Recovery Modalities for Endurance Athletes

Endurance Athletes

Recovery Modalities for Endurance Athletes

Training and Recovery for Endurance Athletes
Endurance training programs need careful planning to ensure that the benefits of strengthening and running are gained, while avoiding or minimising fatigue and injuries. A good training program needs to consider a few important components. Firstly, the strength and flexibility of the anatomical structures like the muscles and joint, secondly the type of stress or load during exercise, thirdly the frequency, intensity and duration of the exercise and finally the recovery techniques and time between training sessions.

Athletes often train very hard for a specific time, increasing the volume and intensity to build more muscle strength and to increase endurance. This is called overreaching. Overreaching is crucial for athletes to increase performance. Adequate recovery techniques help to maximise this process. However, when overreaching is done without sufficient recovery time it may lead to increased fatigue and reduced performance. Overtraining or overtraining syndrome is a chronic over trained state that causes physical, emotional and behavioural symptoms that can last weeks to months . Unfortunately overtraining syndrome is very common. Between 15 to 50 % of competitive endurance athletes can suffer from overtraining syndrome in a season due to overtraining and insufficient recovery processes. Finding a balance between training, competition and recovery is thus a major challenge.
A balance between training load and recovery is important to prevent running related injuries and maximize performance. Athletes often have a busy schedule with little time between training sessions and races. Therefore using specific techniques that can assist with recovery are crucial to enable athletes to maintain performance when optimal recovery is not possible.

Optimal recovery is when all the tissues and systems in the body return to their normal state after intensive or prolonged training. Breakdown of the muscle protein can continue even after the training has stopped. Recovery is crucial after an intense session or eccentric training to repair damaged muscle fibres and to renew the energy stores.
The goals of recovery should be to assist in the repair of damage tissues, to decrease pain and to restore the normal function of the body. Due to the nature of endurance running, athletes have intensive training schedules and regularly partake in competition on consecutive days. The “more is better” principle during endurance sport often causes athletes and coaches to overlook recovery.
Recovery Modalities
A planned recovery process may include different recovery modalities where each has a specific goal during the recovery process. Different fitness levels and training methods require different recovery modalities. Recovery modalities are any techniques used by athletes that increase the rate and quality of their recovery after competition or training. Unfortunately, scientific evidence for the effectiveness of different recovery modalities is limited and of poor quality. Runners often use the recovery modalities that elite athletes, coaches and advertising agencies recommend rather than what scientific data prescribes.
Recovery methods can and should include nutritional substances like protein, carbohydrates and vitamins to replace depleted energy stores and to assist with muscle and tissue healing. It commonly includes other activities and techniques like light exercise known as active recovery, stretches, massages, compression garments, different types of cold or heat water immersion, or complete rest to enable the body to recover faster. The following section discusses the different types of recovery modalities.

Anti-Inflammatory Medication (NSAIDS)
Athletes all over the world use non-steroidal anti-inflammatory drugs (NSAIDs) regularly to decrease pain, assist with recovery and to accelerate their return to sports. NSAIDs are often used as a preventative tool and have potential to improve performance. NSAIDs have an inhibitory effect on the initial inflammatory response, influencing the healing phase of the body. NSAIDs can therefore impair the repair process of the body as they change the natural healing process after an injury.

Although NSAIDs has been showed to reduce pain and improve function after an acute injury it cause multiple harmful side effects that are often overlooked to achieve the short term goal of decreased pain and increased recovery. Despite all the side effects of NSAIDs it is still widely used. Regular use of NSAIDs can lead to side effects of the gastrointestinal systems. It can also cause dehydration and liver and kidney disorders. There is good evidence for the effective use of NSAIDs in short term pain relief, but as NSAIDs are not much more effective than Paracetamol, it is recommended that NSAIDs only been used when justified in specific situations. The minimal effective dose for the shortest amount of time should then be prescribed. The use of Paracetamol, instead of NSAIDs is recommended in the initial 48 hours after an injury to promote adequate tissue healing. It is widely recommended to avoid using NSAIDs during sport, due to their negative effect of on soft tissue healing and the multiple side effects associated with them.

