Archive for the ‘Recovery & Regeneration’ Category

Optimizing Recovery – PREPARE

On my way to the ACSM Health & Fitness Summit #ACSMSummit to present on evidence based strategies to optimize recovery and prevent over-reaching.  Looking forward to sharing this information with the fitness professional community at this wonderful conference.

During this presentation we will discuss the multiple factors that lead to fatigue and ultimately over-reaching / over-training following repeated bouts of strenuous exercise.  We will then discuss the 3R’s system, which focuses on evidence based recovery strategies to maximize the benefits of strenuous exercise and minimize the risk of a catabolic response.  As part of this process we’ve developed the PREPARE score (Planned Recovery to Enhance Performance and Regenerate), which is a survey individuals can take and see their recovery scores in the 3R areas (Re-Fuel, Rest, Retain Movement Efficiency).  The score is meant to help guide individuals optimize their recovery behaviors during strenuous training periods to maximize the anabolic response and minimize the catabolic response of strenuous training regimens.

A PDF copy of the presentation is available.  Enjoy!  DAP

Recovery – PREPARE ACSM Health & Fitness Summit 2013 Handout Low Res


Impact of Diet on Game Performance


Souglis AG, Chryssanthopoulos C, Travlos AK, Zorzou AE, Gissis I, Papadopoulos C, Sotiropoulos A (2012) The effect of high vs. low carbohydrate diets on distances covered in soccer, Journal of Strength and Conditioning Research, doi: 10.1519/JSC.0b013e3182792147

A summary of this recent article can be accessed at the following blog site:

 Brief Summary:

In short, the researchers compared the effects of a high carbohydrate diet to a low carbohydrate diet on measures of work load during a soccer match.  Players consumed either the high (8 g CHO per Kg body mass) or low (3 CHO per Kg body mass) carbohydrate diet for 3.5 days prior to a scheduled game.  An estimated energy and macronutrient content of the prescribed diets during the intervention period for a 70-Kg player is listed below.

High CHO Diet Low CHO Diet
Total Kcal 2869 2873
Carbohydrate (g) 565 212
Fat (g) 44 95
Protein (g) 85 95

Distances traveled during the match were recorded using GPS devices.  Players who consumed high carbohydrate diets traveled significantly greater distances during the soccer match compared to those who consumed a low carbohydrate diet:

  • Total distance covered over entire game: 13% greater in high carbohydrate players
  • Total distance covered in first half: 12% greater in high carbohydrate players
  • Total distance covered in second half: 16% greater in high carbohydrate players

These findings provide insight into the importance of diet / nutrition to actual game related performance.

National Recovery Day – PEAKc Recovery Recommendations

The National Athletic Trainers’ Association and Gatorade have partnered to establish July 11 as National Recovery Day.

In this spirit of National Recovery Day we are posting a set of recommendations for promoting optimal recovery in athletes and physically active individuals.

The first step for recovery is to ensure movement efficiency.  Research demonstrates that a 10-15 minute dynamic warm up can effectively improve movement efficiency, enhance performance, and drastically reduce musculoskeletal injury (e.g. ACL injury rates are decreased 60-85%).  The PEAKc Dynamic Warm Up Program can help achieve these goals.  Information on the PEAKc Dynamic Warm Up Program can be found at the PEAKc website.  We recommend that this type of program be performed 3 times per week.

Another important aspect of recovery is to perform a proper cool down following training and competition.  This includes exercises to promote active recovery, muscle relaxation and lengthening, and activation of muscles prone to inhibition.  The PEAKc Recovery Program provides an overview of exercises to perform as part of a systematic and integrated recovery program.  We recommend that this type of program be performed 3 times per week.

Other vital components of recovery are proper nutrition and hydration (Re-Fuel) and rest.  An overview of recommended Re-Fuel and Rest strategies is provided in the PEAKc Refuel and Rest Strategies handout.

Regular compliance with the these recommendations for maintaining movement efficiency, re-fueling, and rest can help promote the optimal physiological environment to recover and maximize your training potential.

