Monday, March 12, 2018

Innovations in Sports Science - Recovery

For an athlete, recovery is just as important as the exercise portion of our intervention.  Just as there has been advances in exercise, there has also been advances in recovery tools & equipment.  The recovery tools that we will discuss today fall into three categories, mobility tools, soft tissue/myofascial release and pneumatic compression.  The specific tools we discuss are ones that we have been exposed to and use.  But this should not be considered an endorsement of these products.  If you are interested in these tools, you should investigate them independent of this discussion.  We should all understand there are a lot of other tools out there and these are simply the ones we have the most experience with.

Mobility Tools:  Foam rollers have long been a part of our tool kit when dealing with athletes.  Everyone has their own little spin on mobility exercises with them and advancements in this area often include varying degrees of stiffness, varying contours of the roller and varying surfaces (smooth, ridges, pressure balls).  However, one company has taken the foam roller to a whole new level.  Hyperice started in 2010 and primarily in the area of some new ice compression devices.  Although these are great and something we use, this is not the focus of our discussion.  In 2012, hyperice launched a product called the Vyper.  

The Vyper is a foam roll that incorporates high intensity vibration.  Some suggest that including vibration during a stretch results in tonic vibration reflex but studies are not clear on this (Cakar et al. J Phy Ther Sci 2015).  As  with any innovation, it may take a while for the science to catch up and explain why it works.  End of the day, athletes love it and from an N of 1 (trying it on myself), it does aid in my recovery.  For myself as well as the athletes that I work with (which are mostly lower extremity), they get a lot of benefit of use post exercise.  Typically, we will apply this, followed by soft tissue work then closing out with the pneumatic compression.    

For our athletes, we use this to facilitate stretches and provide some myofascial release.  Typical protocol includes performing at the end of the exercise session.  Everyone has their own philosophy on doing before or after, for me, I find the best therapeutic effect doing at the conclusion of exercise.  Typically I have the athlete roll their  IT band, hip flexors, Quads, Hamstrings and calves with the Vyper.  Each of these are done while the athlete simultaneously does a gentle stretch to the area.

Soft Tissue/Myofascial Release:  This is a big and growing area.  Some of the biggest innovations in this area in the last 5 years is IASTM (instrument assisted soft tissue mobilization).  There are a lot of different products out there and as a clinician with over 20 years of experience, I can say personally, the advent of these devices has saved my career and my hands.  Personally I think one of the most valuable tools we provide our patients is our hands and ability to use them in a therapeutic fashion.  The tools that I use the most are Hawk Grips.

There are a lot of great tools out there and a lot of great certifications, this one just happens to be my preference.  Working through an athlete's myofascial restrictions can sometimes take a lot of pressure through the clinicians hands and joints.  I would consider myself a fairly strong guy but many times what I was able to do for an athlete was more limited by my joint pain than the athlete.  With IASTM tools, this has greatly enhanced the therapeutic effect that I can provide.  Typical protocol is using the IASTM tools while providing the area with a stretch.  IT band is a perfect example where I will place them in a lengthened position and perform my IASTM.  I may even include some gentle contract relax with this.

Pneumatic Compression:  There are a lot of folks out there that have not experienced this yet. Some may know Game Ready which is a device that provides pneumatic compression along with ice.  We use these devices a lot in sports medicine and especially with our athlete that are recovering from an injury.  For the athlete who is experiencing swelling or is post op, this is the kind of device I will default to.

However, for athletes who are in the later phases of rehab or who are in the performance phases, recovery is still vital but they may not need the cryotherapy aspects of the Game Ready and may benefit from more full limb pneumatic compression.  That is where the Normatec comes into play.  The Normatec is usually placed on both limbs at the same time and for 15 to 30 minute period of time.  During this time, the athlete is usually placed in a recliner and in a relaxed position.   The Normatec goes through phases of compression starting at the foot and works its way up the extremity toward the core.  Athletes often report this as a relaxing massage type feeling.  The evidence supporting the use of this in recovery for the non-injured athlete is very compelling and growing each year.  Typically, this is how we will wrap up a session with the athlete.  So they have performed their exercise routine, done the Vyper, had some IASTM and the finish off with a round of Normatec and come cold water.

Hopefully you found this discussion useful.  If you enjoy our blog, please share with others.  We do this out of passion for what we all do and the more we can touch and influence, the more impact we can have on our respective professions.

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu. 


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