Recovery Protocol

Summary of: 
FOOTBALL RECOVERY STRATEGIES 
(Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti, 2015)

Does Fatigue Cause injury?

• High intensity exercise leads to fatigue.  
  
• Fatigue causes a decline in performance.  
  
• A high percentage of injuries occur late in each half of a game, suggesting that fatigue is a risk factor for injury.

Fatigue Mechanisms

• Combination of central and peripheral factors.
  
• Central fatigue = decreased maximal voluntary muscle contraction and sprinting ability.
  
• Peripheral fatigue = muscle soreness, damage, and inflammation.
  
• Depletion of glycogen stores.
  
• Dehydration.
  
• Muscle damage / stiffness / swelling.
  
• Mental fatigue / motivation.
  
• Jet lag / disrupted body clock / stress / poor sleep.

How long does it take to recover from exercise?

• Immediately after a match, 20M sprint time, quadriceps strength, and vertical jump height are decreased by about 10%.  
  
• Full recovery can take between two and four days.  
  
• Injury rates are increased when there are less than 6 days between matches.

"When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover."

What can we do to reduce fatigue after exercise and recover faster?

Nutrition & Hydration

Immediately after a match, players should drink a large volume of fluid (about 150% of the sweat loss) with a high concentration of sodium (about 500 to 700 mg/L of water), flavoured milk, and tart cherry or berry juice. Then, they should eat a meal containing high-glycaemic index carbohydrate and protein within the hour following play.

Rehydration and consumption of carbohydrates and protein are effective techniques for optimising repair of muscle damage.  The addition of sodium at 500-700mg/L promotes fluid retention, stimulates thirst, delays urine production, and increases glucose absorption.  It is recommended to drink a large volume of fluid after the match instead of small quantities gradually.

It is recommended to take 1.2g of carbohydrate per kilogram of bodyweight per hour for up to 5 hours after a match to enable maximum re-synthesis of muscle glycogen stores.

20g of milk protein during the first 2 hours of post-exercise recovery stimulates muscle protein synthesis.  Flavoured milk is an effective beverage for post-exercise recovery. It contains carbohydrate and proteins in similar amounts to those used in studies demonstrating improved post-exercise recovery.

Juices such as tart cherry juice, tomato juice, or berry juice are also recommended to enhancing the recovery process. These juices are loaded with a high antioxidant capacity, which reduce oxidative stress and inflammation.

Alcohol delays recovery as it is a diuretic, increases urine output, impairs sleep, delays the muscular recovery process, and decreases maximal strength.

Sleep

• Sleep is an essential part of recovery management.
  
• Lost sleep reduces endurance performance, maximal strength, cognitive performance, and the immune system.  
  
• Less than 7 hours sleep per night triples the risk of infections and double the risk of musculoskeletal injuries.
  

Cold water immersion

• Several meta-analyses confirm the benefits of cold-water immersion for recovery.
  
• The recommended regime of cold-water immersion is: whole-body immersion lasting 10 to 20 minutes at a temperature of 12 to 15°C immediately after the match.
  

Active recovery

• Active recovery performed after a match does not present any benefit for physical performance.
  

Massage

• Most studies fail to find a significant beneficial effect of massage for recovery.
  
• Psychological benefits: decreased subjective symptoms of soreness / improved perceptions of recovery.
  

Stretching

• There is no substantial scientific evidence to support the use of stretching to enhance post-exercise recovery.
  
• Stretching is not clinically worthwhile in reducing muscle soreness in the days following exercise. 
  
• Recovery of physical performance is not improved after stretching.
  

Compression garments

• Meta-analysis on the effects of compression garments on recovery following damaging exercise indicated that the use of compression garments had a moderate effect on recovery of muscle strength, muscle power, creatine kinase and in reducing the severity of delayed onset muscle soreness.  
  
• A placebo effect due to wearing the garments could not be excluded.
  

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CONCLUSION

1. The first step is hydration; the mass of the players should be measured and compared to the pre-match body mass in order to propose the appropriate quantity of fluid to drink (150% of body mass lost). The fluid should contain a combination of water and a large amount of sodium (500 to 700 mg/L of water).
   
2. The second step consists in drinking a tart cherry juice and chocolate milk in order to restore glycogen, to reduce oxidative stress and inflammation, to stimulate muscle repair and to promote quality and quantity of sleep.
   
3. The third step is the cold bath. The players should immerse themselves up to the neck at a temperature between 12 and 15°C for 10 to 20 minutes to accelerate the recovery process.
   
4. The fourth step is to wear a compression garment until bedtime.
   
5. The fifth step is to eat a meal high in carbohydrate with a high-glycaemic index and protein within 1 hour after the match (for example soup, well-cooked white pasta or mashed potatoes, chicken or fish, yogurts or cake).
   
6. The final step is to have a good night’s sleep.
   

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WATCH DR DUPONT'S PRESENTATION AT ASPETAR'S POST-EXERCISE RECOVERY CONFERENCE: