Abaïdia A-E1, Dupont G2
1 University of Lille, Unité de Recherche Pluridisciplinaires Sport Santé Société, France et Institut Supérieur du Sport et de l’Education Physique de Sfax, Université de Sfax, Tunisie
2 The Football Exchange, Research Institute for Sport and Exercise Sciences , Liverpool John Moores University, Liverpool, UK. + FFF, performance lab, CNF, Domaine de Montjoye, Clairefontaine-en-Yvelines, France
Introduction by the editor Boris Gojanovic
Recovery from intense efforts and matches demands special consideration, and recent years have seen the development of multiple new modalities which promise faster and better recovery. The world of professional football has taken notice, especially due to the repetition of matches and reduction of number of days in between for the best teams playing in the Champions League. Abd-Elbasset Abaïdia presented at the #SportSuisse2018 conference for Grégory Dupont, who was on duty with the World Cup winner French National team.
With all the science, hype and innovation around recovery, you may be surprised to read about the effectiveness and the recommendations for each possible modality discussed in this paper. Everything that glitters is not gold, and the usual wise advice from your grandmother might have been true all along: eat, sleep, drink water. She might have been wrong on the “keep warm” advice, as cold exposure might have advantages.
La récupération des efforts intenses et des matchs est un sujet qui s’est passablement développé ces dernières années, avec moult promesses de solutions innovantes qui permettent de récupérer mieux et plus vite. Le monde du football professionnel n’y est pas indifférent, notamment en raison de la répétition des matchs rapprochés, comme c’est le cas pour les équipes jouant la Champions League. Abd-Elbasset Abaïdia a présenté l’état des connaissances et des pratiques actuelles à la conférence #SportSuisse2018, en remplacement de Grégory Dupont, lequel était en déplacement avec les Bleus.
Avec toute la science, la technologie et l’innovation autour de la récupération, vous serez peut-être surpris de lire les recommandations pour chacune des modalités discutées dans cet article. Tout ce qui brille n’est pas de l’or, et les bons vieux conseils sages de grand-maman n’étaient peut-être pas si faux: manger, dormir, boire. Par contre, elle se trompait peut-être par rapport au froid, dont les avantages semblent intéressants.
In elite football, the number of matches per season is very high with up to 60-80 matches for some players. In these conditions, the number of weeks with two matches per week is greater than the number of weeks with one match per week. A single match leads to an acute fatigue, characterised by a decline in maximal muscle strength (Magalhães et al., 2010), which requires several days to fully recover. When the schedule is congested (i.e. two matches per week over several weeks), the repetition of matches can lead to a chronic fatigue among the players who play regularly, as the recovery time between two successive matches may be too short. The Federation Internationale de Football Association recommends at least 2 days between two matches, but this is not a rule, it is solely a recommendation. Anecdotal interviews revealed a feeling of exhaustion from the players with the repetitions of the matches. However, these subjective statements may not have a sufficient evidence base. In this instance, a recovery period from 48h to 96h between two matches is associated with and increased injury risk suggesting insufficient time to fully recover. This aspect will be addressed in the first part of the article. One of the questions that can arise is how much time does a professional player need to fully recover? This aspect will be addressed in the second part of the article. The third part will deal with the actions performing during a match that may lead to fatigue and the potential mechanisms involved. In line with the three first part, the effects of recovery strategies will be addressed in a fourth part before finishing with the practical applications.
Effects of a congested schedule on physical performance and injury rate
During a match, players perform some actions inducing muscle damage: sprints, jumps, changes of direction, shoots, tackles. Performing muscle damaging actions leads to a decrease of neuromuscular function immediately after exercise and sometimes for several days. During a match, fatigue occurs temporarily after short- term intense periods in both halves; towards the end of the match and after the match. Many non-contact injuries occur during the latter stages of each half (Hawkins RD et al., 2001; Ekstrand et al., 2011), suggesting that fatigue can be a risk factor of injury. However, fatigue can also come from the repetition of the matches. During periods where the schedule is particularly congested (i.e. two matches per week over several weeks), the recovery time between two successive matches can be between 2 and 4 days, which may be insufficient to restore normal homeostasis. As a result, players may experience acute and chronic fatigue potentially leading to underperformance and/or injury. Dupont et al. (2010) showed that injury incidence in professional football players playing the UEFA Champions League, is 6.2 times higher when two matches per week were played (25.6 injuries per 1000 hours of exposure) in comparison with one match in a week (4.1 injuries per 1000 hours of exposure). The authors studied match-related physical performance and injury rate playing either one or two matches per week during two seasons. These results were supported by an absence of significant difference between 1 versus 2 matches per week in physical performance during official matches, characterised by total distance covered, high-intensity distance, sprint distance and number of sprints. Bengtsson et al. (2013) reported also, in a UEFA study, that muscle injury rates were increased in matches with a recovery period of 4 days or less in comparison with a recovery of 6 or more days. This study involved 27 professional teams over 11 seasons. Taken together, these results show that a recovery period from 48h to 96h between two matches is associated with and increased injury risk suggesting insufficient time to fully recover. The present data highlight the need for improved recovery strategies to maintain a low injury rate during periods with congested match fixtures. However, before focusing on recovery strategies, it is necessary to identify the time course of recovery, to determine the fatigue mechanisms as well as the actions in a match that may lead to fatigue. The knowledge of these mechanisms should allow the application of appropriate and rationalized recovery strategies.
