Recovery modalities for athletes
by Alberto Fernando Martínez·
Many athletes will deal with pain at some point in their lives. This can be experienced in training or in your daily activities. Pain can inhibit athletes from reaching their full potential, enjoying their training, and disrupting their daily activities.
Pain is a very motivating stimulus and athletes often go to great lengths to find a remedy for it. Also, poor recovery can lead to injury and pain and should be a priority for athletes. But what are the research-supported modalities (methods of treatment) to get athletes back to doing what they love? This article will discuss the various modalities that an athlete can use or receive from a health professional to alleviate their pain state and increase their recovery.
What is pain and where does it come from? Pain is a protective mechanism that is transmitted to our brain (ie central nervous system, CNS) so that we can react and move to safety (shown in figure 1). For example, when you touch a hot stove, receptors in your hand send signals up your arm, spinal cord, and brain to indicate that your hand is being damaged. Your brain then reads these signals, interprets what is happening, and sends a new signal down through your spinal cord, through the nerves in your arm, and finally into your hand to initiate the pull-away reflex. hand of danger (this signal travels at about 50 meters per second, fast!).
These pain-sensing receptors are called “nociceptors” and they send pain information through the spinotamic or paleospinotamic tract to relay information to the brain (Al-Chalabi et al., 2018). These same receptors are what it feels like to cut your toe, touch a hot oven, pull your hamstrings, or the soreness you feel in your muscles a few days after a workout (delayed muscle soreness).
Many athletes are familiar with delayed-onset muscle soreness . Delayed-onset muscle soreness is theorized to be caused by muscle contraction causing microdamage to tissue (Sonkodi et al., 2020). This is the most widely accepted theory for the cause of late-onset muscle soreness, but there are other postulated theories as well. For the purposes of this article, it is only important to know that delayed-onset muscle soreness is caused by exercise and indicates the need for the athlete to rest and recover (Burnett et al., 2010).
Not all pain reaches the brain quickly. Pain that requires an immediate reaction is fast and is delivered via thin, myelinated (myelination refers to a sheath-like covering that insulates the fibers and aids in the speed of a signal) nociceptive fibers located in the spinal cord. . However, an aching pain that is dull uses larger fibers that are not myelinated. This allows the body to transmit different types of pain.
Now that we know what pain is, the different ways pain can present itself, and its purpose, why should athletes worry about it? Pain is common in athletes and is often associated with injury (Hainline et al., 207). When an athlete is in pain, they are unable to perform optimally, they may develop compensations that alter their movement patterns (which subsequently lead to further injury), and their mental health will suffer. All of these factors contribute to an athlete ultimately failing to improve. So how do athletes respond to pain? The remainder of this article will discuss recovery modalities that research supports to decrease pain and increase recovery in athletes.
The focus of this article is specific to techniques or treatments that are backed by research. All athletes must include proper nutrition and sleep in their daily routine in order to recover to full capacity. External factors such as stress also contribute to an athlete's general health and susceptibility to injury (Salim et al., 2015).
1). Dry needling is a minimally invasive modality and requires small needles inserted into areas where there is muscle or joint pain. Many athletes use dry needling through a chiropractor or physical therapist, often combining it with rehabilitation exercises to reduce recovery time (Korkmaz et al., 2022). Dry needling is similar to deep tissue massage, but it is administered in a fraction of the time. Similarly, dry needling has been found to alleviate pain symptoms in people with results lasting up to 3 months after 4 treatments (Martin-Corrales et al., 2020). Similarly, Koppenhave et al. (2016) found that patients using dry needling self-reported less pain that was statistically significant, had greater range of motion in the shoulder (the area in which participants were receiving dry needling), and had an increase in pain. pain threshold (the ability to withstand pain). In addition, pain associated with a trigger point has been found to be significantly reduced with dry needling and, compared to other manual techniques, it is a more efficient and faster method (Dommerholt, 2011; Gerber et al, 2015).
