Monitoring of recovery strategies for elite athletes3 Opinions
In my previous two articles on TheSportinmind, adequate rest (napping) and sufficient sleep are discussed as two of the most commonly reported methods for managing fatigue and enhancing recovery (Hausswirth et al.; MyllymÄKi et al., 2011; Samuels, 2008). I discussed how research supports napping as a prophylactic strategy to supplement the physical and psychological rejuvenation of adequate sleep health. These articles support the high importance of recovery strategies to help athletes alleviate post-match fatigue, regain performance faster and reduce the risk of injury. Further, fatigue post competition is reported as multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue (Nedelec et al., 2013). Thus, recovery strategies that aim to address these deficiencies can ultimately help performance and reduce the risk of sports injuries.
Recovery strategies include appropriate sleep, nutrition and immediate post training/match procedures. Sleep and nutrition have the most support in the evidence based medical literature as well as cold immersion therapy, however, the evidence for other strategies to either increase or decrease inflammation is still lacking. These other strategies include active recovery, stretching, compression garments and electrical stimulation. Further, the use of hypoxic environments, although still having limited evidence, is becoming more common across senior and junior elite competition. These recovery strategies need to be implemented in conjunction with each other in line with the various stages of recovery. For example, Paulsen and colleagues (2010) present the biphasic pattern of recovery where rapid metabolic recovery occurs immediately post training/competition as well as a second slower phase of recovery during subsequent days related to muscular repair.
A position statement of recovery strategies in elite European soccer states cold immersion therapy to be superior during congested or acute training and competition periods when compared to passive recovery, contrast water immersion and hot immersion (Nedelec et al., 2013). Cold immersion therapy acts by reducing the amount of blood flow to the extremities, which enables increased venous delivery and cardiac efficiency at the core (Nedelec et al., 2013). Further, it appears that the temperature of cold immersion therapy also acts as a natural analgesic by inhibiting the pain-spasm cycle through the reduction of nerve conduction velocity, muscle spindle activity, the stretch-reflex response and spasticity (Wilcock, Cronin, & Hing, 2006). The benefit of cold immersion therapy applies when performed immediately after exercise as well as throughout the recovery process. Cold immersion at 9 to 10 degrees centigrade for ten to twenty minutes has been found to have beneficial effects on anaerobic performance, as measured by maximal strength, countermovement jump and sprint ability (Nedelec et al., 2013). Biochemical markers also appear to be reduced post cold immersion therapy with decreased myoglobin and creation kinase levels observed as well as subjective athlete soreness (Nedelec et al., 2013).
Active recovery, also termed the ‘warm down’ or ‘cool down’ period, is characterised by light aerobic activity (cycling, running or swimming) at low intensities for a duration of 15 to 30 minutes (Nedelec et al., 2013). Compared to passive recovery, this strategy has been found to enhance blood lactate removal and help to accelerate pH recovery. This does not automatically translate to improved subsequent performance and may lead to impaired glycogen synthesis, particularly in Type I muscle fibres. Thus, although active recovery is utilised by up to 81% of the population there is no strong evidence to suggest that this should be included as a recovery strategy.
Stretching can be included as a recovery strategy or a separate session over the weekly training schedule to increase the range of motion around joints highly utilised in the movement demands of the athlete’s particular sport. Stretching exercises have the potential to also decrease musculotendinous stiffness to help prevent injury (Nedelec et al., 2013). Although up to 50% of athletes use stretching as a recovery strategy, a recent meta-analysis found stretching to be not clinically worthwhile for reducing muscle soreness in the days following exercise (Herbert, de Noronha, & Kamper, 2011).
