Rest To Go Further

Clinical physiologist and avid runner Ray Loh shares tips and ways on how to recover effectively after a gruelling marathon.

  • Massage 
  • Compression Garmentss 
  • Stretching 
  • Hydrotherapy 
  • Active Recovery 

Massage has been commonly used as a treatment for injury as well as post-race recovery intervention.  

It has been suggested that massage can provide many physiological benefits from reducing muscle tension and stiffness, increasing joint flexibility and range of motion to increasing blood flow, increase relaxation and enhance immune and endocrine function. As such, it is thought that it can reduce muscle pain, spasm and swelling, increasing the rate of healing, and speed recovery via decrease of lactate concentrations, increase skin and muscle temperature, decrease anxiety and lower the feeling of fatigue and tiredness. The mechanism behind massage is well documented. Biomechanical, physiological, neurological and psychophysiological mechanisms have been suggested. However, research studies based on different exercise protocols have produced mixed results.

A few researches examining concentric exercises such as hand grip strength and vertical jump have demonstrated that deep muscle massaging after exhausting exercises improves performance. Other researches using eccentric exercises found that post-exercise massaging did not alter lactate concentrations and has no effect on DOMS. However, perceived muscle stiffness and fatigue were lower following massage. A particular research on marathon runners found no effect of massage immediately following a marathon on quadriceps peak torque output or soreness. However, when combining massage with active recovery, the outcomes were better when compared to massages and passive recovery. Data has shown that massage with active recovery has improved performance significantly. However, when comparing massage with active recovery to cold water therapy and active recovery, the latter was shown to be more superior in terms of recovery.

Previous researches seem to show that the effect of massage was favouring concentric exercises more than eccentric exercises. Although there was limited evidence that massage may reduce muscle soreness, some has suggested that the benefits in performance may be seen only 24 to 96 hours following exercise when inflammatory processes are at their peak. More high-quality research is needed to support the claimed benefits of post-exercise massage for recovery.

In recent times, compression garments are used as a running aid for distance runners to enhance performance and aid recovery has been gaining popularity.  

It started as a treatment for medical patients with circulatory insufficiency and was later introduced into the sports scene for recovery after a research in the late 1980s showed that compression socks lowered blood lactate levels in athletes after extensive exercise training. However, the exact mechanism that can lead to improvement in biomechanical and physiological benefits has yet to be established.

The main function of compression garments is to generate pressure gradient with decreasing pressure from distal to proximal limbs. The use of compression garments has been reported to improve blood flow and venous return. It is thought that the pressure created may provide more support to the muscles than conventional running shorts and may reduce the intramuscular space available for swelling, attenuating the inflammatory response and thus reduce muscle soreness. As such, it has been suggested to be used as a recovery intervention to stimulate muscle recovery without the energy requirements as compared to active recovery.

Current research mainly agreed that wearing compression garments during exercise does not improve performance. However, their efficacy on recovery has shown mixed results. Some studies has shown a reduction in creatine kinase (CK) and perceived muscle soreness in athletes who wore compression garments for at least 12-24 hours for recovery, while other studies have found no difference in lactate concentration, flexibility, plasma CK, myoglobin concentrations, swelling and subsequent exercise performance.

A particular study looking at the application of compression compared between three groups of athletes who wore compression garments during exercise, after exercise and both during and after exercise. They found that athletes who wore compression garments during and after exercise had a lower recovery lactate concentration. However, they concluded that the lower values may be due to lactate being retained in the muscular bed rather than an enhanced rate of lactate removal.

Today, the benefits of compression apparel have grown beyond enhancing athletic performance and recovery. The society is accepting its multiple uses such as its ability to wick away moisture, quick dry, cooling, comfort and trendy. There are still many questions such as the effective pressure gradient, limbs only or whole body compression and duration of wear to be effective. Although current reports have been equivocal about the use of compression garment for recovery, it is still too early to discount its potential ergogenic value.

Stretching has the least evidence in terms of its efficacy in recovery of performance but yet it is the most commonly used and taught post-exercise recovery intervention.  

It is thought that stretching can reduce muscle soreness and stiffness, prevent injury and relax the muscle. However, there are not enough results showing that stretching can increase muscle recovery, and the rationale behind the practice of stretching during recovery period is not clear.

