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An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis

Dupuy, O., Douzi, W., Theurot, D., Bosquet, L. and Dugué, B., 2018. An evidence-based approach for choosing post-exercise recovery techniques to reduce markers of muscle damage, soreness, fatigue, and inflammation: a systematic review with meta-analysis. Frontiers in physiology, 9, p.312968.

In today’s letter

• Overview of the what recovery strategies are best to recover from delayed onset muscle soreness

• Rapid Results = Massage seems to be the most effective method for reducing DOMS and perceived fatigue. Perceived fatigue can be effectively managed using compression techniques, such as compression garments, massage, or water immersion

• 3 Reads to check out to further you knowledge about recovery

• Meme of the week: Assessing range of motion for the 1st time🤣 

Aim of study

To compare the impacts of the most frequently used recovery methods on muscle damage, delayed onset muscle soreness (DOMS), inflammation, and perceived fatigue caused by physical exercise

Did you know?

• Maximising an athlete's performance or a patients rehab involves more than just training. It requires a balance between training and recovery to prevent maladaptation from overload

• Avoiding overtraining helps prevent muscle damage and tissue inflammation.

• DOMS and increased perceived fatigue are common issues within sports and recreational gym goers.

• Blood concentrations of muscle damage indicators (e.g., creatine kinase) and inflammatory biomarkers (e.g., C-reactive protein, interleukin-6) can help in assessing muscle recovery.

• Exercise-induced disruption can temporarily reduce muscular force.

• These disruptions can disturb the sense of joint position and decrease physical performance.

• Which ultimately can lead the increase of risk of injury if bad recovery between training sessions is done

• Complete recovery is the return to homeostasis of various physiological systems after exercise

Recovery interventions analysed in this study are

1. Massage

2. Compressive garments

3. Water immersion

4. Stretching

5. Cryotherapy

6. Cold water immersion

7. Active recovery.

• Most recovery interventions share common processes that help reduce exercise-induced muscle damage and inflammation

Discussion

Massage

• Massage has been used traditionally to help recovery after exercise in both sports and rehabilitation contexts, with positive effects observed.

• Muscle damage induces DOMS, and massage may boost muscle blood flow and decrease muscle eodema.

• A 20–30 minute massage performed immediately after or up to 2 hours post-exercise has been shown to effectively reduce DOMS for 24 hours after exercise.

• Significant effects of massage were observed up to 96 hours post-exercise as well, thus no need to rush it in.

• In elite athletes, such as ultra-marathon runners, massage significantly reduced perceived pain.

• The reduction in circulating cortisol and an increase in beta-endorphin concentrations may explain the decreased perceived fatigue following massage.

• Studies on DOMS and fatigue often evaluate creatine kinase, interleukin-6, and C-reactive protein due to their involvement in muscle damage and inflammation.

• This meta-analysis found massage to be the most effective recovery technique for reducing circulating creatine kinase and Interleuken-6 levels after exercise.

• A decrease in blood creatine kinase concentration may reflect reduced muscle damage and indicate faster recovery post-exercise.

• Massage increases blood and lymph flow, which blunts the creatine kinase response by enhancing its removal from damaged tissues and increasing its clearance from the blood.

• It is assumed that massage helps flush neutrophils from injured areas, preventing fiber necrosis and creatine kinase efflux.

• A significant reduction in fatigue was observed, though results varied between males and females, with females experiencing a faster and shorter reduction in fatigue.

Compression garments

• Similar to massage, compression garments and cold water immersion significantly and positively impacted DOMS and perceived fatigue, though to a lesser extent.

• This study confirmed there are significant benefits on DOMS 96 hours post-exercise.

• A significant decrease in perceived fatigue was also found when compression garments were used.

• Wearing a whole-body compression garment for 24 hours after intense resistance training significantly reduces perceived fatigue.

• The beneficial effects of compression garments on DOMS and perceived fatigue may be due to reduced swelling and edema, smaller changes in osmotic pressure, and improved venous return.

