Recovery Strategies
In recent years, various new forms of recovery strategies have become increasingly popular and had been adopted for modality of choice in national sport in football cricket, rugby, tennis and athletic and other sporting organisations (Holmes and Willoughby, 2016). Protect, rest, ice, compression and elevation (PRICE) is an everyday standard modality when dealing with acute injuries due to bleeding and swelling, which will occur following injury. Cryotherapy methods can help to reduce haemorrhaging and swelling and ice helps to reduce the metabolism and tissue damage caused by a secondary hypoxic injury (Knight et al., 2012).
Although there are many different types of treatments which are commonly and ubiquitously used to speed recovery from injury, however no standard guidelines to which is best to use have been established yet, nor a target temperature or compression is yet to be identified. This is largely due to a lack of understanding regarding mechanism and modalities through cryotherapy (White and wells, 2013). Several studies have investigated and reviewed the effects of cryotherapy for reducing pain and speeding the recovery for musculoskeletal tissue. The literature has shown that the magnitude of tissue temperature change is positively correlated with cryotherapy modalities to present a larger thermal gradient, longer duration and larger surface area although is adversely associated with a decrease in intramuscular temperature (Bleakly et al., 2012).
Following this, RICE (rest, ice, compression, elevation) has been an effective method in professional sport and amateur sport. It has been suggested that a tissue temperature of between 10 and 15°C is low enough to reduce metabolism from a compression and elevation to reduce blood flow (MacAuley, 2001 – cited in Bleakley et al., 2004). Another study investigated PRICE in a randomised controlled trail in the management of an ankle sprain and found that the combination of compression and cryotherapy did facilitate healing. A logical progression to examine these modalities effects the intermittent ice application can facilitate a quicker recovery (Bleakly et al., 2007).
This recovery method is thought to decrease oedema formation through vasoconstriction, where blood vessels become narrow which reduces the flow of blood to the surface of the skin, subsequently decreasing the amount of swelling. After this, the blood vessels re-open (dilate) allowing blood to return to the area, known as a hunting response. Certain chemicals that are released into the blood when the tissue is damaged exaggerate this pain; hence vasoconstriction decreasing pain (Mourot et al., 2007).
Other recovery strategies, such as soft tissue massage improve the absorption of substances within the body tissues. It causes the pores in tissue membranes to open to allow fluids and nutrients to pass through. This helps the removal of waste products such as lactic acid and encourages muscles to intake oxygen and nutrients to aid recovery. Furthermore, massage can help elevate swelling. Massage can stimulate blood flow due to the pressure used in a massage technique, which compresses then releases the blood vessels aiding a pumping action. This promotion of blood circulation to other limbs aids lymphatic drainage, increasing nutrients and oxygen to help decrease the muscle fatigue (Best et al., 2008).
Evidence has shown from recent studies that sports massage application significantly decreases delayed onset of muscle soreness within the acute phase of recovery, concluding that Davies (2016) verifies the effectiveness of massage as an intervention to enhance and aid in the recovery process.
The various modalities have been questionable throughout the different literature as many various athletes have used these different types of recovery strategies but what is the best method?
Olympic athletes sustain many injuries, which require the correct recovery method in order for them to return to play as quick as possible. Siedlik et al, (2016) explored advanced treatment for Olympic level athletes using four different modalities including massage, manipulation and mobilisation, soft tissue therapy and general medical treatment. This study found that all methods of recovery were successful at different rates, although the nature of each made it difficult to analyse efficiently using standard descriptive statistics. The data limited to analysis of simple treatment patterns without measures of efficacy. Therefore, researchers should focus on including an outcome measure to compare information.
After an injury, the first question asked by most athletes and coaches is ‘When will I be able to compete again?’ The answer to this question is influenced by many factors. However, in most cases the goals of the injured athlete is to facilitate a safe return to sport. The Strategic Assessment of Risk and Risk Tolerance (StARRT) framework is a three-step model, which helps estimate the risks of different short-term and long-term outcomes associated with return to play, and factors that may affect. One of these factors is using the quickest recovery method (Arden et al., 2016).
