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Before and After: Rest, Recover, Regenerate

November 24, 2009

On the way to the Stanford med school library to do some research for this post, I biked past two high school teams prepping to scrimmage and later a hundred some peeps playing in a high-level club tournament at another field on campus. Adjacent to them was an IM game of Ultimate, and what all these games shared was a love of the sport and a diversity of ages, from high school students to college players, graduate students and working professionals in their twenties, thirties, and beyond.

As we get older, common wisdom holds that the body breaks down, that we are fundamentally unable to play or run as we age. What if, at least to some meaningful degree, this perspective just was not correct? The Rarámuri (Tarahumara) runners described in Born To Run play and “compete” in ultramarathons through their sixties, and Dara Torres won her latest Olympic medals at the age of 41.

Of course, it’s worth noting that the Rarámuri have been running close-to-barefoot for their entire lives, and we may not be able to afford the coaching and recovery staff of an Olympian such as Dara, but I think there’s at least some occasion for hope =)

"Muscle Man versus the Chameleons" by Lee Nachtigal

Mark Verstegen of Athletes’ Performance has the following saying, “Work + Rest = Success”, but we can we do beyond passive rest before & after we play, practice, and train?

Before we play? We can (1) warmup (see the last blog post on Ultimate Fitness, the DVD), (2) address soft tissue dysfunction, and (3) do active/dynamic joint self-mobilization.

And after? Well there’s always contrast therapy, addressing HRV (heart rate variability), and active recovery to name just three.

In this blog post we’re going to focus on soft tissue work, and leave Z-health styled active joint mobility work for another day. We’ll also mainly point elsewhere for “after” tips & tricks for recovery and regeneration.

If you’ve been in any leading gym, listen to the Strength Coach podcast, or just like to keep up with fitness blogs online, you’ve probably heard of and perhaps started to use foam rollers as part of your recovery routine. And while the science right now is fairly limited on these high-density devices, foam rolling (along with a move away with flexion-heavy core work) is one of the newer trends relative to the way things were done in the 90’s.

Perhaps the simplest way to think of a foam roller is as a poor man’s massage, and as a self-massage device for the larger areas on your body (quads / calves), foam rolling or other forms of SMR (self-myofascial release) are now a staple college-level sports training. If you’d like to learn more about foam rolling, the best free resource I’ve found so far on self-myofascial release is Robertson Training System‘s PDF e-book on SMR.

SMR on the cheap? Grab a foam roller, a tennis and/or lacrosse ball, and throw a water bottle in the freezer (for plantar fascia).

If you foam roll religiously, rather than hit up the PVC pipe as some do, I’d actually recommend you learn more about trigger points and move from the coarse kind of STW (soft-tissue work) you get with foam rolling to more targeted trigger point release work. If you’re tight and/or in pain, Clair Davies’s book The Trigger Point Therapy Workbook is hard to beat.

If you have more dough to drop on SMR, I’ve heard positive reviews of TriggerPoint performance products and a Tiger Tail / Stick may not be a bad idea. And of course if you’re stuck here, finding a qualified bodyworker to work with you will definitely make things easier, whether it’s your local physical therapist, a nearby CK-FMS or Z-health certified trainer, or a bodyworker who practices ART, or so on, will definitely be worth your while.

For the more clinically minded, it’s also worth diving deeper into the world of trigger points, with Janet Travell’s (second edition) of Myofascial Pain and Dysfunction: The Trigger Point Manual (check your nearby medical school library if you’ve got one). Travell, who was the first female doctor to be the personal physician for a US President (JFK), coined the term “trigger point” decades ago, and has written the seminal papers and textbooks in the field.

And whereas much of SMR and STW remains yet to be verified or disproven scientifically, trigger points in particular have been the subject of some scientific scrutiny over the last fifty odd years.

What is a trigger point? According to Travell [1998], a “Myofascial Trigger Point (clinical definition) [is] A hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band. The spot is painful on compression and can give rise to characteristic referred pain, referred tenderness, motor dysfunction, and autonomic phenomena.”

