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How to Enhance Recovery Beyond Nutrition

Today’s guest post comes from Kamal Patel and the team at Examine.com.  If you haven’t heard of Examine.com just yet, you’ve been missing out!  Examine.com is the web’s best resource for evidence-based information on nutrition and supplementation.  They are completely unbiased and only report on scientific fact, not speculation.  The nutrition and supplement fields are filled with anecdotal information, false beliefs, and downright inaccurate claims about efficacy.  Examine.com helps us sort through what is fact and fiction.  Be sure to check out the special offer from Examine.com at the end of this article.

 

How to Enhance Recovery Beyond Nutrition

Training sounds pretty simple on paper. Just eat right, sleep well, and lift a little bit more weight every workout. But every workout takes place in real life, and real life can make training pretty hard.

To improve at the rate that you read about on internet forums – hitting a 315 pound squat or 225 pound bench press after a year of training – you need to train like an athlete. That doesn’t just mean going to the gym three times a week and downing a protein shake afterward. Optimal training only occurs when daily life doesn’t get in the way.

Training like an athlete while working a full time job or going to school is not easy, but fixing weak points in your habits and lifestyle can help avoid training setbacks and plateaus.

Alleviating Soreness and Joint Pain

Exercise causes muscle and joint pain. The severity of the soreness and how long it takes to recover depends on diet and lifestyle, as well as the kind of exercise performed.

The basics

A high-carbohydrate diet is the first step to alleviating post-workout joint pain. A low-carbohydrate diet, while potentially useful for fat loss, is not ideal for resistance training.

People on a low-carb diet should eat the majority of their carbohydrates in the post-workout period. Going into a workout with low glycogen is not ideal for strength training, but if joint pain is interfering with exercise, fixing the problem should be a priority.

Magnesium deficiencies can also exacerbate joint pain and cause muscle cramping in athletes. The lack of other electrolytes, like potassium, can contribute to pain. Potassium deficiencies must be alleviated through dietary changes, since too much potassium on an empty stomach can cause potentially fatal cardiac arrhythmia.

 

Troubleshooting Joint Pain

If dietary changes don’t alleviate persistent joint pain, anti-inflammatory supplements may be able to help.

Anti-inflammatory supplements are not as potent as pharmaceuticals like aspirin, acetaminophen, and aleve. However, curcumin and fish oil are both used to alleviate joint pain in athletes. Though the research on these two supplements is done in the context of arthritis, the benefits should theoretically extend to athletes as well. More research is needed to confirm this effect.

Cissus quadrangularis can alleviate the joint pain that results from specific injuries. If your post-exercise joint pain has persisted for years, you may want to consider consulting with a physiotherapist.

Do not supplement high amounts of anti-inflammatory supplements to dull injury pain. Continuing to work out after an injury can exacerbate tissue damage and increased recovery time, leading to overuse of pain-reducing supplements and permanent damage.

 

Alleviating Fatigue and Lethargy

There’s nothing like proper rest and nutrition to facilitate training, but sometimes you can’t avoid staying up late to finish a paper or getting up extra-early to beat the boss to the office.

 

The basics

Running a caloric deficit is great for weight loss, but not as great for energy levels. Though some people can go for long periods of time on reduced calories, a crash is inevitable. If your diet is interfering with your daily energy, consider a less drastic deficit.

The occasional all-nighter won’t have a long-term effect on gym performance, but consistently poor sleep will. Aim for six to 10 hours of sleep every night, and make sure your sleep environment doesn’t affect your recovery.

A healthy sleep environment is:

  • A slightly cool room tends to facilitate sleep, while a puddle of sweat is awful to wake up in.
  • Smart phones and tablets just before bed will disrupt melatonin secretion, leading to a more difficult time falling asleep.
  • Ears don’t close like eyes do. Even if you sleep through the night, loud noises can still impair sleep quality.
  • Caffeine-free. Any compounds that impair sleep will lower sleep quality, even for veteran coffee drinkers that can drink a pot of coffee at 8:00 p.m.
  • Where you sleep and how long you sleep for should be the same from night to night.

A good sleep environment actually makes it easier to get out of bed in the morning, since improved sleep quality leaves you feeling more rested.