Time course of recovery
Several research teams have studied recovery kinetics of muscle damage markers after a football match. Sprint performance impairment ranges from –3% to –9% post-match, and the delay to fully recover varies between 24h and more than 72h (Andersson et al., 2008; Ispirlidis et al., 2008; Magalhães et al., 2010). When tested immediately after a match, jump performance decrements range from no decrement (Krustrup et al., 2010) to –12% (Magalhães et al., 2010). The time for jump performance to completely recover is between 48 hours (Ispirlidis et al., 2008) to more than 72 hours after the match (Andersson et al., 2008; Magalhães et al., 2010). Immediately post-match, neuromuscular function is impaired with a decrease of muscle strength ranging between –4% and –36% for knee flexors and –6.5% and –14% for knee extensors. The recovery response is highly variable, as in some cases players have recovered 48h after the match (Andersson et al. 2008; Thorlund et al., 2009; Rampinini et al. 2011), while others still did not have recover 72h post-match (Ascensão et al. 2008; Magalhães et al. 2010). Although the validity of biochemical markers for muscle damage is questionable (Warren et al., 1999), creatine kinase concentrations are frequently used to investigate the underlying physiology of the recovery process. Immediately after a match, rises in creatine kinase concentration range from +75% (Ascensão et al., 2008) to +250% (Magalhães et al., 2010). Creatine kinase concentrations peak at 24–48 hours after the match and return to baseline between 69 (Andersson et al., 2008) and 120 hours (Ispirlidis et al., 2008) following the match.
The differences between studies regarding the magnitude of performance decline and the subsequent time course of recovery could be explained by the fact that the recovery process was tracked following football match (Ispirlidis et al., 2008; Andersson et al., 2008; Magalhães et al., 2010; Ascensão et al., 2008). Several studies (Di Salvo et al., 2009; Dupont et al., 2010) have pointed out the high variability and poor reliability of physical performance such as high-intensity running distance during football matches, which depends not only on the fitness level but also on the match status (i.e., whether the team is winning, losing or drawing), quality of the opponent (strong or weak), and the match location (i.e., playing at home or away). Secondly, some extrinsic factors may also influence players’ work rate such as the climatic conditions and type of pitch (e.g. grassy, muddy, artificial). As a consequence, the amount of fatigue induced by the different football matches may vary greatly and affect the time course of recovery. This variability inherent to a football match makes it difficult to translate findings from one study to another.
To conclude for this part, scientific evidence indicates that a recovery period between 48h and 72h is insufficient to fully recover after a football match. Studies have not shown a normalisation of physical performance within the 3 days consecutive to a football match (Andersson et al., 2008; Ascensão et al., 2008; Fatouros et al., 2009; Magalhães et al., 2010). The results suggest that performance can be impaired for 72 hours and more. When playing two matches per week, the 3-day recovery time between two successive matches may consequently be insufficient to fully recover. This long-lasting reduction in physical performance testifies the presence of some fatigue processes that recover slowly after the match.
This part focuses mainly on the mechanisms that contribute to post match fatigue. The decrement in performance characterizes post football match fatigue. Long-lasting fatigue may be caused by both impaired excitation-contraction coupling and structural damage (Allen, 2001). According to Rampinini et al. (2011), fatigue in football is determined by a combination of central and peripheral factors both immediately after the match and within hours of recovery. Central fatigue seems to be the main cause of the decline in maximal voluntary contraction and sprinting ability, whereas peripheral fatigue seems to be more related to increased muscle soreness and therefore may be linked with muscle damage and inflammation
Muscle glycogen is a major substrate for energy production during a football match. Studies have shown a relation between muscle glycogen depletion and the decrement in high-intensity distance frequently observed at the end of a match (Mohr et al., 2003). As muscle glycogen repletion after a high-level football match requires between 2 and 3 days when a specific nutrition plan is provided, this fatigue can also affect the post-match fatigue. Additional factors involved in the fatigue may be observed in the last quarter of the match such as dehydration and thirst. Mohr et al. (2010) reported a net fluid loss of more than 2% of the initial body mass, after a match played in a hot environment (31.2 to 31.6 °C). The net fluid loss during the match and the fatigue index in a post-match sprint test were significantly correlated (r=0.73; p < 0.05). However, the role of dehydration in post football match fatigue is likely limited. When guidelines are respected, the time to rehydrate is estimated to be as long as 6 hours (Shirreffs et al., 1996).
Post football match fatigue may also be explained by match-induced muscle damage. The repetition of changes of direction, accelerations and decelerations throughout a football match may induce muscle damage. The actions performed during a match integrate eccentric contractions triggering a mechanical stress on muscle fibers, during which the muscle is stretched to a deformation of some sarcomeres inside the muscle. Muscle soreness and an increase of some biological markers concentrations, such as creatine kinase, may accompany the decrease of muscle force following participation to a football match (Davies and White 1981).
Additionally, mental fatigue is a factor to consider to explain post football match fatigue. During a match, players have to cope with physical aspects but also with cognitive aspects, meaning taking into account, at the same time, the position and movements of the ball, of the opponent and of the teammates. In this context it can be hypothesized that cognitive function may be altered after a football match. When the competitive fixture list is congested, the time in between matches may be insufficient to recover the initial level of psychological resources, potentially leading to lack of motivation and mental burnout. Multiplication of travels may lead to the disruption of circadian rhythms (jet lag or arrival during the night) and sleep leading to an increase of the level of stress.
