Recovery Techniques for Athletes: What Does the Evidence Say?

A successful athlete HAS to find that perfect balance between training and recovery. Read that again.

 

The goal of training is to overload in an effective manner so that adaptations will lead to improved performance, not excessive overload with inadequate recovery. So, it’s not a surprise that every athlete is constantly looking for ways to recover faster. Sure, we’ve stretched for years, but should we just because that’s what we’ve always done? With new products released daily with recovery claims, coaches touting that one method is superior to the other, and trendy alternate interventions that athletes love to jump on immediately, what does the science say? Today we will cover sleep, stretching, and a few alternate interventions.

 

 

What is recovery, really?

 

Recovery shouldn’t be considered effective unless the athlete reaches a higher state of fitness after recovery. So, if an athlete is simply reducing fatigue or returning to baseline of fitness, this actually represents incomplete recovery. Did the athlete improve fitness level? Did the athlete acquire a new sport specific skill? Did the athlete increase strength? These are the questions we should be asking about an effective recovery.

That said, the goal of recovery is to ensure that an athlete efficiently recovers restores and recovers after training session to proceed to the next session without injury.

Disclaimer: Because recovery is a relatively new area of scientific research, I still promote and encourage athletes to experiment with various recovery techniques to identify useful individualized recovery strategies, however, I will be providing current evidence as it relates to athletic recovery.

 

Stretching

Despite the evidence presented, any athlete can stretch after practice or competition, it’s not necessarily going to do more harm than good. While it may not an immediate form of recovery, but in an effort to avoid injury, an athlete looking to improve (range of motion) ROM. So, for someone who may have a mobility restriction, post practice may be a good time to work on facilitating ROM improvements that can help avoid potential injuries in the future. Post practice is an ideal time because of the increased muscle temperature.

 

Possible Adaptations

Although stretching is a common ritual post workout, with what we know now, it is reasonable to question the relevance of both static and dynamic stretching after training. Literature regarding the effects of stretching is conflicting, sparse in some areas, although it is the most widely used strategy in terms of recovery. When looking at team sport athletes, Kinugasa and Kilding, (2009) assessed the effects of 7 minutes of static stretching following a football game. Stretching was not as effective as contrast water therapy with active recovery in terms of an athlete’s perceived recovery. Similarly, Montgomery et al. (2008) reported that a combined recovery strategy (stretching and carbohydrate intake) performed after competitions was not as effective for restoring physical performance.

In contrast, Dawson and colleagues (2005) reported that stretching following an Australian football match significantly improved power output compared to a control group. Additionally, Miladi and colleagues (2011) reported that dynamic stretching was significantly superior to other forms of recovery for maintaining performance and energy levels. Finally, stretching has also been found to improve range of motion and reduce muscle soreness compared to a control (Kokkinidis et al., 1998). There is also much evidence that muscle soreness cannot be reduced with stretching, so this data is ambiguous.

As can be concluded from the above findings, there have been mixed reports regarding the benefit of stretching as a recovery strategy. However, two separate reviews of recovery methods concluded that there was no benefit for stretching as a recovery modality (Barnett, 2006; Vaile et al., 2010). It is important to note that to date, there have not been any detrimental effects on performance associated with post-exercise stretching so it doesn’t hurt to incorporate (Halson, 2013).

My personal takeaways on stretching include that if stretching takes place, the emphasis on dynamic movements rather than static stretch positions is important for recovery stretching. However, if the goal is enhancing ROM, static stretching is reasonable.

 

Recommendations

Static stretching (holding between 15-30 seconds) is effective for improving flexibility (Fleck & Kraemer, 2014). So, while it may not be for recovery, if flexibility is the goal, then static stretching would be reasonable to incorporate in the athlete’s program at another time.

If the goal was to improve flexibility over time, the athlete would static stretch within 5-10 minutes after training, the athlete would ideally perform static stretching to help facilitate ROM improvements when the body is warm (this is not intended to relieve soreness, which is semi ambiguous). Static stretching, when an antagonist is moved slowly to the limit of ROM, should be performed three to five times and held from 15 – 30 seconds (Fleck & Kraemer, 2014). If the athlete trained upper body that day, then static upper body stretches should be performed post training. If the athlete trained lower body that day, then static lower body stretches should be performed post training.

 

Safety concerns:

  • No overstretching, which can cause injury.
  • So, for static stretching the athlete should slowly move to the limit of ROM and then hold.
  • For dynamic stretching it will be a controlled bounce.

