by Dallas Hartwig, PT, MS
As a physical therapist and strength and conditioning coach, I’ve spent a good portion of my professional career talking to people about recovery, either in the clinic following an injury or in the gym following a high-intensity workout. Since I believe that brief, high-intensity exercise is the most productive in terms of maximizing fitness and minimizing risk of overuse injury and excessive oxidative stress on the body, I prescribe exercise programs that look a lot like CrossFit, with a heavy emphasis on strength movements and gymnastics.
Unfortunately, there’s a lot of information out there about how to exercise, but far less information about the application of proper rest and recovery techniques. I see more sub-acute and chronic injuries resulting from inadequate recovery from exercise (especially with high-intensity programs), than resulting from an acute or traumatic incident. The primary fault lies with inadequate or improper recovery from exercise, not the type or intensity of exercise. (To put it another way, it’s not that you’re hurting yourself doing pull-ups – more often than not, it’s because you’re not properly recovering from those pull-ups.)
I believe that a high intensity exercise program is both effective and sustainable life-long, when combined with good nutrition and recovery practices. So I find myself educating my PT patients about nutrition, sleep, active recovery techniques, and stress management practices as often as I do about the physiology of connective tissue healing, lumbar stabilization, or biomechanics. It was this experience that, in part, led Melissa and me to develop a comprehensive and integrative practice (Whole9) to help our clients continue to aggressively chase health and performance without being hindered by nagging pain and injuries.
At some point in our lives, we’re likely to find ourselves over-trained, under-recovered, under-fed, under-slept, over-caffeinated, and (eventually) actually injured. Ideally, the early stages are the time to pay attention to what your body is trying to tell you, and take immediate action to ensure those nagging aches and pains don’t become a seriously limiting chronic injury. So here are the Whole9′s recommendations for what to do when you’re All Banged Up.
1. Take extra rest days. I’m not talking about swapping your rest day from Wednesday to Tuesday – I’m telling you to skip a bunch of workouts. I’m a proponent of taking an entire week off once or twice a year from hard training – and can think of no better time to do so than when you’re banged up. And once you go back to intense training, you also need to give that injured body part another week or three of rest. Yes, really – rest it longer than you think you should. Trust me, you’d rather take three weeks off from all pulling exercises than be plagued with chronic injuries (and sucky performance) for the next six months. Finally, don’t even think about doing two workouts a day or a long met-con to “make up for” your extra rest days. The whole point is extra rest.
2. Get felt up (or feel yourself up). Seek out a good massage therapist. Cyclic compression of muscles after intense exercise reduce swelling and muscle damage. Massage can improve muscle function, resulting in less swelling and fewer signs of inflammation after exercise. Too busy to book an hour long massage? If you’re beat up, no you’re not… skip today’s workout and hit the massage table. Too broke to see your massage therapist every week? Luckily, there are cheaper and still-effective alternatives. Spend enough intimate time with your foam roller to make your significant other jealous. Buy a Stick and use it. Work with a tennis ball or lacrosse ball for some self-myofascial release.
3. Keep moving. Low intensity exercise can protect and enhance the immune system, even when you’re banged up or sick. It also helps with injury prevention and recovery. Moving your body increases blood flow and the number of cells that eat up “debris” in the injury. It also increases oxygen levels to speed up healing, and increases circulation to remove the debris out of injured areas. Finally, exercise prevents stiffness and decreases the formation of scar adhesions. Stay active with movements different from those you normally perform during workouts, but remember to keep things light and easy. Think dynamic warm-up drills, kripalu yoga, an easy swim or a brisk walk. And people… stretch.
