Good to Go: The Strange Science of Recovery for Athletes by Christine Aschwanden

As a health and wellness professional (I’m a personal trainer, gym manager, and wellness coach), I’m fascinated by all of the little gadgets, tools, methods, and ideologies that athletes use to try and gain an edge in performance and/or recovery. And the interesting thing is that all of these methods tend to trickle down to the masses where the science and data behind them tend to be dubious at best, and usually result in smart people throwing away their money at a problem that may or may not exist. Christine Aschwanden goes behind-the-scenes and digs into all of this science, data, and research behind almost every recovery modality you can think of (massage, chiropractic, foam rolling, accupuncture, cupping, floating, stretching) and determines if spending $100 for a cryotherapy session — or the like — is worth your while. The conclusion? Not really. But sometimes it’s ok to splurge, because if you THINK something works for you, then maybe it just does.

• Scientists should be asking after a study: how could this be wrong?
• One or two beers after exercise is all good, not detrimental to recovery, but more than that can damage recovery; women might recover better with alcohol because of estrogen offering a protective effect against muscle damage
• Just because you can measure something doesn’t mean it’s answering your question; science is incremental
• Does it work? Well, maybe, might be the best answer
• Gatorade = illusion of casuality
• Gatorade turned the drinks sodium, phosphorus and potassium into a selling point by rebranding “salt” with their scientific name of electrolytes, which is the scientific term for molecules that produce ions when dissolved in water
• As long as people drink fluids with a meal after exercise, you are fine replenishing electrolytes
• You don’t need to drink your salt even if you need to replace electrolytes, which is just a fancy name for salt
• 40 years of sports drink research doesn’t add up to much — placebo, marketing, studies designed to find a benefit
• The marketing relies on the premise that dehydration raises health risks and hinders performance and recovery, but that is overstated; more marketing than science
• Drinking according to thirst is more effective than trying to systematically “replace” fluids after a race; marathoners that lose the most fluids are actually more successful in races
• Hyponatremia — too little sodium in the blood (overhydrated); low blood sodium causes cells in the body to swell
• Symptoms of it are often confused with dehydration — weakness, headache, nausea, dizziness, lightheadedness
• You don’t have to be dehydrated to get heatstroke
• Your body is adapted to cope with fluid loss, especially during exercise; when you exercise you lose fluid and salt which means a small change in your “plasma osmolality”, the concentration of salts and other soluble compounds in your blood
• When you lose salt through sweat, your brain senses the drop and directs the release of ADH (antidiuretic hormone) which prods the kidney’s to to activate aquaporins, which are like tiny straws that poke into the kidneys to draw water back into the blood
• Easy to overhydrate, because our bodies are so good at conserving water
• Even if you don’t drink anything, which isn’t recommended, your blood sodium levels will rise in response to sweat losses and your body will shift fluid to maintain balance
• Thirst is how your body ensures that you seek fluids when you need them
• Color of your pee is really just a measure of how concentrated your urine is; if it’s got more waste than water, it’s dark; if it’s mostly water, it’s light and clear
• What you really want to know is what’s going on in your blood, and your pee can’t tell you that
• Very light urine might mean you are just overhydrated and you’ve taken in more water than you need, which isn’t necessarily good for an athlete before an event; if you drink too much before an event, you prime your body to be less adept at holding on to fluids
• Drink to thirst! Conserve water!
• If you finish an ultra endurance event at the same weight you started, you are overhydrated
• Cramps are mainly neuromuscular fatigue, not really a hydration issue or electrolyte issue
• Nutrient Timing, especially for protein? Not really a thing post workout, at least it doesn’t have to be ingested immediately for benefits
• No real difference to someone taking protein right before or after a workout
• Post workout window for protein (repair and recover) is open for 4–5 hours, maybe more
• Smaller amounts of protein spread throughout the day seems to have the most benefit
• Carbs are the same, as long as you take in some your glycogen stores will be replenished and the window is large post workout; however, if you are a competitive athlete it’s different, if you are competing again soon you should definitely take in those carbs immediately
• Usain Bolt ate about 100 chicken nuggets every 24 hours during the 2012 olympics — he simply needed carbs and a familiar food (he couldn’t find his local fare at the olympic village): race-recover-race — he just needed food, immediately
• when your muscles are hungry for fuel, they don’t care where the energy comes from
• Fast food isn’t great, obviously, but all those energy bars, powders? still processed, additives and all that
• What should you eat after exercise? whatever you body is hungry for. NBA players love PB&J
• Coconut water isn’t more hydrating or useful than regular water or better for recovery; cherry juice is promising with improved muscle function and anti-inflammatory stuff, but not definitive
• Antioxidants for preventing muscle soreness have a very small benefit
• Undereating is a huge problem for athletes: Relative Energy Deficiency in sport (RED)
• For an athlete, focusing on adaptation (to food) in the preseason and replenishment during the season (more immediate timing) might be the way to go
• Icing!
