Posts in recovery
Ibuprofen's Impact on Muscle Growth and Development

Non Steroid Anti Inflammatory Drugs (NSAIDS) such as ibuprofen are the most common drugs listed on our patients intake paperwork.  Patients are often using these drugs due to their beneficial effects on pain and inflammation.  Due to being sold over the counter these drugs are often thought to be free of side effects, but they lead to close to 80,000 hospitalizations and 8,000 deaths due to gastrointestinal bleeding.  In addition to these serious consequences, NSAIDs are also thought to delay or prevent healing after acute ligamentous and bone injury as well as reduce the beneficial adaptations to exercise.

A recent article in the American Journal of Sports Medicine studied the impact of NSAID use on the effects of an exercise program (Rooney et al. 2016).  The authors conducted an animal study placing animals in either an exercise or sedentary group.  Within each group half of the animals were placed on NSAIDs and were followed over the 8 week course of exercise.  The authors found the NSAIDs did not impair the beneficial mechanical adaptations to exercise such as stiffness or tissue quality, but did decrease the cross sectional size of the muscle.  The results of the study suggest the animal's medication use attenuated the normal growth of the muscles in response to the exercise.    

This study adds to the existing literature on the impact of NSAIDs on healing and adaptations to exercise.  Patients are advised to speak with their primary care doctor regarding these medications, their effects and side effects.

Return to Play after Achilles Tendon Rupture

Achilles tendon ruptures mainly occurs in middle aged adults, males > females, participating in sports with high levels of jumping or high force activity.  The repair and recovery time of these tendon ruptures is lengthy due to the post operative immobilization, weight bearing, and exercise restrictions.  Prior research has shown only 1 in 2 athletes returns to play at 1 year post op.  Among these athletes who do not return some may either choose not to return to their previous sport due to fear of reinjury while others have placed themselves at greater risk of injury due to not restoring their leg's strength, balance, agility, and coordination to pre injury levels.  

A recent article in the British Journal of Sports Medicine reviewed the available evidence to determine an athlete's ability to return to play after achilles tendon repair.  (Zellers et al. 2016).  The authors reviewed 108 studies of over 6500 patients and found on average 80% of athletes return to play at pre injury levels.  The average time to return to sport after a course of Physical Therapy was 6 months.

Athletes are encouraged to use Physical Therapy following an Achilles Tendon injury to accelerate their healing and improve their chances of recovery.  

Compression Garment's Impact on Running Recovery and Performance

Compression garments including shorts, tights, and socks have gained in popularity among both amateur and professional runners.  Manufacturers and athletes claim improved circulation, recovery, and performance can be found using these products either during or after a run.  As with many products in health, fitness, and performance these claims should be taken with a grain of salt until supported by research institutions.

A recent article in the journal Sports Medicine evaluated the available evidence on the psychological, physiological, and performance effects of compression garments (socks, calf sleeves, shorts, and tights) in runners (Engel et al. 2016).  The authors found moderate beneficial effects for delayed onset muscle pain/soreness and delayed muscle fatigue in athletes wearing compression garments during run.  Additionally, smaller beneficial effects were noted for improvements in running economy and time to exhaustion suggestion these garments may slightly improve performance.  Important to note is the lack of significant effects on sprint, middle, or long distance timed runs or physiologic variables such as cardiac output, blood lactate levels, or body temperature were noted in the review.  

In short, compression garments seem to have their greatest impact on perceived muscle pain/soreness and recovery, but performance effects are small.  

ACL Reconstruction in Older Athletes

ACL injuries are on the rise across the United States as more individuals participate in athletic activities.  As described in prior posts, the majority of these ligament injuries do not involve contact but rather occur with deceleration and directional changes in sports.   Athletes with decreased strength, balance, and coordination are unable to dissipate forces placing greater loads on their knee ligaments.  One segment of the population at risk of ligamentous injury due to these factors includes “weekend warrior” athletes over the age of 40. 

The necessity of repairing a torn ACL injury in these older athletes is debatable with many patients able to return to activity, albeit often at a lower level, with conservative treatments alone.  A recent review article examined the outcomes associated with ACL repair among athletes >40 years old.  Mall and colleagues analyzed the results of 452 patients (average age 48) who underwent ACL repair (Sports Health. 2016).  The authors reported few complications and a low failure rate among this population along with A or B outcomes in >80% of patients. 

The results of this review suggest ACL repair combined with post operative Physical Therapy is a safe and effective alternative for patients with ACL tears. 


Sleep’s Impact On Endurance Performance

Money and time are two finite resources affecting us each day.  We struggle to meet the demands of family, work, community, and our endurance training.  Busy endurance athletes often forgo the recommended 8-10 hours of sleep required for optimal recovery to squeeze in another commitment compared to their team sport peers.  The choice to cut sleep time doubles an athletes risk of injury (Milewski et al. 2015) and leads to decreased mental, emotional, and physical performance as we lose the important balance between recovery and training.  Recovery of our body systems is promoted by hormonal activity as we sleep.  Reductions in hormone secretions at night leads to decreased immune function, recovery, muscle and bone growth, as well as, metabolism.  

In 2011 researchers examined the impact of sleep duration on 2 consecutive days of run trials, one interval and one distance trial (Skein et al. Medicine Sci Sp Ex).  Authors reported decreased muscle glycogen (stored fuel in muscle) storage after a poor night's sleep compared to more rested athletes.  This decreased storage lead to slower performance on the upcoming run trials and these athletes also reported worsened moods and higher levels of stress.  Similar results are seen in both endurance and weight training studies.  

Each of us will have to make decisions on time management each day, but athletes should place an emphasis on the quantity and quality of sleep each night to maximize both recovery and performance.  Newer research is also examining the benefits of a "power nap" for 30 minutes after lunch each day.  This nap may help combat the loss of sleep hours at night and improve mental and physical performance in the sleep deprived athlete.