Posts tagged recovery
Do Compression Socks Help With Muscle Recovery?

Athletes have always sought remedies and treatments which accelerate their recovery from workouts. Optimal recovery allows for higher training intensities and in turn better performances during their sport of choice. Delayed onset muscle soreness (DOMS) is one of the most common reasons athletes struggle to reach a desired training intensity during a subsequent workout. Successful treatment approaches to reduce DOMS include a post workout cool down, nutrition, hydration, and foam rolling, but more recent attention has been focused on compression garments. These garments including leggings and socks are designed to optimize circulation across exercised muscles. Previous research has found no association between wearing a compression garments and improved performance, but there may be an effect on muscle soreness and recovery.

Heiss and colleagues examined the impact of compression socks on muscle performance, flexibility, circulatory markers, and recovery (JOSPT. 2018). Authors studied healthy young adults as they performed an exercise protocol designed to induce DOMS. Participants performed eccentric calf lowering using a weighted vest (25% of body weight) on an incline plane. They performed 5 sets of 30 reps with 10 seconds of rest between sets. After the exercise session, each participant immediately donned a compression sock on 1 randomized leg and wore the garment for 60 hours after the exercise session while the bare leg served as the control. Authors assessed muscle perfusion using contrast ultrasound and a MRI to assess muscular injury associated with DOMS. No effect of compression socks were found on circulation, flexibility, muscle soreness, calf circumference, or muscular injury. In contrast, authors did find a change in muscle stiffness between the legs depending on sock use.

This study supports our current understanding regarding compression socks. These garments remain an personal choice, but performance and recovery benefits remain inconclusive.

Eating for Recovery After Injury

Acute muscle strains and sprains remain one of the most common injuries we encounter at our Boulder Physical Therapy clinic.  In a previous blog post we summarized the findings of new research studies showing how early Physical Therapy accelerates a patient's recovery after these injuries.  In addition, to exercise and sleep, nutrition also plays an important role in recovery.  A healthy, balanced diet is critical in post operative or injured patient.  

Collagen is a key structural protein in many of our body tissues including blood vessels, muscles, ligaments, and tendons.  It remains an essential natural resource utilized by our body during the healing process.  Many factors have been shown to reduce collagen production including smoking, simple sugars (candy, soda), and UV light.  These factors can damage proteins necessary for collagen formation and in turn healing.  

Conversely, collagen production is increased with exercise and may be augmented through nutrition and diet.  Nutritionists recommend a diet sufficient in protein due to its' high content of amino acids especially leucine.  Leucine has been shown to both reduce the breakdown of muscle and enhance muscle synthesis in animal studies.  Key sources of leucine include chicken, cheese, eggs, whey and soy protein powder.  In addition to protein intake, colorful fruits and vegetables also play a key role in recovery due to the abundance of anti oxidents found in berries and vegetables.  The vitamins found in this food group facilitate muscle and soft tissue recovery.

There are numerous supplements claiming to accelerate recovery, but like most supplements many fail to demonstrate statistical significance above a placebo.  Small studies have found an accelerated recovery from injury when collagen and Vitamin C are combined in supplementation, but more research is needed before widespread use.  Outside of supplementation, gelatin and bone broths are found to have high contents of collagen. 

Patients are advised to follow up with a nutritionist and their medical doctor before any significant change in diet or beginning any nutritional supplement.


Will Cold Water Immersion or an Ice Bath help my recovery?

When I first started seeing athletes in the early 2000s we often placed athletes in cold baths in an attempt to both reduce post workout soreness and facilitate recovery.  Since this time we have moved toward more active recovery strategies including aerobic exercise, corrective exercise, static stretching, and foam rolling.  A new study examined the impact of cold water immersion on an athlete's recovery.

Anderson and colleagues placed athletes through 45 minutes of intermittent run training and then provided one of three 12 minute recovery methods: 14 degree C, 5 degree C, or a seated control group (J Strength Conditioning Research, 2018).  The athletes were assessed immediately after exercise over a 3 day period.  Peak power output measured on a cycle ergometer was improved in the 5 degree vs. 14 degree or control group 24 hours after exercise.  Conversely, both the control and 5 degree were more effective than the 14 degree C immersion at 48 and 72 hours.  Mean power output on the cycle ergometer was higher in the control vs. either cold water immersion group.  No changes were noted in either lactate or creatine kinase levels.  The authors concluded repeated bouts of exercise are initially impaired following cold water immersion and the treatments should not be used for acute recovery.  Athletes are encourage to choose more active recovery methods (cool down) as well as adequate nutrition, hydration, and sleep. 