Train Hard, Recover Harder

Sleep Impacts Player Value in Professional Sports

Data from new research looking at the impact of daytime “sleepiness” on the careers of professional athletes was recently presented at the SLEEP 2012 conference.  These data demonstrate the impact of increased daytime “sleepiness” on a players career.  Essentially this research found that athletes who experienced higher levels of daytime “sleepiness” were less likely to remain with their team after they were drafted.  Those athletes who had low levels of daytime “sleepiness” were more likely to remain with their team in the following years after they were drafted.

These findings have two important implications.  First, it may be important to consider an athlete’s sleep habits as part of the player evaluation process when considering to draft an athlete.  These findings suggest that athletes with high daytime “sleepiness” levels are more likely to not remain with that team in the coming years after being drafted, as such they are a low value.  Conversely, athletes with better sleep habits and low daytime “sleepiness” levels are a higher value pick as they are more likely to remain with their team that drafted them.  Second, the ability to quantify the level of “sleepiness” can be easily quantified using standard survey instruments.  Thus, this is an easy assessment to incorporate into player evaluations and recovery programs to ensure they are maximizing their athletic and regeneration potential.

The bottom line is that research has repeatedly demonstrated the importance of sleep on player performance and recovery.  Thus, improving sleep behaviors should be a part of an athlete’s comprehensive recovery program to maintain performance and promote regeneration.

The press release for this study is listed below:

“Coaches, owners and fantasy-league traders take note: Sleep researcher W. Christopher Winter, MD, has uncovered a link between a pro athlete’s longevity and the degree of sleepiness experienced in the daytime.

Winter presented two studies at SLEEP 2012 that associate the career spans of baseball and football players with their voluntary answers on a sleepiness questionnaire. The results show that less sleepy football players tended to remain with their drafting NFL teams after college. In addition, attrition rates for sleepier baseball players trended higher than MLB averages.

“A team’s ability to accurately judge a prospect or a potential trade in terms of the value they will get for that player is what makes or breaks many professional sport teams,” said Winter, principal investigator of the studies and the sleep advisor for Men’s Health magazine. “These studies demonstrate that a simple evaluation of sleepiness may be a powerful tool to add to the list of tests athletes already undergo, such as the Wonderlic Cognitive Abilities Test and the 40-yard dash.”

The football study looked at 55 randomly selected college players who landed in the NFL, finding that sleepier athletes only had a 38 percent chance of staying with the team that originally drafted them. In comparison, 56 percent of the less sleepy players were considered a “value pick” because they did stay with the original team. The baseball study analyzed the sleepiness scale of 40 randomly selected baseball players and found that players who reported higher levels of daytime sleepiness also had attrition rates of 57 percent to 86 percent, well above the 30 – 35 percent MLB average.

Winter said measuring sleepiness could do more for a team than help it decide who to draft. “Addressing sleepiness in players and correcting the underlying issues causing sleepiness may help to prolong a player’s career,” he said.

Winter and his colleagues at Martha Jefferson Hospital Sleep Medicine Center and CNSM Consulting in Charlottesville, Va., used the Epworth Sleepiness Scale (ESS), a short questionnaire that can be helpful in detecting excessive daytime sleepiness. EDS is a common symptom of many sleep disorders such as obstructive sleep apnea.”

Lower limb compression improves recovery following intense bouts of exercise

Jakeman, J. R., C. Byrne, et al. Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. European Journal of Applied Physiology 109(6): 1137-1144, 2010.

PMID: 20376479

RATIONALE & PURPOSE: High intensity physical activity is associated with a significant physiological demand placed on the body’s muscle tissue. Today’s competitive climate surrounding athletics is characterized by a high frequency of competition and training sessions that commonly occur “back-to-back” in a short time frame, commonly not permitting time for adequate rest and recovery. The level of play and performance that is represented by today’s athlete commonly requires a large volume of high-intensity physical activity, increasing demand on the body’s musculature, potentially leading to exercise-induced muscle damage (EIMD). EIMD is associated with impaired muscle function, delayed-onset muscle damage, decreased self-paced exercise performance, and increased perceived exertion during exercise. It is intuitive the above signs and symptoms of EIMD may contribute to performance decrements for the athlete. It is thus imperative that efficacious, evidence-based clinical practices targeted at minimizing the effects of EIMD be deployed by sports medicine professionals to facilitate recovery after strenuous physical activity with a potential benefit of improving athletic performance and decreasing injury risk. The purpose of this study was to examine the efficacy of the use of lower limb compression on recovery from EIMD symptoms, and to determine if the use of compression clothing after high-intensity exercise affects subsequent athletic performance.

