Rest and Recovery

• Rest and recovery have the greatest influence on injury risk.
• Loading and recovering follow physical activities, training, or competition.
• Significant disruption to homeostasis within the tissue can be localized or physiological.
• Greater load or more intense training leads to a greater effect on homeostasis.
• Exercise or physical activity leads to recovery to a normal level.
• Super compensation occurs which means athletes move past their normal level.
• Exercising before reaching a normal level can lead to overtraining.
• Excess activity during the recovery period increases the risk of injury.
• Recovery is divided into categories based on area: local and general physiological.
• Local recovery involves soft tissue structures, such as tendons, muscles, ligaments, and nerves.
• General physiological recovery is the focus of most recovery literature.
• Recovery can also be broken down into normal and pathological.
• Normal recovery is post-exercise in a normal population.
• Pathological recovery is post-exercise in a population with comorbidities or previous injuries.

Local Tendon Recovery Research

• Research explores local normal recovery, specifically tendon recovery post-exercise.
• A 2017 study with 23 military subjects examined the Achilles tendon and patella tendon after a 7.7 km march.
• Diagnostic ultrasound was performed prior, after, and 72 hours later to assess tendon size and vascularity.
• Following exercise, there was a trend towards a decrease in tendon size.
• After three days, 22% of subjects showed hypervascularity, which is increased blood supply, within the tendon visible on Doppler, and an increase in tendon dimensions.
• Achilles and patella tendons have high fluid content, aiding elasticity and response to loading. This also results in fluid loss during exercise.

Tendon Degradation and Synthesis

• Following exercise, tendons experience both degradation and synthesis.
• Up to about 30 hours, degradation is predominant.
• After 30 hours, synthesis starts overriding degradation.
• This underpins the recommendation to avoid exercise within 48 hours, allowing tendons to recover.
• 20% of athletes have an increased hypervascular response that doesn't recover normally.
• Even in normal individuals, there is variation in recovery responses.
• Athletes with a history of recurrent tendon injuries may need longer recovery periods.

Cold Water Immersion

• A systematic review found that cold water immersion has a more positive effect than passive recovery.
• Water temperatures between 10 to 15°C for 10 to 15 minutes yielded the best results.
• Cryotherapy that is too cold may not be as effective.
• 10 to 15 minutes of cold exposure leads to Hunting's reaction, which includes vasodilation and vasoconstriction.
• Hunting's reaction pumps out lactic acid.
• Cold water immersion alleviates symptoms of DOMS and reduces CK levels after high-intensity exercise.
• Cold water immersion had no effect on muscle strength but did impact muscle power recovery.
• Studies found that cold water immersion attenuated long-term gains in muscle mass and strength.
• Cold water immersion seems to reduce super compensation effect.
• Cold water immersion may be more suitable as a recovery strategy during the season when the goal is to maintain performance levels rather than improve them.

Stretching

• Stretching has no significant effect on DOMS and fatigue.
• Stretching may increase DOMS.
• Stretching as an adjunct with other recovery strategies may improve recovery.
• The effect of stretching on pathological recovery requires more research.

Foam Rolling

• Post-rolling slightly decreased exercise-induced decreases in sprint and strength performance.
• Post-rolling reduced muscle pain perception.
• The effects of foam rolling on performance recovery are minor and negligible.
• Foam rolling may be more effective as a warm-up activity.
• If an athlete benefits from foam rolling, its use is acceptable, as there is no evidence of harm.

Compression Garments

• Compression garments had a significant positive impact on DOMS and perceived fatigue.
• Improvement was more subjective.
• Concentrations of interleukin or creatine or CRP in the muscles didn't objectively change.
• No harm results from using compression garments.

Sleep

• Sleep plays an important role in athletes' performance and recovery.
• Sleep is most effective on sports-specific skill execution and performance.
• Napping and sleep hygiene strategies don't seem to have the same effect as simply sleeping longer.

Nutrition

• The first two hours after exercise are critical for replacing muscle glycogen.
• Consuming carbohydrates immediately after exercise leads to faster muscle glycogen re-synthesis.
• High glycemic index foods lead to faster muscle glycogen synthesis.
• Relatively consistent evidence supports the benefits of blackcurrant extract, tart cherry juice, beetroot juice, branched-chain amino acids, chlorine, and caffeine.
• There is relatively consistent evidence of no benefits from vitamins C and E in recovery.
• Mixed or inconclusive evidence exists for pineapple, pomegranate juice, watermelon juice, green tea, cur cumin, creatin, glutamine, vitamin D, and N3 polyunsaturated fatty acids.
• Given the importance of psychological recovery, if a recovery strategy causes no harm, it's acceptable for the athlete to use it.