BPK 241 Lecture 12

Goals of Recovery

• After exercise:

  • Fluids and fuels lost or consumed during exercise must be replaced

  • Body temperature and regular cardiovascular function must be restored

  • Damaged tissue must be repaired

Recovery

• “The body will adapt as long as the applied stress is not greater that the body’s capacity to adapt”- JF Esculier

• Work-Load Management

A Decrease in Capacity

• Sleep

• Stress

• DOMS

• Nutrition/H2O

An Increase in Load

• Distance

• Duration

• RPM

• Speed/ Intensity

• Frequency

Poor Load Managament

• (Too much, too soon or too little, too late) may be a key reason to the development of delayed recovery of musculoskeletal injuries

• Need to quantify workload

• Distance run, distance cycled, laps, swims, etc.

Intensity?

• TSS (Training Stress Score) - Training Peaks point system (100% effort for 1 hour = 100 pt)

• RPE (Rating of Perceived Exertion) x Duration (min) = GOLD STANDARD

• Can use this information to follow the 10% rule

How to measure recovery?

• Metabolic by products of intense exercise

• Study measured 200 products in blood following intense exercise

• Of the 200, 20 changed in response to intense exercise

• Most products known like blood lactate, creatine kinase and breakdown products of fat, sugar and amino acids

• One was new - increased expression of gene nur77, leading to insulin release regulating glucose use and fat breakdown

Biological Markers

• Biomarkers- generally refers to measurable indicator of some biological state or condition

• Ex:

  • BP

  • HR

  • Blood Lactate levels

  • Creatine Kinase

  • Hormone Levels

RestQ-Sport

• Recovery-Stress Questionnaire for Athletes

  • Measures stress and recovery rates in athletes

• 76 item questionnaire

  • There is 36 item short-form version

• Questions related to recovery from sport

Monitoring athlete response to training

• Athlete: Training Diary

  • HR, Body weight, sleep

  • Diet, rest, active rest - hot/cold, self massage, stretch

  • Time management

• Coach: Communication

  • Direct: athlete questionnaires

  • Indirect: Body language

  • Monitor and alter work to rest ratio

• Therapist

• Parent

Simple ways for athlete’s to monitor recovery

• Record:

  • Quality of Sleep

  • Morning resting heart rate

  • Morning body weight

  • Daily rating of fatigue levels

Recovery Methods

• Active recovery/ Relative rest

• Massage/ Soft tissue treatments

• Acupuncture/ Acupressure

• Nutrition/ Rehydration

• Hydrotherapy

• Sleep

• Mental/Emotional

• Compression

Active Recovery & Relative Rest

• Low intensity activity assists blood circulation, helps remove lactate from muscle

• Active rest allows athlete to physically & psychologically recover from training fitness levels

  • Cross training

INTENSITY of Active Recovery

• Menzies et al (2010) looked at intensity of active recovery:

  • Found that higher intensities (60 to 100% of lactate threshold) compared to lower intensities (0 to 40% of lactate threshold) showed better recovery

• 10 males, 5 mins running at 90% VO2 Max → Followed by recovery running at % of VO2 max 100%, 80%, 60%, 40% or 0% (total rest)

• Active Recovery better than passive (total rest) recovery

• Active recovery at 80-100% lactate threshold better lactate clearance than recovery at 40% of lactate threshold

Massage Therapy/ Soft Tissue Treatments

• Act to increase blood flow

• Enhance delivery of oxygen and nutrients

• Remove metabolic byproducts

• Warming/stretching of tissues provides temporary increase in ROM

• Increased muscle relaxation as a result of decrease in excitability of motor neuron pool

• Improved mood states and feeling of well-being

Massage: Assistance Devices

• Foam ruller

• Theragun

• Rollers

Acupuncture/ Acupressure Theories

• Several theories on how acupuncture can help recovery

  • Gate control theory

  • Augmentation theory

  • Endorphin theory

  • Neurotransmitter theory

  • Circulation theory

Acupuncture: Exercise

• Acupuncture points during treadmill run (PC6 and ST36)

  • Sham group had needles inserted 1cm away from above pts

• Measured max HR, VO2 max, blood lactate at 5, 30 and 60 min post exercise

• Acupuncture group had:

  • At 30 min post exercise: Lower HR and blood lactate

  • At 60 min post exercise: Lower blood lactate

Acupuncture

• Both acupuncture and sham acupuncture appear to have a mild beneficial physiological effects:

  • Stimulate regions of the brain associated with natural opiate production

  • Nonspecific analgesic effects through a postulated mechanism of “diffuse noxious inhibitory control”

• Little difference in the effects of real, sham and no acupuncture

Nutrition

• Recovery through nutrition encompasses complex range of process that includes:

  • Refuelling muscle and liver glycogen (carb) stores

  • Manufacturing new muscle protein, RBC, other cellular components as part of repair and adaptation process

  • Replace fluid and electrolytes lost in sweat

  • Allow immune system to handle damage caused by exercise

Carbohydrates

• Serious athletes may need to consume between 7-12 g of carb per kg body weight each day to ensure adequate glycogen stores

