing length. That's an isometric contraction. 

2. Concentrically. This is how we typically think of a muscle working. If you do a bicep curl, your biceps are working as they shorten to lift the weight. That's a concentric contraction. 

3. Eccentrically. This is the Mac Daddy of the contraction types. Eccentric contraction is how a muscle does work but gets longer at the same time. Imaging that I suddenly drop a very heavy box into your arms. You are trying with all of your might to keep the box lifted, but you are slowly and steadily losing. The box is dropping inch-by-inch but you are doing your darndest to keep it from falling. Your biceps are likely working like crazy, but they are getting longer and longer. This is an eccentric contraction. 

Eccentric contractions literally rip our muscle fibers apart from each other on a microscopic level. Eccentric workouts make us the most sore, but they also have the potential to make us the strongest if we do them deliberately and rest appropriately afterwards. 

So which kind of contraction is the most responsible for DOMS? You got it- eccentric contraction. Have you ever wondered why continuous downhill running (think St. George Marathon) makes your quads feel like a quivery bowl of jello? It's because your quads have been contracting eccentrically for miles, making sure that your knees don't buckle as you charge downhill. 

So is your race truly over? I say no. Not until you battle through the impending cold, insatiable run-gers, and awkward use of the towel holder to sit on the toilet. You aren't done, not yet. 


There is one more rare but significant consequence of ultra distance racing that needs to be discussed. Hypertrophy is a fancy word for "muscles getting bigger and stronger". Muscles hypertrophy when you challenge them regularly and the heart, being one big muscle, is no different. The heart beats faster and stronger during exercise. If you adopt an active lifestyle and workout regularly, your heart will hypertrophy just like any other muscle. This occurs especially in the muscular walls of the left ventricle, which is the chamber of the heart that pushes oxygenated blood to the rest of the body. Left ventricular hypertrophy (LVH) can be beneficial for endurance athletes because a single heart beat will circulate more oxygenated blood compared to our sedentary peers...and we need that oxygen!

So LVH is a good thing, right? Usually, but not always. Sometimes the muscular walls of the left ventricle can enlarge so much that the inside of the heart chamber actually becomes smaller. The left ventricle will be very strong, but the amount of blood that can enter and exit it is reduced. In this case the normally beneficial enlargement of the left ventricle can mimic hypertrophic cardiomyopathy (HCM). HCM disrupts the normal function and well being of the heart. It is also the most common cause of sudden cardiac death in athletes below the age of 35yrs old.

Obviously, this is where things get serious. There is no substantial evidence to suggest that exercise itself, even of silly proportions, is innately deleterious to our heart. However if you have a known cardiac issue (such as an arrhythmia, dizziness, family history, palpitations, etc) it is a very, very, VERY good idea that you see a cardiologist on the regular. Am I saying that you should think twice before you sign up for your next 50k? No, not at all. Chances are, you will be fine. But if you have any concerns or warning signs, why wouldn't you check in first? 

On only a slight side note...did you know that a yearly wellness exam is FREE with every health insurance plan? Every one. There is absolutely no reason that you shouldn't see a doctor once a year. Just in case, just because. 

So, seekers of knowledge! This concludes a very long, but hopefully informative series on what happens to your body during a marathon, ultramarthan, ironman, or other ultra distance races of silly proportions. 

Stay tuned for more by joining the mailing list and, as always, feel free to share this post. 


Your Friendly Neighborhood Physical Therapist