In summary, the decline in maximal voluntary contraction and sprinting ability seems to be linked to central fatigue, whereas increase of muscle soreness and therefore seems very likely linked to muscle damage and inflammation, which are peripheral factors. Post football match fatigue may be associated with glycogen depletion, muscle damage and mental fatigue.
According to Bishop (2008), the general consensus is that the translation of sport science research to practice is poor.
In order to reduce the gap between sport science research and practice, a survey on the recovery strategies currently used in professional football teams was performed (Nédélec et al., 2013). The most common recovery strategies used and perceived effective by football clubs include nutrition (97% of respondents), sleep (95%), cold-water immersion and contrast water therapy (78%), active recovery (81%) and compression garments (22%) (Nédélec et al. 2013). However, do these recovery strategies have an evidence base to be able to confidently recommend as part of the recovery strategy to enhance player recovery, especially during match congestion? Following this survey, the level of scientific evidence justifying these recovery strategies was reviewed. For this review, the level of scientific evidence focused on the effects of the recovery strategies on the change in the measured physical performance.
A computerized literature search was performed using PubMed. The following keywords were used in different combinations: “recovery”, “muscle damage”, “football”, “markers”, “strength”, “force”, “blood”, “DOMS”, “nutrition” “proteins”, “carbohydrates”, “sleep”, “cold-water immersion”, “hydrotherapy”, “cryotherapy”, “massage”, “stretching”, “compression garments”, “meditation”, “oxygen therapy”, “occlusion”, “foam roller”, “electrostimulation”, “relaxation”.
Systematic reviews and meta-analysis were included to define the relevance of the strategies used to accelerate recovery kinetics.
The methodological quality of the included reviews was assessed using the Assessing Methodological Quality of Systematic Reviews (AMSTAR) tool (Shea et al., 2007). The quality and the risk of bias were assessed, based on the AMSTAR score: high quality, very low risk of bias (AMSTAR ≥10); high quality, low risk of bias (AMSTAR 8–9); low quality, high risk of bias (AMSTAR 3–7); low quality, very high risk of bias (AMSTAR ≤2) (Table 1).
Then, when a level of scientific evidence was defined, a final graded recommendation was assigned according to the following classification: A–high, B–acceptable, C–weak, D–insufficient evidence to provide a recommendation or sufficient evidence to reject use/ to implement (Table 1).
1. Nutrition and hydration
This goal may be attained by implementing a nutritional strategy after a football match. Such a strategy should include consumption of foods leading to the replenishment of glycogen and water stores and to the optimization of muscle damage repair.
Loss of intracellular volume reduced rates of glycogen and protein synthesis (Shephard and Leatt, 1987). In this context, complete restoration of fluid balance after a match is an important part of the recovery process. After match-induced dehydration (~2% of body mass), full rehydration status will take 6 hours, if a high-sodium (61 mmol.l-1, about 3 times higher than the sodium concentration found in many commercial sports drinks) drink volume greater than 150 to 200% of the sweat loss, is consumed (Shirreffs et al., 1996). The addition of sodium to rehydration beverages (500 to 700 mg/L of water) is recommended as it promotes fluid retention, stimulates the thirst while delaying urine production, and increases glucose absorption in the small intestine (Shireffs and Maughan, 2000). It is recommended to drink a large volume of fluid after the match instead of small quantities gradually. This recommendation is due to the fact that the high rate of post exercise fluid consumption results also in a faster fluid balance restoration compared to a low rate of fluid intake (Kovacs et al., 2002). However, a small volume of fluid should be prescribed after this initial large consumption of fluid. Addition of a small amount of carbohydrate into the water can also be advised as it stimulates fluid absorption in the gut and then improves palatability (Shireffs and Maughan, 2000).
In a survey conducted on a professional team from the Italian Serie A followed during 5 years, 66% of the players declared to be regular drinkers of alcoholic beverages (Volpi and Taioli, 2012). However, alcohol consumption should be avoided after a match as it delays the ability to recover. Firstly, alcohol has diuretic properties, which increases urinary output and consequently the level of dehydration (Shireffs and Maughan, 2000). Secondly, it delays the muscular recovery process. The decline in maximal strength at 36 hours post-exercise was associated to muscle damage and was significantly greater in the alcoholic beverage condition
(1 g.kg-1 bodyweight ethanol as vodka and orange juice) compared to an isocaloric non-alcoholic beverage condition (Barnes et al., 2010). Thirdly, it impairs sleep efficiency (Feige et al., 2006), a vital function in the recovery process.
Between 2 and 3 days are needed to observe muscle glycogen repletion after a high-level football match. Without specific guidelines, muscle glycogen concentration in top-level players was about 50% of the pre-match value 2 days after a match (Jacobs et al., 1982). Optimization of the resynthesis of muscle glycogen stores is effective when consuming carbohydrates with a high glycemic index. Studies have shown that an intake of 1.2 g carbohydrate per kg per hour immediately after a match, at 15–60 min intervals for up to 5h, enables maximum resynthesis of muscle glycogen stores (Jentjens and Jeukendrup, 2003).
