Runners cross the finish line of the 2016 New York City Marathon. Experts say take marathon recovery as seriously as training. (AP)

Fall marathon season is here. Thousands of athletes – from the fastest to the back of the pack – train to meet the challenge of running 26.2 miles. If you’re one of them, you probably don’t think beyond crossing that finish line. Maybe you should.

The moments after finishing a marathon can be euphoric. But the hours and days ahead can bring a world of pain: your legs will hurt, and so will your arms. Walking will be difficult; stairs – even curbs – will seem impassable. Your feet – and toenails – will take a beating.

“For some people, especially novice runners, it’s the most sore they’ll ever be in their lives,” said Scott Trappe, director of the human performance lab and professor of human bioenergetics at Ball State University. “Recovery is one of the more underutilized aspects of the runner’s toolbox. You have to take it as seriously as your training.”

Running a marathon is a grueling event, especially for first-timers. The biggest effect is on the muscles. Running depletes them of glycogen – the stored form of glucose – the muscles’ main source of energy. Prolonged pounding of the feet and legs on the pavement, especially downhill running, also causes microscopic tears in the muscles.

Running a marathon stresses the heart, lungs and the body’s thermoregulatory system that controls the body’s internal temperature.

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

We asked sports medicine experts—as well as some seasoned marathoners—to share their tips for a successful recovery:

What’s best for post-race pain relief?

If you need to take something for pain relief, don’t take an NSAID (non-steroidal anti-inflammatory drug), but stick to acetaminophen, which doesn’t affect inflammation, said experts, who believe inflammation promotes healing.

“There is no doubt that NSAIDs interfere with several of the muscle pathways involved in muscle formation, turnover and recovery,” Trappe said. “After a marathon, if the discomfort is considerable, go with acetaminophen over the NSAID.”

“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, while they may provide temporary relief, they come with potential risks, such as gastritis and acute kidney injury.”

What causes post-marathon pain?

For years, the buildup of lactic acid (lactate)—a chemical produced when cells break down carbohydrates—has been blamed for post-marathon muscle burn and soreness. It’s also a myth, experts say.

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

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

Should you take an ice bath or a warm shower?

Some athletes dive into an ice bath following a tough game or other intense competition. But “the emerging consensus is that warm, not cold, is better,” Joyner said. “Whether this speeds recovery at the cellular level or just makes people feel better is an open question.”

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

Amby Burfoot, who won the Boston Marathon in 1968 and is still running at 78, heads straight for the hot tub.

“My body is stiff and sore, and the warm water feels very comforting,” he said. “I’m not going to do anything to stress my leg muscles for the next few weeks, so I don’t have to think about ice and anti-inflammatories and stuff like that.”

Should you run or not run the next day?

The fastest runners often do—their talent, training, and body type allow them to bounce back quickly—but it’s probably not a good idea for the rest of us.

“Elite voters have put in a lot more miles and are also lighter,” Trappe said. What’s more, after they train for hitting, “the overall trauma to them is not as significant,” he said.

“They’re on the trail for less time,” he said. “They’re still beaten, 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. Most runners should take it easy and give their bodies two to four weeks to get back to normal, he added.

He and others recommend light “cross-training” activities in the days following a marathon, such as swimming, walking and light spin cycling.

“Savor your accomplishments and go into a period of active rest, which means modest levels of physical activity and stretching until your leg fracture recovers,” Joyner said.

Burfoot, who has run about 75 marathons (she’s lost count), starts with very gentle incline cycling, spin cycling and elliptical training a few days after the marathon.

“Nothing heavy or high resistance,” he said. “Maybe I’ll walk three to four miles a day the second week, then start running the third week. Back in the day, I wanted 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 layoff.”

Should you get a massage?

Some research suggests that massage helps, while others say the effects are inconclusive.

“It feels good, if not too aggressive, and it 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 out from a scientific perspective.”

Does it take longer to recover as you get older?

“The older you get, the longer it takes” to recover, Trappe said. “We’re getting smarter and tend to respect the process more.”

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

“You can’t run miles and expect to fully recover from both training and running a marathon,” she said. “Don’t have high expectations. Train before and after running a marathon. Don’t think you can carry on high-mileage training weeks forever.”

What should you eat after a marathon?

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

Cheryl Bimler Link, 62, a retired information technology specialist from Dublin, Ohio, said she quickly forgot her post-marathon pain after a friend gave her a blood test in the runners’ tent.

“The tomato juice and salt settled my stomach and made me feel great,” she said. “Or maybe it was the vodka.”

Connie Chan, 70, a retired college professor from Orleans, Mass., who has run 33 marathons, said she eats whatever she wants for days, “including French fries and maybe onion rings.” before returning to a healthy state. diet.

Mary Harada, a retired history teacher from Durham, NH warns against abuse. Decades ago, after her last marathon, she ate an entire frozen cheesecake.

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

How can you deal with post-marathon letdown?

“The post-marathon blues are real,” Trappe said. “You were focused on this big goal and now you don’t have that goal anymore.” He suggests planning ahead for something big soon after, like a vacation, “just to give your mind something else to do.”

Julia Kim, 65, a technology executive in Boston, spends two days “swearing never again,” then signs up for another.

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

“I appreciate that I was able to reach another marathon finish and I’m happy that I still have the ability and strength to complete 26.2 miles,” he said. “And hopefully I can do it again next year.”