Nutritional Recovery Modalities
Adequate nutrition is recommended and crucial for the body to function optimal during sport. Multiple factors play a role in determining adequate nutrition. These factors include the type of exercise, duration and intensity, the level of training, gender and the nutritional and hydration status of an athlete. As a rule exercise lasting for longer than one hour needs additional nutrition.
Nutrition influences the performance of athletes, especially endurance athletes, as they require higher energy levels and extra protein intake to ensure adequate muscle function. Athletes need adequate energy intake for prolonged or intense training to avoid the loss of muscle mass and bone density, menstrual dysfunction, fatigue, illness and prolonged recovery.

Endurance athletes burn mostly carbohydrate and fat as fuel during exercise but 1-6% of energy used comes from protein. When the carbohydrate is burned up during endurance exercise, protein becomes a more important fuel. In order to improve recovery it is recommended to:
– To consume carbohydrates to replace muscle energy
– Consume protein to repair and build muscles
– Optimize fluid intake to ensure normal electrolyte balance

Gels, bars and sports drinks are dietary supplements that can be a very convenient supplement for active people.

Protein is an important source of energy. Optimal protein intake should be between 0.8 to 1.8 g/ kg of body weight. About 0.8 g/ kg/day is enough protein for a non exercising male older than 19 years but may be not enough to support the protein needed during exercise or for the repair of muscles after exercise. The International Society of Sports Nutrition and most other literature recommend 1,0g/kg to 1.6 g/kg per day for endurance exercise depending on the fitness of the athlete and the duration and intensity of the training program. As the intensity and duration of a training program increases, additional protein is needed to ensure performance and optimal recovery. But no extra protein supplements are required for recreational athletes on a normal balanced diet, performing low to moderate training.

Some popular believes are that chronic intake of increased amounts of protein is harmful to the kidneys and could cause renal failure; or that it increases the risk of osteoporosis, as a high protein diet can increase the excretion of calcium. Both these believes are unfounded as there are no evidence of harmful effects of ingesting high amounts of protein in a healthy active person.

Carbohydrates and Glycogen
Glycogen or carbohydrates (carbs) is the primary fuel source for intermittent high intensity exercise or sub maximal exercise like endurance exercise or repetitive resistance exercise. Carbohydrates maintain the blood glucose levels during exercise. Depending on an athlete’s training program between 6 g/kg/day to 10 g/k/g/day of carbohydrate is recommended.

Carbohydrate loading has been around for many years and is one method that is used to ensure adequate glycogen stores. Carbohydrate loading can consist of a low-carbohydrate diet while training for a week and then to switch to a high-carbohydrate diet combined with rest for the three days prior to competition. More recent research showed that the low-carbohydrate diet is unnecessary and only three days of high-carbohydrate is necessary prior to competition to ensure sufficient glycogen stores. They found that it is possible to replenish the glycogen stores in 24 hours.

Renewal of the glycogen stores has been showed to be higher than when carbohydrate is consumed directly after exercise than two hours later. The frequency that carbohydrate is consumed or the form it is in does not seem to matter.
Although vitamins are consumed in small amounts it is vital to regulate health and the function of a body. Vitamins can be classified as water or fat soluble. Important water soluble vitamins are vitamin C and vitamin B. Vitamin B regulates the carbohydrate, fat and protein metabolism. Therefore vitamin B has a role in energy metabolism. Vitamin C has an effect on the recovery process from intense training and acts like an anti-oxidant. It can boost the immune system. Vitamin C deficiency can increase fatigue and reduce energy. Intense or endurance exercise can cause temporary immune-depression in athletes, making them prone to infections like upper respiratory tract infections .
Vitamin A, vitamin D and vitamin E are fat soluble vitamins. They have an indirect influence on energy metabolism. Vitamin A and vitamin E help with reducing muscle damage and supporting recovery after exercise.

Athletes often use mineral and vitamin supplements; mostly to compensate for inadequate diets, to provide extra nutrient and energy during intense training programs, to aid their performance or to prevent illness and infection. Scientific studies have shown that most physical active adults consume an adequate amount of vitamin C. Therefore a diet that includes a variety of foods ensures adequate vitamins and minerals and reduce the need for added vitamin and mineral supplements.
Cryotherapy/ Cold Treatment
Cryotherapy is the cooling of a part of the body. Cryotherapy cools the skin and the underlying tissues of the body. It alters the blood flow by causing blood vessel constriction, reducing the swelling and pain. If combined with water immersion the pressure of the water can move fluids from the legs or arms to the heart. Examples of cryotherapy are cold water immersion, like swimming in a cold pool or the application of ice packs.

