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TRANSCRIPT
Recovery from Ultra-
Endurance Competition
Martin D. Hoffman, MD, FACSMProfessor of PM&R, University of California Davis
Chief of PM&R, VA Northern California Health Care System
Founding Member, Ultra Sports Science Foundation
Chief Medical Officer, Ultra Medical Team
Disclosure: The contents presented herewith do not represent the views of the Department of Veterans Affairs or the US Government.
Competing Interests: None
Overview
•Recovery from a 161-km ultramarathon (2015)
•RCTs of massage vs. IPC vs. control
• 161 km ultramarathon (2015)
• 39-103 km ultramarathons (2016)
•Placebo controlled trial of Vit B2 vs. placebo (2016)
•Questions
Time (--)
Plasma [CK] (++)
Age (-)
Time (--)
Plasma [CK] (++)
Time (--)
Plasma [CK] (++)
Female Sex (++)
Longest Training Run/Race (+)
Time x Plasma [CK] (--)
Time x Longest Training Run/Race (--)
Time x Female Sex (-)
Conclusions from WSER Study
of Recovery
•Lower body muscle pain, soreness and fatigue can
return to baseline within ~5-7 days following a 161-km
ultramarathon, but functional recovery requires more
time.
•Recovery time is largely related to post-race plasma
[CK]. A secondary factor includes longest training run
(longer improves rate of functional recovery).
So…..appropriate training is an important method
for enhancing ultramarathon recovery.
Are there interventions that can
enhance the rate of recovery?
*
* *
Conclusions from WSER Study of
massage vs. IPC vs. control
•A single post-race massage and IPC treatment provides
immediate subjective benefit, but no evidence for
extended subjective or functional benefits.
Might daily massage or IPC
following a race be effective at
enhancing ultramarathon recovery?
2016 Tarawara Ultramarathons (TUMs) Study
A randomized controlled trial of manual therapy and pneumatic
compression for recovery from prolonged running – An extended study
Amanda M. Heapya*
, Martin D. Hoffmanb, Heidie H. Verhagen
c, Samuel W.
Thompsona, Pavitra Dhamija
a, Fiona J. Sandford
d and Mary C. Cooper
a
a Department of Health and Sport, Toi Ohomai Institute of Technology, Rotorua, New
Zealand.
b Department of Physical Medicine & Rehabilitation, Department of Veteran Affairs,
Northern California Health Care System, Sacramento, CA and Ultra Sports Science
Foundation.
c Fortebody Reconditioning, Rotorua, New Zealand.
d QE Health, Rotorua, New Zealand.
400 m
Ru
n T
ime (
sec)
Pre
-Rac
e 1
Pre
-Rac
e 2
Post
-Rac
e Day
3
Post
-Rac
e Day
5
Post
-Rac
e Day
7
Post
-Rac
e Day
14
70
80
90
100
110
120
130
MT
IPC
Control
Mu
scle
Pain
an
d
So
ren
ess R
ati
ng
Pre
-Rac
e
Post
-Rac
e
Post
-Rac
e Day
1
Post
-Rac
e Day
2
Post
-Rac
e Day
3
Post
-Rac
e Day
4
Post
-Rac
e Day
5
Post
-Rac
e Day
6
Post
-Rac
e Day
7
Post
-Rac
e Day
14
0
2
4
6
8
10
MT
IPC
Control
Mu
scu
lar
Fati
gu
e S
co
re
Pre
-Rac
e
Post
-Rac
e
Post
-Rac
e Day
1
Post
-Rac
e Day
2
Post
-Rac
e Day
3
Post
-Rac
e Day
4
Post
-Rac
e Day
5
Post
-Rac
e Day
6
Post
-Rac
e Day
7
Post
-Rac
e Day
14
0
20
40
60
80
100
MT
IPC
Control
Conclusions from TUMs Study of
massage vs. IPC vs. control
•Lower body muscle pain, soreness and fatigue, and
400 m run times can return to baseline within ~5
days following 39-103 km ultramarathons.
•Daily post-race massage and IPC provide minimal
immediate subjective benefit, but no evidence for
extended subjective or functional benefits.
Does riboflavin before and during a
161-km ultramarathon control
exercise-related muscle soreness
during the event and improve
functional and subjective recovery?
Conclusions from Placebo Controlled
Trial of Riboflavin vs. Placebo
•Preliminary work suggests that riboflavin
supplementation before and during prolonged
running might reduce muscle pain and
soreness during the exercise, and may
enhance early functional recovery.
Key Points
•Massage and IPC can make you feel a
little better (temporarily), but do not
appear to have extended benefits in this
environment.
•Riboflavin deserves more investigation.
•If you want to recover faster, then be
well trained!