OVERVIEW OF RESEARCH METHODS: Seventeen (n=17) physically active females participated in this study. Participants were randomized to a treatment (n=8) and passive recovery (n=9) group. Individuals in the treatment group used lower limb compression tights for 12 hours immediately following a bout of damaging plyometric exercise (10 x 10 repetitions of plyometric drop jumps from 0.6 m box). Athletic performance measures (squat jump height, counter-movement vertical jump height, isokinetic knee extensor strength), perceived soreness (visual analogue scale), and muscle damage (creatine kinase activity) were collected as markers of EIMD following the damaging exercise. EIMD indicators were collected prior to and 1, 24, 48, 72, and 96 hours post-exercise. Indicators of EIMD were compared between the treatment and passive recovery groups.


Perceived Muscle Soreness:  Individuals using the compression clothing experienced decreased soreness compared to the individuals in the passive recovery group. Individuals using the compression clothing reported less soreness at 1, 24, 48, and 72 hours after damaging exercise.

Squat Jump Height:  The compression-clothing group experienced less of a decrement in squat jump performance compared to the passive recovery group. A less severe performance decrement was observed at 24, 48, 72, and 96 hours following damaging exercise.

Countermovement Jump Height:  At the 48 hour mark the compression clothing group experienced less of a decrement in countermovement vertical jump performance compared to the passive recovery group. There was no significant difference in countermovement vertical jump performance between the treatment and passive recovery group at all other time points.

Isokinetic Muscle Strength:  The compression-clothing group experienced less of a decrement in absolute peak muscle torque compared to the passive recovery group. Individuals using the compression clothing were observed to have a less severe decrease in peak muscle torque at 24, 48, 72, and 96 hours after damaging exercise.

Creatine Kinase Activity:  There was no difference in creatine kinase activity between groups. Both groups were observed to have increased creatine kinase activity 1 and 24 hours following damaging exercise.


The results of this study provide a basis for using compression clothing following intense levels of physical activity in athletic females. The findings suggest that the use of compression clothing immediately following potentially damaging exercise may decrease the symptoms of EIMD including perceived muscle soreness, muscle strength, and functional performance (as assessed by the vertical jumping activity). It should be noted that the exact mechanism by which the compression clothing decreases the severity of the symptoms of EIMD is not fully understood, however a significant difference in the severity of objective performance decrement (% of baseline) and subjective symptom levels is evident, favoring the use of compression clothing. Furthermore the performance variables demonstrated the greatest group differences at the 48 hour mark, a time frame that commonly separates bouts of competition in both amateur (and possibly more commonly) in professional sports such as basketball, hockey, soccer, and tennis. The results of this study provide substantial evidence that there are benefits of using compression clothing to facilitate recovery after intense physical activity, improving both objective performance measures and reported symptoms of EIMD.

As a result, clinicians should consider the use of compression clothing as a treatment modality to facilitate recovery after intense physical activity that is associated with EIMD. Compression clothing worn after bouts of intense physical activity may minimize performance decrements observed between successive competitions or training sessions. Additionally, the effect of compression on reduction in perceived soreness may promote optimal movement strategies that may otherwise be compromised due to discomfort or decreased muscle function. Promoting optimal movement is likely associated with the observed benefits in performance and may also decrease the risk of injury for an athlete participating in competition and/or training sessions that fall within a acute period. The exact physiological mechanisms by which compression minimizes performance decrements and perceived levels of soreness following intense exercise are not fully understood, and more research in this area is warranted. However, the results of this study suggest compression clothing worn after intense physical activity enhances recovery after potentially damaging exercise, and should be considered by sports medicine professionals as a viable treatment modality to minimize performance decrements and injury risk in athletes participating in successive sessions of physical activity in which optimal athletic performance is favored.

