One of the key components to returning to peak performance at the next opportunity or competition is adequate and appropriate recovery. Generally speaking, this includes passive recovery such as adequate nutrition, hydration and sleep, and active recovery which includes modalities such as massage therapy, foam rolling, stretching and many more. Recovery in an athlete involves two goals: (1) returning to the initial, pre-exercise level of function and (2) adapting (i.e. supercompensation), strengthening or improving some function in their respective activity or sport. Simply improving the sensation of fatigue can be considered a form of recovery. For others, improved performance and adaptation at a sport or strength may be a form of recovery. Finally, coming back from an injury is a form of a recovery.
In part 1 of this series, we’ll review the current evidence for massage therapy, foam rolling and stretching, and to see which, if any, have beneficial effects on recovery for the athlete.
Possible mechanisms by which massage therapy may exhibit their effects are biomechanical (deceased adhesions, stiffness and increased muscle compliance and range of motion), physiological (increased blood flow and circulation, increased parasympathetic activity, decreases stress hormones), neurological (decreased pain, tension and neuromuscular excitability) and psychological (increased relaxation, decreased anxiety); although none are well supported in the literature.
In general, there are few, well controlled studies evaluating the effects of massage therapy on recovery making firm conclusions difficult. However, massage therapy has no known side effects, generally feels good and is not prohibited by governing bodies. Regarding massage therapy’s ability to help with recovery, it appears to help with perceived fatigue and DOMS and improve blood flow. It may help with strength, but the research is quite limited. There are no good studies suggesting it helps with objective recovery parameters such as lactate clearance. Athlete should also consider the potential psychological benefits of massage on recovery. It’s important to note that widely variable experience and techniques utilized by individual therapists can affect results.
Foam Rolling. Foam rolling is loosely defined as self-manual therapy technique which uses body mass on a foam roller to exert pressure on the soft tissue for the purpose of myofascial release. It is commonly used by athletes to help treat or prevent myofascial symptoms such as adhesions, scarring, improve flexibility, treat delayed onset muscle soreness (DOMS), promote recovery and athletic performance. For many individuals, foam rolling may be advantageous as it can be performed by the athlete, eliminating the need for a massage therapist, and is cost effective and convenient.
In summary, foam rolling appears to aid in recovery following exercise, especially with DOMS, range of motion and sensation of fatigue post-exercise. Some evidence suggest foam rolling as a recovery tool may actually improve performance in subsequent activity. There are a few studies which found no benefit. When taken in totality, these finding suggest that foam rolling may aid athletes recovering from post-exercise fatigue and DOMS and return to training sooner. No studies showed a negative impact on performance. The convenience of using foam rolling to self treat prior to or following exercise at the convenience of athlete makes it an easy recommendation as a recovery aide.
Stretching can be active or passive, static or dynamic. In active stretching, the agonist muscles are recruited to bring a joint to its range of motion barrier, whereas in passive stretching, other modalities bring the joint to its range of motion barrier (i.e. bands, gravity, assistant). Static stretching involves bringing the limb to its barrier range of motion and holding it at the barrier for a period of time (i.e. 30 seconds, etc) whereas dynamic stretching involves moving the joint through extremes in range of motion without long pauses at the barrier (i.e. swinging a leg forward and backward to extremes of hip flexion and extension). Proprioceptive neuromuscular facilitation (PNF) is a combination of active and passive stretching where the agonist or antagonist muscle is activated while stretching through the range of motion barrier (i.e. contracting quadriceps muscle while stretching the hamstring muscle).
In summary, stretching is a well accepted ritual in sports and physical activities of all types. The benefits of stretching on range of motion, mobility and injury prevention are clear. The benefits of stretching as a modality for recovery are less clear and underwhelming. There are a few studies suggesting it helps with DOMS and muscle strength, however a large cochrane review found the evidence to not produce clinically important reductions in DOMS. It does appear to increase parasympathetic tone which may aid in the relaxing nature of stretching. One can not definitively say at this point, based on the evidence, that stretching provides any significant benefit in post-exercise recovery but other known benefits mean that you should continue to to stretch as a part of your overall physical fitness and wellbeing.
Conclusion. In summary, massage therapy and foam rolling likely aid in recovery of the post-exercise athlete. Massage therapy appears to help with perceived fatigue and DOMS and improve blood flow to the soft tissues. Foam rolling appears to have similar effects, resulting in a decrease in the sensation of fatigue and delayed onset muscle performance. Regarding stretching as a recovery modality, the evidence is underwhelming and the best studies find no significant benefit. All three of these modalities are relatively safe, and there is no evidence that they hurt recovery, so athletes can continue to utilize them at their discretion as a recovery tool. All three, especially stretching, have additional benefits unrelated to recovery. More robust research is needed to definitively determine the degree of benefit of each of these and the optimal parameters for recovery (timing, duration, etc).
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