But what is the quickest method for recovery? The recovery method is dependent on the injury, the sport and the person. Most of the research examines the impact of psychological factors on return to play but the athlete must think the method used is productive for it to work and to be psychologically convinced the patient is ready for return to play, without considering; ‘What if I get injured again?’ or ‘What if I’m not as good as I was?’ (Arden et al., 2016).
Specific goals for recovery or rehabilitation may depend on the sport. It’s important that the clinician’s knowledge of the sport, and working closely with coaches in using various recovery exercises for decreasing pain. Many physical therapists apply sports specific isometric exercises to decrease pain and increase strength at the same time for a recovery method (Arden et al., 2016).
Rugby players have a variety of recovery strategies for the high impact sport but what is best suited for that sport? Gill et al, (2006) found an enhanced rate and magnitude of recovery was observed in the contrast water therapy and compression garment treatment. Low impact exercises immediately post-competition, wearing compression garments, or carrying out contrast water therapy enhanced blood flow more than passive recovery in young male rugby athletes.
To conclude, there are various new and old forms of recovery methods, but the big question is, ‘What is the best?’ Different studies have investigated literature behind each modality and the success rate behind the recovery method. Most, if not all modalities are successful, although numerous studies have suggested that different recovery strategies are dependent on the sport, activity and individual involved (O’Sullivan et al., 2013).
References
Ardern, C.L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., Gojanovic, B., Griffin, S., Khan, K.M., Moksnes, H. and Mutch, S.A., 2016. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med, 50(14), pp.853-864.
Best et T.M., Hunter, R., Wilcox, A. and Haq, F., 2008. Effectiveness of sports massage for recovery of skeletal muscle from strenuous exercise. Clinical Journal of Sport Medicine, 18(5), pp.446-460.
Bleakley, C., McDonough, S. and MacAuley, D., 2004. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine, 32(1), pp.251-261.
Bleakley, C., McDonough, S., Gardner, E., Baxter, D.G., Hopkins, T.J., Davison, G.W. and Costa, M.T., 2012. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Sao Paulo medical journal, 130(5), pp.348-348.
Bleakley, C.M., O’Connor, S., Tully, M.A., Rocke, L.G., MacAuley, D.C. and McDonough, S.M., 2007. The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain. BMC musculoskeletal disorders, 8(1), p.125.
Davies, J., 2016. Are The Effects of Deep Tissue Sports Massage on Delayed Onset Muscle Soreness Present in University Athletes (Doctoral dissertation, Cardiff Metropolitan University).
Gill, N.D., Beaven, C.M. and Cook, C., 2006. Effectiveness of post-match recovery strategies in rugby players. British journal of sports medicine, 40(3), pp.260-263.
holmes, m. and willoughby, d.s., 2016. the effectiveness of whole body cryotherapy compared to cold water immersion: implications for sport and exercise recovery. international journal of kinesiology & sports science, 4(4)
Kargarfard, M., Lam, E.T., Shariat, A., Shaw, I., Shaw, B.S. and Tamrin, S.B., 2016. Efficacy of massage on muscle soreness, perceived recovery, physiological restoration and physical performance in male bodybuilders. Journal of sports sciences, 34(10), pp.959-965.
Knight, K., Knight, K.L. and Draper, D.O., 2012. Therapeutic modalities: the art and science. Lippincott Williams & Wilkins.
Mourot, L., Cluzeau, C. and Regnard, J., 2007. Hyperbaric gaseous cryotherapy: effects on skin temperature and systemic vasoconstriction. Archives of physical medicine and rehabilitation, 88(10), pp.1339-1343.
O’Sullivan, S.B., Schmitz, T.J. and Fulk, G., 2013. Physical rehabilitation. FA Davis.
Siedlik, J.A., Bergeron, C., Cooper, M., Emmons, R., Moreau, W., Nabhan, D., Gallagher, P. and Vardiman, J.P., 2016. Advanced Treatment Monitoring for Olympic-Level Athletes Using Unsupervised Modeling Techniques. Journal of athletic training, 51(1), pp.74-81.
White, G.E. and Wells, G.D., 2013. Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extreme physiology & medicine, 2(1), p.26.