Recovery is an essential component to the entire training process. High volumes of training and competition with inadequate recovery can lead to symptoms of fatigue and an associated increased risk of injury. Recovery strategies aim to accelerate the recuperation process so that the individual is better prepared for the next training session.
A review of the literature on the popular strategies which are used to accelerate recovery highlights a lack of overwhelming evidence supporting any of these techniques. Despite this absence of scientific support, there is fairly strong anecdotal evidence to suggest that “something is better than nothing”.
The Physiology of Recovery
There are fluctuating grades of muscle damage after training and competition, ranging from negligible to more serious damage. Inflammation, impaired muscle function, loss of intracellular fluid and muscle glycogen are likely following heavy training.
This may present as ‘Delayed Onset Muscle Soreness or DOMS’, a temporary loss in muscle force production, disrupted joint position sense, decreased physical performance, increased perception of fatigue and increased risk of injury.
From the perspective of an athlete, recovery should be defined as the point at which they are able to return to training without the limitations of sore muscles or an increased risk of injury. However, this is not always possible due to scheduled training or competition.
In addition, this does not exclude the fact that there are cognitive processes which also need to recover following stressful training, life, work, school, or period of travel across time zones for warm weather training or competition which may interfere with sleep patterns. Optimising recovery strategies requires an individualised approach which addresses all aspects of the individual’s lifestyle, including sleep, nutrition, stress exposure and physiological recovery.
Recovery Modalities Literature Overview
Dupuy et al 2018 https://doi.org/10.3389/fphys.2018.00403
Massage
Massage has been a traditional pillar of post exercise recovery. Theoretically massage is said to increase blood flow and reduce muscle oedema. A 20-30minute massage provided immediately or within 2 hours of completing exercise has been indicated to provide relief from DOMS for up to 96 hours. Massage has also been shown to lower perceived pain and fatigue levels following exercise bouts.
Creatine Kinase, Interlukin-6 and C-reactive protein have been associated chemical markers of post exercise muscle damage. Massage has been highlighted as the most effective modality for lowering post exercise concentrations of these chemical makers which may explain the reductions in perceived pain and fatigue.
Foam Rollers
A form of self-massage in which the target musculature is compressed and rolled using a variety of foam rollers, bars or sticks. The motion places a direct and sweeping pressure on the tissues stretching and generating friction.
Suggested mechanisms for this self-massage include altering mechanical tissue stiffness, releasing adhesions, analgesic effects mediated via pain modulatory systems, increased blood flow and parasympathetic circulation. Psychophysiological responses include improved perception of wellbeing and recovery.
Research concludes that foam rolling variations seems to be an effective strategy for short term improvements in flexibility without compromising muscle performance. Use in warm up does show small improvements in sprint performance at least for elite level athletes. It also highlights that recovery for strength and sprint parameters are also improved.
Positive effects on muscle soreness are noted post rolling although the physiological mechanisms are not currently understood. Psychologically, the official may feel less pain post exercise rolling, therefore one could argue this is sufficient to justify this modality despite the lack of measurable physiological benefits.
Theragun
A percussive therapy device that provides amplitude of deep tissue massage at a frequency of 1750 or 2400 pulses per minute specifically designed to stimulate the neural pathways. Underlying theoretic principles include mechanotransduction, shear and heat to improve fascial gliding and prevent micro tissue adhesions.
Reduced pain and sensitivity by stimulation of the nervous system which activates pain gate mechanisms, lowers muscle tone, improves proprioception, circulation and lymphatic removal of metabolic waste products. Theragun is new technology and there are currently 8 randomised controlled trials being undertaken including recovery, pain management, flexibility, proprioception and performance.
Compression Garments
Theoretically compression garments reduce the space available for swelling and oedema via the external compression applied to the limb. This compression also maintains relative osmotic pressure within the interstitial space to improve fluid diffusion via the lymphatic system and venous return, improve microcirculation and elimination of metabolic waste products.
Literature suggests compression garments induce a significant and positive impact on both DOMS and perceived fatigue following exercise. The improved effect of compression garments on DOMS has been shown to last up to 96hours post exercise.
Specifically, high pressure compression garments were shown to be more effective than low pressure garments. The effect of compression garments on post exercise muscle damage blood markers such as Creatine Kinase, Interlukin-6 and C-Reactive Protein was in contrast and no changes were noted.
