In part one and two, we looked at what was recovery, the types of passive and active recovery techniques available.

In part three, we look at recovery that requires assistance and references.

Thank you to everybody who provided articles and information on this series.

Assisted Recovery

The definition of assisted recovery is it requires external assistance. This assistance can be a person, medicine, or clothing for example. In part two we discussed certain stretching that required external assistance. This was done as the external assistance was to aid in the stretch.

Assisted recovery is at the top of the Recovery Pyramid

Massage/Body Work Therapists

This is a broad category and can include, but is not limited to, the following,

· chiropractors,

· osteopathy

· massage therapists,

All these forms of therapy can provide an essential provision of recovery to you. Massage therapy would be the most often used, but chiropractic and osteopathic have a place in overall scheme of recovery.

With any form of recovery treatment, the benefit increases and improves with consistency and regularity of treatment. With bodywork therapy, whether this is with a chiropractor, osteopath, a massage therapist, or some other bodywork professional this act of consistency and regularity become more important due to the following.

1. Practitioner gets to know client, and

a. How the person reacts to certain treatments

b. Particular areas of concern

2. An initial and ongoing treatment plan can be developed and followed

Chiropractic Therapy

The practice of chiropractic focuses on the relationship between structure (primarily the spine, and pelvis) and function (as coordinated by the nervous system) and how that relationship affects the preservation and restoration of health. (What_is_Chiropractic)

Australian chiropractors are five year university trained, and are government registered and government regulated health professionals. (Chiropractic_Qualifications)

Osteopathic Therapy

Osteopaths treat focus on how your skeleton, joints, muscles, nerves, circulatory system, connective tissue and internal organs function as a holistic unit. Many structural problems in the body may affect proper mobility or function and can lead to other problems. (osteopathy-and-you)

Australian osteopaths complete a five year university training, and are government registered and government regulated health professionals (qualifications-and-training)

Massage

Massage is the methodical manipulation of muscle and other soft tissue for the relief of discomfort and tension using pressure and friction.

Many techniques are used to reduce pain, enhance performance, improve range of movement and aid recovery. http://www.sportsmassage.com.au/what-is-massage

Self Massage and Self-Myofascial Release (SMR)

We discussed bodywork therapists and suggested regular and consistent treatment will be beneficial to the recipient. This can be issue for a number of reasons, including but not limited too.

1. Cost

2. Finding a good therapist

Self Massage and SMR is cost effective way of providing a recovery tool that is performed by the athlete.

Some of the benefits believed to result from self-massage and (SMR) include

· Reducing muscle fatigue,

· Tightness and imbalance;

· Aiding recovery; and

· Gaining muscle awareness.

By using these techniques regularly, you will become familiar with how your muscles normally feel, and will learn to recognise any changes (for example, an increase in tightness or pain).

A good booklet on self massage is ais-self-massage-booklet.pdf, Mike Robertson also has a handy eBook, which is available when you join his site, for free, that is comprehensive and easy to follow.

Self massage and SMR are considered a poor mans' version of body work therapy but an important part of recovery. I first read about this here

These self treatment techniques require minimal equipment that includes,

· Foam Rollers

· Tennis Balls

· Cricket Balls

· Golf Balls

· The Stick

That in most cases cost less than an hour massage.

Eric Cressey in his article the_joint_health_checklist outlines a minimum, acceptable and optimum amount of mobility, static stretching and soft tissue work per week. The table below outlines these for an athlete under the age of 32.

Under 32 Athlete	Minimum	Acceptable	Optimum
Mobility	2	3	5
Static Stretching	1	2	3
Soft-Tissue	2	3	4

Cressey: 2006

Cold Therapy

The use of cold therapy is thought to,

· Constrict blood vessels and flush waste products, like lactic acid, out of the affected tissues

· Decrease metabolic activity and slow down physiological processes

· Reduce swelling and tissue breakdown

Then, with rewarming, the increased blood flow speeds up circulation, and in turn, improves the healing process. Although there is no current protocol regarding the ideal time and temperature for cold immersion routines, most athletes or trainers who use them recommend a water temperature between 12 to 15 degrees Celsius and immersion times of 5 to 10 minutes and sometimes up to 20 minutes.

A table below gives a guideline on the relevant temperature and how much time you need to spend immersed at a relevant temperature. NOTE if you work in Fahrenheit as a quick guide double the number and add thirty.

Degrees (Celsius)	Treatment Time
>18	Up to 30 minutes
15-18	20-25 minutes
12-15	15-20 minutes
10-12	12-15 minutes
7-10	8-10 minutes
<7	Avoid
Source: The Athlete’s Guide to Recovery

Cold Treatment is best done after intense training/competition, as part of the immediate post training/competition plan. It is generally thought that this type of treatment should be done within an hour of the intense session.