Written by: Barnett Frank, MA, ATC

Approved by: Darin A. Padua, PhD, ATC

To Stretch or Not Prior to Exercise? A systematic review of the effects of acute static stretching on maximal muscle performance

Kay AD, Blazevich AJ.  Effect of Acute Static Stretching on Maximal Muscle Performance: A Systematic Review.  Medicine and Science in Sports and Exercise 44(1): 154-164, 2012.

PMID: 21975448

RATIONALE & PURPOSE: There is currently a significant amount of controversy surrounding the issue of performing static stretching prior to exercise.  Sports medicine professionals have often recommended that static stretching be performed prior to exercise as part of a comprehensive warm-up to help facilitate proper muscle length / balance and ready the body for physical activity.  However, more recent research has shown that static stretching can negatively maximal force production when performed immediately prior to exercise.  As a result, there has been a recent trend for sports medicine professionals to recommend eliminating static stretching from pre-exercise warm up routines for fear that performing static stretching pre-exercise may reduce physical performance of individuals.  Inspection of studies investigating the effects of static stretching on physical performance measures reveals that a wide range of static stretching protocols and physical performance tests have been used across studies.  As such, it is not entirely clear how certain aspects of static stretching (e.g. duration of stretch) may affect different physical performance measures (e.g. concentric force, eccentric force, isometric force, power, speed, etc…).  Thus, the purpose of the systematic review was to compare the effects of the duration of static stretching performed prior to exercise on a range of physical performance measures.

OVERVIEW OF RESEARCH METHODS: A total of 106 articles were included in the systematic literature review.  Each article was reviewed by 2 separate individuals and the quality of the study was evaluated using a standardized instrument (PEDro rating sheet).  To determine the effects of static stretch duration on physical performance measures the authors created 4 separate categories for static stretch duration based on the protocol used in a specific study.

  • Less than 30 seconds of continuous static stretching
  • 30 to 45 seconds of continuous static stretching
  • 1 to 2 minutes of continuous static stretching
  • More than 2 minutes of continuous static stretching

Once grouping studies into the appropriate static stretch duration category the authors evaluated the stretching protocols effects on different physical performance measures used across the different studies.  This was performed by determining the average change in physical performance across those studies grouped in a given stretch duration category for each of the different physical performance measures.

KEY FINDINGS: Studies using a static stretching protocol of less than 30 seconds did not negatively impact the different physical performance measures (maximal strength, speed, power).

Studies using a static stretching protocol of 30 to 45 seconds also did not negatively impact the different physical performance measures (maximal strength, speed, power).

Static stretching protocols using greater than 60-seconds of continuous stretching (1 to 2 minutes or more than 2 minutes) negatively impacted physical performance (maximal strength, speed, power).  Thus, 60-seconds of continuous static stretching appears to be the threshold at which static stretching can begin to produce negative changes in physical performance measures.  Interestingly, the negative change in physical performance beyond 60-seconds continues up to 2-minutes of continuous static stretching, but then plateaus at that time.

CLINICAL IMPLICATIONS:  The findings of this systematic literature review may have important implications on the design of pre-exercise warm up procedures.  Based on these findings a continuous static stretch held for less than 60-seconds should not have any negative impact on maximal physical performance (maximal strength, speed, or power).  Given that static stretches are typically held for 30-seonds during pre-exercise warm up routines than the use of static stretches should not be harmful to physical performance performed immediately after the stretching protocol.  The average change in physical performance measures for stretches held less than 60 seconds was -0.5% (SD=2.8%).  Thus, these data overwhelmingly indicate that static stretching for less than 60 seconds has no detrimental effects on muscle strength, power, or speed.

As a result, static stretches should not be discouraged as part of the pre-exercise warm up routine so long as the static stretch is held for less than 60 seconds.  Including static stretching may be an important component of the pre-exercise warm up routine to help establish proper muscle length prior to performing functional movements.  This may in turn help minimize faulty movement patterns when performed in conjunction with other exercises to maintain muscle balance (strengthening of weak or inhibited muscles) and promote proper neuromuscular control (functional movement patterns focused on movement quality).  Future research is needed to determine if incorporating static stretching with these types of exercises as part of a pre-exercise warm up routine will not only further minimize the risk of decreased physical performance, but actually improve physical performance by promoting optimal movement efficiency and control.