Performing muscle-damaging exercise, such as seen in football, leads to muscle protein synthesis and muscle protein breakdown. Consuming proteins after a match enables to have a net positive protein balance, to repair muscle damage following exercise. After a match, consuming a high-protein diet may accelerate recovery of muscle function (Cockburn et al. 2008). The timing and the quantity of protein to ingest is not clearly defined, although scientific evidence has shown a beneficial effect of 20g milk protein or an equivalent of 9g amino acids on muscle protein synthesis rates during the first 2 hours of recovery (Beelen et al. 2010) and beneficial effects on cycling exercise performance (Saunders et al., 2004). Flavored milk, which is an easily accessible and relatively inexpensive dairy product, is an effective beverage for post-exercise recovery. It contains carbohydrate and proteins in similar amounts to those used in studies demonstrating improved post-exercise recovery. Many studies have also confirmed the significant effects of post-exercise chocolate milk supplementation on subsequent exercise performance (Pritchett et al., 2009; Ferguson-Stegall et al., 2011).
Some juices such as tart cherry juice, tomato juice or berry juice are also recommended to enhancing the recovery process. These juices are loaded with a high antioxidant capacity, which reduce oxidative stress and inflammation. The ingestion of these juices prior to and following exercise-induced muscle damage is able to accelerate muscle strength recovery (Howatson et al., 2010; McLeay et al., 2012).
In conclusion, immediately after the match, players should drink a large volume of fluid (about 150% of the sweat loss) with a high concentration of sodium (about 500 to 700 mg/L of water), flavored milk and tart cherry or berry juice. Then, they should eat a meal containing high-glycaemic index carbohydrate and protein within the hour following play.
Grade of recommendation:
A – high: to implement.
Playing football match at night time (8 to 9pm) involves high physical and mental load, as well as a high emotional stress. In addition, post-match routines (medical care, recovery strategies, meal and return trip) frequently lead to a very late bedtime, which may also alter sleep quality and quantity. In a survey performed in a football team participating to the UEFA Europa League, 95% of the players declared a worse sleep after night matches (Nédélec et al., 2015). This may be a consequence of the physical and mental load involved during a match but also to a high emotional stress (Nédélec et al., 2015). Sleep loss negatively affect endurance performance, maximal strength and cognitive performance (Reilly and Edwards, 2007). Sleep and the immune system are also closely linked. Subjects with less than 7 hours of sleep per night in the weeks preceding exposure to a rhinovirus are about 3 times more likely to develop a cold than those with 8 hours or more of sleep (Cohen et al., 2009).
As shown in the previous part, a high-glycaemic index meal is recommended for rapid restoration of muscle glycogen stores. This diet has been shown to significantly reduce sleep onset latency compared with a low-glycaemic index meal (Afaghi et al., 2007) and was most effective when consumed 4 hours before bedtime compared with the same high-glycaemic index meal given 1 h before bedtime. Some other nutrients such as those contenting tryptophan (Halson, 2008) or melatonin (Halson, 2008; Howatson et al., 2012) are also recommended to decrease sleep onset latency and/or to improve sleep quantity and quality. Tryptophan-containing foods include milk, meat, fish, poultry, eggs, beans, and leafy green vegetables, while high concentrations of melatonin are contained in tart cherries.
A poor night’s sleep may be compensated by a short post-lunch nap. When followed by a 30-minute recovery period, a nap may improve alertness and aspects of mental and physical performance after partial sleep loss (Waterhouse et al., 2007). The ability to nap for short periods during the day may be a useful skill for players especially during a congested schedule. Sleep quantity extension is another strategy to improve physical performance. According to Mah et al. (2011), extended sleep beyond one’s habitual nightly sleep contributes to improved athletic performance, technical skills, reaction time and daytime sleepiness in basketball players.
Other recommendations for sleep induction include benefiting from a dark and quiet environment by using eyeshades and earplugs, listening to relaxing music and adopting regular sleep-wake schedules. Conversely, consumption of caffeine prior to the match for performance enhancement, alcohol as a means of celebrating after the match, and hyper-hydration could lead to sleep disturbance.
Sleep is an essential part of recovery management, as sleep disturbances after a match are common which may negatively impact on the recovery process.
3. Cold-water immersion
The principle of cold-water immersion is to immerse the body into a water with a temperature under 15°C for an exposure period comprised between 10 and 15 minutes (Halson, 2011; Poppendieck et al., 2013). Several meta-analysis performed in order to analyze the effects of cold-water immersion on recovery kinetics. Results have consistently shown a beneficial effect of this strategy on force, sprint and jump recovery (Leeder et al. 2012; Poppendieck et al. 2013). The optimal use of cold-water immersion is a whole-body exposure of 10 minutes at a 10°C temperature immediately after exercise (Versey et al. 2013). Other strategies such as whole-body cryotherapy are based on the principle of using cold to accelerate recovery kinetics. A study compared cold-water immersion and whole-body cryotherapy effects on recovery kinetics. The results showed that cold-water immersion was more beneficial than whole-body cryotherapy to accelerate recovery of jump height and subjective ratings (Abaïdia et al., 2017a).
Grade of recommendation:
A – high: to implement.
