Endurance sport coaches prescribe activity for athletes. We’re trying to improve bodies and maximize the economy of them by varying degrees in endurance events. This is a big deal, we don’t take it lightly. For this reason we have an evidenced based approach that governs everything we we do. This includes recovery which is one of our six pillars of performance. This passage aims to help athletes make sense of the claims that are made to have proposed silver bullets that recover athletes faster. What really works as it pertains to recovery?
The questions we have to start with are, 1) what do we actually mean by recovery and 2) what does the preponderance of empirical evidence demonstrate and reveal to us? Answering the latter first may prove helpful in this passage. Let’s provide examples of what’s NOT an example of good evidence. When people say “I tried “X” and it felt great, I know with certainty that it worked on me.” Another example that I hear, generally on social media is, “my friend Sam Sneed did it and she said it definitely worked and she’s super fast!”
Needless to say neither of these examples represent good empirical evidence. It’s simply not possible for any individual to say that they alone know with certainty that something worked, because they are an “n of 1” (i.e., n=1). In order to conclusive say that something works within the framework of the scientific method, “n” needs to ideally equal as high a number as possible to demonstrate statistical significance and survive empirical scrutiny.
Strong empirical evidence that something works means the claim(s) by those promoting the treatment, device, product, service or ingestible survived the rigorous scrutiny of independent high quality double or single blind randomized controlled trials with what are called control groups (1). Ideally the research was preregistered and confirmed through peer review. In so far as it is possible, there has been a meta analysis completed (an analysis of all analyses on a topic). Finally a determination can then be made on whether or not the results are conclusive and/or impressive enough to justify taking action on whatever it is that is being tested.
What Does Recovery Mean?
Since that is out of the way, let’s talk recovery. A common problem with product and service providers that make claims to “recover athletes faster” is that they often mean different things by recovery. Training is stress. Peripheral fatigue and overuse complications are the phenotypic effects of that stress post training. We’re purposely and deliberately stressing and sometimes shocking or overloading the body so that training stress can go into the body and manifest as fitness after the body repairs itself and harvests gains. What chiefly matters to athletes and coaches is post training cellular structure repair and healing. Even more specifically, peripheral healing from damaging effects of training volume, training intensity and hard racing (2).
The onus is on the claimants to demonstrate proof that their product/service will heal bone, ligament, tendon, muscle, fascia or otherwise bring about quicker soft tissue healing and toughness. High cost products and services in the marketplace have a herculean task to substantiate their claims based on this standard. So caveat emptor (let the buyer beware) and be highly skeptical of everything. For injuries, athletes should seek board certified physicians or sports medicine practices that employ real medical protocols (3).
The Current State of The Science on Recovery
The exponential growth of treatments and products aimed at recovering endurance athletes has sparked a litany of research efforts with some currently underway right now. The latest meta analysis released just last year in Frontiers of Physiology indicated there are approximately 1,700 studies evaluating the efficacy of various methods proposed to recover athletes faster. These include various forms of massage including self massage, active recovery techniques, cryotherapy/cryostimulation, water immersion, hyperbaric chambers, electrostimulation, compression garments and electrostimulation (4).
The researchers submit there is a challenge in framing hypotheses for some of the research because differences in what people mean by recovery. For instance many of the studies test “perceived” muscle soreness or perceived fatigue. In other words, testing the athlete’s perception of whether or not something worked post training may not be completely useful because these tests are highly susceptible to placebo effects. Scientists did attempt to formulated some tests of inflammation and muscle soreness with various types of blood tests but even these have limitations.
What we can draw from the meta analysis is first we need to formulate more effective tests and conduct more research in order to derive better results on what matters to athletes and coaches. What matters is peripheral healing in the clinical sense from the damaging effects of training. Some of this is research is ongoing. Second, out of the methods tested none of them were remotely impressive. Certainly not enough to justify taking action on them given their costs.
With that being said, slightly better results (and I do mean slightly) came from various forms of massage and ice baths. Unfortunately everything else was either a marginal positive impact or flat out useless. Again understand that even the ones on the top of the list are suspect since the current testing methods are not the best at controlling for placebo effects. Funnel plot analysis also demonstrates some poor quality positive studies. Some methods may have also had second order effects such as reducing stress hormone cortisol or psychological impact on the athlete’s relaxation feelings. I can grant that this alone can have some value and a role within training cycles (5).
Here is where the rubber meets the road. Biology is only going to allow you to recover so fast from training or injury. Ultimately the only thing that can repair and heal bone, ligament, tendon, muscle or fascia is time. If anything is ever empirically proven to heal faster, it will just be subsumed into medicine and you’d know about it from a real doctor. Athletes and coaches need to employ intelligent integrated recovery protocol within training cycles and/or seek out real medical protocol in the case of injury.
If you want to do something that is going to allow you to be more efficient at recovering it is to simply get fitter. Fitter bodies recover more efficiently because the structures around exercise damaged parts are stronger and more resilient. Finally, the restorative properties from good sleep quality and good nutrition act as synergists to the recovery effort.