Most studies have reported that post-exercise static stretching has no effect on the signs and symptoms of soreness and following performance with a few reports showing that pain sensation was reduced after eccentric exercises. When comparing the efficacy of stretching with other recovery intervention, results have shown that active recovery is still more effective than passive recovery and stretching alone following a fatiguing leg extension and flexion exercise. However, the current trend is moving towards dynamic stretching as a single recent research has shown that dynamic stretching produces a significantly superior results than active and passive recovery.

Hydrotherapy refers to exposing our body into water to achieve therapeutic effects.  

It is thought that hydrotherapy can decrease stress, relief pain, increase circulation, decrease inflammation, reduce soreness, calm the nervous system and thus speed up recovery and perhaps improve maintenance of performance. The three most common techniques used are cold water immersion, hot water immersion and contrast water therapy.

Among the three techniques, cold water immersion is the most commonly used hydrotherapy technique adopted by elite athletes. The physiological response and benefits of our body towards cold water immersion is well documented. Although most researches favour cold water immersion, the application of the treatment is still not clear. It is thought that the temperature, duration of immersion and the immersion of body parts such as whole body or just affected limbs affects the outcome of the treatment. Currently, there are still no clear guidelines on the most effective procedure and duration of exposure. The current practice of cold water immersion is performed with body immerged in 10-15 degrees water for a period of around 14-15 minutes.

Hot water treatment on the other hand received little attention. The mechanical benefits of hot water treatment remained to be elucidated. The main agreeable advantage of hot water treatment seems to be improving blood circulation. A particular research has reported that warm water immersion post-exercise has enhanced maintenance of performance. However, a significantly higher level of plasma CK concentration was also observed suggesting either greater damage to the muscles cells or an increased leakage of proteins from the muscle into the blood. Current commonly used hot water treatment protocols are performed in waters warmer than 37 degrees with durations between 14 -20 minutes.

The studies on contrast water therapy are also limited. However, it is commonly used in sports medicine and other sporting community for injury and post-exercise recovery. Alternating both hot and hot water treatment, contrast water therapy is believed to be able to reduce edema through the pumping action created by peripheral vasoconstriction and vasodilation. This may elicit many of the same benefits of active recovery and more as it imposes less energy demand. A research investigating the effect between cold, hot and contrast treatment found that cold and contrast water immersion improve overall recovery including better maintenance of performance from highintensity cycling compared to hot water and passive recovery. A typical practice in contrast water therapy is to use the 1:1 ratio by alternating 1 minute in hot water and 1 minute in cold water for about 7 rotations.

When comparing the results between passive recovery and cold, hot and contrast water therapy, data reported that cold and contrast water therapy were more effective than passive recovery in reducing DOMS, edema, improve recovery of isometric force and thus overall dynamic power. Although hot water immersion was effective in recovery of isometric force, it was ineffective for recovery of all other markers when compared to passive recovery.

Active recovery in the form of low-intensity aerobic activities such as easy-paced jogging, swimming and cycle is the most common form of recovery intervention adopted by majority of athletes next to stretching.  

Current trends encourage athletes to cross train to reduce stress on the same muscle group as the sport the athlete competes in. Active recovery is often thought to be the most superior due to the fact that it can enhance blood flow to the exercised area and thus increase clearance of lactate and other metabolic waste products via increased oxygen delivery and oxidation. Reducing lactate concentrations after exercise has always been an important factor to athletes when planning a recovery strategy although research in this area is not conclusive. A research comparing different running intensities and their rate of lactate removal during active recovery has reported that maximum lactate clearance was observed at higher intensities close to lactate threshold. Moreover, some studies have shown that enhanced removal of lactate concentration does not improve subsequent performance as post-exercise lactate concentration will return to resting levels even with passive rest within most recovery period available. Studies in this area are still incomplete and questionable.

Current researches have shown mixed results with no clear direction being defined yet. At this moment, it seems highly likely that recovery interventions are highly individualised, depending on the nature of the sport and the fitness level of athletes. However, it does conclude that most form of recovery intervention is still better than passive recovery. A study comparing the effectiveness of low-intensity active recovery with contrast water therapy, compression garments and passive recovery has shown that all strategies are superior to passive recovery with no significant different between each strategy. As a distance runner, my consideration for recovery intervention will be based on factors on convenience, energy demand of the intervention, additional stress to my legs, time consumed and its effectiveness. Sometimes passive recovery seems to provide better psychological aids then other interventions after a long exhausting run.

Ray Loh 

Originally published in RUN Singapore.