A trigger point is an area of widespread local pain that can be acute (short-term) or chronic (long-term). This local pain point can radiate to other surrounding regions. Evidence supports that trigger points develop from overuse of muscles (Bron et al, 2012).
Additionally, Korkmaz and Ceylan (2022) found that when dry needling was combined with therapeutic exercises there was a reduction in pain intensity immediately, after treatment, and three months later . Finally, dry needling has been found to decrease trigger point pain regardless of location and to be more effective than stretching or percutaneous electrical nerve stimulation (Boyles et al., 2015).
Percutaneous electrical nerve stimulation (PEN) is similar to dry needling, but involves the application of a small electrical current to the needle. This modality is similar to a transcutaneous electrical nerve stimulation (TEN) commonly seen in an athletic recovery room (electrical stimulation is applied to the top of the skin through a pad that is attached to the skin).
two). Cupping or cupping involves placing a cup that is heated or sucked into the skin to overstimulate the pain fibers (causing the pain signal to decrease), increase local blood flow (which improves recovery and healing) and stimulate the synthesis of collagen (a protein that aids in the healing/building of connective tissue, such as muscle). Similarly, venting is supported by research to be successful in decreasing training-associated inflammation, as well as decreasing associated hypertonicity (muscle tension) (Lowe, 2017). Additionally, suction has been shown to decrease chronic back pain (Castro Moura et al., 2018) and improve functional recovery by increasing soft tissue health (Chiu et al., 2020). Research shows that cupping can also improve range of motion (Murray & Clarkson, 2019).
3). A common modality that many athletes use on a daily basis is the foam roller or foam roller . Researchers have found that foam rolling muscle deployment decreased stiffness in athletes and improved range of motion when used with dynamic stretching before and after a training session (Hendricks et al., 2020). Additionally, foam rolling has been found to increase recovery in exercise-induced muscle damage if the athlete's foam rolls sore muscle groups within 72 hours of training (Skinner et al., 2020). Similarly, foam rolling has been found to reduce muscle soreness in athletes using it post-workout (D'Amico et al., 2020). Lastly, automyofascial release, such as foam rolling, also improves recovery and can increase performance results when implemented correctly (Richman et al, 2019). This can include foam rolling as well as other tools (like sticking your foot out with a lacrosse ball).
There are variable results with other forms of automyofascial release techniques, such as a massage gun. This is due to the fact that there are many types of massage guns available with different attachments and vibration frequencies. These variables can change the results produced and make the overall effects of a massage gun difficult to quantify without focusing on one brand. However, research supports that massage guns can be used prior to a workout to decrease perceived muscle soreness and increase range of motion in a muscle group prior to exercise (Martin, 2021).
4). High Velocity Low Amplitude (HVLA) adjustments can be used by athletes through a chiropractor to decrease chronic pain (pain lasting more than 3 months) and acute pain (pain lasting less than 3 months). For example, Leemann et al. (2014) found that patients with acute and chronic low back pain using chiropractic care had a significant improvement in their symptoms and a decrease in reported pain levels. Similarly, one study found that CrossFit athletes with low back pain had a significant decrease in pain and an increase in joint range of motion when receiving HVLA adjustments compared to athletes who did not (Moehlecke and Forgiarini, 2017). Additionally, research shows that HVLA adjustments combined with therapeutic exercises decrease pain from chronic ankle instability and improve range of motion, decrease pain, and increase stability (Shin et al., 2020). Overall, research supports that HVLA treatment may help to stretch surrounding soft tissue (muscles), release compression on nerve roots due to joint restriction, and prevent muscle atrophy (decrease in muscle size due to lack of use) (Chu et al., 2019). These results are ideal for athletes to perform optimally and without pain.
For a more detailed description of HVLA adjustments and what neurophysiological mechanisms are supported by research to cause changes in the body, readers can see my previous article on the Morning Chalk Up community page, "A Case for Chiropractic Care." : Do athletes need it?"