4. Active recovery
This strategy involves running, biking or swimming at low intensities for durations of 15 to 30 minutes. When performed between 30 and 60% of maximal oxygen uptake and lasting at least 15 minutes, active recovery enhances blood lactate removal (Belcastro and Bonen, 1975) in comparison with passive recovery. As faster lactate removal does not necessarily involve better performance during subsequent exercise, lactate removal should not be the criterion used to test the quality of recovery. In several studies aimed at comparing active and passive recovery modalities, exercise performance after active recovery did not improve, despite lower lactate concentrations (Weltman and Regan, 1983; Bond et al., 1991), while other studies showed that passive recovery improved performance in subsequent exercise (Dupont et al., 2003; 2004). Additionally, some studies have indicated glycogen synthesis impairment when active recovery is performed immediately after high-intensity (Choi et al., 1994; Fairchild et al., 2003).
In a set of studies on recovery between two football matches separated by 3 days in elite female players, Andersson et al. (2008; 2010) investigated the effects of 1 hour of active recovery (low-intensity cycling and resistance training) performed at 22 and 46 hours after the first match. Results showed that active recovery had no effects on the recovery pattern of physical performance markers (i.e. countermovement jump, 20-m sprint performance, maximal isokinetic knee flexion and extension), perceived muscle soreness and biochemical markers (i.e. creatine kinase, urea and uric acid), oxidative stress markers and antioxidants. According to these results, an active recovery performed after a match does not present any benefit for football-related physical performance.
Grade of recommendation:
A – high: to reject.
In terms of recovery of performance, Studies have shown that massage was not an efficient technique to accelerate recovery kinetics of neuromuscular function (Barlow et al., 2007; Poppendieck et al. 2016) or global exercises (Robertson et al. 2004). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage (Crane et al., 2012), and presents psychological benefits. Massage decreased the subjective symptoms of delayed onset muscle soreness and increased perceptions of recovery (Hemmings et al., 2000). In conclusion, benefits of massage are still lacking regarding recovery of performance. Conversely, the majority of the evidence points towards massage being effective in alleviating muscle soreness and improving perceptions of recovery.
Grade of recommendation:
B – acceptable: to implement.
Elite football teams devote a substantial amount of training and match preparation time to stretching. Dadebo et al. (2004) reported that the English Premiership clubs allocated almost 40% of total training time to flexibility training. Stretching exercises are performed for several reasons: to improve range of motion, to reduce musculotendinous stiffness, to prevent injury, as well as to promote recovery. However, there is no substantial scientific evidence to support the use of stretching to enhance the post-exercise recovery of football players. In a meta-analysis including 12 studies, Herbert et al. (2011) reported that stretching is not clinically worthwhile in reducing muscle soreness in the days following exercise. Recovery of physical performance is not improved after stretching (Lund et al., 1998).
Grade of recommendation:
A – high: to reject.
7. Compression garments
Principle of compression garments is to increase the pressure on the ankle and to decrease it on the mid-thigh in order to improve the venous return and thus reduce venous stasis in the lower extremities. Wearing compression garments following a match may have beneficial effects on recovery kinetics. The effectiveness of compression garments on muscle force and power is underpinned by a high level of scientific evidence (Hill et al. 2014; Marques-Jimenez et al. 2016; Brown et al. 2017). Results indicated that the use of compression garments had moderate effect on recovery of muscle strength, muscle power, creatine kinase and in reducing the severity of delayed onset muscle soreness. As studies did not have a placebo condition (i.e., using a garment, but no compression), a placebo effect due to wearing the garments should not be excluded.
In conclusion, the use of compression garments may provide an easy-to-use recovery strategy in a team. They could be useful during air travel, especially during long flight, to reduce the risk of deep vein thrombosis (Bartholomew et al., 2011).
Grade of recommendation:
A – high: to implement.
8. Electrical stimulation
Electrical stimulation involves the transmission of electrical impulses via surface electrodes to peripherally stimulate motor neurons thus eliciting muscular contractions. Transcutaneous electrical nerve stimulation and low-frequency electrical stimulation are the modalities most frequently used for recovery purposes. The effects of electrical stimulation on the recovery of strength production capacity and on the reduction of muscle soreness were reviewed by Malone et al. (2014). This review failed to find a significant effect of electrical stimulation on the ability to maintain performance after an exercise, but reported a beneficial effect of electrical stimulation on the reduction of muscle soreness and perception of fatigue.
In conclusion, although electrical stimulation is often used for recovery purposes, no scientific evidence exists regarding its effects to maintain physical performance. The level of scientific evidence concerning the effect of electrical stimulation on subjective rating such as muscle soreness is also limited.
Grade of recommendation:
B – acceptable: to implement.
9. Strength training session
Performing a heavy load strength training session is also a way to stimulate growth hormone and testosterone secretion. Performing an upper-limb strength training session after lower-limb exercise may accelerate recovery kinetics of concentric force, as previously shown (Abaïdia et al., 2017b). This strategy may be implemented the day after a match during the training session.
Grade of recommendation:
B – acceptable: to implement.
10. Foam roller
Systematic reviews have been performed in order to evaluate the effects on recovery kinetics (Beardsley and Skarabot, 2015; Cheatham et al., 2015; Schroeder and Best, 2015). Conflicting results were found, regarding the effects on neuromuscular performance, but beneficial effects were found on muscle soreness. The ideal dosage is not defined in the reviews focusing on this strategy. Other studies are needed to specify the effects of foam roller on recovery kinetics.
Grade of recommendation:
B – acceptable: to implement.
In summary, some recovery strategies such as hydration, diet, sleep, cold-water immersion and compression garments are effective to accelerate the recovery process. An example of a practical recovery protocol based on scientific evidence is proposed in Figure 1.