 

 

Sleep 

Recommendations have been published stating that adults need at least 7 hours of sleep for optimal health, however, more may be better, especially for advanced athletes (Watson, 2015).

It’s important to note that more than a third of the adult US population reporting sleep durations of less than the recommended 7 hours of sleep, and about 15% reporting sleep durations of less than 6 hours (average American currently only sleeps 6 hours and 31 minutes a night during the week) (Centers for Disease Control and Prevention, 2008).

Poor sleep not only puts athletes at risk for injury, but plays a vital role in recovery from injuries and procedures (Malhorta, R.K., 2017).  Fewer than 6 hours or having inadequate rest was associated with injury in younger athlete (Luke, A., 2011). It’s important to note the age of each athlete as adolescents sleeping more than 8 hours were less likely to be injured (Von Rosen, P., 2016). Therefore, younger athletes need more sleep.

 

Possible Adaptations

Kobe Bryant said it best when he claimed that, “Sleep is one of the best performance enhancers there is.”

Sleep is needed to help with memory consolidation and learning, and sleep disruption may be associated with decreased ability to learn and improve skills necessary for team performance (Walker, 2015).

Sleep is also important to the body’s physiological (reaction times, learning and memory), and cognitive restoration. Various studies performance improvements have been found in weightlifters and other athletes when sleep exceeded 7 hours each night. Dr. Walker claims that when you practice with a good night’s sleep, you can perform 20 – 30% better than the day before. But he also claims that with sleep deprivation (less than 6 hours), your physical exhaustion can drop up to 30%, a staggering difference. Also, since peak muscular strength is correlated to sleep, the less sleep you have, the higher chance that your performance will be hindered. Although there isn’t a lot of data, there is some that demonstrate higher injury rates among athletes with lack of sleep.

There is a linear relation between sleep deprivation and injury rate. In fact, there was a 60% increase in injury rates when they compared athletes who received 5 hours versus 9 hours of sleep. This is due to exhaustion, tiredness, and stability muscles start to fail. Shorter sleep periods do not allow time for cells to repair and regenerate. So, after workouts and training, the inability to fully recover will wear and tear – eventually increasing the likelihood of serious injuries.

Evidence has demonstrated worse serve accuracy in tennis players who were sleep deprived (Reyner, L.A., Horne, J.A., 2013). Another study showing sleep deprivation negatively affected recovery after a rugby league match, specifically impairing performance and cognitive function (Skein, 2013).

 

Recommendations

7 hours of sleep (more for athletes, more for adolescents)

  • Try to stick to a schedule. Regular sleep routines (waking and sleeping same time each day will help drastically).
  • Limit light one hour before bedtime (no screen time, turn lights off, etc.). An hour of screen time can delay the production of melatonin by three hours and will lead to less REM sleep.
  • Avoid alcohol and heavy meals before bed.
  • Turn down the heat and keep it cool (your brain needs to drop temperature to initiate sleep). I personally cannot sleep in the heat and this explains why.

 

Safety concerns:

Decline in performance, possible increase in injury rate, impaired reaction times, learning memory and increased heart rate with sleep deprivation. Also, overall health can be affected, shorter lifespan, link to Alzheimer’s disease, obesity, diabetes and certain types of cancer.

 

Alternative interventions

Although research is ambiguous for the following interventions, it’s important to look at an individuals needs first to see if experimenting with each recovery technique is a reasonable course.

Hydrotherapy

May be a reasonable intervention for athletes with various types of joint pain (back, hip, shoulder, etc.) or excessive fatigue.

 

Possible adaptations to performance:

Although hydrotherapy is incorporated widely into post-exercise recovery regimes, information regarding these interventions is largely anecdotal. The human body responds to water immersion with changes in the heart, peripheral resistance and blood flow, as well as alterations in skin, core and muscle temperature (Wilcock et al., 2006). The changes in blood flow and temperature may have an effect on inflammation, immune function, muscle soreness and perception of fatigue.

Recommendations:  

  • water temperature between 38–40°C for hot water.
  • recommended to have sessions monitored by someone who is qualified and experienced with hydrotherapy.

Safety concerns:

  • If athlete has open wounds or heart problems, it may not be a safe intervention.
  • Close monitoring for falls, or drowning, or lightheadedness.

 

Cold water immersion and icing

Icing may be reasonable for athletes with an acute injury to reduce inflammation. In general cold can be more penetrating than heat.

