Recovery Strategies

Adequate recovery is optimum, if the individual is to wholly gain from training

and hindrance of injury occurrence (Nedelec et al, 2012). Contemptible recovery
declines performance and causes fatigue and lethargy; therefore if these
symptoms are highlighted and the training load is condensed, the consequence
commonly referred to as overreaching is swiftly inverted (Podlog et al, 2011).
However research has displayed a recurrent retort, to symptoms such as
weakened performance and lethargy; due to an increase in training (Bieuzen et
al, 2012). Therefore potentially leading to overload training syndrome, it is of
grave importance the individual and coach to monitor the training regime
concisely therefore a recommendation of a training diary should be utilised in
order to record all sessions, rest days, amount of sleep and early morning heart
rate (Lundkvist et al, 2012). Note: if the early morning pulse amplifies over
consecutive days (especially when) allied with weakened performance and
lethargy, training ought be abridged or avoided for a few days (Nedelec et al,
2012). It is also important to provide efficient recovery periods when proposing
the training regime, remembering to include; recovery (or rest) days in the
weekly training cycle (micro-cycle) and easy weeks in the long term cycle
(macro-cycle) (Bieuzen et al, 2012).

Delayed onset muscle soreness

Overuse
Local tissue
swelling
Decreased blood

Tight

Figure .1 Development of increased muscle compartment pressure ()

Soreness escorts muscle injuries such as strains, due to the incidence of
inflammatory cells or a build-up of metabolites (Glasgow et al, 2014). Delayed
onset of muscle soreness (DOMs) transpires subsequent to particular types of
activity (Marquet et al, 2015). DOMs is a full dull ache which develops 1224hours post unacquainted physical activity (may cause greatest pain and
discomfort between 24-72hours post activity); emblematic occurrence following
the first or second bouts of a new exercise regime (Glasgow et al, 2014). DOMs
has been exposed to be worse with eccentric exercise (involving muscular
contraction while muscle is lengthening) and arises due to activities such as
downhill running, jogging, step aerobics and jumping (Hyldahl and Hubal, 2014).
It is indistinguishable the etiology of DOMs nevertheless research has
recommended six theories; lactic acid, muscle spasm, torn tissue, enzyme efflux
and tissue fluid theories (Demirhan et al, 2015). It has also been mentioned for

individuals who train habitually will experience DOMs less although may still
experience some type of soreness subsequent an unfamiliar exercise stint (Olsen
et al, 2012). Anti-inflammatory medication has not been found to assuage
symptoms of DOMs (Demirhan et al, 2015). The severity of DOMs is determined
via the type of force elicit to the muscle (Singla et al, 2015). For example running
downhill in comparison to walking down hill will cause greater force therefore the
soreness triggered will undoubtedly be greater as a result of running downhill
(Tufano et al, 2012). As will a high volume of repetitions in comparison to a low
volume consequently enable development of progressing into a new activity
(Matthews, 2014).
Characteristics of DOMs (beyond local muscle pain):
Inflammation of the affected limbs
Inflexibility of the joint escorted by provisional diminution in the joints
range of motion
Tenderness to the touch
Transitory decline in strength of the affected muscles (lasting days)
In exceptional or severe cases muscle breakdown to the extent that the
kidneys may be placed at peril
Eminent creatine kinase (CK) enzyme in the blood, signalling muscle tissue
damage.
Table 1. Characteristics of DOMs (Vila Cha et al, 2012; Kanda et al, 2013 and
Matthews, 2014)
Factors which emerge to diminish DOMs include efficient warm down, post event
massage, active non-weight bearing exercise, hydro-therapy and spa baths
(Kanda et al, 2013 and Glasgow et al, 2014).
Active recovery
Active recovery is a dynamic activity, with encompasses less intensity and
volume in comparison to normal workout routine (Davey et al, 2013). Usually
utilised on a rest day from training i.e. brisk walking. This form of recovery is
beneficial opposed to passive recovery (complete rest from exercise) (Devlin et
al, 2014). Active recovery is believe to aid the bodies metabolise pathways of
recovery (White & Wells, 2015). Psychological benefits are apparent due to the
release of endorphins among other positive attributes (Perry, 2014). Also leads to
adherence to dietary requirements throughout daily movement providing
opportunity to burn additional calories (Devlin et al, 2014). Popular forms of
active recovery include; self-myofascial release, walking, lighter weight lifting
(medicine ball, kettle bells etc), hiking, swimming, yoga and cycling (Ali et al,
2012). Aerobic exercise at low intensity and volume hence aiding mobility and
decrease stress on joints through thorough ROM (Dave et al, 2013).
Warm down
A period of milder activity immediately following the conclusion of intense
exercise is thought to reduce the degree of muscle soreness and stiffness
following exercise (Olsen et al, 2012). The length of the warm down generally

