I rang in 2017 by attempting the Ultra Trail Tai Mo Shan, a 100-mile ultramarathon through Hong Kong’s Hills. Around mile 60 I suffered food poisoning and battled nausea, dehydration and migraines before DNF’ing (Did Not Finish) at the 86-mile checkpoint. It was only the morning after, as I rehydrated and the headaches passed, that I realized the toll on my legs.
During the back half of the ultra I sprained my left MCL and developed severe inflammation in both IT bands.
Either of these injuries can sideline a runner for several months. In this post I will share my steps* for how I designed a recovery plan and kept myself on track to begin training again within thirty days.
Step 1: Take Stock
Following the race I gently stretched to inventory soreness and range of motion. I massaged each muscle, joint and ligament to gauge pain threshold. I began with my toes and feet and worked up to ankles, calves, knees, quads, glutes and hips.
Even before the inventory it was obvious my feet and legs had taken a beating. Four toenails were blackened or cracked and my left ankle had already ballooned from swelling. Both calves felt like stone (predictably, given the 40+ calf cramps out on the course).
My left knee was the sorest of all – I was unable to extend and contract without severe pain in my MCL (the medial collateral ligament connects the two bones in your knee). My quads felt like bowstrings pulled to their limit with both IT bands throbbing (the iliotibial band connects your knee and hip). Fortunately, my hamstrings, glutes, hips and back were merely tight but without damage.
Taking quick notes in a training log helps establish a baseline and enable closer progress tracking.
Step 2: Timely Triage
Lactic acid deposits can markedly slow recovery. Immediately following the inventory, I took two anti-inflammatory ibuprofens and drank as much water as I could swallow. I then set to work rolling each muscle to clear debris. I started out at an easy pace with gentle pressure but gradually accelerated as the tissue loosened.
It’s best to apply more pressure when you’re pulling the roller toward your core as this aids circulation and clears more residual faster.
My left knee and IT bands were too tender for any significant movement but rolling helped warm up my calves and quads for gentle stretching.
Stretching in the days following a marathon or ultra can damage exhausted or micro-torn muscle tissue. Start slow and use caution to avoid setbacks.
Next, in an effort to salvage four blackened toenails, I lanced blisters under the nail to drain the fluid and relieve pressure (with partial success as only two nails have fallen off in the weeks since). My face, neck and ears were sunburned from overexposure to tropical rays so I applied Aloe vera to reduce the sting.
The path to recovery can feel daunting so small wins provide an outsized mental boost.
Step 3: Sleep Smart
Sleep is our body’s time to rejuvenate and make replenishing repairs. But not all sleep is equally valuable.
Depending on your injury, different sleeping positions can significantly aid (or inhibit) your recovery. I sought to optimize MCL recuperation during sleep. The MCL shortens when your leg is extended while lengthening when bent. Sleeping with a straight leg (and shortened ligament) for several hours would make walking an ordeal the day following.
My solution was to sleep with both legs bent 90 degrees. This kept my MCL elongated and allowed gravity to channel more fluid from the IT bands, two key objectives in my recovery. I targeted seven hours of sleep split between a four- and three-hour block bookended by ice therapy sessions. This arrangement enabled me to reduce swelling while properly recharging each evening.
Sleeping smart accelerates healing so it’s worth devising a winning strategy.
Step 4: Chill Out
The virtues of icing are well documented. I sought to reduce swelling in my ankle, knee and IT bands so went with a steady diet of ice baths. Shortening the treatment interval accelerates results so I began a thrice-daily icing schedule: 8pm, 2am and 6am. By dividing sleep around ice therapy sessions I experienced less knee and ankle stiffness the following morning.
Ice baths are unpleasant (especially early mornings!) but particularly effective at reducing swelling.
Step 5: Drink Up
Research suggests that besides sleep, fluids are your best friend. I aimed to drink twelve glasses of water, three whey protein shakes, and three glasses of fresh vegetable juice each day. My body craved protein and essential vitamins to aid in muscle repair.
Fluids are particularly critical in the first week of recovery so make a hydration schedule and set calendar appointments or phone alarms so we remember to follow it.
Step 6: Chow Down
An optimized diet provides recovery rocket fuel. After the ultra I stocked the pantry with salmon (omega-3 fats for anti-inflammatory effect), almonds (omega-6 fats for building antioxidant capacity), and Brazil nuts (magnesium, zinc, and a jolt of testosterone for faster recovery). To stay on track at work, I packed greens and three salmon fillets for lunch and a full stash of DIY trail mix for snacking.
I’m no Martha Stewart in the kitchen so I prepared a simple stir fry dinner of potatoes (to replenish muscle glycogen), broccoli and cauliflower (to eliminate free radicals while boosting anti-inflammation response), and eggs (which contain the vital amino acid leucine). Add your favorite meat and spices and dinner is served.
Recovery is taxing so your body will crave macronutrients to restock vital supplies. My appetite was ravenous the week following the ultra. Between five daily meals, snacks, and protein shakes I was consuming upwards of 7,000 calories.
The road to recovery starts in the kitchen so plan accordingly.
Step 7: Keep Score
I have a “small things, all things” mentality so aim for 100% consistency in training. I treated my recovery no differently.
For each day I adhered to the full recovery program, I placed a big red X on the wall calendar. The desire to keep building my “winning streak” kept me on track for the 2am ice baths and IT band rolling sessions that stung the most.
Find a fun way to keep score and you’re more likely to follow through, too.
Distance running is enormously rewarding – we have the fortune of finding strength in solitude while exploring nature’s surreal splendor. To continue enjoying this great gift, it’s critical we invest in recovery with the same focused determination we do our weekly mileage.
I am very fortunate to have pushed through rehab and am now back onto ultra training. I’ve qualified for a place at the Hardcore Hundred Miles, a trail ultra in the Philippines with over 37,000 ft. of cumulative elevation gain.
With just three months until the starting gun, I’m working to build my endurance, flexibility, and grit through a customized “Prehab Program” designed to prepare my mind and body for the stresses of the trails of the Philippines.
In the meantime, see you on the trails!
*These seven steps are reflections on what worked for me. I am NOT a doctor, and none of this advice should be taken without first speaking to a qualified medical professional.
About the Author
Greg Nance is the Seattle Seahawks 12Ambassador and works to expand education access as Chairman of Moneythink and CEO of Dyad.com. Learn more at www.gregnance.org and connect on Instagram for daily training tips and ultra stories: Nance.Greg.