According to the recommendations previously shown in this article, a protocol of recovery should be implemented immediately after a match. Below and in figure 1, we provide an example protocol of how post-match recovery may be organized:
- Foods with a high amount of high glycemic index carbohydrate and a high amount of protein in the hour following the match should be consumed. Chocolate milk is considered as a good product as it contains protein and carbohydrates, and as some studies have shown its beneficial effect on recovery kinetics (Pritchett et al. 2009; Fergusson et al. 2011). Additionally, post-game re-hydration is an important issue, it is recommended to replenish players water stores by consuming fluid (150% of body mass lost) with a high amount of sodium (500 to 700 mg.l-1 of water) (Nédélec et al. 2013).
- Cold-water immersion soon after finishing the match can be performed ideally in a bath with a temperature of 10°C for 10 minutes.
- Massage for a duration of 5 to 12 minutes. The best results on muscle soreness are obtained with a combination of effleurage, petrissage, tapotement, friction and vibration techniques.
- Wearing compression garments with a high level of pressure (for example: 15 mm Hg at the thigh level and 25 mm Hg at the calf level) until bed time and the days following the match.
- Doing everything possible to have a good night sleep, however, if the 1st night sleep is poor, this should be compensated with a nap the following day (Nédélec et al., 2015). Optimizing sleep is possible by sleeping at least 8 to 10 hours, switching-off all the lights, decreasing the temperature of the room and adapting the food ingested in the afternoon by avoiding drinks such as coffee or tea.
Abd-Elbasset Abaïdia, PhD
Université de Lille, EA 7369 –
URePSSS – Unité de Recherche
Pluridisciplinaires Sport Santé
Société, F-59000 Lille + Unité de
Recherche Education, Motricité,
Sport et Santé UR15JS01, Institut
Supérieur du Sport et de l’Education
Physique de Sfax, Université de Sfax, Tunisie
Abaïdia AE, Lamblin J, Delecroix B, Leduc C, McCall A, Nédélec M, Dawson B, Baquet G, Dupont G. Recovery from exercise-induced muscle damage: cold water immersion versus whole body cryotherapy. Int J Sports Physiol Perform. 2017a;12(3):402-409.
Abaïdia AE, Delecroix B, Leduc C, Lamblin J, McCall A, Baquet G, Dupont G. Effects of a strength training session after an exercise inducing muscle damage on recovery kinetics. J Strength Cond Res. 2017b;31(1):115-125.
Afaghi A, O’Connor H, Chow CM. High-glycemic-index carbohydrate meals shorten sleep onset. Am J Clin Nutr 2007 Feb;85(2):426-30
Allen DG. Eccentric muscle damage: mechanisms of early reduction of force. Acta Physiol Scand. 2001 Mar;171(3):311-9.
Andersson H, Raastad T, Nilsson J, et al. Neuromuscular fatigue and recovery in elite female soccer: effects of active recovery. Med Sci Sports Exerc 2008 Feb;40(2):372-80.
Andersson H, Karlsen A, Blomhoff R, et al. Active recovery training does not affect the antioxidant response to soccer games in elite female players. Br J Nutr 2010 Nov;104(10):1492-9.
Ascensão A, Rebelo A, Oliveira E, et al. Biochemical impact of a soccer match – analysis of oxidative stress and muscle damage markers throughout recovery. Clin Biochem 2008 Jul;41(10-11):841-51.
Babault N, Cometti C, Maffiuletti NA, et al. Does electrical stimulation enhance post-exercise performance recovery? Eur J Appl Physiol 2011 Oct; 111(10):2501-7.
Barlow A, Clarke R, Johnson N, et al. Effect of massage of the hamstring muscles on selected electromyographic characteristics of biceps femoris during sub-maximal isometric contraction. Int J Sports Med 2007 Mar; 28(3):253-6.
Barnes MJ, Mündel T, Stannard SR. Acute alcohol consumption aggravates the decline in muscle performance following strenuous eccentric exercise. J Sci Med Sport 2010 Jan;13(1):189-93.
Bartholomew JR, Schaffer JL, McCormick GF. Air travel and venous thromboembolism: minimizing the risk. Minn Med 2011 Jun;94(6):43-9.
Beelen M, Burke LM, Gibala MJ, et al. Nutritional strategies to promote postexercise recovery. Int J Sport Nutr Exerc Metab 2010 Dec;20(6):515-32.
Belcastro AN, Bonen A. Lactic acid removal rates during controlled and uncontrolled recovery exercise. J Appl Physiol 1975 Dec;39(6):932-6.
Bengtsson H, Ekstrand J, Hägglund M. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013 Aug;47(12):743-7.
Beardsley C, Škarabot J. Effects of self-myofascial release: A systematic review. J Bodyw Mov Ther. 2015 Oct;19(4):747-58.
Bishop D. An applied research model for the sport sciences. Sports Med 2008;38(3):253-63.
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. 2012 Feb 15.
Bond V, Adams RG, Tearney RJ, et al. Effects of active and passive recovery on lactate removal and subsequent isokinetic muscle function. J Sports Med Phys Fitness 1991 Sep;31(3):357-61.
Brophy-Williams N, Landers G, Wallman K. Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance. J Sports Sci Med 2011;10:665-70.
Brown F, Gissane C, Howatson G, van Someren K, Pedlar C, Hill J. Compression Garments and Recovery from Exercise: A Meta-Analysis. Sports Med 2017 Apr 22. doi: 10.1007/s40279-017-0728-9. [Epub ahead of print].