varies with the level of the participants activity, but ranges from 5-15minutes
(Argus et al, 2013). This should be followed by stretching of the muscles used in
the activity (Olsen et al, 2012). A warm down is especially beneficial when
strenuous activity needs to be performed later the same day or the next day
such as occurs in tournament situations (Argus et al, 2013).
Contrast bathing
Decrease swelling by alternating heat and cold to create an alternating
mechanical force (Higgins et al, 2012). These baths are used after the acute
phase of injury to reduce swelling (Elias et al, 2012). The injured extremity is
immersed in a hot bath for 4 minutes, followed by a cold bath with ice and water
for 1-2minutes (Elias et al, 2012). This should be repeated three to seven times
(). A cold bath should be used to finish therefore encouraging vasoconstriction
(Higgins et al, 2012).
Cryotherapy
Application of cold or ice for the treatment of acute or overuse injury; was first
mentioned by Hippocrates around 400BC and has been widely used ever since
(Leeder et al, 2011). It is an inexpensive easily assessable and effective
(Hohenauer et al, 2015). Superficial application of ice results in changes of the
skin, subcutaneous, intramuscular and joint temperature (Glasgow et al, 2014).
The extent of temperature change is dependent on the method and length of
application and the cooling temperature (Leeder et al, 2011). Skin and
subcutaneous temperature decreases to a greater degree than muscle tissue,
however muscle tissue temperature may remain decreased for up to 45minutes
after removal of cryotherapy (Elias et al, 2012). The decrease in intra-articular
temperature is closely related to the decrease in skin temperature (Elias et al,
2012).
A decrease in tissue temperature stimulates cutaneous receptors to excite the
sympathetic adrenergic fibres to constrict local arterioles and venules (Demirhan
et al, 2015). Vasoconstriction reduces the swelling associated with bleeding and
inflammation (Hausswirth et al, 2011). It leads to a decreased rate of metabolism
and production of metabolites as well as decreased oxygen requirements,
therefore limitations on the extension of the injury to uninjured tissues
(Hohenauer et al, 2015). Decreased metabolism reduces the inflammatory
response and therefore decreases vascular permeability and edema (Demirhan
et al, 2015). Lower tissue temperature also increases blood viscosity and further
reduction of blood flow and leakage of fluid into the extravascular space
(Hausswirth et al, 2011).
Local effects of cooling include; a decrease in motor and sensory nerve
conduction velocity, a decrease in the rate of firing of muscle spindle afferents
and stretch reflex responses (Hohenauer et al, 2015). A decreased acetylcholine
levels and therefore a decrease in pain and muscle spasm (Demirhan et al,
2015). The indications contraindications and complication of cryotherapy (Leeder
et al, 2011).

There are numerous varied methods in regards to the application of cryotherapy

(Elias et al, 2012). These of which include cold packs, crushed ice wrapped in a
moist cloth or towel (most effective and inexpensive). Reusable gel packs or
chemical ice packs, are all inexpensive methods and may be placed against the
skin over the injured area (Demirhan et al, 2015). Ice should be applied 15mins
every 1-2hours if necessary (Elias et al, 2012).
Ice massage can be used especially for superficial conditions e.g. tendinopathy
or tenoperiostitis (Leeder et al, 2011). Ice massage can be performed with ice
blocks or water frozen in a device similar to a deodorant stick or cheaper method
a polystyrene cup and rubbed directed onto the affected area (Glasgow et al,
2014). Massage usually performed in a circular motion for 5-10minutes (Leeder
et al, 2011). Ice slush or a bucket containing both ice and cold water may be
utilised for the treatment of injured extremities i.e. ankle (Glasgow et al, 2014).
Cold sprays are usually used as a rapid skin coolant and commonly utilised as a
temporary anesthesia (Elias et al, 2012).
Superficial heat
Superficial heat is widely used in the treatment of soft tissue injuries both for
pain reduction and promotion of healing (Cleary et al, 2014). Superficial heat
increases tissue temperature to varying degrees (Elias et al, 2012). It has also
been shown to increase the extensibility of collagen tissue, reduce muscle
spasm, produce analgesia, produce hypermia and increase metabolism (Cleary
et al, 2014).
Heat should not be applied in the first 24hours following an acute injury (Malanga
et al, 2015). Heat can be applied in a number of different ways including; warm
showers and baths, warm whirlpools, heat packs and paraffin wax (Malanga et al,
2015).

Hydrotherapy
Is a form of treatment widely used in the treatment of sports injuries can be used
in conjunction with other forms of rehabilitation (Webb et al, 2013). Specific
exercises can be executed to rehabilitate the injured extremity (Webb et al,
2013). The exercises can be aimed at pain relief, muscle spasm, relaxation or
restoration of full joint movement (Halson, 2011). Hydrotherapy exercises may
result in increased muscular strength power and endurance as well as
improvement of functional level including coordination and balance (Halson,
2011).
Hydrotherapy may be beneficial in acute or overuse injuries (Stanley et al, 2012).
In acute injuries the warmth and buoyancy of the water, induces relaxation
reduces pain and encourages early movement (Higgins et al, 2012). Isometric
exercises, can commence against the buoyancy of the water (Halson, 2011).
Range of motion exercises may be easily performed and may be assisted by
buoyancy (Stanley et al, 2012). It is also possible to use hydrotherapy wearing

