Recovery modalities: What’s worthwhile? Along with some massage discussion.

Posted on February 2, 2015

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This was originally going to be part of a mailbag, but it’s a longer discussion than I like to put in there, so I made it its own post. It fits with the mailbag mantra though: this is (lightly edited) email conversation. By its nature it’s not as thorough or complete as a regular post.

I do link a thorough paper at the end, which reviews a plethora of recovery modalities. I highly recommend it if you’re looking for a more in depth look at all this. A common response to these types of things is, “Well, even if it’s not doing anything more than a psychological benefit, isn’t that ok?” Sometimes that can be ok; sometimes it isn’t. I’m going to hit on this, and the paper does too, but in different ways.

Which brings us to this covering some topics which are prone to pissing off the internet, which I’m all for. However, if you’re the type whose only reason for going from horizontal to vertical every day is to unleash your anonymous vitriol upon the world, please remember the style of discussion going on before you have an aneurysm. If you find yourself getting worked up, I’d ask yourself, “Am I mad because this is false information? Or am I mad because there is a serious lack of evidence for the thing I make a living either doing, selling, or making, and I don’t want to accept it? Am I upset because the thing I link my identify to may be wasting people’s time and money?”

I write more for everyday people, but this client is a professional athlete battling some leg issues, which is why you’ll see us veer off into certain realms I don’t often talk about.

“What are your thoughts on shit like tiger balm before training to trick my brain on that pain pathway a bit?”

I don’t like anything which can mask pain before training. (Before a game is a different story, as I’m sure you understand.) I want people being able to feel exactly what bothers them, how much, when, etc. It’s a big reason why ibuprofen is ok afterwards (sporadically, not every training session), but not before. You miss valuable information.

“Okay that makes sense re masking pain.  I was just thinking I’ve come to expect pain in a lot of things and it’d be nice to get out of that mindset.”

I can certainly see the logic in the tiger balm approach you mention. It’s more the risk outweighs the potential benefit to me.

And then when it comes to anything external, my approach with people is always, “Is this something you’re willing to do all the time / consistently?” (For some, this means the rest of their life.) And or “Can you do this in any circumstance?”

This is my main issue with manual therapy / massage. You can’t do it anywhere, you don’t always have access to a good therapist, you’re reliant on someone else, etc. Tiger Balm, to a lesser extent, fits here. e.g. do you want to put tiger balm on before every workout, will you always have it, being reliant on it, what happens the time you don’t put it on, etc.

This is why when it comes to only working on one issue, I really have people doing completely at home type workouts, with only their bodyweight. Exercise is something people want to / should be doing regardless, and an at home / bodyweight only program doesn’t fall into any of the external modality pitfalls. (The ability to be reliant solely on your own body is probably the biggest aspect.)

“On your points about manual therapy and those types of things, I think that makes sense when you’re working with general population who are after general health and wellbeing.  And I agree about not wanting to rely on external stuff to feel a certain way (I know you’re okay with caffeine, but apart from games, I avoid it for this reason exactly. I don’t want to have a shitty workout- or day for that matter- because I didn’t drink my preworkout or cup of coffee), but for competitive athletes, if they have the time and especially money to put in for extra therapy that will improve performance, then I wouldn’t see it as a negative. I was actually going to ask you your thoughts on soft tissue work in general.

I read your article about foam rolling and I thought it made good sense re: avoiding poor positions that will lead to pain, and not fucking up tissue by grinding it too hard.  But what do you do if it’s just passive tissue tension that is making it hard to get into positions and move well? If you need to lower the tone to do this, what is your approach?

And as far as other general recovery stuff, do you recommend anything? If you were only concerned with improving performance as much as you could, or recovering from an injury as quickly as you could, without worrying about long term reliance on external stuff, would your approach change?

I have a good EMS unit with pulsing recovery modes that I have used in the past. Also have this massage roller (now that I know your thoughts on foam rolling) – http://www.rollrecovery.com/r8/ – what do you think about these types of things?”

In terms of recovery modalities: With athletes and higher performance, things certainly have room to change. That said, I’ve yet to come across much I think is worth the time and effort. Even if money isn’t part of the equation. With tissue work, the only thing I’m for is a nice, general, relaxing massage. (Sporadically, not after every training session.)

Other than a few who have extremely good hands, I don’t believe massage therapists are doing what they think they are to tissues. I’m not even sure they can do what they think they can. From a research perspective, they seem to have no idea what they’re doing. Trigger points have been debunked; I’ve addressed scar tissue myself. Any time they talk about lengthening something they ignore the fact the other end of the muscle isn’t fixed, so the rubber band (muscle) isn’t being pulled from both ends, meaning it’s not lengthening. (You *could* work on this, I just haven’t seen someone do it.)

Even the ones with great hands, I’m not sure they really know what they’re doing, if it’s even anything, other than helping the person relax, which, to a certain extent, I’m ok with. Tom Myers is perhaps the most noteworthy manual therapist in the world right now. I’ve seen him speak in person myself, and have seen other interviews with him. He can’t give a sound explanation. And to his credit, I’ve seen him say, “You always have to train the tissue.” Meaning even his own results are confounded by the variable of simultaneously training the tissue!

->Even if the hands are great, then you run into the external issue again. Say you find someone you really like in Hawaii [this client’s offseason location]. Or wherever. But then in season [not in Hawaii] you’re feeling stiff and don’t have access to this person. Unless you’re Kobe Bryant flying your people all over the world. Often with these types of things, people get attached to someone. Between the fact someone’s hands are touching you and the personal conversations, many get to where, no matter what, someone else can’t get the job done. “I have a guy.” It may be far fetched, but the brain has a big influence on these things, so it’s worth considering. This is why I’m more for the general massage. You can find that just about anywhere.

Because when it comes to tone, a muscle can be as flexible or relaxed as possible, but that still doesn’t mean it’s going to act that way once the person moves, which is what everything comes down to. So, if someone is particularly stiff or toned after something, then I like to get them moving and work on those areas. Albeit in a light manner. (Essentially the Tuesday, Friday, Sundays we’re working on.)

Other things I like: It can never be mentioned enough, sleep. And then just a good active lifestyle besides training. This is primarily walking for someone who is already training hard. If it’s scenic, that’s even better, as that can really help ease the mind. (The brain / nervous system is what holds tone!)

Other general relaxing things can work too, depending on the person. Hot tub for instance.

Nutrition wise: Unless you’re doing something quite unusual here, there’s usually not much to work on. So long as carbs and protein are sufficient. (If you’re an endurance athlete, there is room to get more specific here. (*Lots* of carbs.))

That’s an interesting roller. I haven’t come across that one before. The issue with any athlete performing their own tissue work is inherent in doing so is having to work at it. That the benefits of relaxing are taken away by having to exert effort.

Stress plays a big role in the healing process; it impedes it. So, the converse is what you really want to be focusing on. That said, relaxing can be taken too far, as you definitely want to get the body moving for recovery. For some, they’ll take relaxing to the extreme “Alright, I don’t have to get out of bed today.” That’s certainly too much.

All that said, particularly as an athlete, there is something to be said for what you feel works for you. To some degree, whether it’s placebo or not doesn’t matter. If you find EMS or something harmless like that works for you, have at it. Personally, during my athletic days, I always felt more stressed by feeling like I constantly had to be doing something of this vain. It’s been a big relief throughout the years to find the body, when given the proper environment, handles nearly all these things as well as possible on its own.

“Thanks for that explanation on recovery. Your point on feeling stressed about doing the recovery stuff actually makes a lot of sense to me.  It’s always just been stuff I thought I needed to do, but now that I think about it, it probably does add some stress.

And the mental thing about getting used to one therapist also makes sense, as on away games I was far more worried about straining a muscle because I didn’t have access to my usual massage therapist. 

One thing though… Maybe I have just drank the kool aid on massage stuff, but even though therapists don’t know what exact effect they are having on the muscles, doesn’t mean they aren’t having a (perhaps positive) effect, right? I feel like any form of manual therapy doesn’t lend itself well to research, because how difficult a control group would be to set up, and all the confounding factors involved…but I always just believed the anecdotal evidence (often from high level coaches) that it had great effects.”

Oh definitely. I believe there can be a positive effect, but I believe it’s more on the nervous system than any particular change in specific tissue. This is back to that relaxing aspect. Being touched tends to release some positive hormones as well. Here’s an article I quickly found going over some of this: http://www.npr.org/templates/story/story.php?storyId=128795325

This is all with the caveat the therapy doesn’t beat the shit out of you. See: therapists doing the idiotic thing of bruising people.

What I particularly don’t like about manual therapy or massage work is those who think they’re going to get rid of X ailment that’s been bothering you for over a year, or however long.

One thing to add regarding that article, I wonder if you’re someone who is already in a relationship [this client is], if you’re already getting all the benefits you’re going to get from having another person touch you.

If you want a more detailed look at all this, this is one paper: Using Recovery Modalities between Training Sessions in Elite Athletes: Does it Help? It discusses things such as how massage may, if anything, divert blood flow *away* from muscles. How massage may have a psychological benefit, but not a physiological, and why this can be a BAD thing. If you think you’re more recovered than you actually are, you may engage in more intense training than you should. 

As I alluded to in the discussion, overall, there doesn’t seem to be much one can do to enhance recovery. There are things you can do to hamper it. Binge drink is a pertinent example for athletes, as is training too much, too often. But other than a relaxing day where you do a bit more than lay down the entire day; work on some easy movements, you’re probably not going to achieve much. 

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Posted in: Miscellaneous, Pain