5). Near-infrared laser therapy is a modality that increases mitochondria in muscle tissue (an organelle that is important for tissue growth and repair). This modality can be performed by a doctor, physical therapist, chiropractor or other health professionals who offer the service. Near-infrared laser therapy (also known as low-level laser therapy or cold laser therapy) is supported by research to improve muscle performance (Dos Reis et al., 2014). However, unlike the other modalities typically used after exercise, near-infrared laser therapy is beneficial before and after exercise. When athletes did a near-infrared laser therapy session prior to their training, they produced results supporting that near-infrared laser therapy improved muscle performance and increased recovery (Abedi Yekta et al., 2021; Leal-Junior et al., 2015). Another study found that near-infrared laser therapy before a training session also increased an athlete's muscle strength gain (Baroni et al., 2015). Additionally, research shows that near-infrared laser therapy after exercise increased muscle mass, reduced muscle soreness, and reduced muscle damage (Ferraresi et al., 2016). Essentially, near-infrared laser therapy has the same physiological mechanisms before and after exercise, but the goal of the therapy changes. For example, if the goal is to prevent injury, use near-infrared laser therapy before exercise, and if the goal is to enhance muscle tissue healing, use it after exercise.
For interested readers, the mechanisms behind near-infrared laser therapy are due to the decrease in oxidative stress found in the body during and after exercise. This suggests that near-infrared laser therapy modulates the body's redox system (a system that removes harmful free radicals from the blood) (De Marchi et al., 2012).
There is a difference between near-infrared laser therapy and red LED light exposure (an increasingly popular modality for use in saunas or also delivered in a device similar to a tanning bed). Near-infrared laser therapy uses a higher wavelength and can focus on a certain area. This allows it to penetrate the skin and also precisely target an area. Red light therapy is a weaker wavelength without a focusing mechanism, making it less specific and less likely to penetrate the skin (this modality is useful for wound healing or reducing some scarring vs. muscle recovery ) (Dungel et al., 2014).
So what recovery modality should an athlete use? This may look different for each athlete based on time available, personal results, and finances. Figure 2 breaks down the modalities discussed.
This is not an exhaustive list, but it represents popular modalities that are backed by research. Other modalities, such as the use of a sauna or cold therapy, were also investigated. For example, saunas showed little or short-term effect on muscle recovery (Jakeman et al., 2009; Mero et al., 2015), but caused a significant increase in exercise tolerance (the maximum workload achieved during exercise) (Ohori et al., 2012). Cryotherapy showed a decrease in perceived muscle pain due to less inflammation of the muscles, but more research is needed to investigate the full benefits and proper implementation (Kwiecien & McHugh, 2021) (Rose et al., 2017) . Additionally, other research found that cold immersion therapy (submersion in water below 59 degrees Fahrenheit) showed similar results to cryotherapy. Cold immersion therapy reduced inflammation, swelling, and muscle pain (Peake, 2019). However, the same study found that body composition influences cold immersion therapy outcomes, and that protocols for use change based on the exercise performed (such as resistance exercise vs. high-intensity training). Cold immersion therapy has consistently significant results for recovery, but the best mode of application for individual athletes still needs further investigation.
In general, there are many modalities that an athlete can use to increase recovery and decrease pain. Depending on the time and resources available to each athlete, you can dictate which modality they use. The techniques discussed in this article are a good starting point for athletes looking to experiment with which modality unlocks their peak performance, in and out of competition. Physical therapists, chiropractors, and other similar health care companies often offer a variety of treatment methods. These facilities can be beneficial places for recovery guidance and an athlete to try out different modalities to find what their maximum recovery regimen entails. A pain free athlete is a better performing athlete (mentally and physically). Therefore, recovery modalities increase athletic performance and should be used by all athletes.
Via Morning Chalk Up.