Compression garments are those that apply pressure on the lower limbs to increase the femoral blood flow using the principle of increased pressure at the ankle and reduced pressue at the mid-thigh. Although these garments have been reported to reduce post training session soreness and increase comfort, there is yet to be any strong evidence supporting these as a recovery strategy for improved subsequent performance. As yet, no studies have shown any improvements in repeated sprint performance, peak-power output, isokinetic strength, sprint, agility and counter-movement jump performance (Nedelec et al., 2013). As yet, the amount of pressure applied with compression garments has not be investigated to a precision that provides ergogenic benefit. Compression garments have been reported as providing to additional benefit in comparison with active recovery, contrast water therapy or massage (Nedelec et al., 2013). However, there have been no reports of impaired performance in the use of compression garments and as long as they do not impact on any other recovery strategy, such as reducing sleep quality due to night time discomfort, compression garments provide an easy to use recovery strategy that may be of particular benefit when athletes travel.
Massage is used in up to 78% of athletes as a recovery strategy and can be defined as “mechanical manipulation of body tissues with rhythmical pressure and stroking for the purpose of promoting health and well-being” (Standley, Miller, & Binkley, 2010). There is limited evidence supporting physiological benefits of massage, with no improvements in blood flow, blood lactate removal and neutrophil counts (Nedelec et al., 2013). Despite this, psychological benefits including mood state, perceived soreness and perceptions of recovery, have been well documented (Hemmings, Smith, & Graydon, 2000). As massage can be characterised by a number of different treatment methods, research to date is inconclusive as to whether the perceptual improvements due to massage translate to improvements in function or performance.
Currently, a number of recovery strategies are being used in elite sport, across the senior and junior levels. As well as the well documented benefits of adequate sleep health (both quantity and quality), adequate rest (helped by napping), appropriate dietary and nutritional intake, cold water immersion presents as an evidence-based strategy to improve function and performance after acute periods of high training and match loads. Further strategies, including active recovery, stretching, compression garments and massage may have perceived benefits but are not strongly supported by the literature in function and improved performance. It is recommended that player recovery strategies, such as those above, be included as a type of training in the daily monitoring of elite athletes. Recovery strategies could be monitored by the amount of minutes that players engage in these strategies. Such monitoring will then help to obtain an overall population estimate of athlete recovery strategies in response to high training and match loads in sports other than European football (soccer).
Hausswirth, C., Louis, J., Aubry, A., Bonnet, G., Duffield, R., & Le Meur, Y. Evidence of Disturbed Sleep and Increased Illness in Overreached Endurance Athletes. Medicine & Science in Sports & Exercise.
Hemmings, B., Smith, M., & Graydon, J. (2000). Effects of massage on physiological restoration, perceived recovery and repeated sports performance. British Journal of Sports Medicine, 2000(34), 2.
Herbert, R. D., de Noronha, M., & Kamper, S. J. (2011). Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews, 7(CD004577).
MyllymÄKi, T., KyrÖLÄInen, H., Savolainen, K., Hokka, L., Jakonen, R., Juuti, T., . . . Rusko, H. (2011). Effects of vigorous late-night exercise on sleep quality and cardiac autonomic activity. Journal of Sleep Research, 20(1pt2), 146-153. doi: 10.1111/j.1365-2869.2010.00874.x
Nedelec, M., McCall, A., Carling, C., Legall, F., Berthoin, S., & Dupont, G. (2013). Recovery in soccer: Part II- recovery strategies. Sports Medicine, 43(1), 9-22.
Paulsen, G., Crameri, R., & Benestad, H. B. (2010). Time course of leukocyte accumulation in human muscle after eccentric exercise. Medicine & Science in Sports & Exercise, 2010(42), 1.
Samuels, C. (2008). Sleep, Recovery, and Performance: The New Frontier in High-Performance Athletics. Neurologic Clinics, 26, 169-180.
Standley, R. A., Miller, M. G., & Binkley, H. (2010). Massage's effect on injury, recovery and performance: a review on techniques and treatment parameters. Strength & Conditioning Journal, 32(2), 64-67.
Wilcock, I. M., Cronin, J. B., & Hing, W. A. (2006). Physiological response to water immersion: a method for sport recovery? Sports Medicine, 36(9), 747-765.
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About Tim Lathlean
PhD Candidate, Monash Injury Research Institute: Training loads, fatigue, sleep health and injury risk #AFL