It's the day after the marathon. You get out of bed feeling like you should have gotten the license plate of the truck that just ran over you. You find you can walk small steps but notice you can go upstairs but downstairs is nearly impossible. You take a shower, stretch, eat at least your weight in breakfast and then realize you need to call in sick to work. There is no way you can work today. It just hurts too badly. Your bed is calling but you know if you crawl back under the covers, tomorrow will be worse.

Does this sound familiar? I think every runner who races has felt this pain I'm describing at one time or another. It could be after a marathon, a PR in the 5K or just an extra hard track workout. Why is this? What did you do wrong? How could you have done differently so this post-race soreness wasn't so acute? Or is this the price you pay for a fast time?

Let's explore delayed onset muscle soreness.

Delayed onset muscle soreness (DOMS) was always thought to be caused by the build up of lactic acid in the muscles. This theory has been debunked for years after multiple muscle biopsy studies. The most popular theory is that DOMS is the result of muscle tissue breakdown caused by microscopic tearing precipitated by activity that is either more intense or more prolonged than normal. The pain associated with this injury is most likely due to inflammation which is why the pain usually is delayed at least several hours after the acute damage and can last for several days.

So, what can we do about this pain? Can we prevent it? Can we make it go away faster? Or do we just have to suck it up and endure it as a side-effect of our never ending pursuit of faster and longer training and racing intensity.

Reality: No method has been shown to scientifically and significantly speed the recovery from DOMS BUT there is some empirical data that a few things do help us endure it.

Let's look a little closer at some common treatments:

1. Gentle running or walking. Most marathon runners will tell you that if you stay in bed the next day it will get worse. That stiff and sore feeling will take forever to go away! Take a 30 minute walk or a gentle run. It seems to help, but no studies have been done that I can find that show that this

2. Massage. I love massage. In fact, I think that endurance athletes that get a regular massage perform better. What does the science show? Massage has been shown to temper the pain and swelling associated with DOMS, but it does not help you recover faster.

3. Ice. I love an ice bath after a marathon! (yes, I accept that I am crazy) Again, lots and lots of marathon runners will agree with me that ice has been shown to help with pain and swelling but unfortunately science says no real effect on the muscle function.

4. Gentle stretching makes you feel better, but does not help with faster recovery in recent studies. There are even some people that will say that stretching makes the muscle injury worse. I disagree, but the jury is still out.

5. Vitamin C. We know that vitamin C plays a role in repairing connective tissue and there are some reports that suggest that antioxidant supplementation can attenuate the effects of delayed onset muscle soreness. However, this is not confirmed by clinical trials. Bummer, that would have been easy!

6. Protein supplements. A protein supplement taken either during training or directly after has shown to help muscle function. No good studies, but hope for the future.

So what is a runner to do? There are no good studies that show that anything really helps treat DOMS! Even anti-inflammatories really don't help (and can get you in trouble in large doses!) Prevention is the key to decreasing DOMS and even may help us prevent it in the long run.

How can you prevent DOMS?

There is always one in every crowd that answers, "Run slower." Ha Ha!!

But seriously, while DOMS is common and annoying, it is not a necessary part of racing. There are many things you can do to try to prevent and shorten the duration of DOMS. Who knows, it may even help you avoid it!:

1. Hire a coach! I love mine! He keeps me from doing anything stupid. Even a season marathon runner can use the help of a coach to keep them from running too hard and hurting themselves. The older you get, the more a coach helps! If you don't want a formal coach, have a personal trainer to keep you in check!

2. Warm up before activity. This means at least 15 to 30 minutes before racing or track work. Light running and race pace stride-outs pre-race can help!

3. Cool down then gentle stretching after exercise. At least 15 minutes of gentle stretching can really help the muscles recover and decrease DOMS. Again, no science, just years of experience!

4. Always follow the 10% rule. You have been hearing this since high school but never listening; start gradually and build up your time and intensity no more than ten percent per week.

5. Don't be stupid! Avoid too much, too soon, too fast syndrome. It gets all of us in trouble!

DOMS is a regular visitor in most distance runners' lives. This does not have to be debilitating, but prevention is your best defense against this nagging pain. We have discussed some of the treatment options and suggested methods for prevention. Above all, remember that DOMS is normal but pain for more than 5 to 7 days can signify an injury. Consult your doctor if your pain persists!