• Compression garments might also reduce exercise-induced muscle damage and inflammation.

• This meta-analysis did not find significant changes in creatine kinase, Interleukin concentrations after using compression garments post-exercise.

Cold Water Immersion

• Cold water immersion significantly affects DOMS and perceived fatigue, but the effect size on DOMS is small.

• A previous meta-analysis showed that it had positive affects on DOMS 96 hours post exercise

• Optimal Cold water immersion protacol for reducing DOMS is 11–15°C for 11–15 minutes.

• Immersion in water below 15°C positively impacted inflammation.

• The common explanation for it’s impact on DOMS and fatigue is the reduction of exercise-induced inflammation and muscle damage.

• Authors observed a significant, though small, positive effect of Cold water immersion on creatine kinase concentration in the blood after intensive exercise.

• The level of immersion and cold water temperature may reduce eodema and pain sensation after intense exercise.

• Hydrostatic pressure may help transport fluids from muscles to the blood, reducing metabolites.

• Cold temperature-induced vasoconstriction may reduce fluid diffusion into the interstitial space and diminish the inflammatory reaction, reducing pain sensation.

Contrast water therapy

• Contrast water therapy, which involves alternating baths in warm and cold water, is often used for recovery.

• The authors found that it significantly impacted DOMS, though the effect size was small, but it did not affect perceived fatigue.

• Contrast water therapy significantly reduced pain perception at 24, 48, and 72 hours post-eccentric exercise.

• Alternating cold and warm water causes peripheral vasoconstriction and vasodilation, which may reduce eodema formation, influence inflammatory pathways, and decrease pain.

Active recovery

• Active recovery showed comparable effect to contrast water immersion on DOMS, but with a larger effect size but NO impact on perceived fatigue.

• The influence of Active recovery on DOMS following intense exercise has been recognised for over 30 years.

• However, the effectiveness is only significant during a brief post-exercise period (within the first 2 hours).

• This meta-analysis did not demonstrate a superior effect of Active recovery compared to other recovery techniques

• It did not affect inflammatory marker concentrations in the blood in the studies analysis. However, it may be duration dependent

• After a rugby match, 1 hour of low-intensity water exercise did not affect circulating creatine kinase concentration, whereas 7 minutes of low-intensity exercise improved creatine kinase clearance.

• The significant effect of Active recovery may be attributed to increased blood flow in muscle tissue, aiding in metabolic waste removal and potentially reducing muscle damage and pain

Cryotherapy

• Cryotherapy effectively reduced DOMS post-exercise, though with a relatively small effect size.

• Variations in impact are likely due to considerable defference in cryo methods used, such as exposure settings (e.g., cold chamber or cryocabin), timing, temperature (-30 to -195°C), and treatment frequency.

• Fonda et al. demonstrated a positive effect of whole-body cryotherapy on DOMS post-exercise with a 3-minute exposure at -140 and -195°C.

• However, Guilhem et al. and Vieira et al did not observe such an effect

• While whole body cryotherapy was associated with improvements in muscle fatigue, pain, and well-being in some studies, this meta-analysis found its effect on DOMS to be short-lived, with a positive effect observed within 6 hours post-exercise.

• Cryotherapy performed 24 hours after exercise ended showed NO improvements

Stretching

• This study found no significant effect of stretching on DOMS and fatigue.

• Stretching has not been recommended post-exercise for some time, as it may increase DOMS according to Herbert and Gabriel (2002) and Herbert (2011).

• Overall, the analysis confirmed that stretching did not positively impact DOMS, and results within 6 hours after exercise suggested that stretching might even contribute to DOMS.

Top 3 resources

To further your knowledge about recovery

1. Periodising recovery strategies for sports - LINK

2. Great resource to send to your patients that explains DOMS - LINK

3. A fantastic video showing how muscles regenerate - LINK

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