Sporting groups use the water at the beach as a cold treatment for recovery. In Tasmania, which is the southernmost state of Australia, the average temperature of the water in winter is around 12 degrees and in summer, it is 18 degrees. According to http://www.surf-forecast.com/breaks/Clifton-Beach/seatemp, the average monthly temperature at Clifton beach is as follows.

Month	Temp (⁰C)
Jan	15
Feb	16
Mar	15
Apr	14
May	14
Jun	13
Jul	12
Aug	12
Sep	12
Oct	12
Nov	13
Dec	14

The maximum temperature was recorded in March of 18 degrees, and the lowest temperature was recorded in August of 11 degrees.

It would be impossible to do cold therapy in the ocean in the northern climes of Australia.

Types of Cold Therapy

The most common are

· Ice Massage

· Cold Water Immersion

· Cold Showers

Ice Massage

Ice massage is as the name implies. Ice massage is as simple as massaging the affected area with ice for 5 to 10 minutes. There are special devices that make the use of this method easy, the simplest method is with Styrofoam Cups filled with water and frozen. When you need more ice, you simply peel a little of the top of the cup as needed.

Cold Water Immersion

This can be a plunge pool or ice bath for example.

Ideally used following a heavy weights session, between training sessions or during the acute phases of muscle injury, soreness or bruising. Try to build up a total of 5 minutes in the plunge pool.

A sample session for a beginner may look like this,

Shower before use

1 minute plunge- (try to relax as much a possible!)

2 minutes out of water (air temperature)

Repeat 4-5 times

Someone with experience may do the following

· Shower before use

· Immerse for allotted time

Cold Showers

Is not something I recommend, if you have other options, but showers have a good place for contrast therapy that are discussed later in the article.

As general rule with a cold shower, go as cold as you can tolerate. Initially that will not be that much but over time, you may find that the water out of the shower is not cold enough.

General precautions

Do not use the spa/plunge facilities if you have any of the following:

A history of heart disease

A cold or virus

An open wound

Bruising

Diarrhoea

Recent injury

Strictly speaking straight treatments should be restricted to easy days of training or on off days, and avoid them after an intense training session unless part of a contrast therapy after this session.

Heat Treatment

The use of heat treatment can

Reduce pain

Reduce stiffness

Decrease muscle spasm

Increase blood flow to the area which promotes healing

Heat treatment can generally be broken up into two,

1. Dry

2. Wet

Most common type of treatments are

· Dry

o Heat Bags (includes wheat bags, and other such devices)

· Wet

o Sauna

o Hot Shower

o Hot Plunges

Heat Bags

A heat bag is a good source of providing heat treatment, one that requires only some form of heating such as a wheat bag, gel pack or hot water bottle.

It is easy to use and requires not special facilities.

Heat bags are good to use at night, prior to sleeping.

Sauna

Spending time in a sauna can be beneficial although it is probably best to limit it to a maximum of 20 minutes. It is also wise to use a cold towel around the neck and heat to limit heading of the brain.

Saunas can be used in two ways.

1. Heat therapy

2. Part of contrast therapy

If used as heat therapy, do so on easy days of training or off days

Hot plunges

Plunges can be used at the end of a day or on a rest day as a relaxation technique. Do not use if you have damaged muscles, a recent injury or bruising.

Shower before use

Do not use spa for extended periods of time (no greater than 10-15 minutes)

Always re-hydrate while using the spa

Stretching and jet massage can be utilised in the spa environment

Hot plunges can be used in the same way as a sauna.

General Precautions

The following are contraindications (times when heat treatment is not suitable) which apply to heat therapy:

Sensory changes (cannot feel if it is too hot)

Heat injury

Hyper or hypo-sensitive to heat

Circulatory problems

During the acute phase of injury

Infections

Malignant tumours

Most of these are due to the massive increase in blood flow to the area. With conditions such as infection or malignant tumours, heat would increase the risk of spreading the infected or cancerous cells in the much increased blood flow.

Contrast (Hot and Cold) Treatment

This is a combination of both heat and cold in treatment

It is typical that you start with hot and finish with cold. If you live in cold climate, in Australia certain parts may classify as cold in winter (such as a Canberra winter), you can finish on hot.

To use a hot and cold treatment you require a device(s) that provide hot and cold. These are some options that most people have available freely or for minimal cost

1. Adjustable Shower

2. Shower and Bath

3. Spa/Sauna and Cold Shower

With number, two and three the first equipment provides the heat.

A sample session could be as follows.

Shower before use

Contrast Session

2 minutes hot

1 minute plunge (Try to relax as much as possible!)

Repeat 4-5 times

Always finish on cold (plunge)

Re-hydrate before, during and after session

Contrast therapy is ideally used at the end of a training day- do not use if you have damaged muscles, a very recent injury or bruising.