 

Troubleshooting sleep quality

Some sleep issues can be alleviated through supplementation. People that have issues with sleep latency, meaning they have trouble falling asleep, can supplement melatonin or lemon balm.

Melatonin is a hormone that regulates sleep, but people with no difficulty falling asleep will not experience any further sleep benefits.

Lemon balm is a light sedative used to alleviate intrusive thoughts that can interfere with sleep.

Supplements that improve sleep quality, as opposed to sleep latency, include glycine and lavender.

About three grams of glycine taken thirty minutes before bed will improve sleep quality, but the supplement becomes less effective after prolonged use. To use glycine in the long term, avoid taking it daily.

Lavender, used in aromatherapy, is associated with improved sleep. Rubbing lavender oil on a pillow before bed can also improve sleep, but some people may experience skin irritation due to long-term exposure of skin to oil.

If stress is causing reduced sleep quality or poor sleep latency, supplements called adaptogens can help the body adapt to stress, resulting in fewer stress-related side effects, like fatigue and anxiety.

The most popular adaptogens are ashwagandha, Rhodiola rosea, and Panax ginseng. Ashwagandha is sometimes supplemented by athletes because it may improve cardiovascular performance and muscular strength. Siberian ginseng is another adaptogen option for people that get sick often, though it has very little effect on physical performance.

Breaking through plateaus

There’s a lot of factors to keep track of during long term training. Hitting a plateau can be frustrating because it takes time to isolate the factor responsible.

 

The basics

Daily caloric intake is the biggest influence on physical performance. Carbohydrates are more effective for strength training than fatty acids, but both are necessary for busting through plateaus.

Addressing general energy levels, fatigue, and joint pain is also a vital aspect of breaking through a plateau.

 

Troubleshooting plateaus

Supplements that improve physical performance can be useful for breaking through training plateaus. Creatine is the go-to recommendation, while caffeine (400mg) can be used once or twice a week as a pre-workout supplement.  Please note that although 400 mg is listed as a low dose in some studies, this would be a relatively high dose for someone who is caffeine naive.

There is preliminary evidence that suggests cholinergics like CDP-choline and Alpha-GPC may improve physical performance in a non-stimulatory way, but more research is needed to confirm this effect.

 

Identifying Lifestyle Weaknesses

To facilitate effective training, learn to isolate the weak points in your habits and work to improve them. Start with obvious factors, like staying up too late, and address others as they arise, whether in training, at work, or in life.

 

Examine comKamal Patel is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics. Kamal has also been involved in research on fructose and liver health, mindfulness meditation, and nutrition in low income areas.

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Foam Rolling for Recovery

Foam rolling has become a popular component of most personal training and sports performance program.  It is simple to perform with cheap equipment.  But more importantly “it works.”

There has been quite a bit of debate on what “it works” means to different people.  This was probably perpetuated by naming the use of a foam roller as “self-myofascial release.”  Many have argued that foam rolling does nothing to “release” the fascia as the ability to deform fascia significantly is well beyond the means of a simple piece of foam or PVC pipe.

At times, that has lead to the knee-jerk reaction of some to essentially say that foam rolling does nothing to the fascia, thus must be useless and a waste of time to perform.  Too bad it wasn’t just called “self-massage.”

Many, including some prominent strength coaches, have argued back saying again that “it simple works” because people feel better after foam rolling.

I couldn’t agree more.  However, I’m not a big fan of just say “it just works.”  I want more than that.

 

Foam Rolling Helps Recovery

self-myofascial release for recoveryWhile foam rolling has become popular, it still is used most often as a way to prepare for training.  However, a recent research report was published in the Journal of Athletic Training that looked at the effect of foam rolling after training on delayed onset muscles soreness (DOMS) and performance.

In the study, 8 collegiate men performed a 10×10 squat protocol to completely exhaust their quads and cause DOMS.  The groups performed this two times, once with performing foam rolling afterward and another time without foam rolling.  In the experimental group, foam rolling was performed immediately after squatting, as well as 24- and 48-hours later.

Foam rolling for recoveryThe foam rolling procedure consisted of 2 rounds of rolling for 45 seconds each over the quads, adductors, hamstrings, IT band, and Glutes.

Results of the study showed that DOMS was significantly reduced when foam rolling was performed.  However, they also discovered 30 meter sprint time, broad-jump distance, and change-of-direction speed were all negatively effected by the presence of DOMS, but the impact was lower if they performed foam rolling.

