Thursday, 3 August 2017

Recovery, recovery, there’s no-thing like recovery.....

... for  breaking every human bone, due to the law of gravity.

More on that story later..

Recovery:  restoration or return to any former and better state or condition.”                                                              (

Somewhat like Homer Simpson I spend much time thinking about taking it easy. Not exactly plotting how to get away with watching the game with a stack of beers, more how best to allow my body to recover. Sometimes I seem to spend my life thinking about recovery -  my own and that of all my patients.

Training theory applied to running.

It is not during the training session that the body makes the required positive changes and adaptations that we runners are seeking. It's during the recovery time after.

“Training is giving a large enough stimulus that it creates an adaptation” Steve Magness

An optimal training stimulus causes fatigue and breakdown of the body’s systems and muscles - for example small amounts of tissue damage - micro tears - which weakens the tissue. During recovery the body repairs damage and replenishes energy stores. With adequate recovery the body super-compensates, rebuilding itself stronger and more efficient than before in anticipation of the next challenge. This process improves performance as well as reducing the risk of injury.

I have a passion to improve my own running - to run faster, to run longer, to improve my results on the fells and in orienteering and to improve my times on the roads.

To achieve this I spend much time, usually whilst out running, musing on what training stimulus my body needs to get fitter, stronger and more robust. Too much and I will place myself at greater risk of injury or illness, too little and I won’t improve.

But, perhaps unusually for a runner or a running coach, I spend an equal amount of time thinking about my recovery. When is my body ready for the next stimulus? Has it recovered yet? If I run Park Run hard on Saturday and race, a classic distance orienteering course on Sunday then can I do the Burbage Fell Race on Tuesday? Will I have recovered enough?

If the gaps between hard sessions are too long  I will start to get slower and weaker. But if the gaps are too short the same will happen - I will get slower and weaker. Much thought is invested in getting that balance right. Sometimes tough decisions are needed - for example to miss out on a race I’d really like to be doing.

Figure A: Level of preparedness becomes depleted by training stress, only to be restored as time moves on through recovery. According to the model, you leave compensation through recovery, and surpass earlier preparedness opening a window to reintroduce training stress. (Zatiorsky & Kraemer 2006)

Training theory applied to Physiotherapy treatment.

The process of training - stressing the body beyond its natural tolerance and then allowing it to recover and supercompensate - applies also to treatment and rehabilitation of injury.

Every day. I am trying to help my patients understand how to increase their fitness, strength and robustness in some way.

It could be specific to the injured or painful tissue or to connected tissue and muscles around the injured area, or it could be to the whole body. Almost every long term treatment involves a stimulus - specific exercises, a series of training sessions or a low intensity activity such as walking for ten minutes once a day. The goal is to tailor the stimulus so it is just right for that patient. Too much and I will cause more pain and put the patient at risk of further injury - to little and their body won’t repair itself to the level it was before the injury.

But… as with with my own training it's not just about the stimulus, I need to also consider the recovery from the stimulus. Without that the treatment is as likely to be damaging as beneficial. Just as for my own running training, helping each patient to heal is about striving to find the optimal balance between stimulus and recovery specific to that person.

How long does recovery after a stimulus take?

Time required to recover depends on the amount of damage the stimulus has done.

Very gentle easy exercises or activities will cause little damage or fatigue and so can be repeated again very quickly, even within the hour. With very painful or acute injuries I frequently prescribe these very gently exercises or activities. Little and often.

Exercises or activities that provide a greater stimulus and challenge to the body need a much longer recovery time, between six and forty eight hours depending on how demanding they are. This sort of stimulus is what I am aiming for both with my own training and longer term patient rehabilitation once any acute symptoms have settled down.

Races and challenges that are really demanding need even longer for recovery. If the body has been significantly deplinished from the stimulus it may need days or even weeks to recover. An extreme example is Steve Birkinshaw’s record-breaking run round the summits of all 214 Lake District Wainrights in seven days. He covered 321 miles with 91,600ft of ascent and descent with only a few hours rest each night. His story of the challenge, “There is No Map in Hell” describes in detail how it took him months to properly recover.  

How can I speed up the recovery process?