Cheatham SW, Kolber MJ, Cain M, Lee M. The effects of self-myofascial release using a foam roll or roller massager on joint range of motion, muscle recovery, and performance- a systematic review. Int J Sports Phys Ther. 2015 Nov;10(6):827-38.
Choi D, Cole KJ, Goodpaster BH, et al. Effect of passive and active recovery on the resynthesis of muscle glycogen. Med Sci Sports Exerc 1994 Aug;26(8)992-6.
Cockburn E, Hayes PR, French DN, et al. Acute milk-based protein-CHO supplementation attenuates exercise-induced muscle damage. Appl Physiol Nutr Metab 2008 Aug;33(4):775-83.
Cohen S, Doyle WJ, Alper CM, et al. Sleep habits and susceptibility to the common cold. Arch Intern Med 2009 Jan 12;169(1):62-7.
Crane JD, Ogborn DI, Cupido C, Melov S, Hubbard A, Bourgeois JM, Tarnopolsky MA. Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Sci Transl Med. 2012 Feb 1;4(119):119ra13. doi:10.1126/scitranslmed.3002882.
Dadebo B, White J, George KP. A survey of flexibility training protocols and hamstring strains in professional football clubs in England [published erratum appears in Br J Sports Med 2004 Dec;38(6):793]. Br J Sports Med 2004 Aug;38(4):388-94.
Davies CT, White MJ. Muscle weakness following eccentric work in man. Pflugers Arch. 1981 Dec;392(2):168-71.
Di Salvo V, Gregson W, Atkinson G, et al. Analysis of high intensity activity in Premier League soccer. Int J Sports Med 2009 Mar;30(3):205-12.
Dupont G, Blondel N, Berthoin S. Performance for short intermittent runs: active recovery vs. passive recovery. Eur J Appl Physiol 2003 Aug;89(6):548-54.
Dupont G, Moalla W, Guinhouya C, et al. Passive versus active recovery during high-intensity intermittent exercises. Med Sci Sports Exerc 2004 Feb;36(2):302-8.
Dupont G, Nedelec M, McCall A, et al. Effect of 2 soccer matches in a week on physical performance and injury rate. Am J Sports Med 2010 Sep;38(9):1752-8.
Ekstrand J, Waldén M, Hägglund M. A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup. Br J Sports Med 2004 Aug;38(4):493-7.
Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011 Jun;45(7):553-8.
Fairchild TJ, Armstrong AA, Rao A, et al. Glycogen synthesis in muscle fibers during active recovery from intense exercise. Med Sci Sports Exerc 2003 Apr;35(4):595-602.
Feige B, Gann H, Brueck R, Hornyak M, Litsch S, Hohagen F, Riemann D. Effects of alcohol on polysomnographically recorded sleep in healthy subjects. Alcohol Clin Exp Res. 2006 Sep;30(9):1527-37.
Ferguson-Stegall L, McCleave EL, Ding Z, et al. Postexercise carbohydrate-protein supplementation improves subsequent exercise performance and intracellular signaling for protein synthesis. J Strength Cond Res 2011 May;25(5):1210-24.
Halson SL. Nutrition, sleep and recovery. Eur J Sport Sci 2008 Mar;8(2): 19-26.
Halson SL. Does the time frame between exercise influence the effectiveness of hydrotherapy for recovery? Int J Sports Physiol Perform. 2011 Jun;6(2):147-59.
Hawkins RD, Hulse MA, Wilkinson C, et al. The association football medical research programme: an audit of injuries in professional football. Br J Sports Med 2001 Feb;35(1):43-7.
Hemmings B, Smith M, Graydon J, et al. Effects of massage on physiological restoration, perceived recovery, and repeated sports performance. Br J Sports Med 2000 Apr;34(2):109-14.
Herbert RD, de Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database Syst Rev 2011 Jul 6;(7):CD004577.
Hill J, Howatson G, van Someren K, Leeder J, Pedlar C. Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med 2014;48(18):1340-6.
Howatson G, McHugh MP, Hill JA, et al. Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports 2010 Dec;20(6):843-52.
Howatson G, Bell PG, Tallent J, Middleton B, McHugh MP, Ellis J. Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. Eur J Nutr. 2012 Dec;51(8):909-16.
Ingram J, Dawson B, Goodman C, et al. Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. J Sci Med Sport 2009 May;12(3):417-21.
Ispirlidis I, Fatouros IG, Jamurtas AZ, et al. Time-course of changes in inflammatory and performance responses following a soccer game. Clin J Sport Med 2008 Sep;18(5):423-31.
Jentjens R, Jeukendrup A. Determinants of post-exercise glycogen synthesis during short-term recovery. Sports Med 2003;33(2):117-44.
King M, Duffield R. The effects of recovery interventions on consecutive days of intermittent sprint exercise. J Strength Cond Res 2009 Sep;23(6):1795-802.
Krustrup P, Zebis M, Jensen JM, et al. Game-induced fatigue patterns in elite female soccer. J Strength Cond Res 2010 Feb;24(2):437-41.
Leeder J, Gissane C, van Someren K, Gregson W, Howatson G. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med. 2012 Mar;46(4):233-40.