 

Implications

Based on this article, I’m not sure we are any closer to understanding “why” foam rolling works, however we do understand more of “how” foam rolling works.

Foam rolling isn’t just a way to prepare for training, but also a useful tool to recover from training.

Foam rolling should be performed both before and after training, and likely even on off days after training.  Doing so will reduce the amount of soreness you have after a hard session and allow you to train hard or perform better next time.  This is important for everyone from the personal training client to the in-season athlete.

Put simply, foam rolling helps you recover faster and then perform better, I know everyone at Champion is definitely still foam rolling!

 

How I Use Foam Rolling and Self-Myofascial Release

This month’s Inner Circle webinar will be on how I use foam rolling and self-myofascial release in my programs.  I’ll be going over specific techniques using a variety of tools to perform a comprehensive self-myofascial release program.  You can simple roll back and forth, but there are better ways to incorporate self-myofascial release to be even more effective.

The webinar will be on Thursday March 19th at 8:00 PM EST but I’ll record it for those that can’t make it live.

 

 

 

 

 

 

Understanding and Managing Fatigue

Today’s article is a guest post by Eric Cressey on not only understanding fatigue, but how to manage fatigue as well.  This is a really interesting topic to me, as “recovery” is probably the next big area we need to really research and optimize so we can enhance performance for everyone from rehab patients, to fitness enthusiasts, to professional athletes.  This is an invaluable lesson that rehabilitation specialists can pick up on from the strength and conditioning world, manage fatigue properly and you’ll see faster outcomes.

 

Understanding and Managing Fatigue

Perhaps it’s coincidence, or perhaps the scientific community is finally catching on, but recently, there have been several studies looking at the role of short- and long-term recovery in preventing and rehabilitating injuries.

Here’s a research study that demonstrates relationships among a variety of scheduling and recovery factors and injury rates.  The part I found most interesting was that researchers observed that sleeping fewer than six hours the night prior to a competition led to a significant increase in fatigue related injuries.

Additionally, researchers at Stanford recently demonstrated the profoundly positive effect that “sleep extension” has on a variety of performance variables in high-level basketball athletes.

These results, in themselves, aren’t particularly surprising: fatigue impacts performance – whether that’s on the field, or in the rehabilitation realm. Anyone who has ever trained an athlete on a Saturday morning after he’s had a late Friday night, or rehabbed a roofer after he’s completed a 10-hour-workday, will tell you that there are certainly less-than-optimal times to get the work in.

What research like this doesn’t tell us, though, is that not all fatigue is created equal – and I suspect that this is one area where strength and conditioning specialists can “return the favor” to rehabilitation specialists for all that we’ve learned from them over the years. Very simply, the very best strength and conditioning coaches I know are the ones who are masters of managing competing demands, including strength training, mobility drills, soft tissue work, movement training, metabolic conditioning, and sport-specific training. In order to effectively manage all these factors, it’s imperative to understand the different stages of fatigue. On the rehabilitation side of things, every injured athlete likely has some element of fatigue that not only impacted his/her injury mechanism, but will impact the response to a given rehabilitation program.

 

Over-what? Over-everything!

In their classic review, The Unknown Mechanism of the Overtraining Syndrome, Armstrong and VanHeest discussed the importance of differentiating among overload, over-reaching, overtraining, and the overtraining syndrome (OTS). They defined the terms as follows:

  • Overload – “a planned, systematic, progressive increase in training stimuli that is required for improvements in strength, power, and endurance”
  • Over-reaching – “training that involves a brief period of overload, with inadequate recovery, that exceeds the athlete’s adaptive capacity. This process involves a temporary performance decrement lasting from several days to several weeks.”
  • Overtraining – training that “exceeds over-reaching and results in frank physiological maladaptation(s) and chronically reduced exercise performance. It proceeds from imbalances between training and recovery, exercise and exercise capacity, stress and stress tolerance; training exceeds recovery, exercise exceeds one’s capacity, and stressors exceed one’s stress tolerance.” 
  • Overtraining Syndrome (OTS) – “a set of persistent physical and psychological symptoms that occur subsequent to prolonged application of heavy training loads. The critical diagnostic factor is a chronic decrease in performance, not simply the existence of SAS [signs and symptoms].”

