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Targets for Recovery

Physiologic Recovery Targets: The Hidden Network of Factors Killing Performance

In recent times, there have been many terms used to explain the volatile and often unpredictable nature of athletic underperformance.

If only the underlying processes were linear, things might be easier in terms of ensuring sustained progress and consistent performance.

In a sense, unpredictability, manifested as the ever-looming possibility of the underdog to overcome or the lack of guarantees in performance and competitive outcome, actually contribute to the addictive nature (perhaps even "dopamine rush") of sport for participants and spectators.

In an attempt to control uncertainty, lofty theories such as Dynamical Systems and Chaos Theories have been considered and perhaps go some way to giving a model to determine the likelihood of positive outcomes in team and individual sports (Lambert, 2005) but by far the most consistently utilized and favored tool used to limit uncertainty and drive probability of favorable outcomes in athletic performance is simply good old preparation. And this article is intended to cover just that - a simple outline of what we can do to help the athletes prepare for competition.

Four years ago, as I listened to Michael Gervais outline some of his thoughts on athletic preparation at a conference in New York, what really stuck with me was this idea that an athlete "choking" was simply an inability to access their skill set at a critical moment.

The context of his presentation was based on the cognitive contribution to performance. This began the process of my exploring the concept of building cognitive resilience as a component in athletic training.

Fergus Connolly referred to building cognitive resilience in the context of "precovery" (not sure if he actually coined the phrase). Precovery, however, should occur in multiple dimensions.

Brandon Marcello recommends that recovery strategies commence one month prior to competition. In stating this he was primarily referring to nutritional support but it would seem reasonable that cognitive resilience strategies might require a comparable time frame. It would also seem reasonable that common physical activities such as the FIFA 11+ or the implementation of Nordics into weekly practice routinely might serve the same purpose in the physical dimension. Precovery efforts might also be directed at mitigating an experience that spans each of these dimensions: fatigue.

Given that the body is self healing and self regulating, instead of considering a continual push towards homeostasis, we need to more accurately think of the body as consistently in a state of flux. The term homeodynamics is a far more appropriate term for the ongoing regulatory changes occurring across all systems of the body. This considers our physiologic buffers to withstand stress without disorganization and dysfunction of the body's systems and in other words, makes us more resilient. In figure 1, taken from Halson (2014), we can split these factors into six distinct domains.

Mismanagement of fatigue, can lead us down the path of functional overreaching, non-functional overreaching and ultimately overtraining. We therefore might categorize four main systems that can both separately and collectively affect the athlete's ability to perform a given task to their optimum level; cognitive, central, metabolic and peripheral.

This becomes important as the type of fatigue manifesting will require a distinct strategy and targeting for recovery. As the physiologic systems in the body are fluid, as must be the work of the performance team in caring for the athlete, ideally done in a coherent and integrated way (for more information on how this sort of structure might work, we can see Dijkstra et al., 2014, an open access paper on the theory of a fluid structure in a sports organization).

What factors then can affect athletic performance?

Figure 1. Chart showing factors that can influence athletic performance (adapted from Halson 2014)

1. Training/Competition

The load, or the act of performing work in preparation for carrying out an event, needs to be prescribed and controlled to gain the optimal outcomes with minimal negative effects. We need to factor in external and internal components of load. Or as a practitioner, at least understand different training effects and the acute and chronic consequences of training and competition strain placed on the athlete. There is some evidence that different tissue types also respond differently to varying workloads.

High acute match workload and high previous season workload were risk factors for tendon injuries, but high medium term (indicating 3-month workload) was protective suggesting that tendons need constant conditioning to maintain integrity. For bone stress injuries, high medium term workload and low career workload were risk factors, suggesting that bone resilience is developed over a career in a gradual manner. For joint injuries, high previous season and career workload were risk factors, this suggests that we do need to consider strategies to preserve our joints as much as possible as they do not have the regeneration potential of other structures, albeit these results were from studies on cricket fast bowlers, nonetheless, this type of thought process is important in individualizing our therapeutic approach (Orchard et al., 2015).

2. Lifestyle

This is the "rest of the day". Education and guidance are the most effective tools we have here to positively influence the athlete. An active interest in the athlete's holistic wellbeing, as well as trust and authenticity can lead to a deeper understanding of how the athlete's home life may be impacting either positively or negatively on their performance. Nothing grows well in a toxic environment. For example, it has been shown that during exam time, student athletes are more prone to injury. This should be buffered by altering other modifiable components such as training volume at this time.

For example, sleep loss or deprivation can have major effects on performance, motivation, perception of effort and cognition in addition to countless other biological functions. Monitoring and behavior modification can be helpful in this area. The most popular option is actigraphy or a simple sleep diary which can help in determining if there are underlying fundamental problems with sleep such as apnea or major disturbances, or if a sleep hygiene program should be considered.

3. Health

Under extreme stress, the athlete's immunological system can be compromised. In addition, there are many reciprocal pathways between immune function, inflammation and fatigue. Incidence of upper respiratory tract infection in athletes is notably higher during competition time for numerous reasons, and probiotic prescription has been shown to mitigate some of this risk.

In particular, we must be proactive about checking vital signs, fluctuations in HRV may gave insight into the athlete's health status.

4. Environment

Simple factors such as the temperature of a bed room can have significant impact on quality of sleep. Derek Hansen recently also suggested the evaluation of air quality using a spec sensor. Toxicity from mold or pollution can have both acute and chronic effects and best to be avoided where possible. In addition, in the absence of time to acclimatize, we need to also remain vigilant to the possible negative effects of temperature, humidity and altitude on athletic performance and wellbeing.