No penguins were injured in the writing of this post

Alcohol's Impact on Performance and Recovery

Many athletes enjoy a cold beer or drink after a long workout or on the weekend after a long work/training week.  The acute, short term effects of these alcoholic drinks are well established, but new research is looking into the impact of alcohol on hydration levels, future athletic performance, and recovery.  Alcohol effects all of our body systems and has a strong impact on future athletic performance.  Authors have established higher risks of injury, slow healing, and delayed return to sport among frequent alcohol users (Volpe et al. ACSM. 2017).  Of course many of alcohol's effects are dose dependent but research shows even small amounts of drinking prior to exercise leads to changes in our body's physiology and utilization of energy and oxygen.  These changes lead to decreased endurance performance across many athletic disciplines.  

Conversely, post exercise consumption of alcohol is more common among both amateur and professional athletes.  Research has shown post exercise alcohol use interferes with the body's ability to recover from exercise training.  Specifically, disrupting necessary muscle repair and protein synthesis in the tissues even if adequate meals are eaten concurrently.  In addition, drinking after exercise can disrupt the sleep cycle leading to a poor quality of sleep.  These cumulative effects explain the higher rates of injury among athletes who frequently drink compared to those who do not.  As in many other areas of life, moderation may be the key to limiting these acute and chronic effects on performance. 


Q and A with Boulder Professional Triathlete Nicole Valentine
PHOTO CREDIT: Alan Torres @ATV Photography

PHOTO CREDIT: Alan Torres @ATV Photography

1. Can you tell us a little bit about what got you into triathlon?

I grew up as a swimmer and then switched to cross country running in high school and college. At the time, I had friends who were doing triathlons and always thought that if I could get my hands on a bike, it would be fun to try one. While living abroad in Costa Rica after college, I finally bought my first bike – a mountain bike and did my first triathlon there after a few years of endurance mountain bike racing. It was an absolute blast and I ended up placing first female by a decisive margin. I was hooked.

2. Were you competitive in other sports?

Yes, I grew up playing every sport possible – soft ball, soccer, field hockey, lacrosse, swimming.

3. What are some of your career highlights in endurance sports?

In 2015, my last year as an age group athlete, I came in 5th at the Ironman World Championship in Kona and 3rd at the Xterra World Championship in Maui two weeks later. I won the Outrigger Double Award for the second year in a row for the fastest combined time at Ironman and Xterra World Championships. What was particularly memorable about this accomplishment is that I actually fell and crashed on the mountain bike midway through the Xterra race and broke my collarbone. Determined to finish the race if I could, and defend my title, I got back on the bike. I finished the technical mountain bike course and then was able to overtake some of my competitors on the run to place third. Standing on the podium with a sling on my arm was my proudest moment to date in endurance sports, as I knew I had given it everything in that race.

4. What brought you to Boulder for training?

In 2015 I had my sights set on trying to obtain a pro card in Xterra off-road triathlons. I had heard about what a great place Boulder was for training due to the altitude, ample roads, trails, and mountains for running and biking, as well as sports injury specialists and support facilities like MEND, and of course, the number of elite athletes and training groups. I convinced the firm I worked for to let me work remotely, and came out to Boulder for eight months to try the lifestyle.

5. Tell us a little bit about your training philosophy, especially in relation to staying healthy and injury free.

I’m finding that the training itself is just one slice of the pie and in order to support the elite athlete lifestyle and heavy training, you need to put as much emphasis on nutrition, recovery, and injury prevention, otherwise the training cannot happen.

6. What's your favorite recovery food?

Sweet potatoes and Healthy Skoop protein powder. I eat sweet potatoes pre workout, during training for fueling, and for post workout recovery – I love them! I’ve been switching over to a vegan diet and have found that Healthy Skoop plant based protein powder has been amazing for ensuring I’m getting enough protein in and I love the taste.

boulder-triathlete-lovato performance-nicole valentine

PHOTO CREDIT: Alan Torres @ATV Photography

7. How important are the small things, like stretching, weight-lifting?

I’m finding this year that all of the small things – sleep, nutrition, recovery, stretching, pre workout muscle activation, strength training, massage, PT, etc. make the difference between just getting the workouts in (and constantly battling oncoming injuries), and nailing every training session consistently and making huge fitness gains as a result.

8. What role does Physical Therapy play in your training?

Physical Therapy is a critical piece of the recovery puzzle. Whenever I feel that my body is taking a hit from the intense training load, I know that I need to get PT work done in order to keep training going and prevent a full blown injury from happening.

9. How many workouts a week are you doing?

On average, I have 2-3 workouts a day and about 16 workouts a week. It’s a very high training load.