Lund H, Vestergaard-Poulsen P, Kanstrup IL, et al. The effect of passive stretching on delayed onset muscle soreness, and other detrimental effects following eccentric exercise. Scand J Med Sci Sports 1998 Aug;8(4):216-21.
Magalhães J, Rebelo A, Oliveira E, et al. Impact of Loughborough Intermittent Shuttle Test versus soccer match on physiological, biochemical and neuromuscular parameters. Eur J Appl Physiol 2010 Jan;108(1):39-48.
Mah CD, Mah KE, Kezirian EJ, Dement WC. The effects of sleep extension on the athletic performance of collegiate basketball players. Sleep. 2011 Jul 1;34(7):943-50.
Malone JK, Blake C, Caulfield BM. Neuromuscular electrical stimulation during recovery from exercise: a systematic review. J Strength Cond Res. 2014 Sep;28(9):2478-506.
Marqués-Jiménez D, Calleja-González J, Arratibel I, Delextrat A, Terrados N. Are compression garments effective for the recovery of exercise-induced muscle damage? A systematic review with meta-analysis. Physiol Behav 2016;153:133-48.
McLeay Y, Barnes MJ, Mundel T, Hurst SM, Hurst RD, Stannard SR. Effect of New Zealand blueberry consumption on recovery from eccentric exercise-induced muscle damage. J Int Soc Sports Nutr. 2012 Jul11;9(1):19.
Mohr M, Krustrup P, Bangsbo J. Match performance of high-standard soccer players with special reference to development of fatigue. J Sports Sci 2003 Jul;21(7):519-28.
Mohr M, Mujika I, Santisteban J, et al. Examination of fatigue development in elite soccer in a hot environment: a multi-experimental approach. Scand J Med Sci Sports 2010 Oct;20Suppl. 3:125-32.
Nédélec M, McCall A, Carling C, Legall F, Berthoin S, Dupont G. Recovery in soccer : part ii-recovery strategies. Sports Med. 2013 Jan;43(1):9-22.
- Nédélec M, Halson S, Delecroix B, Abaidia AE, Ahmaidi S, Dupont G. Sleep Hygiene and Recovery Strategies in Elite Soccer Players. Sports Med 2015;45(11):1547-59.
Pointon M, Duffield R. Cold water immersion recovery after simulated collision sport exercise. Med Sci Sports Exerc 2012 Feb;44(2):206-16.
Poppendieck W, Faude O, Wegmann M, Meyer T. Cooling and performance recovery of trained athletes: a meta-analytical review. Int J Sports Physiol Perform. 2013 May;8(3):227-42.
Poppendieck W, Wegmann M, Ferrauti A, Kellmann M, Pfeiffer M, Meyer T. Massage and Performance Recovery: A Meta-Analytical Review. Sports Med 2016;46(2):183-204.
Pritchett K, Bishop P, Pritchett R, et al. Acute effects of chocolate milk and a commercial recovery beverage on postexercise recovery indices and endurance cycling performance. Appl Physiol Nutr Metab 2009 Dec;34(6): 1017-22.
Rampinini E, Bosio A, Ferraresi I, et al. Match-related fatigue in soccer players. Med Sci Sports Exerc 2011 Nov;43(11):2161-70.
Reilly T, Edwards B. Altered sleep-wake cycles and physical performance in athletes. Physiol Behav. 2007 Feb28;90(2-3):274-84.
Robertson A, Watt JM, Galloway SD. Effects of leg massage on recovery from high intensity cycling exercise. Br J Sports Med 2004 Apr;38(2):173-6.
Saunders MJ, Kane MD, Todd MK. Effects of a carbohydrate-protein beverage on cycling endurance and muscle damage. Med Sci Sports Exerc 2004 Jul;36(7):1233-8.
Schroeder AN, Best TM. Is self myofascial release an effective preexercise and recovery strategy? A literature review. Curr Sports Med Rep. 2015 May-Jun;14(3):200-8.
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjansson E, Grimshaw J, Henry DA, Boers M.
AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62(10):1013-20.
Shephard RJ, Leatt P. Carbohydrate and fluid needs of the soccer player. Sports Med. 1987 May-Jun;4(3):164-76.
Shirreffs SM, Taylor AJ, Leiper JB, et al. Post-exercise rehydration in man: effects of volume consumed and drink sodium content. Med Sci Sports Exerc 1996 Oct;28(10):1260-71.
Shirreffs SM, Maughan RJ. Rehydration and recovery of fluid balance after exercise. Exerc Sport Sci Rev. 2000 Jan;28(1):27-32.
Thorlund JB, Aagaard P, Madsen K. Rapid muscle force capacity changes after soccer match play. Int J Sports Med 2009 Apr;30(4):273-8.
Volpi P, Taioli E. The health profile of professional soccer players: future opportunities for injury prevention. J Strength Cond Res. 2012 Dec; 26(12):3473-9.
Warren GL, Lowe DA, Armstrong RB. Measurement tools used in the study of eccentric contraction-induced injury. Sports Med 1999 Jan; 27(1):43-59.
Waterhouse J, Atkinson G, Edwards B, et al. The role of a short post-lunch nap in improving cognitive, motor, and sprint performance in participants with partial sleep deprivation. J Sports Sci 2007 Dec;25(14):1557-66.
Weltman A, Regan JD. Prior exhaustive exercise and subsequent, maximal constant load exercise performance. Int J Sports Med 1983 Aug;4(3):184-9.
Comments are closed.