5. Psychological Stress

Although there are questionnaires and assessments specifically designed for this, an awareness and understanding of the athlete's profile and psychological state will give as much, or more insight into their emotional state. Rhythms and structure around training and competition do much to provide support the athlete in this regard. However, access to sport psychologists and taking care of some of the very basic tenants of health maintenance are effective and meaningful. Sport is cognitively demanding, requiring sustained attention, decision making and constantly fighting the "urge to quit". In the same way that muscle depletes of it's energy stores in response to fatiguing exercises, the central nervous system does likewise, with increasing volumes of byproducts of neural activity present after increased cognitive load.

6. Nutrition

The sports nutrition needs of the athlete can be divided into three categories: metabolic supply, hydration status and functional or structural repair. As a priori, we also must keep in mind that results gleaned from studies typically report and average requirement, so individualizing across the board is most appropriate, especially since requirements do show significant inter-athlete variation. That being said, most recent guidelines suggest that for carbohydrate ingestion more complex carbohydrates should be consumed around 3-4 hours before practice or competition. This can be supplemented during the one hour prior to competition with a small amount of easily digested carbohydrate to help meet needs during the event, if desirable and tolerated by the athlete. Equally, caffeine or carbohydrate mouthwash could be considered (remember the effect that caffeine has on the adenosine receptors) as an adjunct. If an event is to continue beyond 60 minutes, some additional fueling should be considered during participation, however it should be something which is easily digestible.

In the post practice/competition period, glycogen stores need to be replenished, although it can take up to 2 days to fully replace spent glycogen (Thomas, Erdman and Burke, 2016).

Fluid loss occurring during exercise varies on an individual basis, on average being one litre per hour, however two times this amount is possible, and in work with our football players in the Caribbean, it was commonplace to see even more than.

This was often compounded by the athletes being dehydrated even prior to training or matches. This meant that careful attention needed to be paid to hydration continuously, we can not assume that players are always going to present in an optimal state to perform.

Generally, replacing 16oz per pound of weight loss is sufficient, however, for recovery, an athlete should drink around 20-24 oz/lb lost to account for continued ongoing fluid loss through sweating and urination.

For those not already doing so, the simplest method is taking a pre/post weigh in session. This of course does not help the athlete who is already dehydrated prior to practice.

Protein replacement in some ways remains contentious but, athletes should try to consume a bolus shortly following training or competition. Bear in mind that it is likely that the muscle is responsive to protein for up to 24 hours following exertion and therefore there is no rush to consume the protein (albeit in shake or other form) in the 60 minutes after finishing. Therefore, athletes can consume around 20 g about every 3 h throughout the day to make sure that their protein needs are being met.

Regarding protein quality, we all know that supplements must be carefully selected, in addition, we do want to encourage casein rich supplementation prior to sleep as this seems to have an enhancing effect of muscle protein synthesis during sleep (Daytime pattern of post-exercise protein intake affects whole-body protein turnover in resistance-trained males, 2012).

Some of the most effective strategies for addressing this is through direct engagement with the athletes. One of my performance nutrition colleagues locally has introduced cooking classes into the club she works at, to teach the players about food preparation and the value of fueling to perform.

Taking these six factors into account, the thoughtful practitioner will appreciate that maintaining performance (note I did not say wellbeing) is a constant dance between depletion and restoration. By taking a holistic approach we can identify where we can add most value and influence to principally protect the athlete's health but also support their performance. We can provide an ongoing positive input to help guide the athlete, in response to our monitoring and feedback, to mitigate the omnipresent chaos and distractions that compete with and shape the elite athlete's environment at the highest levels.


Dijkstra H, Pollock N, Chakraverty R, Alonso J M. Managing the health of the elite athlete: a new integrated performance health management and coaching model. Br J Sports Med. 2014 Apr; 48(7): 523-531.

Halson SL. Monitoring training load to understand fatigue in athletes. Sports Med. 2014; 44(Suppl2): 139-147.

Kellmann M, Bertollo M, Bosquet L, Brink M, Coutts AJ, Duffield R, Erlacher D, Halson SL, Hecksteden A, Heidari J, Kallus KW, Meeusen R, Mujika I, Robazza C, Skorski S, Venter R, Beckmann J. Recovery and performance in sport: consensus statement. Int J Sports Physiol Perform. 2018 Feb 1;13(2):240-245.

Lambert E, St C, Noakes T. Complex systems model of fatigue: integrative homeostatic control of peripheral physiological systems during exercise in humans. Br J Sports Med. 2005 Jan; 39(1): 52-62.

Moore DR, Areta J, Coffey VG, Stellingwerff T, Phillips SM, Burke LM, Cléroux M, Godin JP, Hawley JA. Daytime pattern of post-exercise protein intake affects whole-body protein turnover in resistance-trained males. Nutr Metab (Lond). 2012 Oct 16;9(1):91.

Orchard JW, Blanch P, Paoloni J, Kountouris A, Sims K, Orchard JJ, Brukner P. Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. Br J Sports Med. 2015 Aug;49(16):1064-8.

Thomas DT, Erdman KA, Burke LM. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: nutrition and athletic performance. J Acad Nutr Diet. 2016 Mar;116(3):501-528.

Nicky began his career as a chiropractor with a background in physiological sciences. Since graduation he has held and developed numerous posts privately and within organisations. His career highlights include teaching for the GSSI in the Caribbean and around Latin America, holding the position of head of performance for a professional soccer team as well as establishing a private practice in Puerto Rico.

Since leaving Puerto Rico in the aftermath of the devasting hurricanes in 2017, Nicky has been focused on the development of his new project, "The Recovery Doctor", as well as collaborating with other like minded groups and professionals in the world of professional sports.


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