The important parts of this definition are that TrPs (trigger points) are generally defined as being located in skeletal muscle, and that pain or tenderness can be referred, which means that if your back hurts it might be actually referred from a trigger point higher up or lower down in your kinematic chain.

Another “common misconception” according to Travell is that “simply treating the TrP should be sufficient”, whereas you often want to release the trigger point and stretch+strengthen the appropriate areas (physical therapy style) as well as “upload new software” to your brain that tells it to use your muscles appropriately. Otherwise, trigger points will return when stressors add up over time.

Travell continues in writing that “central TrP in the upper trapezius is apparently the most frequently identified myofascial TrP location in the body” [Gerwin Shannon in Pain, 1997] and that the
“quadratus lumborum is one of the most commonly overlooked muscular sources of low back pain and is often responsible, through satellite gluteus minimus trigger points (TrPs), for the “pseudo-disc syndrome”…” [p.29 1992 ed. of Travell, lower body volume].

To unpack that, what does that mean for you? Well if you’re having upper body (neck / shoulder pain) perhaps you have active or latent trigger points that need to be addressed, through self-massage or bodyworker care or mobility work, and if you’re having lower-back pain perhaps you might want to self-palpate for TrPs around your QL (quadratus lumborum)… (easier done with a ball, stick, or fingertip than a roller) and of course, check out some of the resources linked to above.

There’s some debate as to how much pressure one should apply to trigger points, or even whether we should focus too narrowly on TrPs rather than the postures and motor programs that maintain in the first place, but these discussions aside, it’s definitely worth at least learning about what your body feels like, first hand.

What then, after the game? You probably know of cooling down and static stretches, but perhaps you haven’t heard as much about contrast therapy, HRV work, and active recovery.

Active recovery is the simplest to explain–it says what it means and means what it says. As mc explains in her blog post on addressing DOMS (delayed on-set muscle soreness), active recovery–getting your heart rate up the day or two after a hard practice/tournament seems to help you recover better than simply doing nothing at all.

The benefits of contrast therapy, for example using hot and cold showers, are a little bit more unclear, but I found it interesting that washing your face in cold water might help “immediately accelerating post-exercise parasympathetic reactivation“. As you may or may not recall, the sympathetic nervous system is your “flight or flight” response, whereas your parasympathetic nervous system corresponds a bit better to relaxing and recovering. So, we want to discourage, at times, sympathetic stress and encourage a parasympathetic response. If you’d like to learn more, go read a bit about the tug-of-war between these two nervous systems.

What then, is HRV or heart-rate variability training? Well it’s one way to encourage a parasympathetic response by practicing the ability to increase the coherence of the variability of your heart rate (which naturally speeds up and slows down over the course of seconds and minutes). In other words, if your heart rate is varying in a chaotic fashion, you’re probably in fight-or-flight mode, whereas if it’s more coherent, you’re probably nice and chill. One blog post is not enough to explain HRV, but just to link out if you’d like to learn more. Check out the various HRV training methods based on biofeedback, from HeartMath to other biofeedback-based devices.

In sum, remember that “Work + Rest = Success”, so work hard, work smart, rest hard, rest smart =)

10 Comments leave one →
  1. November 25, 2009 3:49 am

    Awesome article with lots of great links and useful information. If any of your readers are in Alberta, Canada, we distribute The Stick.

    • Leslie permalink
      December 28, 2009 6:38 am

      Thanks! The stick is great =)

  2. March 3, 2010 1:41 am

    More on Contrast Therapy via Patrick Ward:

  3. May 26, 2010 11:57 am

    You have a great article, it has a lot of great and useful information. Thanks for sharing.

    • Leslie Wu permalink
      May 26, 2010 3:43 pm

      Glad you found it useful! You practice ART? Nice =)

  4. June 21, 2010 5:12 am

    I noticed you mention Patrick Ward. Anything by him is fantastic!!!

  5. October 29, 2010 6:10 pm

    physical therapy is an interesting branch of medicine coz it deals with rapid healing of the body,-‘


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