• Immediate post exercise period (30 to 60 min window), athletes are encouraged to consume a carbohydrate rich snack or meal that provides 1-1.2 g of carb per kg body weight

• Rates of glycogen synthesis are greatest during this post exercise time (78-93 g carb post exercise)

• This is especially important if the time between prolonged training sessions is less than 8 hours

Immune system

• Recovery is showing that more than 90 minutes of high-intensity endurance exercise can make athletes susceptible to illness for up to 72 hours after the exercise session

• Cortisol and adrenaline, known stress hormones, raise BP and cholesterol levels and suppress the immune system

  • Carbohydrate reduces the stress hormone response to exercise, thus minimizing its effect on the immune system, as well fuels the activity of many of the immune system white cells

Recovery from Intense Exercise

• Rate of protein synthesis increases by 50% 4 hours after intense exercise

• Repair peaks at 24 hours after exercise, rebuilding process is OVER 36 hours after exercise (with experienced athletes)

Protein

• Protein with carbs can almost double insulin response and therefore uptake

• Too much protein interferes with rehydration though

• 4:1 carbs to protein, 15-25 g of protein in 1st hour after exercises

• During the recovery phase there is a reduction in catabolic (breakdown) processes and a gradual increase in anabolic (building) processes, which continues for at least 24 hours after exercise

Rehydration

• Body weight fluid loss of 2% or more results in physiological changes that affect aerobic output

• Athletes should aim to consume 125-150% of their estimated fluid losses in the 4-6 hours after exercises

  • How monitor fluid loss?

• Urine Check

Other Nutritional Interventions

• Good Evidence: Black current extract, tart cherry juice, beet-root juice, branched chain amino acids

• Mixed or inconclusive evidence: pineapple. Pomegranate juice, watermelon juice, green tea, curcumin, creatine, l-glutamine, vitamin D

• Insufficient evidence: green algae extract, ginseng, ginger

• No benefit for reducing DOMS: protein supplementation (before exercise), vitamin C and E

Low Energy Availability

• 28-58% incidence of Low Energy Availability in athletes

Signs and Symptoms of LEA

• Reduced training capacity

• Repeated injury or illness

• Delayed or prolonged recovery times

• Change in mood states

• Failure to lose weight

• Reduced or low bone density

• Reduced libido

• Cessation or disruption in menstrual cycle

• Excessive fatigue

Muscle Supplements

• Protein (0.4g/kg per serving 3-4x day)

• HMB (3g/day)

• Omega 3 (4g fish oil)

• Creatine monohydrate (20g/day for 5 days)

• Polyphenols (food)

Tendon Supplements

• Collagen/Gelatin (proline, glycine)

• Protein-Leucine (20g whey)

• Nitric Oxide (blood flow)

  • Nitrates (beet root, chard)

  • Arginine 8g

  • Citrulline Malate 8g

Bone Supplements

• Protein and carbohydrate

• Calcium (700 mg/day)

• D (per blood work)

Hydrotherapy

• Thermoneutral immersion (>20ºC to <36ºC)

• Cold immersion (<15ºC)

• Hot immersion (<36ºC)

• Contrast immersion (alternating between cold and hot water)

Cryotherapy

• Decreases skin, subcutaneous, and muscle temp, resulting in narrowing of blood vessels (vasoconstriction)

• Beneficials effects include:

  • Reducing sensation of pain

  • Limiting amount of swelling

  • Reducing muscle spasm

  • Clearing metabolites from superficial/ deep tissues

Cryotherapy for DOMS

• Some evidence cold-water immersion reduces DOMS when compared to passive intervention (rest) or no intervention

• Unable to draw definitive conclusions for pain or recovery due to poor methods and small sample sizes

Thermotherapy

• Has opposite effect, increasing tissue temp, resulting in expansion of blood vessels (vasodilation)

• Beneficials effects include:

  • Increasing oxygen/antibody supply

  • Reducing muscle spasm

  • Clearing metabolites

Contrast bath (alternating hot and cold)

• In theory promotes rapid alternation between vasodilation and vasoconstriction, causing “pumping” action in peripheral circulation

• Influences on athletic performance:

  • Equal lactate level and perceived level of recovery as active recovery

  • Quicker perceived level of recovery than passive recovery

Hydrotherapy Contrast Bath Protocols

• Shower: 1-2 min hot, 10-30s cold, repeat 3x

• Bath: 3-4 min hot, 30-60s cold, repeat 3x

• 5 minute ice bath then alternating 1 min hot shower, 1 min cold shower, repeat 5x

Contrast bath: How long is ideal?

• Appears there is NO dose/response relationship: 6-12 mins seems to be ideal dose, there was no further improvement in 18 minutes group

Hydrotherapy Summary

• DOMS - cold and contrast both reduced DOMS after exercise, hot water immersion less effective

• Blood biomarkers of muscle damage/inflammation - cold and contrast reduced blood creatine kinase activity, hot water immersion did not

• Perception of fatigue - Cold immersion (but no contrast) reduces perception of fatigue after exercise

• Performance effects - Cold immersion gave greatest benefits for recovery of sprint performance, smaller benefits for recovery of endurance, jump performance and strength

  • No clear difference between cold and contrast immersion on their effects on performance

  • Both cold and contrast provide more consistent performance benefits compared with hot and thermoneutral immersion

Hydrotherapy added benefit to sleep?