• Anything that reduces your immune response will also delay healing — icing delays this healing because it slows down the process
• Your body fortifies muscles after responding to injury, becoming more resiliant
• Inflammation is your body’s way of healing, and icing delays healing; can obviously reduce pain though
• Cold water immersion reduced gains in muscle mass and strength and blunted the activation of key proteins in the skeletal muscle (cold packs)
• Ice baths might stunt the body’s ability to adapt to whatever training occurred; if an ice bath reduces pain and soreness, than perhaps an athlete could potentially train harder, sooner?
• Athletes might want to not ice during the preseason (let their bodies adapt) but when adaptation has been achieved and the goal is short term performance (in season) go ahead and ice
• Ice can be good in between events when you have to perform again; but if you have time to recover, not worth it; obvious psychological benefits though
• Cryo — began as a treatment for rheumatoid arthritis and other inflammatory disorders
• Cryo reports to “superoxiginate” blood but that’s not really a thing because the blood leaving the lung is already nearly 100% oxygenated under normal conditions; shunting blood to your core doesn’t inject it with extra oxygen
• Cryo isn’t actually as cold as a cold tub, not as painful
• very little evidence it is useful
• Recovery: the theory goes that you stress your body and it responds by fortifying its resources to better handle stress
• Training is only as good as the recovery that follows it; lots of modalities now are aiming to “boost blood flow” — repair the sites that need fixing, deliver oxygen to cells and glycogen to depleted muscles
• Protein can get to the muscles to rebuild damage, glycogen can get to the muscles that have depleted the energy source, and waste products can be sent to the kidney’s or liver for processing and removal
• Lactic Acid isn’t responsible for soreness; lactate may actually provide a source for fuels for muscles in some cases and may even help trigger the production of new mitochondria, the structures in cells that produce energy; the idea that lactate needs to be flushed post workout is misguided
• If you want your blood to flow, heat can help
• Infared Sauna’s? Bogus
• Very few evidence based benefits for massage
• can help anxiety and depression, not much for performance and recovery unless the recovery period is short
• massage also doesn’t clear lactate, which will clear on it’s own anyway
• massage performed shortly after exercise may increase muscle protein synthesis, in Rats; unproven in humans
• Some massages that are too dep can cause PMSM — postmassage soreness and malaise; the idea that you are flushing toxins from your muscles is bogus
• Fascia — connective tissues that wraps around your muscles and tissues like plastic wrap, can actively contract and become stiff
• Foam rollers can loosen up the muscles and they might address adhesions that my form between layers of fascia; fairly good evidence that those that foam roll post workout report less muscle soreness after, but unclear, research is slim
• Recovery pajamas, tights? Meh. Small positive effects from compression garments for both performance and recovery — psychological benefit as they can reduce vibration in a muscle and then give the muscle a “hug”
• Compression devices are largely psychological
• by nature of what they do, athletes have good blood flow, but the simplest and best way to increase blood flow is to exercise and move.
• If you want to promote blood flow with tired muscles, do some light biking or walking — active recovery
• Calming!
• Float tanks — salinity of water allows your body to float weightlessly, and the dark and quiet of the room blocks out distractions
• Stress is stress — if you want to optimize recovery, manage stress
• People who reported low stress levels posted a boost in fitness and power, but those improvements were absent in those with high stress levels; mental stress increases risk of injury in college athletes
• Everyone has stress, how do you relate to it and adapt to it?
• Floating can rebalance the sympathetic and parasympathetic nervous systems
• 25% reduction in blood cortisol after a float; can reduce muscle soreness and improve mood, more relaxed, calm, happy, less worn out and tense; can also possibly improve sleep
• Rest!
• TB12 pajamas? Meh. No evidence to support it works. Claims to absorb body heat and reduce inflammation but as we’ve seen, why are we reducing inflammation?
• Sleep! Hands down the most powerful recovery tool known to science
• Skimping on sleep can blunt the release of hormones involved in muscle building and rejuvination
• Staring at screens before bed not good, better off with a book; screens can delay circadian clock, reduce altertness
• Keep your environment quite, dark, no distractions, go to bed a normal time in a cold dark place to test … don’t set an alarm the first time. When you wake up use that as a starting point to see how much sleep you need
• 7–9 hours, typically; when someone sleeps less, it’s more about their ability to tolerate sleep deprivation better than most
• Chronic sleep loss blunts the sleep drive — trouble shooting and complex thoughts are much more difficult
• If you only sleep for 6 or so hours, it’s the equivalent of drinking 2 -3 beers; 4 hours is like 5–6 beers; staying up all night is like 11 beers
• Increased risk of injury, more sensitive to pain, decreased immune function, more susceptible to viruses
• Sleep reinforces motor learning skills and sleep after practice, in the initial 24 hours, is crucial
• “It’s practice, with sleep, that makes perfect.”