the appropriate splint required for treatment (Halson, 2011). Exercises may be
assisted by floats to aid buoyancy (Stanley et al, 2012). Strength exercises may
also be performed in the water (Higgins et al, 2012). These may be isometrics or
isotonic (both concentric and eccentric) (Stanley et al, 2012). Graded progressive
exercises can be devised utilising buoyancy, varied speed of movement and
movement patterns, varied equipment and altering the length of the lever arm
creating turbulence (Halson, 2011).
Sports massage (post event)
Regular massage contributes to soft tissue recovery from intense athletic activity
(Gatterer et al, 2013). To understand the mechanism of this effect, it is important
to understand the soft tissue effects of intense training (Delextrat et al, 2014).
Reduction of excessive post exercise muscle tone, increasing muscle range of
motion, increasing circulation and nutrition to damaged tissue and deactivating
symptomatic trigger points (Delextrat et al, 2013). As well as improving soft
tissue function, regular massage provides the opportunity for the massage
therapist to identify any soft tissue abnormalities which if untreated could
progress to injury (Gatterer et al, 2013). Masseur should also be aware of
lethargy, inadequate nutrition or musculoskeletal conditions i.e. bone pain. If
possible incorporate massage into warm down to maximise recovery (Gatterer et
al, 2013 and Delextrat et al, 2013).
Rest and sleep
Adequate rest and sleep play an essential part if the individual is to cope with
intense training loads (Fullagar et al, 2015). Therefore may require 10-12hours
sleep; if the individual combines training with either work or studies or all then
the individual may suffer with lack of sleep (Bird, 2013). Long term sleep
deprivation may cause persistent fatigue and ultimately overtraining syndrome
(Moser et al, 2012). Therefore afternoon napping would be advised in order to aid
the complaints of tiredness and weakened performance (Dennis et al, 2015).

Modality

Description

Special concerns

Temperatu
re

duration

Exer

Contrast
bathing

Transition
treatment
between cold and
heat for a
subacute injury,
sympathetic
mediated pain,
stiff joints
Whenever uniform
cold application to
an extremity is

Do not use in acute

setting due to potential to
increase blood flow

Hot bath
40.5C
(105F)
Cold bath
15.5C
(60F)

4 Min hot
1 min cold

Allow
durin

0C (32F)

5-10min

Allow
durin

Ice bath/
water
immersion

Note: this is required for

DOMs increase the blood
flow.
Carries the most risk of
hypersensitivity
reactions: restrict amount

Cryotherap
y

Radiant
heat

Hydrothera
py

Fluidothera
py

PNF

Massage

desired
Decreases pain
Decreases
swelling/bleeding
(vasoconstriction)
Decreases cellular
metabolism
Targets : muscle
spasm, trigger
point pain, acute
swelling/edema,
inflammation,
heat illness,
contusion, acute
injuries, pre and
post event
massage
Heat from infrared lamp; no
discomfort of
weight, good for
treating large
areas
Whirlpool tanks
combine thermal
pressure and
buoyancy effects
of water
Vigorous heating,
ideal for hand or
foot; allows high
temperature
without
discomfort
Comprises
strengthening,
position
awareness and
other factors. This
particular form of
dynamic
stretching enables
dynamic flexibility
to be addressed.
Encourages
increases blood
flow via manual

of extremity immersion
Cold hypersensitivity
Raynauds disease
Circulatory insufficiency
Increased edema after
prolonged use
Superficial nerve damage
Ice burns
Anesthesia (masks pain)

0C (32F)

5-10min

No k
posit
move

Only penetrates a few

millimetres

Dependant
on
intensity,
distance
from source

Up to
20min

Yes

As with all heat

modalities use caution
with peripheral vascular
disease and sensory loss;
avoid full body immersion
Avoid contact with open
wounds

35.540.5C
(95.9104.9F)

10-20min

Grav

35-45C
(95-113F)

10-30min

Yes

Signs and symptoms of

inflammation

n/a

1015minutes

Yes

Contraindications

n/a

3060minutes

Yes

therapy through
utilisation of
specific
techniques to
relieve tension
(trigger points,
frictions)
myofascial
release, warm of
the muscle
(effleurage/petriss
age)
Therefore
relaxation and
relief can be
achieved.
Compressio Encourage
Garments being too tight
n/a
Wear all
n garments vasoconstriction
therefore too restrictive
day
and dilation
causing diminutive effects
therefore aiding
DOMs if present
post activity and
return of blood
flow to the
affected area.
Table 2. Treatment Modalities. (Higgins et al, 2012; Derminhan et al, 2015;
Delextrat et al, 2013; Hausswirth et al, 2011; Elias et al, 2012; Halson, 2011;
Kelly et al, 2005; Osternig et al, 1987; Cardinale et al, 2011; Delextrat et al,
2014; Gatterner et al, 2013; Hamlin et al, 2012 and Hausswirth et al, 2013).

Yes

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