You can’t. And nor should you want to. It's during the recovery period your body is getting stronger and fitter. Try to speed this up and you will reduce the training effect.

But…there are lots of ways you can slow down your recovery.

Optimal recover requires time, rest, sleep and nutrition.

Cutting corners on any of these will slow the recovery process down. Other factors that delay recovery are:

  • Stress
  • Poor health
  • Age. Unfortunately the older we get the longer are body takes to recover.
  • Alcohol
  • High work or life load. This is why professional athletes have a lot of downtime - more than is possible in most jobs.

Does stretching help my recovery?

No. That doesn't mean you shouldn’t do it, it’s just not a part of your recovery process. Here is a previous blog on stretching.

What happens if I don’t allow my body to recover sufficiently?

  • Your injury probably won’t get better and might get worse.
  • Your performance won’t improve and it might get worse. (overtraining).
  • Your body will gradually be able to take less load, not more.
  • You will increase your risk of further injury.

Case study - my 87 year old father-in-law

Three weeks ago my father-in-law, who generally walks with a stick and sometimes with a zimmer, thought it would be a good idea to climb up a ladder onto the garden shed to try to remove some sapling shoots from the garden wall.

The ladder (now locked up and key hidden) and shed.

Unsurprisingly he lost his balance and fell backwards of the shed leading to five broken ribs,three broken back bones and a week in the spinal unit at the Northern General. A former regional standard pole-vaulter who spent his life working in the Lake District mountains his initial recovery was impressive given his age.

He has now been back home for a week. During that week I have been working with him and his excellent NHS physiotherapist to ensure a balance between his training stimulus (activities) and recovery (rest).

‘Just right’ for him at the moment are the daily activities of getting dressed, showering, making his own breakfast and lunch, twice daily physio exercises on the bed and two walks of about 100m. This is the little and often approach. In between these activities he needs to sit and rest to allow his body to recover from these small loads.

If he does too little he will get weaker which at his age is a serious risk. His ability to walk and look after himself will deteriorate. He will also not apply the required stimulus to allow the broken bones to heal well.

However when he does too much the pain in his back and ribs increases and he feels very fatigued. This then forces him to take much longer rest and recovery time which leads back to him feeling sorry for himself and doing too little. So it’s important to get the balance just right.

If he keeps doing the little and often his body will get stronger and the amount of ‘just right’ will slowly increase. He will build up the length of the walks, add more exercises eventually doing them whilst standing rather than lying, and eventually return to his weekly exercise class.

Case study - International Orienteer

Charlotte competing in the world championships in Scotland 2015 (Photo by World of O)

Back in January Charlotte sustained a significant injury to her achilles tendon. Her normal training stimulus was 80km running a week including three tough speed sessions and twice weekly gym sessions.

Following the injury even walking one mile or cycling was too much load for her achilles. Every time she put slightly too much stimulus through the achilles the pain flared up for several days forcing her take even more recovery time.

I regularly see athletes with achilles injuries who have taken more than six months to recovery. Typically they yo-yo, resting until there is no pain and then returning to normal training too quickly, at which point the pain returns. Tendon recovery has been well researched and the scientific consensus is that tendon’s require loading to heal.  

Over the next five months I worked very closely with Charlotte aiming to find the optimal stimulus and recovery to build her back up to a full training week.

Initially this was a short walk or a few calf raises with recovery time between each dose. As the injured tissue got stronger the doses were built. At this point we moved to a stimulus that caused a slight aggravation of symptoms, followed by forty eight hours recovery before applying the next stimulus.

When she started running again it was just for thirty seconds at a time.

Occasionally we needed longer recovery time following an activity, usually because other loads such as having to walk further led to delayed recovery from a run.

As the tendon tissue got stronger we were able to build up the stimulus through adding small amounts of faster running and re-introducing hill running alongside building up the length and frequency of runs.. All the time we were listening to the reaction from the tissue and ensuring adequate recovery before the next stimulus.

After five months of this gradual process she was finally able to put in a normal training week. Charlotte is now fully recovered and although not fully back to her best she is winning local five and ten kilometre races and raced successfully in a World Cup series in May.

If you're interested in understanding more about recovery and how it links to your own injuries and training we will be putting on two evening workshops in September and December 2017.