It’s 5:25am and I’m already on my second coffee. The agonising wails of my teething 10 month old has the whole family up an hour already. Proper up. Not to mention attending to two ‘wee-wee’s’ during the night, only one of which was legit. The other was a false alarm or in other words a way of getting Daddy back into the room to Billys big brother at 1:30am. This is where I would spend the remainder of that short night on the floor with a giant Peppa Pig for a pillow. But as it begins to get brighter outside the pain busting teething granules begin to kick in and Billys fight against sleep is a lost one. For me I am wide awake on a Sunday morning ironically reading an article on the importance of recovery during training. Recovery as in sleep? Ah yes, sleep. I remember that. Power naps after work; drifting off during Countdown after a short day in University to the soothing sum-solving sounds of Carol Vordermann.
Poor quality sleep has been associated with increased rates of injury with athletes who have less than 8 hours sleep almost twice as likely to have an injury compared to those who get 8 hours or more (Milewski et al 2014). While working hard is without question crucial for progression, days missed due to injury can be detrimental to a season. And of all the injury prevention strategies ensuring quality sleep may be the easiest way of all. Insufficient sleep leads to errors, lack of concentration, decreased motivation lack of attention (WHO, 2004): a misplaced foot placement causing an ankle sprain or a mis timed tackle due to lack of focus. Fatigue has been identified as the largest preventable cause of accidents in traffic accidents, higher than alcohol or drug related incidents (Akerstedt 2000). Occupational injuries follow suit with workers with higher levels of sleepiness at greater risk of experiencing an occupational injury than those with a full nights sleep (Swaen et al 2003). Coaches will now monitor their athletes sleep pattern as a risk factor for injury as well as physical indicators. Following injury this should also be taken into account, especially for those struggling to return to full duties or to play.
Recovery is one of the main principles of training but often times one of the forgotten, particularly with rehabilitation. For some it is over utilised when days off exceed those in training. Yet for others it is questionable whether it fits into their training plan at all. A day missed can be seen as an opportunity lost. But what if the structures being stressed (which is what happens during training) are not sufficiently recovered prior to being stressed again? More importantly what if an injured structure being rehabilitated with a strengthening or stability programme is not sufficiently recovered before loading again?
Tissues adapt to load. It is how we get stronger, faster, run further. But for periods after, depending on the aims of that particular session, the muscle will be in a fatigued state. If the timing of that next session is too soon there is an increased risk of injury, particularly overuse injury. If it is too far apart there is also a risk that gains achieved from the initial session may be wasted. Tougher sessions will require longer durations of recovery while less intense sessions will require less. But for those who don’t like taking days off recovery does not necessarily mean complete rest. Recovery sessions can vary from light aerobic activity to cross training, swimming or jogging, even lighter gym sessions depending on the needs of the specific sport. It does not necessarily need to be a day completely off but sometimes a change of scenery can be nice.
For rehabilitation following injury the same principles apply. Work an injured structure too vigorously, too quickly and we can run the risk of secondary issues such as tendonopathy around the area. Remember the area is injured. But also remember it needs to be challenged to get back to fully working capacity again, gradually. Not work it enough and there may be little change seen with insufficient loading. There may be need to work an area or movement to fatigue to get the desired affect but time between sets should be sufficient that quality of the movement pattern being performed is not compromised before the next set or day of exercise. Delayed onset muscle soreness (DOMS) is normal – that feeling after an unfamiliar exercise such as a marathon when coming down the stairs the following morning is more problematic than the marathon itself. By all means take it easy that day but often times the best thing to do is a lighter session at a reduced load.
I was never a great one for recovery days but of late they have been forced into my schedule. The lack of sleep certainly puts me in the ‘at risk’ category but there is little that can be done about that right now. What I can do is to ensure other risk factors for injury are addressed, most importantly some strength training, in my case specific for running.
For more information on any of the issues addressed throughout this article please contact Rob via email at firstname.lastname@example.org, Twitter @mccabephysio, Facebook at McCabe Physiotherapy or visit http://www.mccabephysiotherapy.com
Rob McCabe MISCP
MSc (pre reg) Physiotherapy, BSc Sport Science and Health, MSc Sports Physiotherapy, PG Dip Orthopaedic Medicine
Orchard House, Moorefield Rd, Newbridge, Co. Kildare