• Fixation with sleep data: Orthosomnia
• “Cognitive Shuffle” technique — say “bedtime”, start with b, imagine all the words that start with b, then move on. Technique aims to distract your mind from worrying about falling asleep
• how you “believe” you sleep might be more important than how you actually slept, for cognitive performance
• More important to have a good nights sleep in the week leading up to competition than the night before
• Coffee Naps — Drink a cup of coffee, lie down for 20–30 minutes and then the caffeine kicks in
• Naps improve alertness, motor performance, productivity; between 1–4 p.m. ideal
• If you want to perform at a certain hour, that’s ideally when you should train
• NFL, teams coming from the West have a significant advantage in evening games
• Sleep is the number 1 thing athletes can do to bounce back from training
• Diet!
• If overall your diet is good, special vitamins or nutrients after exercise don’t mean much
• Supplements don’t help you if you don’t have good nutrition in the first place
• BCAA’s, studies are limited, not much there (Branch Chain Amino Acids); they claim to reduce muscle soreness
• most supplement companies are marketing exercises designed to sell products
• Published literature can end up weighted toward positive results; if you have a study you want to publish, you can nowadays bypass peer review but submitting it to any journal that doesn’t have peer review or rigorous standards
• Lots of studies make back claims about a product, or they are designed that way
• Tons of undeclared ingredients in supplements, mainly to make the supplement do something
• Dietary supplements are responsible for 23,000 emergency room visits per year
• Where did the “stuff” in your supplement come from? good luck finding the answer
• 1994 Dietary Supplement Health and Education Act gives the FDA no authority to require supplement manufacturers to demonstrate safety and effectiveness of their product
• FDA can only recall if they can prove a supplement is harmful; attempts to give the FDA more power have been blocked by the nutrition and supplement industry
• “Proprietary Blend” — allows companies to keep the ingredients secret; pixie dust doses and still make claims on the product
• Supplements give people a sense of autonomy over their health and fitness
• Exercise does not create extraordinary nutritional needs, the body was made to move
• Most athletes get their information about dietary supplements from coaches, trainers, friends and family, not the best intel
• Overtraining!
• Overtraining Syndrome — Real. diminishing performance; and unexplained drop in performance
• Failure of recovery, takes 6 months to get over, maybe never — inefficient sleep, not enough rest, poor nutrition, cold, stress
• To the body, stress is stress, no matter where it comes from
• Endurance athletes rarely eat enough food
• Only solution is a long period of rest, which is hard for most
• Life is stress too, so you have to figure that out as well
• Prolonged, heavy exertion can tax the immune system, chance of infection goes up
• If an athlete gets sick when immune system is already low, hard to clear the virus, and if you ignore the symptoms, large chance it will be unable to totally clear it
• Low iron stores can cause fatigue; white blood cell counts can change rapidly for a number of reasons
• Tracking stuff (phones, bands) are hard because of the accuracy, when you screen already healthy people you may end up with more questions than answers, and create problems where they don’t exist
• “Not everything that counts can be measured, not everything that is measured counts.”
• Whey you’re tired, rest.
• Heart Rate Variability — measures time between heart beats when you’re at rest
• High variability indicates your heart is rested and working efficiently, while lower variability is a sign of stress
• Boom or Bust cycle of training is where athletes tend to have illness and injury; need consistency
• for prevention, how is the leadership of your coach? what’s the load on players? do players have someone to talk to internally? what is the player’s overall well being?
• RPE — rate of perceived exertion. on a scale of 1–10 …
• Mood distrubances (depression, anger) can creep up when you are training hard and go down when training goes down
• When quantifying load and response, subjective, self reported measures trumped objective ones (blood, inflammation
• Budget analogy: athletes need to be realistic about how much “currency” they have; aware of how they are responding to training and develop good habits required for recovery
• Blood markers, a single marker at any point in time doesn’t tell much
• Your body’s ability to shuttle oxygen to your muscles is important in terms of performance
• Placebo effect exploits the body’s natural opioid system — expectations create real psychological effects
• Brain and body work together, if you believe something works, it can
• Ibuprofen failed to reduce muscle soreness in a blind study among endurance runners and blood tests revealed those who took it had greater levels of inflammation
• Ibuprofen prior to exercise may actually impede tissue repair and delay recovery; might blunt the gains of hard training
• Stretching might be useless for recovery; static stretching might reduce running economy
• Choice is important — if you choose your recovery method, you enjoy it, rather than having it forced upon you
• People hate waiting, so it makes sense to warm up, stretch, foam roll, even if it might be placebo
• “Feels so good”, “Hurts so good” “It’s working,I can sense it” — placebo in effect, but if you believe it, go for it
• Surgery represents a ritualistic activity that fosters expectations
• Stop cupping! causes bruises, and bruises are blood clots, clotted blood is not flowing properly; cupping has no reported benefits
• Olympic champions used the recovery center much less than those that didn’t win; some athletes are just better
• A subjective sense of how it feels; learn how to read your body and pay attention to what it’s telling you; master the art of stillness
• Require more recovery as we age; DOMS takes longer to resolve in older athletes
• Older athletes have a anabolic resistance to protein that makes it harder for their bodies to convert protein into muscle; more protein as we are older
• Keep it simple and don’t sweat the small stuff; eliminate sources of stress
• Whatever relaxes you is what counts