Cold Water Immersion
An exposure of 11-15 minutes at 11-15°C has been considered optimal for lowering DOMS post exercise.
Mechanisms of cold-water immersion suggest the hydrostatic pressure may facilitate the transport of fluids and metabolites from the muscle to the blood.
Further, vasoconstriction due to the lower temperature may reduce diffusion of fluid to the interstitial space, locally diminishing the inflammatory reaction. Cold alone has also been shown to have an analgesic effect, release of neurotransmitters that regulate fatigue, influence on brain activity relating to arousal and alertness.
Literature on cold water immersion shows significantly lower DOMS for up to 96 hours post exercise, however the small effect size suggests differences are trivial. Research suggests that cold water immersion does not change circulating muscle damage markers within the blood. It has been shown to benefit those athletes involved in sprint performance more than in endurance events. Cold water Immersion does not interfere with adaptations to endurance or high intensity interval training but may inhibit adaptations to strength training.
Contrast Water Therapy
Alternating bathing in warm and cold water is thought to induce a successive peripheral vasoconstriction and vasodilation which may reduce oedema following exercise, influence inflammatory pathways and feelings of pain.
Research suggests a significant impact on lowering DOMS, again with a small effect size and no impact on perceived fatigue. Contrast water therapy has been shown to lower perceived pain at 24, 48 and 72 hours post exercise. It has also been shown to lower Creatine Kinase concentration within blood following exposure indicating diminished muscle damage.
Active Recovery
Active Recovery is another staple modality that has been used for decades. The theoretical basis suggests an enhanced blood flow through muscle tissue may facilitate the removal of metabolic waste, may contribute to a reduction in muscle lesions and pain.
Research indicates significantly positive effects in lowering DOMS but no effect in changing perceived fatigue. Scientific literature points out that active recovery is only beneficial in a short period of time following exercise. Further, active recovery shows no superior benefit when compared against other recovery modalities.
Following training, it has been suggested 7 minutes of low intensity exercise enhances Creatine Kinase clearance. However, alternative literature highlights active recovery shows no influence on Creatine Kinase, Interlukin-6 and C-Reactive Protein blood concentrations.
Cryotherapy
Whole body Cryotherapy has a wide variety of temperatures ranging from -30 to -195°C, variance in exposure methods which include cabins and chambers with the head not exposed. Generally, 3 minutes exposure to these low temperatures are suggested.
Theoretical mechanisms of low temperatures claim a reduction in inflammation, reduced muscle tone to stimulate relaxation, slowing of nerve conduction velocity to inhibit pain. The divergence of methods has led to inconclusive research. Authors have seen positive effects associated with improved muscle fatigue and wellbeing. The effect on DOMS only exists in a short period after exercise <6 hours with no effect thereafter. There has been no influence on Creatine Kinase or C-Reactive Protein in the blood post exercise.
Stretching
Stretching derivatives comprising ballistic, static, dynamic and passive all involve mechanical stimulation of tissues including activation of the various pathways within neural tissue. Stretching has remained a cornerstone of recovery based on anecdotal evidence. Recent research has highlighted that stretching has no positive impact on DOMS or fatigue.
Compex
Neuromuscular electrical stimulation involves placing electrodes upon the skin and delivering and electrical current that is intended to induce segmental sensory inhibition, stimulate blood flow and reduce pain.
Research suggests that Compex is more effective than passive recovery in lowering DOMS, perceived exertion and blood lactic acid concentrations, but is no more effective than active recovery post exercise. Research suggests there is no clear benefit using Compex compared to active or passive recovery for restoring muscle function or performance after exercise.
Sleep
Sleep is acknowledged as a vital element to post exercise recovery. Athletes may experience long term sleep disturbances due to poor sleep hygiene. Late nights, unsuitable sleeping environments, young families or use of technology before bedtime. Research has suggested that by increasing total sleep duration for at least one week an athlete can improve physical performance, reaction times, mood and fatigue levels.
Napping for more than 20minutes later in the day at a suitable interval after earlier exercise may assist mental preparation for later performance. It is important to recognise that sleep requirements vary greatly between individuals and individual motivation will influence how well the athlete adopts good sleep hygiene. The most effective strategies for sleep remain unclear.
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