4. Use thermal modalities (heat and ice) appropriately. If you have an acute injury (less than 5 days old), ice is your best friend. I prefer crushed ice (in a plastic bag inside a pillowcase) instead of those commercial gel packs – they warm up too fast. Apply the ice to the injured area for 20-30 minutes, at least 3 times daily. Or you could apply ice directly to the injured area with ice massage (as pictured above) for 8-10 minutes. Most importantly, don’t put heat on an acute injury. The inflammatory process is biochemical, and heat literally speeds up that process. Heat vasodilates and promotes the accumulation of interstitial fluid (edema), and the last thing you want with a fresh injury is to add to the swelling. If you really love your Tiger Balm or Icy Hot, that’s okay – but these products have no real thermal effect. (You might get the sensation, but it doesn’t actually heat or cool your tissue.)
Chronic injuries (anything that persists for longer than 2-3 weeks) respond best to heat, which improves blood flow to the healing tissue. So once you’re into the 5-plus day range, you can use contrasting hot and cold, alternating every 2-5 minutes for a total of 20-30 minutes, especially post-workout.
5. Remove inflammatory dietary factors. This should be a no-brainer around here. If you’ve been slipping back into old (poor) eating habits, now’s the time to clean up that mess. Get rid of grains, legumes, and dairy altogether. Need I even mention cutting out booze? And though it’s controversial, I’d also recommend eating less saturated animal fat (especially egg yolks and fat from feedlot-raised, grain-fed animals) as it can increase pro-inflammatory compounds in your body.
6. Boost your vegetable intake. Alkaline foods, especially richly coloured vegetables, help to offset the negative effects of acidic metabolic waste. Vitamin C and polyphenols, like those in broccoli and dark leafy greens, are essential for the repair of connective tissue and to reduce inflammation. Vitamins E (found in sprouts, avocado and dark, leafy greens) and A (found in green and yellow vegetables) are also important nutrients for connective tissue and cell repair. In summary, eat more veggies, especially green leafies… but not more fruit. (I’m wary of fruit’s impact on insulin levels, which, when elevated, increase inflammatory markers in the body). Go easy on carbohydrate-dense root vegetables for the same reason.
7. Calm down (your inflammation). The ratio of omega fats in your diet help dictate the “inflammation status” of your body. If your diet consists of mostly omega-6 fats, your inflammation response will be unbalanced and damaging to your cells. To that end, per Robb Wolf’s recommendations, bump up your fish oil supplementation to 0.8-1.0 gram of DHA + EPA per 10 pounds of body weight. The additional omega-3 fatty acids can help tip the balance in your body away from an inflammatory state. Also, avoid concentrated sources of omega-6 fatty acids, such as “industrial” vegetable oils like peanut, safflower, soybean, and corn oils. You could also consider a GLA (gamma-lineolic acid) supplement. (GLA, while in the Omega-6 family, is not converted to the pro-inflammatory arachidonic acid (AA), but rather to dihomo-γ-linolenic acid (DGLA). DGLA competes with AA and prevents the negative inflammatory effects that AA would otherwise cause in the body.)
And it may sound weird, but… don’t forget to brush your teeth and, just as importantly, floss daily. Periodontal disease can contribute to systemic inflammation in the body just like grains, legumes and dairy.
8. Get more and better sleep. This article explains how sleep contributes to a whole host of health and fitness factors, including injury prevention and recovery. During this time period, avoid caffeine, which can disrupt the quality of your sleep even if it doesn’t actually keep you awake.
9. Ditch the Advil. While I don’t purport to be smarter than your doctor, here is one area where I disagree with his recommendation to scarf the Vitamin I (ibuprofen) and other NSAIDs (non-steriodal anti-inflammatories). Sure, NSAIDs suppress the inflammatory process and help with pain control. But research has shown that they actually slow down the overall healing process, and cause the “healed” tissue to be less strong. So allow your body’s healing process run its natural course, and don’t band-aid it with Advil.
Following these tips will help keep you injury-free – and get you out of my PT office that much faster, should you find yourself all banged up. Post questions, leave your feedback or (at least) take the first step and cop to your serious “Vitamin I” habit in comments.