Active Recovery Dr Leon Scott NormaTec

No Pain, More Gain? Exploring Active Recovery

Our sports culture urges us to train more effectively to produce better athletes, but our bodies consistently meet objective and subjective limitations after training.

We need to recover.

We program for this macroscopically with periodization.  However, in our day-to-day training we are still searching for tools that accelerate the rate and quality of recovery.

What are we using now?
As a community of professionals, I am encouraged to see a growing emphasis on recovery tools like sleep, nutrition, active recovery & the utilization of objective measurements of fatigue. Please check out the references below to learn about some of those tools.

Classic tools, like cryotherapy, massage and medications have been utilized to reduce discomfort from processes like delayed onset muscle soreness (DOMS), and potentially accelerate recovery.  I encourage every professional in this forum to look at resources like Delos et al (2013) for a great overview of current tools.  The list isn’t exhaustive, but it will help you create a framework in which you can think about the variety of tools, including some of the classic recovery tools.

However, today, I was asked to address the hottest recovery trend, sequential intermittent pneumatic compression (SIPC).  Popular trade names include Normatec, Recovery Pump and RevitaPump.

What is the theory
Musculoskeletal injury is often associated with swelling associated with the collection of extravascular fluid.  Sometimes, lymphatic vessels are injured, with fluid collecting in the interstitial space.  This occurs in injuries like ankle sprains.  Other times, intracellular/extracellular fluid shifts occurs related to intracellular injury.  This is the process associated with DOMS after intense training.

The former etiology has been successfully treated in the medical community with SIPC.  Specifically around joints, SIPC reduces swelling and increases range of motion.  Considering that swelling also occurs after strenuous exercise, likely from a different etiology, a hypothesis was developed in the 1990’s that SIPCs may assist in post-exercise recovery. The hope was that, by reducing swelling, a return in range of motion, reduction in stiffness, and acceleration in performance may follow.

What is the evidence
There are a few studies that supports an improvement in performance in exercise after the use of SIPC.  However, these studies have poor study design, including small sample sizes and no controls. There are fewer high quality studies, leaving an opportunity for further discovery.  However, the studies that do exist do not support SIPC for performance improvements and accelerated recovery.

Chleboun (1995) used non-sequential compression and found that the swelling associated with intense exercise is reduced, but only temporarily as it returned to a level consistent with a control group on subsequent days.  The duration of improved swelling is unknown. Soft tissue stiffness is also improved compared to controls from days two through five, but not within the first 24 hours.  This finding was consistent with Northey (2016).  I am not aware of any studies, with control groups, that reported a change in soreness, strength, or other performance measures.  It is important to note that all of these studies were in strength training environments, and did not include endurance athletes.

Studies showing improvement in the duration of soreness, strength or performance WITHOUT controls

Weiner A et al.

Zoilkovski A et al.

Studies showing improvement in the duration of soreness, strength or performance WITH controls

None

Studies showing NO improvement in the duration of soreness, strength or performance WITH controls

NortheyJM et al.

Chleboun GS et al.

So why use them?
After seeing the evidence, you may expect me to have a scathing opinion of SIPCs.  Quite the opposite.  I personally own three Normatec devices.  I use them because I experienced the devices and enjoyed the feeling.  I think they’re a “cool” fitness device, and I have no shame in saying that.

Northey’s studied also quantified that athletes who used the SIPC devices enjoyed using them significantly more than other recovery devices or the control group’s passive recovery protocol.

Similar devices are used regularly in medical settings without issues.  So, I am comfortable with them from a safety stand point, too.

In summary, SIPC devices do not slow down recovery, they do not significantly enhance recovery in strength training, and there is no evidence in endurance athletes.  But they feel really good, and sometimes after a tough work-out or long training running we all want to treat ourselves.

References:

Weiner A, Mizrahi J, Verbitsky O. Enhancement of Tibialis Anterior Recovery by Intermittent Sequential Pneumatic Compression of the Legs. Basic Apply Myol. 2001;11(2):p87-90

Cook CJ, Beaven CM. Individual perception of recovery is related to subsequent sprint performance. Br J Sports Med. 2013;47:p705-9

Chleboun GS, Howell JN, Baker HL, Ballard TN, Graham JL, Hallman HL, Perkins LE, Schauss JH, Conatser RR. Intermittent Pneumatic Compression Effect on Eccentric Exercise-Induced Swelling, Stiffness, and Strength Loss. Arch Phys Med Rehabil. 1995; 76:p744-9

Delos D, Maak TG, Rodeo SA. Muscle Injuries in Athletes: Enhancing Recovery Through Scientific Understanding and Novel Therapies. Sports Health. 2013; 5(4):p346-52

Haas C, Butterfield TA, Zhao Y, Zhang X, Jarjoura D, Best TM. Dose-dependency of massage-like compressice loading on recovery of active muscle properties following eccentric exercise: rabbit study with clinical relevance. Br J Sports Med. 2013; 47:p83-8

Chen AH, Frangos SG, Kilaru S, Sumpio BE. Intermittent Pneumatic Compression Devices Physiological Mechanisms of Action. Eur J Vasc Endovasc Surg. 2001; 21:p383-92

Northey JM, Rattray B, Argus CK, Etxebarria N, Driller MW. Vascular Occlusion and Sequential Compression for Recovery After Resistance Exercise. J Strength Cond Res.2016; 30(2):p533-9

Airaksinen, O, Kolari, PJ, Miettinen, H. Elastic bandages and intermittent pneumatic compression for treatment of acute ankle sprains. Arch Phys Med Rehabil. 1990; 71: p380–383

Zolikovski A, Kaye CL, Fink G, Spitzer SA, Shapiro Y. The effects of the modified intermittent sequential pneumatic device (MISPD) on exercise performance following an exhaustive exercise bout. Br J Sports Med. 1993; 27(4): p255-9

Thorsson O, Lilja B, Nilsson P, Westlin N. Immediate external compression in the management of an acute muscle injury. Scand J Med Sci Sports. 1997; 7: p182-90

Mah CD, Mah KE, Kezirian EJ, Dement WC. The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players. Sleep. 2011;34(7):943-50

Guilhem G, Hug F, Couturier A, Regnault S, Bournat L, Filliard JR, Dorel S. Effects of Air-pulsed cryotherapy on Neuromuscular Recovery Subsequent to Exercise-induced Muscle Damage. Am J Sports Med. 2103; 41(8): p1942-51

Bleuzen F, Bleakley CM, Costello JT. Contrast Water Therapy and Exercise Induced Muscle Damage: A Systemic Review and Meta-Analysis. PLoS ONE 8(4): e62356. doi:10.1371/journal.pone.0062356

Bleakley C, McDonough S, et al. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev 2012;2: CD008262.

BJSM reviews: A-Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance Parts 1-44. Br J sports Med. 2009-2013; Volumes 43-47

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