Runners cross the finish line of the 2016 New York City Marathon. Experts say that rest during marathon runs should be taken as seriously as training. (AP)

Fall marathon season is here. Thousands of athletes, from the fastest to the lowest ranked, are training to take on the challenge of running 26.2 miles. If you’re among them, you’re probably not thinking beyond crossing the finish line. Maybe you should.

The moments after finishing the marathon can be euphoric. But the following hours and days can bring a world of pain: Your legs and arms will ache. Walking will be difficult; stairs – even street sidewalks – will seem impenetrable. Your feet and toenails will take a beating.

“For some people, especially novice runners, this is the most painful thing they can ever feel in their lives,” said Scott Trappe, professor of human bioenergetics and director of the human performance laboratory at Ball State University. “Recovery is one of the least used aspects of a runner’s toolbox. You need to take this as seriously as your training.

Running a marathon is a challenging event, especially for first-time runners. The biggest effect is on the muscles. Running depletes glycogen (the stored form of glucose), which is the main energy source for muscles. Long-term hitting of the legs and feet on the pavement, especially running downhill, also causes microscopic muscle tears.

Running a marathon challenges the heart, lungs, and thermoregulation system, which controls the body’s internal temperature.

“The peak function of all of these systems is reduced for hours and at least for several days after running a marathon,” said Michael J. Joyner, MD, a physiologist and anesthesiologist at the Mayo Clinic in Rochester, Minn.

We asked sports medicine experts and several experienced marathoners to share their tips for a successful recovery:

What’s the best thing to relieve pain after a race?

If you need to take something to relieve pain, do not take an NSAID (non-steroidal anti-inflammatory). But experts who believe that inflammation promotes healing prefer acetaminophen, which does not affect inflammation.

“There is no doubt that NSAIDs interfere with some of the muscle pathways involved in muscle formation, regeneration and recovery,” Trappe said. “After a marathon, if discomfort is severe, use acetaminophen instead of NSAIDs.”

“NSAIDs can interfere with the natural healing process,” said John L. Ferrell III, director of sports medicine at Regenerative Orthopedic Sports Medicine, which has several locations in the Washington area. “Also, although they may provide temporary relief, they also come with potential risks such as gastritis and acute kidney injury.”

What causes post-marathon pain?

For years, post-marathon muscle burn and soreness have been blamed on the accumulation of lactic acid (lactate), a chemical produced when cells break down carbohydrates. Experts say this is also a myth.

“What you feel in your muscles is the result of impact, microtrauma and energy depletion,” Trappe said. “Lactate is not as bad a molecule as everyone thinks. Lactate production is actually relatively low from running marathons.”

Ferrell said lactic acid “probably plays a role in pain, but its role has been exaggerated.”

Should you take an ice bath or a warm shower?

Some athletes fall into a tub of ice after a tough match or other intense competition. But “the consensus that has emerged is that warmth is better, not cold,” Joyner said. “Whether this accelerates healing at the cellular level or simply helps people feel better is an open question.”

Ferrell said he recommends starting with heat “because it increases blood flow.” “You don’t want to suppress inflammation right away, but you can use ice for a few days after the healing process begins.”

Amby Burfoot, who won the 1968 Boston Marathon and is still running at the age of 78, heads straight for the jacuzzi.

“My body is stiff and sore, the hot water feels very soothing,” he said. “I won’t be doing anything that will strain my leg muscles for the next few weeks, so I don’t have to think about ice and anti-inflammatories and that kind of thing.”

Should you run or not run the next day?

The fastest runners do this often; Their abilities, training, and body types allow them to recover quickly, but that’s probably not a good idea for the rest of us.

“Elite runners have covered a lot more miles and are also lighter,” Trappe said. Moreover, since they are trained to hit, “the general trauma is not that important to them,” he said.

“They’re not on the course for less time,” he said. “They still get beat up, but not as much compared to a four-hour recreational runner. “The recovery profile is definitely different.”

Don’t underestimate the healing power of rest. He added that most runners should take it easy and wait two to four weeks for their bodies to return to normal.

He and others recommend gentle “cross-training” activities such as swimming, walking and easy-turn cycling in the days after a marathon.

“Enjoy your success and continue with an active recovery period, which means moderate physical activity and stretching until movement in your legs returns,” Joyner said.

Burfoot, who has run about 75 marathons (he’s lost count), starts a few days after the marathon with very easy recumbent cycling, spin cycling, and elliptical exercises.

“There’s nothing hard or high-resistance,” he said. “Maybe in my second week I’ll walk three to four miles a day, then start running the third week. I used to want to get back to training as soon as possible to prepare for the next starting line. Now my first thought is: ‘I can’t wait to start my two-week leave.’”

Should you get a massage?

While some studies suggest that massage helps, others say its effects are uncertain.

“Even though it’s not too aggressive, it feels good and can be a nice reward to enjoy, and it definitely has a placebo effect,” Trappe said. “It may be beneficial, but the verdict is still not clear from a scientific perspective.”

Does it take longer to heal as you get older?

“The older you get, the longer it takes to heal,” Trappe said. “We also become smarter and tend to have more respect for the process.”

Joan Benoit Samuelson, 67, won the first women’s Olympic marathon in 1984 and ran the Tokyo Marathon in March.

“You can’t expect to fully recover by running for miles while preparing for and running a marathon,” he said. “Don’t keep your expectations high. Cross-train before and after running a marathon. “Don’t think you can keep up the high-mileage training weeks forever.”

What should you eat after the marathon?

Replenish your exhausted muscles with calories and fluids for the first 72 hours. Trappe recommends healthy foods like complex carbohydrates like fruits and vegetables and foods low in saturated fat, but understands that not everyone will do this because “you want to reward yourself and go out for pizza and shakes.”

Cheryl Bimler Link, 62, a retired health information technology specialist from Dublin, Ohio, said she quickly forgot about her post-marathon soreness after a friend gave her a Bloody Mary in the runners’ tent.

“Tomato juice and salt soothed my stomach and made me feel great,” she said. “Or maybe it was vodka.”

Connie Chan, 70, a retired college professor from Orleans, Massachusetts, who has run 33 marathons, said she ate whatever she wanted for several days, “including fries and maybe onion ring sandwiches,” before returning to a healthy lifestyle. diet.

Mary Harada, a retired history professor from Durham, N.H., warns against binge drinking. Years ago, he ate an entire frozen cheesecake after his last marathon.

“It was the stupidest thing I’ve ever done after a marathon,” he said.

How can you deal with post-marathon disappointment?

“Post-marathon blues are real,” Trappe said. “You focused on this big goal and you no longer have that goal.” He suggests planning ahead for something big like a vacation soon, “just to give your mind something else to do.”

Julia Kim, 65, a technology executive from Boston, spends two days “cursing: never again” and then signs up for another day.

Burfoot said he feels grateful after every marathon these days, never sad.

“I am grateful that I was able to reach another marathon finish, and I am grateful that I still have the fitness and strength to cover 26.2 miles,” he said. “And I hope I can do it again next year.”