Effects of Multiple Games in a Week on Physical Performance and Injury Rates

Dupont G, Nedelec M, McCall A, McCormack D, Berthoin S, Wilsoff U. Effect of 2 Soccer Matches in a Week on Physical Performance and Injury Rate.  American Journal of Sports Medicine 38(9):1752-1758, 2011.

NOTES: The following article offers unique insight into the effects of multiple games played in a compressed time period on physical performance measures and injury rates in professional soccer athletes.  While this study was conducted in professional soccer athletes these findings may have important implications for all sports in which multiple games are played in a week with little time for recovery and regeneration between games.

To study the effects of recovery time between games two groups of athletes were followed and tracked for in-game performance and injuries.

  • Extended Recovery Group: 6 days or more of recovery between games
  • Short Recovery Group: Less than 4 days of recovery between games

The amount of game playing time was consistent between the Extended and Short Recovery groups (at least 75 minutes played during game, total game time was 90 minutes).  Also, both groups utilized a standard post-game recovery and regeneration protocol (see below for description).  Thus, the primary difference between groups was the amount of time between games.

In-game physical performance was measured using a computerized image recognition software that allowed the researchers to determine the following information from review of game videos: total distance covered during game, distance covered during high intensity running (running speed between 19 and 24 km/hour), distance covered while sprinting (running speed above 24 km/hour).  Physical performance measures between the first game and second game played were compared for both the Short and Extended Recovery groups to determine how the duration of time between games influenced these variables.

An injury was defined to occur when a player was not able to fully participate in future training or games due to physical complaints.  Only muscuoloskeletal injuries were considered as illnesses, diseases, and mental complaints were not included in the analysis.  Injuries were monitored during the time period from the second game played to 4 days after the second game played.  Thus, all reported injuries occurred during the second game played or within the following 4 days.

There was no difference in any of the physical performance measures between the first and second game played for both the Short Recovery and Extended Recovery groups.  Thus, the amount of recovery time between games in this study (less than 4 days vs. 6 days) did not affect total distance covered, high intensity running distance, or sprint distance during games.

Injury rates (# injuries per 1,000 hours of exposure) were computed overall (both practices and games), for practices only, and for games only.  The Short Recovery Group demonstrated a significantly greater overall injury rate, practice injury rate, and game injury rate compared to those in the Extended Recovery Group.   The injury rates were 6.2 times greater for overall injury, 4.7 times greater for game injury, and 3.3 ties greater for practice injury in the Short Recovery group.  Thus, a shorter recover period (less than 4 days) resulted in an increased risk for musculoskeletal injury compared to a longer recovery period (6 days).  However, there was no effect of the recovery periods compared on physical performance measures.

It is compelling to note that a short recovery period does not seem to negatively impact physical performance; however, this is not the case for injury as injury risk is greatly increased.  The authors theorize that the standardized recovery and regeneration strategy may have played an important role in maintaining physical performance measures in the short recovery group.  The recovery and regeneration protocol is listed below:

  • Ice bath immersion for 14 minutes post-training/game
  • Use of compression garments for 12 hours post-training/game
  • Standardized nutrition and hydration plans before and after games (pre-game = large amount of carbohydrates 3 hours prior to game (low glycemic index foods) ; post-game = carbohydrate (high glycemic index) and protein rich foods (sport drinks, milk-shakes, yogurt, soup, sandwiches)
  • No supplements were provided
  • No form of active recovery stretching or exercises were performed

This type of standardized recovery and regeneration program may have helped players to recover quicker and thus explain why there was no decline in physical performance during games for both Short and Extended Recovery groups.  However, these recovery and regeneration procedures were not able to minimize injury risk.

Additional measures may need to be taken, in addition to these procedures, to ultimately reduce injury risk when there is a short recovery period between games.  Other procedures that have also shown success in facilitating recovery and regeneration include massage or deep compression post-training (e.g. foam rolling), active stretching, and  whole body vibration.  Research is needed to determine if incorporating these additional procedures as well as a focus on maintaining muscle balance may help reduce the risk of injury when there is a short recovery period between games.

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