Cold and heat are legal methods to enhance performance during sport . The use of locally applied ice decreases the skin and underlying tissues’ temperature causing vasoconstriction of the blood vessels with reduced blood flow and a decreased metabolism for the area. This can reduce inflammation, swelling, pain and the injury
Lately there is some thought regarding the possibility that ice might decrease the muscle adaptation or training effect of the muscle after training. Some possible negative effects of ice application on athletic performance have been noted previously. It is therefore recommended that ice should only be used after a specific injury, or in combination with other recovery modalities .

Contras Temperature Water Immersion
Contras temperature water immersion is the immersion of part of the body in water at temperatures of more than 30 °C and less than 15 °C respectively. The alternating hot and cold temperature results in a pumping action that helps recovery by increasing blood flow and assist in the removal of metabolic by-products.
Unfortunately there is a lack of research to establish the best dosage of contras temperature water immersion.

Passive Recovery or Complete Rest
Passive recovery or rest is a natural and most common thing for a body to do when tired. During rest the heart rate and metabolism slow down and muscles use less energy.
Unfortunately there is no specific scientific evidence to tell us the most advantageous time and frequency to rest for optimal recovery.

Active Recovery
To warm down or recover actively after exercise is a commonly used principle. During active recovery in the upright position more blood is shifted to the legs, causing the muscle in the legs to pump the blood back to the heart and increase the blood flow. This increase in the blood flow increases the metabolism and helps to restore energy levels and the removal of metabolic by-products. This assist the recovery process and healing of damaged muscles.

Active recovery includes any form of exercise done at a slow heart rate. It is recommended to perform the same type of activity as the activity you wish to recover from, for example running or walking for runners. Unfortunately is no available literature to specify the most effective timing or duration of active recovery.

Stiff and painful muscles are commonly associated with overtraining and exercise. This muscle stiffness can increase immediately after exercise and may last for up to five days. Overtraining cause structural changes to the muscle fibres. Stretching a stiff muscle cause changes in the muscle fibres, possible leading to faster recovery.

Even though there is no great research to support it, stretching prior to activity is commonly used all over the world to prevent injuries. The perceived effect of stretching is to improve flexibility, to relax muscles and to reduce muscle soreness and stiffness. Some research recommends stretching to increase the muscle length, as reduced flexibility is a risk factor for muscle injuries. But lately a lot of research is done on the ability of the muscle to control lengthening (or eccentric working) during activity. It seems that controlling the movement and length of a muscle might be more important than the flexibility of a muscle to prevent injuries. When a muscle is tired the ability to control the lengthening of a muscle is reduced. A tired muscle therefore has a reduced ability to absorb energy and is at higher risk for injuries.

There is some scientific evidence to suggest that pre-exercise stretching need to be done carefully to avoid overstretching. Overstretching can lower the pain threshold of a muscle and has been associated with increase muscular fatigue. It is therefore recommended to rather stretch after exercise. Avoid stretching into pain, hold each stretch 20 – 30 seconds and repeat each stretch twice.

Massage is widely used and can include a variety of different techniques. Massage increase blood circulation as is evident by the redness of the skin during and after a massage. It can decrease the inflammatory response and muscle spasm while resulting in muscle relaxation and improved flexibility and range of motion.
Massage is commonly used before and after exercise and races as a recovery modality. Massage has a psychological effect, lowering stress levels and creating a feeling of well-being that might play a role during recovery. Unfortunately there is no good scientific evidence available to tell us the most effective timing, techniques or frequency of massages during the recovery process.

Compression Garments
Compression garments are available in different shapes and sizes, from full body suits to socks covering only the lower legs. There is little scientific evidence to proof the effect of compression garments during the recovery process. Compression garments are thought to increase the blood circulation by assisting the muscle pump action mechanism. It improves the removal of metabolites, increases the flow of oxygen to the muscles and reduces swelling. Thus compression garments might reduce muscle pain and fatigue.
Most literature recommends gradual compression garments as it may possibly be effective in assisting the normal venous blood flow from the ankle to the heart without causing a tourniquet effect. Compression garments need to be worn immediately after strenuous or prolonged exercise to improve recovery, but the ideal duration to wear these garments has not yet been established.