Possible adaptations to performance:

  • Cold water immersion or contrast water therapy for a duration of 14–15 min has been shown to improve performance in selected studies, again there are conflicting studies.
  • Intermittent icing can also be used immediately following injury as an effort to reduce pain, acute swelling, damage to affected tissues, which can speed recovery and decrease rehabilitation time (Prentice, 2017).

Recommendations:

  • Use appropriate temperatures and duration for water immersion. Research has found positive effects of water immersion at temperatures of 10–15°C for cold water.
  • The ratio of hot-cold water immersion during contrast-water therapy should be 1:1. Research that has reported positive performance effects used seven rotations of 1 min hot and 1 min cold (Halson, S. L., 2013).

Safety concerns:

  • Excessive cold to be avoided. Single layer of toweling with direct ice.
  • Water and crushed ice to reach a temperature of 50-60 degrees F
  • 10-15 minutes
  • Some athletes may be allergic to cold (hives and swelling), other rare adverse reactions include nerve palsy or Raynaud’s phenomenon.

 

Massage

May be reasonable to increase blood flow and improve recovery among athletes.

Possible adaptations

Several reviews of the effects of massage have concluded that while massage is beneficial in improving psychological aspects of recovery, most evidence does not support massage as a modality to improve recovery of functional performance (Barnett, 2006; Weerapong et al., 2005). However, such stimulation and manipulation of soft tissue can be used to dilate and drain capillaries, which may facilitate recovery.

Recommendations:

To increase blood flow and circulation, a variety of massage techniques can be introduced. Friction massage can be used in conjunction with mobilization techniques to relieve stiffness and breakdown adhesions.Friction is helpful around joints where tissue is thin. Bracing with the heels of the hands, then hold the thumbs steady and moving fingers in a circular motion.

Safety concerns:

Using lubricant so the skin doesn’t become irritated. Making sure the athlete is positioned properly. Massage should be performed by someone experienced.

 

Conclusion:

Recovery strategies such as hydrotherapy, low intensity active recovery, massage, stretching or various combinations of these methods may have merit as recovery-enhancing strategies, but more research is needed. Importance should also be placed on optimal post-exercise nutrition and adequate sleep to maximize recovery and reduce fatigue from exercise.

 

 

Stay tuned for part II (nutrition and active recovery). Happy Training Friends!

Xo,

Nat

 

References:

Prentice, W. E. Principles of athletic training: A guide to evidence-bashed clinical practice (16th ed.). New York, NY: McGraw-Hill Education; 2017.

Fleck, S. J., & Kraemer, W. J. (2014). Designing resistance training programs (4th ed.). Champaign, IL: Human Kinetics.

Malhorta, R.K. (2017). Sleep, Recovery, and Performance in Sports. Neurology Clinics. 35(3):547-557. doi: 10.1016/j.ncl.2017.03.002

Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep 2015;38(6):843–4.

Reyner, L.A., Horne, J.A. (2013). Sleep restriction and serving accuracy in performance tennis players, and effects of caffeine. Physiology and Behavior Journal. 2013;120:93–6.

Centers for Disease Control and Prevention (2008). Effect of short sleep duration on daily activities—United States. MMWR Morb Mortal Wkly Rep 2011;60: 239–42.

Walker, M., Stickgold, R. (2015) It’s practice, with sleep, that makes perfect: implications of sleep-dependent learning and plasticity for skill performance. Clin Sports Med;24:301–17.

Luke, A., Lazaro, R.M., Bergeron, M.F., et al. (2011). Sports-related injuries in youth athletes: is overscheduling a risk factor? Clinical Journal of Sports Medicine, 21(4):307–14.

Von Rosen, P., Frohm, A., Kottorp, A., et al. (2016). Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes. Scand J Med Sci Sports.

Mougin, F., Simon-Rigaud, M.L., Davenne, D., et al. (1990). Influence of partial sleep deprivation on athletic performance. Sci Sports. 5:83–90.

Halson, S. L. (2013). Recovery Techniques for Athletes. Sports Science Exchange.

Sands, W.A., McNeal, J.R., Murray, S.R., Ramsey, M.W., Sato, K., Mizuguchi, S., Stone, M. (2013). Stretching and its Effects on Recovery: A Review. Strength and Conditioning Journal. 35(5):30-36. doi: 10.1519/SSC.0000000000000004

Skein, M., Duffield, R., Minett, G.M., Snape, A., Murphy, A. (2013). The Effect of Overnight Sleep Deprivation After Competitive Rugby League Matches on Postmatch Physiological and Perceptual Recovery. Journal of Sports Physiol Performance. (5):556-64. doi: 10.1123/ijspp.8.5.556.

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