By: Kimberly Stein, PhD, Gatorade Sports Science Institute
Pick up a trade publication, walk through an expo at a conference, check out your Twitter feed—the latest and greatest recovery modalities are often front and center, but it can be difficult to navigate which ones to include in your recovery programs. When evaluating recovery modalities, your questions might include: Will the athletes like using it? How easy is it to use? How portable is it? What is the cost? Is there science to support its use?
The science question is often the toughest to answer. To be cutting edge, new technologies are often not based on sound theories but are put into play before a strong body of scientific evidence is established to advocate for the benefits. Furthermore, if athletes “feel” a benefit, that might be all the evidence that is needed for adoption.
New recovery modalities are a great example of this. While a body of published literature does exist around the use of modalities to promote recovery, it’s difficult to make strong evidence-based recommendations on which to use since the work is fairly scattered. The work is scattered among different approaches with different outcomes, such as soreness, biochemical measures, subsequent performance (and there are many ways to define performance), etc.
While it is beyond the scope of this article to do a full literature review, the following table summarizes the most recent literature on the benefits of recovery modalities, not inclusive of those techniques you may use to treat specific injuries:
|Hydrotherapy (cold water immersion and contrast immersion)||Data on cold water immersion are mixed, with newer research suggesting no benefit over active recovery.1,2,3 Contrast immersion is beneficial for recovery of performance outcomes (for example, sprinting), although studies with team sport athletes are limited.8|
|Compression Garments||May be beneficial for recovery from exercise-induced muscle damage, particularly to reduce swelling, perception of soreness and recovery of muscle function. Data are limited on the impact of use during sleep, although one recent study does indicate a benefit.8,13,15|
|Data so far are limited, but do appear to improve blood flow and decrease pain.14,17|
|Neuromuscular Electrical Stimulation (NMES)||Likely psychological benefit for recovery, but no evidence to support functional or physiologic recovery.8|
|May have subjective benefits, but body of literature does not support a benefit to enhance subsequent performance.11|
|Data are mixed. One study found vibration applied to the elbow flexors following eccentric exercise alleviated muscle soreness;5 another study did not find a benefit of whole body vibration on soreness or performance outcomes following.12 Data do not exist to compare whole body to localized vibration. Effective for short-term pain relief and increased range of motion.7|
|Myofascial Release||May be beneficial to decrease muscle soreness.3|
|Whole Body Cryotherapy
|Appears effective to decrease pain related to inflammation and promote recovery; however, appropriate use guidelines and safety procedures should be followed.6,9,10|
Baseball: In-Game Modality Use
Specific to baseball pitchers, two published research studies evaluated modality use between innings. In the first, the use of an NMES device on the shoulder decreased ratings of perceived exertion (RPE) when used between innings of a simulated game, as compared to passive and active recovery.16 In the second, intermittent arm cooling between innings of a simulated game also decreased RPE, led to maintained pitch velocity in the later innings and improved perceived recovery as compared to no cooling.4 While this work is far from conclusive, it does indicate modality use for in-game recovery could be useful.
Which Is Best?
In the scientific literature, most often the effectiveness of a given modality is compared to rest or active recovery. Without direct comparisons in a well-designed study, we don’t have evidence to determine which is the “best.”
In the absence of this type of evidence, it is likely a good practice to narrow in on the benefit your athlete is looking for, and then find the modality within that category that really makes a difference in how your athlete feels. See the following chart for examples. While this is a bit simplistic, since several of the modalities have overlapping benefits, it is a good starting point.
|PRIMARY PROPOSED BENEFIT||MODALITY|
|Enhance Blood Flow||Pulsed compression, compression garments, contrast water immersion, NMES|
|Decrease Pain||Dry needling, vibration, myofascial release (including foam rolling & deep tissue massage)|
|Decrease Pain, Inflammation & Swelling (particularly post injury)||Ice, cold water immersion, whole-body cryotherapy|
|Feels Good||Massage, stretching|
- Offer a variety of modalities to decrease physical and psychological adaptation.
- Allow the athletes to find the modalities that help them feel the best.
- Consider easy-to-apply modality use during travel when movement is limited, such as compression garments and mobile NMES units. Data do not exist to support a benefit during travel, but in theory, promoting blood flow when the athlete cannot be mobile may be beneficial, and anecdotally, athletes report feeling less stiff and sore.
Many would argue that the scientific evidence clearly points to the two “best” recovery modalities—nutrition and sleep. Of course, athletes may not perceive or feel a benefit from these as immediately as with the modalities discussed above, but nothing can overcome poor nutrition and sleep. Additionally, improving nutrition and sleep habits can require some significant behavior changes. An ideal recovery program should be a blend of ground work put in, helping your athletes achieve solid nutrition and sleep habits paired with additional modalities that fit within your program that the athletes find beneficial.
- Allan R & Mawhinney C. (2017). Is the ice bath finally melting? Cold water immersion is no greater than active recovery upon local and systemic inflammatory cellular stress in humans. J Physiol. 595:1857-1858.
- Anderson D et al. (2017). The effect of cold versus ice water immersion on recovery from intermittent running exercise. J Strength Cond Res. doi: 10.1519/JSC.0000000000002314.
- Beardsley C & Skarabot J. (2015). Effects of self-myofascial release: a systematic review. J Body Mov Ther. 19:747-758.
- Bishop S et al. (2016). The effect of intermittent arm and shoulder cooling on baseball pitching velocity. J Strength Cond Res. 30:1027-1032.
- Cochrane D. (2017). Effectiveness of using wearable vibration therapy to alleviate muscle soreness. Eur J Appl Physiol. 117:501-509.
- Costello J et al. (2015). Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD010789.pub2.
- Espejo-Antunez L et al. (2017). Dry needling in the management of myofascial trigger points: a systematic review of randomized controlled trials. Complement Ther Med. 33:46-57.
- Halson, S. (2013). Recovery techniques for athletes. Sports Science Exchange. Vol. 26, No. 120, 1-6. www.gssiweb.org
- Hohenauer E et al. (2015). The effect of post-exercise cryotherapy on recovery characteristics: a systematic review and meta-analysis. PLoS One. 10(9): e0139028.
- Lombardi G et al. (2017). Whole-body cryotherapy in athletes: from therapy to stimulation. An updated review of the literature. Front Physiol. doi: 10.3389/fphys.2017.00258.
- Malone JK et al. (2014). Neuromuscular electrical stimulation during recovery from exercise: a systematic review. J Strength Cond Res. 28:2478-2506.
- Manimmanakorn N. et al. (2015). Effect of whole-body vibration therapy on performance recovery. Int J Sports Physiol Perform. 10:388-395.
- Marques-Jimenez D et al. (2016). Are compression garments effective for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis. Physiol Behav. 153:133-148.
- Sands W et al. (2015). Dynamic compression enhances pressure-to-pain threshold in elite athlete recovery: exploratory study. J Strength Cond Res. 29:1263-1272.
- Shimokochi Y et al. (2017). Effects of wearing a compression garment during night sleep on recovery from high-intensity eccentric-concentric quadriceps muscle fatigue. J Strength Cond Res. 10:2816-2824.
- Warren, C et al. (2015). Effects of three recovery protocols on range of motion, heart rate, rating of perceived exertion, and blood lactate in baseball pitchers during a simulated game. J Strength Cond Res. 29:3016-3025.
- Zuj KA et al. (2017). Enhanced muscle blood flow with intermittent pneumatic compression of the lower leg during plantar flexion exercise and recovery. J Appl Physiol. doi: 10.1152/ japplphysiol.00784.2017.