• Sleep onset corresponds closely to maximal rate of decline in core temp

• 1% change (drop) in skin temperature results in less delay in sleep onset (approx 3 mins)

• Core temp decline through loss of heat from extremities

Sleep Definition

• Sleep is recognized as critical element of post exercise recovery

• Athletes can experience short-term sleep disturbance due to travel, jet lag, unfamiliar sleeping environments and pre-competition anxiety

• Athletes can experience long-term sleep disturbance from poor sleep hygiene, chronic insomnia, poor adaptation to training loads

Sleep Stages

• Divided into 5 stages

• 3rd and 4th stages (slow wave sleep) most important for athlete recovery

  • Pituitary gland releases growth hormones

• Stage 5 is REM sleep or paradoxical sleep

  • Dreaming occurs during this stage

Healthy Sleep Patterns

• Fall asleep within 30 mins

• Sleep throughout night with brief awakenings

• Feel refreshed within 1 hour of waking (5-7 days per weeks)

How much sleep is needed?

• Adolescents

  • Suboptimal = <8 hours per night

  • Borderline = 8 hours per night

  • Optimal > 9

Sleep & Concussion Recovery

• Sleep Hygiene

  • Sleep quality

  • Decrease body temp at night

    • Hot shower 1 to 2 hours before

    • Mattress cooler

  • No screen time 1 hour before bed, lots of sunlight during day

  • Black out curtains

  • Weighted blanket

  • Exercise (earlier in day)

  • Caffeine - ½ life is 12 hours (variable)

  • Food - stop eating eariler

Sleep Deprivation

• During sleep deprivation (4 hours per night):

  • Glucose metabolized less efficiently

  • Elevated levels of cortisol

• After only 1 week of sleep restriction:

  • Healthy males (18-27 y.o.) have reduced ability to manage glucose, similar to that of elderly

  • Bone density??

Sleep Deprivation and Injury

• Sleep was strongest predictor of injury

• Adolescents (grade 7 to 12) getting less than 8 hours of sleep per night were 70% more likely to be injured compared to those getting >8 hours per night

• Less than 6 hours = 400% more likely to be injured

Mental/Emotional Recovery

• Debriefing

• Emotional recovery/contingency planning

  • Access to social support

• Mental toughness/ emotional control skills

• Relaxation techniques

  • Progressive muscle relaxation

  • Imagery & visualization

  • Breathing exercises

Compression

• Medical compressions garments (20-40 Hg) used to improve recovery in hospital by:

  • Promoting venous blood flow

  • Decreasing venous stasis

  • Preventing thrombosis in post-operative patients

Sport Compression

• Requires minimum pressure of 18 Hg at ankle and 8 Hg at mid thigh to mimic hemodynamic effect of exercise and increased venous return from the legs

Suggested benefits of Sport Compression garments

• Enhancing blood circulation to peripheral limbs

• Reducing blood lactate concentration during exercise bouts

• Enhancing warm-up via increases in skin temp

• Increasing vert jump height

• Improving repetitive jump power

• Reducing muscle oscillation upon ground contact

• Increasing torque generated about joints, improving performance and reducing the risk of injury, for example, assisting the eccentric action of the hamstring at the end of the swing phase in running

• Reducing the effects of delayed onset muscle soreness in the days following strenuous exercise

• Increasing feelings of positive leg sensations both during and following strenuous exercise

Evidence-based Benefits of Compression Garments

• Systematic review and metanalysis demonstrated wearing compression garments after exercise reduced DOMS and perception of fatigue

• Effects of wearing compression garments on biomarkers of muscle damage and inflammation are more modest

• High-pressure compression garments that exert high compression restore muscle function more effectively compared with low-pressure compression garments

Intermittent Pneumatic Compression

• Periodic inflation of external cuffs, moving from ankle, calf, knee and thigh

Intermittent Pneumatic Compression Test

• Shuttle run test, followed by vertical jump, also VAS pain rating

  • Repeated 3 times with 3 days rest in between followed by 1 of 3 treatments

    • rest 1 hour

    • low pressure treatment 1 hour (compression ratio 20:15 10mmHg from ankle calf thigh)

    • high pressure treatment (1 hour 70:65 60mmHg)

  • Vertical jump tested again

  • Vertical jump decreased in all 3 groups,

    • amount decreased in high pressure tx significantly than low pressure tx or rest

Summary: Recovery Study

• Ice bath vs hot bath vs hot bath & “recovery oil”

• Given scientific literature on benefits of “recovery oil”

• Significant improvement in recovery with ice bath and “recovery oil” group

• “Recovery oil” was dish soap

What are the benefits of recovery techniques?

• How much of recovery is placebo?

• Does it really matter?