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for several more weeks. A Danish study in 2007 tested well-trained runners a week after a marathon, when soreness was no longer a factor. Using electrodes to stimulate muscle contractions, the researchers found that the muscles themselves had fully recovered—but when the runners tried to voluntarily contract their muscles, they were still much weaker than before the race. This suggests that the lasting fatigue after a marathon has a neuromuscular origin—the signal from the brain to the muscle fibers is disrupted somewhere along the signal path (one theory suggests the disruption is caused by overloaded receptors in the spine).

Despite their best efforts, researchers haven’t had much success in figuring out how to speed up the recovery process. A classic study in 1984 compared experienced marathoners who took a week of complete rest to those who ran 20 to 45 minutes a day after the race. After a week, the rested group had better leg muscle strength and slightly higher levels of energy storage in their muscles, though the differences weren’t large. Other studies with similar results suggest that it’s best to be cautious and make a gradual return to activity. Start with walking (or gentle biking or swimming) instead of running during the first four or five days. After that, proceed with a “reverse taper” that reaches normal training no sooner than two weeks after the race. And be flexible: if your legs still feel dead after three weeks, congratulate yourself on having pushed very close to your limits in the race—and give them more time to recover.

Can “platelet-rich plasma” cure my tennis elbow or Achilles tendon?

One of the minor subplots in the media frenzy that engulfed Tiger Woods in late 2009 was his connection to a Toronto sports doctor named Anthony Galea, who said he had injected Woods at least four times with “platelet-rich plasma,” or PRP, to help his recovery from knee surgery. Further investigation revealed a long list of prominent athletes from Olympic sports and almost every major professional league who had received PRP therapy during injury rehab.

For the general public, the investigation offered a rare peek into the world of cutting-edge, sometimes experimental sports medicine treatments that top athletes rely on. It also offered hope for recreational athletes sidelined by chronic tendon injuries—was it possible that a simple, non-invasive procedure might heal them? In fact, Galea reported that about 40 percent of patients seeking the treatment from his clinic were recreational rather than professional athletes. But researchers are still hotly debating whether the technique actually works, and if so, how it should be used. (Despite rumors to the contrary, PRP is not illegal; however, since the beginning of 2010, elite athletes who are subject to drug testing have had to apply for a “therapeutic use exemption” before receiving PRP therapy, and injections of PRP directly into muscle tissue are banned.)

The technique is designed to help injuries that don’t heal well on their own. For example, unlike muscles, tendons have a very poor blood supply, so minor tears and inflammation tend to heal slowly. PRP therapy involves drawing a small amount of the patient’s own blood, spinning it in a centrifuge to concentrate the most useful components (the platelets), and then re-injecting this concentrated plasma at the injury site. The platelets then release various “growth factors” that stimulate the body’s natural healing response.

The technique isn’t new—the first attempts to harness the growth factors in platelets date back at least to the early 1980s, and surgeons have also experimented with PRP to aid in bone grafts. But it’s only in the last five years or so that small pilot studies have shown the technique’s potential for tendon injuries. Initial results for Achilles tendinopathy and tennis elbow—two stubborn tendon problems that often resist non-surgical treatment—were promising, but the studies were neither randomized nor placebo-controlled.

Only now are the first proper clinical trials emerging, and the