10. If you could be successful at any other sport, what would it be and why?

I think I might be good at Ultra running. I’d love to give it a try! I know so many amazing runners in Boulder and am so inspired by the mileage they put in!

11. What's the hardest decision you've ever made?

Leaving a successful career in marketing for a financial services firm on the east coast to turn professional as a triathlete and move to Boulder. It has been a bumpy and incredibly difficult transition, but I am happy to be pursuing my dream. I know that this is what I’m meant to do.

12. Who makes you laugh more than anyone?

My coach, Michael Lovato. He has a great sense of humor which is so appreciated when we are jumping in the pool at 5:45am for swim practice. I wouldn’t be able to endure such a tough lifestyle without his great coaching support and the camaraderie of my Lovato Performance teammates.

13. What are some of your competitive goals for 2017 and 2018?

This year, my goal has been to place on the podium in Ironman races and so far I’ve been quite lucky to do so with 6th place at Ironman 70.3 Puerto Rico and 5th place at Ironman 70.3 Peru. I’m finding that nailing the nutrition, injury prevention, and recovery is making the difference. I hope to keep climbing the podium steps in the pro field!

Optimizing Your Warm and Cool Down with Foam Rolling and Dynamic Stretching
Photo Credit:

Photo Credit:

The warm up is an essential element of any strength and endurance training session.  Starting your workouts with a proper warm up prepares your body for the upcoming demands of exercise, improves performance, and reduces your risk of injury.  In prior decades, warm ups consisted of brief aerobic activities followed by static (prolonged hold) stretching of major upper and lower body muscle groups.  As the scientific research on warm ups developed over the past decade we have come to better understand the detrimental effects of prolonged static stretching (>20 seconds) on upcoming athletic performance. 

Prior research has shown static stretching reduces sprint and distance running performance, decreases running economy and jumping performance, as well as, impairs strength testing.  Conversely, dynamic stretching involving short duration multi joint movements has been shown to reduce injury risk and improve performance in endurance and team sports.  These dynamic movements should closely mimic the demands of the athlete’s sport to assist in preparing the muscles and nervous system for optimal performance. 

Underlying this performance improvement is a phenomenon called post activation potential (PAP).  PAP describes the improvement in the muscular and nervous systems’ ability to communicate, contract, and perform immediately after brief, repetitive contractions of the given muscle.  An example of this phenomenon includes the use of a plyometric program where an athlete performs a larger jumping movement after a smaller preparatory jump.  The first jump primes the muscles and nervous system to produce a better performance on the second jump than would be possible with a single isolated jump. 

A second key area of our warm up should include foam rolling.  The repeated, short duration pressure applied by rolling equipment has been shown to improve mobility.  The mechanism behind this improvement is thought to be due to an improvement in the stretch tolerance of the muscle.  By reducing or eliminating the muscle’s signals to the nervous system to stop the pressure or stretch we are subsequently able to move through a greater range of motion.  Recent research highlights the benefits of working with a roller to both augment the effects of a dynamic warm up and improve recovery after training.

Dynamic warm up-leg rolling-foam roller-calf
dynamic warm up-calf-soft tissue mobilization

Scientific research in this area has highlighted the benefits of combining foam rolling and soft tissue mobilizations with dynamic warm up activities.  Athletes who performed soft tissue work on major upper and lower extremity muscles prior to performing dynamic, multi joint movements performed better than their peers who performed a dynamic warm up alone.  The soft tissue work likely allowed the participants to move through a greater range of motion during their dynamic warm up augmenting the effects of the dynamic movements alone.  Athletes are encouraged to perform their warm ups after foam rolling to maximize performance.

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thight-soft tissue mobilization-roller

Foam rolling and soft tissue mobilization should also be incorporated after workouts due to their positive impact on muscle recovery.  A recent review article in the International Journal of Sports Medicine examined the impact of foam rolling on range of motion, delayed onset muscle soreness, and performance (Cheatham et al. 2015).  The 14 combined research articles supported the use of foam rollers to improve short-term flexibility and range of motion.  Importantly, unlike static stretching, rolling was not found to have any detrimental effects on future muscle or athletic performance and can be used safely before training or events.  When used after a challenging workout rolling may accelerate recovery by reducing delayed onset muscle soreness and improving ensuing muscle performance.  Athletes should strike for 2-3 bouts of 45-60 seconds on affected muscle groups followed by gentle, static stretching for optimal cool downs and recovery. 

In summary, the foam roller and soft tissue mobilization tools are quickly gaining in popularity as essential warm up and cool down tools.  Utilization of this equipment has been shown to reduce pain and soreness, improve flexibility and recovery, as well as increase sports performance.  Athletes are encouraged to utilize this equipment as part of their daily training programs.