HomeSportsThe race to the starting line: running again after having Covid-19

The race to the starting line: running again after having Covid-19

In March 2020, Dr. Niall Elliott was planning the Summer Olympics with his colleagues from the British Olympic Association. Plans were laid out for what to do if an athlete suffered a catastrophic injury or mental health crisis in the run up to the Games. There were meetings about how to get some of the best athletes in the world around the world and how to solve logistical problems.

They had plans for just about everything except a global pandemic, he said.

Overnight, Dr. Elliott began providing support and care to athletes left without access to training facilities and fearful of how this new virus could affect their athletic careers. The questions were endless and the answers few.

“We were very cautious at first because it was a new virus,” said Dr. Elliott. “We just didn’t know what the impact on the body would be.”

The pressing question for athletes: How long would Covid-19 render you unconscious and when could you return to training?

Olympians and weekend warriors have asked that question ever since. And the answer continues to change as clinicians learn more about the coronavirus and its variants wreak havoc on training schedules.

The key is to reset expectations and rethink a timeline for a full return to play or a return to racing.

“Compared to most viral illnesses, the expectation athletes should have is that, on average, it takes them twice as long to get back to where they were,” said Dr. Tod Olin, director of the Center for Exercise Breathing. and Performance of National Jewish Health in Denver, he said. “So if someone usually returns to activity within a week after having a seasonal flu, it can take two weeks to return after having Covid-19. But for many people it also takes three to four weeks, and for a fraction of people it takes considerably longer.”

That’s a tough pill to swallow for athletes looking to get back to being themselves as soon as symptoms subside. And it’s not easy telling runners to slow down when many of their goals are to speed up.

In june 2020, Dr. Elliott published a protocol that has evolved and been adopted by other clinicians as more data has become available about the virus and how it affects athletes. The initial protocol called for a gradual return to play in six stages, starting with a minimum rest period of 10 days and progressing to increased frequency, duration and intensity of training sessions.

In the two years since then, clinicians have distinguished how to manage athletes based on upper neck symptoms and lower neck symptoms. Patients who have upper neck symptoms tend to recover more quickly and may return to athletics faster than those with lower neck symptoms who may experience fatigue, aches, and lung or heart problems.

That distinction, along with patients who test positive but remain asymptomatic, helped Dr. Elliott adjust his guide to a five stage protocol, one that best serves athletes looking to return to training. Patients can now jump to different stages of the protocol based on their symptoms and their severity.

And in the year of post-vaccine data, doctors found that increasing the pace or intensity of training sessions can backfire dramatically.

“They’re used to solving all problems by trying harder,” said Dr. Olin, who has worked extensively with Olympians. “And covid-19 is seemingly unique if you push too hard, if you train through this, there’s this setback phenomenon, one that’s analogous to a hamstring injury, where if you’re getting a little bit better and then you try to go down the hammer for a workout and you’re three months behind.”

I should know, it happened to me. I tested positive for Covid-19 in early May and started to get back into my running routine, albeit at a slower pace, without any real training, soon after. To my great surprise, I tested positive for Covid-19 again four and a half weeks later. (Yes, really, it is very possible). If you were itching to run again the first time, you were bouncing off walls the second. This week, I thought I had recovered enough to do a short speed workout. But when I get to that first interval, it’s like my body is laughing at me: “No.”

I learned that getting to the starting line of a race, or onto the playing field, shouldn’t be a race at all.

But athletes, and possibly runners in particular, have a special brand of impatience when it comes to lacing up again. When we asked Running Newsletter readers to share their stories about getting back to running after COVID-19, hundreds shared their ongoing frustration and small victories. Many shared a sense of gratitude for returning to a career and countless expressed dismay that his recovery is still ongoing.

Aquene Kimmel, a 26-year-old runner, said her first run after testing positive for Covid-19 last December was “a slow jog that felt harder than it had in years.” The hills are even harder for her than she remembers, and her pace has never been the same as before, she said.

Dave Madigan, 52, had Covid in March and despite slowly getting back to running, he said he found the effort harder than it should be. “My VO2 max isn’t much different than I’d expect, but I feel really exhausted,” Madigan wrote, referring to oxygen consumption, a measure of aerobic fitness. “I tried some short intervals, but they were much harder than normal.”

It took Jenna Ciongoli, 38, a few months before she felt so out of breath. “Even now, seven months later, while I’m back to running as much as I used to, I still don’t feel as fast as I used to,” she wrote.

As a pulmonologist in the ever-busy city of Denver, Dr. Vamsi Guntur of National Jewish Health is used to these responses and has started talking to athletes about resetting their expectations.

“What we consider recovery versus what athletes consider recovery is different,” said Dr. Guntur.

“One Olympian very early on, before the vaccine, said, ‘I’m used to working hard. I want to push myself,’” he recalled. “I told him, ‘I know you can, but I don’t want you to.'”

It’s a sentiment that doctors and experts are sharing even more widely after vaccinations, warning of a regression if athletes return to high-intensity training or racing before their bodies are ready.

“You will always have another meet, another race, another training session,” Dr. Elliott repeated.

“But you only have one body,” he added. “You have to take care of it.”

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