Overload is inherent to a successful training process, and over-reaching is actually quite valuable when used appropriately. For instance, in our training programs at Cressey Performance, we generally fluctuate training stress in four-week programs as high (1), medium (2), very high (3), low (4), where the deloading in week 4 allows for adaptation from the fatigue imposed during week 3.

However, over-reaching is far from overtraining – a term that is thrown around far too often among even the most qualified individuals in the world of health and human performance. Over-reaching may be attained in as little as 7-10 days, and remedied in a matter of days or weeks with adequate deloading. Conversely, the process of overtraining must take place for months for the outcome, OTS, to be apparent. Recovery from OTS requires at least several weeks – and more often several months; in other words, you really have to go out of your way to get to overtraining syndrome.

Since high level performance – and even just normal physical health – is a priority, it is imperative that coaches, parents, and athletes recognize the signs and symptoms of over-reaching and overtraining syndrome – and the differences between the two. According to Armstrong and VanHeest, the signs and symptoms of OTS may include:

  • Decreased physical performance
  • General fatigue, malaise, loss of vigor
  • Insomnia
  • Change in appetite
  • Irritability, restlessness, excitability, anxiety
  • Loss of body weight
  • Loss of motivation
  • Lack of mental concentration
  • Feelings of depression

 

What All These “Overs” Mean to You

Many of these signs and symptoms are shared between over-reaching and OTS, so how do we know the difference? How do we know when to hold back for a day or two (for overload recovery), 7-21 days (over-reaching), or even months (overtraining syndrome)?

Unfortunately, as much as I would like to be able to offer you the magic answer, I can’t do so. The scientific community has yet to agree on a single, highly sensitive diagnostic test to differentiate among the three.  In fact, the only diagnostic tests that are universally accurate are those of physical performance; if performance drops off, there must be some degree of accumulated fatigue.

Other measures – such as heart rate, bloodwork, metabolic rate, substrate metabolism, and a host more – are subject to so many factors that they are hardly reliable tests of one’s training status.

As an example, research from Fry et al. had subjects perform ten sets of one repetition on machine squats at 100% of their one-rep maximum for 14 days straight. That’s an absurd volume of high-intensity resistance training, especially in a trained population. You know what, though? The only thing that dropped off was performance; hormone status (as measured by bloodwork) really didn’t change much at all.

Conversely, crush an endurance athlete with volume, and this same bloodwork will look terrible. The take-home point is that it’s a lot harder to “overtrain” on intensity than volume. And that’s where the problem exists when you’re dealing with athletes: just about every sport out there is a blend of volume and intensity. We don’t just train or rehabilitate shotputters or Ironman competitors; we get athletes from soccer, basketball, baseball, hockey, tennis, and a host of other sports.

So, what is a coach or rehabilitation specialist to do when trying to determine just how much fatigue is present, and what the best course of action is to guarantee an optimal return-to-play as quickly as possible?

In two words: ask questions.

In my opinion, the absolute most important step is to establish communication with athletes and – in this case – patients. Ask about training practices before an injury, sleep patterns, dietary factors, family life, concurrent illness/injury, changes in body weight, and appetite.

These may seem like obvious questions to ask, but we live in a one-size-fits-all world of pre-made templates and rigid systems – and people can fall through the cracks all the time. My experience has been that those most commonly “thrown under the bus” in this regard are the most dedicated athletes forced to train or rehabilitate in a “general health” world. As an example, we had an adult athlete client request a Vitamin D test from a primary care physician last year, and he was turned down because he wasn’t “a post-menopausal female.” As it turned out, he was severely clinically deficient, and normalizing his Vitamin D was a big game-changer for him.

Simply asking the right questions will always help the cause when it comes to determining just how “systemic” what you’re dealing with really is. And, in the process, it gives you an opportunity to show a client or patient how much you care before they even care how much you know.

 

Eric CresseyEric Cressey, MA, CSCS is the President of Cressey Performance, a Boston-based facility specializing in baseball development.  He publishes a free daily blog and weekly newsletter at www.EricCressey.com. Cressey and Reinold collaborated on Optimal Shoulder Performance: From Rehabilitation to High Performance.  If you liked this article on understanding and managing fatigue, you’ll love Eric’s website.