Table 1: Training and Competition Fatigue

Type of Fatigue	Main Causes for Fatigue	Expression of this Fatigue	Recovery Strategies
Metabolic Fatigue (energy stores)	· Training lasting one hour or more, or · From several (even shorter) sessions a day, & · It can be cumulative when training or performing over a number of days	· Athlete fatigues sooner than is normal for that athlete · Athlete struggles to complete a session or event	· Rehydrate & refuel before, during & after training · Use contrast temperature showers or pool or spa and cold plunge, or active recovery activities · Meal within 1-2 hours of training & monitor hydration
Neurological Fatigue (nervous system) Peripheral Nervous System Fatigue (muscles)	· After short high intensity sessions, e.g. weights, plyometrics, complex skill execution, etc. · After long but low intensity sessions especially involving repetitive movements, e.g. steady state swimming, running, cycling, paddling, rowing, etc.	· Reduced localized force production e.g. slow feet. reduced acceleration, poor technique, etc.	· Rehydrate & refuel (including small amounts of protein as well as carbohydrates) before, during & after training · Within 5 – 15 minutes after training use a spa or shower with jets focused on the large & fatigued muscles · After training or later in the day – massage large muscle groups using jostling / light shaking technique
Neurological Fatigue (nervous system) Central Nervous System Fatigue (brain)	· Low blood pressure levels · High pressured training session – especially involving rapid decision making & reactions · Poor motivation e.g. monotony of training, emotional factors, injury etc.	· Lack of drive · Lack of motivation	· Steady & regular intake of carbohydrates during training & after training to maintain normal blood glucose levels · After training – unwind, listen to music, visualization · Sauna – contrast hot and cold · Rest
Psychological Fatigue (emotional, social, cultural)	· Lack of team or squad cohesion, personality conflicts etc. · Competition pressures, event venue, residential conditions, parents, coach, media, etc. · Other lifestyle stresses o home, school exams, personal relationships	· Athlete loses self confidence or self esteem · Poor interaction & deteriorating communication with other athletes & staff · athlete’s body language, increased signs of anxiety, negative attitudes, etc. · Quality of sleep is poor	· Focus on process rather than outcome performance measures · Debrief by identifying 1-3 things that worked well and 1-3 that need more work · Take mind off training with escapist or funny movie, TV, book, or socialize with family & friends · 10-15 minutes before bed switch off from the day by using relaxation techniques
Environmental & Travel Fatigue	· Disruption of normal routines, especially biological clock · Disruption to sleep, waking and meal times · Sedentary & limited body positions on long journeys, i.e. 30 minutes or more · Adapting to different climates and time zones	· Athlete takes longer to warm-up, are slower to start · Unforced errors in the first 15 minutes are well above normal · Athletes fatigue sooner than normal	· Preparation planning will minimise fatigue · Stay hydrated and refuelled · Stay cool in the heat - use a pool, shade, iced towels, etc. · Keep moving as much as possible on long journeys · Minimise visual fatigue by wearing sunglasses outside & limiting time on computers & play stations

Source: https://www.swimming.ca/docs/LTAD/Recovery%20and%20Regeneration%20Sept.%2012.pdf

Sources

Vaile, J.; Halson, S.; Gill, N.; Dawson, B., Effect of Hydrotherapy on Recovery from Fatigue. Int'l J. Sports Medicine, July 2008.

Kylie Louise Sellwood, et al. Ice-water immersion and delayed-onset muscle soreness: a randomized controlled trial Br. J. Sports Med., Jun 2007.

Vaile JM, Gill ND, Blazevich AJ. The effect of contrast water therapy on symptoms of delayed onset muscle soreness. J Strength Cond Res. 2007 Aug;21(3):697-702.

http://www.trainingsmartonline.com/images/Free_Triathlon_Articles/Triathlon_Training_Recovery.pdf (7 July 2012)

https://www.swimming.ca/docs/LTAD/Recovery%20and%20Regeneration%20Sept.%2012.pdf (7 July 2012)

http://www.ausport.gov.au/ais/sssm/fatigue_and_recovery/faqs (7 July 2012)

http://www.chiefscientist.gov.au/2010/07/sport-and-science-winning-athletes-gold/ (7 July 2012)

http://sportstrainingblog.com/sport-general/recovery-training-competition (7 July 2012)

http://www.brendanchaplin.co.uk/wp-content/uploads/2011/03/Athlete-Recovery-Guide.pdf (7 July 2012)

http://www.t-nation.com/free_online_article/sports_body_training_performance/what_i_learned_in_2009 (7 July 2012)

http://www.ericcressey.com/tag/workout-routine (7 July 2012)

http://www.surf-forecast.com/breaks/Clifton-Beach/seatemp (7 July 2012)

http://evidencebasedfitness.blogspot.com.au/2008/02/rest-vs-active-recovery.html (7 July 2012)

http://www.bodyrecomposition.com/training/active-versus-passive-recovery.html (7 July 2012)

http://www.bodyrecomposition.com/training/the-importance-of-rest.html (7 July 2012)