What you will learn from reading Good to Go:
– Why the common go to recovery tools may not work as well as once believed.
– The flaws in recovery based science studies and how marketing trumps truth.
– Why the best recovery strategy can often be found by just trusting the feelings of your body.
The new buzzword – ‘Recovery'”
The following are just a few of the tools available to aid in recovery that are commonly used at the moment: sauna, hot/cold contrast, compression therapy, vibration therapy, BioMat, soft tissue tools, E-Stim, Marc Pro, and infrared therapy.
In the past, recovery was viewed as a state of being that was achieved by abstaining from activities such as training, standing for long periods, socialising late into the night, or engaging in stressful situations. It was simply a time to rest, sleep, and relax with a good book. However, today, recovery has become an action-oriented process. Athletes, both professional and amateur, are just as passionate about their recovery routines as they are about their training. In fact, recovery now has its own set of tools and equipment.
Recovery is no longer a passive downtime between workouts. It has become an integral part of an athlete’s training regimen. Regardless of the sport, top athletes don’t just train hard, but they also put in the same level of effort into their recovery practices.
The recovery arms race:
The market for products and services that claim to aid in post-exercise recovery is booming, according to the numbers. This search for a competitive edge in recovery has created a race, with athletes seeking faster bounce-back methods and entrepreneurs rushing to offer solutions not just to professionals, but also to recreational athletes and fitness enthusiasts.
Today, there seems to be a product or service marketed for every aspect of post-exercise recovery. Feeling tired? Try a recovery drink to restore energy. Sore muscles? Choose from massagers, compressors, supplements, or cold treatments. Feeling run-down? Check out a massage or meditation app. Struggling with sleep? There are trackers and apps for that too.
But what exactly is “recovery,”? The proliferation of recovery products and services can seem excessive, since we all know what recovery is and how to achieve it in its most basic form – a return to readiness following intense exercise or competition. Nevertheless, we have managed to make every aspect of it, such as nutrition, relaxation, and sleep, much more complicated, expensive, and time-consuming than before.
Despite knowing that a protein supplement or special compression sleeve is unlikely to change our lives, we still fall for convincing sales pitches, especially when they promise to make us better than before. We hold onto the hope that the right nutrient or tool could solve what is holding us back and unlock our untapped potential.
With these questions in mind, Christie embarked on an investigation of the complex physiology that determines how our bodies recover and adapt to exercise. She aimed to understand the fundamentals and science of recovery.
Chapter 1 – Just-So Science
Is beer a good recovery drink?
Christie Aschwanden’s curiosity was piqued when she drank a beer after running with friends, prompting her to question whether beer could truly be considered a recovery drink.
Although media articles and sports drink advertisements have emphasised the importance of replenishing fluids and carbohydrates, beer’s alcohol content posed a potential problem, despite its ability to deliver these nutrients.
Despite marketing claims, Christie was interested in knowing whether scientific research supported or contradicted the idea that beer could aid or hinder recovery. Unfortunately, she found limited research on the topic. While some studies focused on athletic performance while under the influence of alcohol and hangovers’ impact on physical performance, Christie wanted to investigate whether drinking beer after an event would harm her recovery.
Designing a Beer Study:
If beer (or, more specifically, the alcohol in beer) impairs recovery, we’d expect that runners who drank it after their depleting afternoon run would run out of gas faster in the next morning’s run to exhaustion compared to those who didn’t drink booze. Beer might also make the exhaustion run feel more difficult, so we’d ask runners to rate how hard the effort felt throughout the run. Finally, the alcohol might alter the proportion of fat and carbohydrates burned for fuel, and so we’d also take a metabolic measurement that could capture this too.
They had hypothesised that there were three measures that alcohol might alter during the run to exhaustion: ratings of perceived exertion (how hard the run felt), respiratory exchange ratios (a measure of what kind of fuel the body is burning), and the time required to reach the exhaustion point. The results showed no difference between trials for the first two factors, but the third one, time to reach exhaustion, showed a difference worthy of publication.
It turned out that the men in the study reached their breaking point an average of 21 percent sooner the morning after they’d downed the alcoholic beer, while our women, on average, kept running 22 percent longer during the run to exhaustion following the alcoholic beer.
If the results were correct, it meant that women could improve their recovery after a hard run by drinking beer.
Deconstructing the studies issues:
Despite hoping that the study would demonstrate that beer was an excellent recovery drink for runners, Christie remained unconvinced. After participating in the study, she felt dubious about the outcome, which enabled her to recognise and acknowledge some of the common pitfalls of sports performance studies.
Run to Exhaustion (RTE):
At first, Christie Aschwanden accepted the run to exhaustion (RTE) as a reliable measure of recovery. After all, it was commonly used in sports performance studies. However, participating in the study made her doubt the effectiveness of the RTE as a measure of recovery.
The RTE did not feel like a true test of recovery to her, but rather a test of endurance in a lab setting. Participants ran at 80% of their maximum capacity, feeling some discomfort and fatigue but never truly reaching total exhaustion. As a result, the RTE became more of a mental challenge rather than a physical one. Christie found herself questioning whether she was truly exhausted or simply tired of running. While the RTE captures an important psychological aspect of recovery, it is not a perfect test. Participants in the study felt that the open-ended nature of the RTE made it seem arbitrary and contrived, and it did not reflect real-life events.
Nudging people to score certain times:
During the pre-study orientation meeting, someone inquired about the expected duration of the run to exhaustion. It was estimated that most people would last about 20 minutes. After the study, it became clear that this information had influenced the participants to aim for running at least 20 minutes. It had essentially given them permission to stop after that time.
Had we provided a different estimate, say, 40 minutes, it is likely that the participants would have tried to run at least that long. To address the limitations of the run to exhaustion test, a review of various tests of athletic performance found that a time trial or race of a set distance yielded more reliable, valid, and sensitive results compared to tests that required individuals to exercise until they could no longer continue.
In our study, the ratings of perceived exertion—which are essentially just an answer to the question “how do you feel?”—seem more relevant, and on those we found no clear pattern to suggest that beer had an effect.
Doing Good Science:
They had put in a lot of effort to design a rigorous study, and Christie had faith in our scientific methods. Our intentions were noble, and she was hoping for an interesting result. It’s natural to want our work to succeed, and she must admit, she secretly hoped that our study would prove that beer and running were a great combination. This primed her to believe in and exaggerate our findings. Her excitement for our study created a naive attitude that could have easily overridden any skepticism.
Christies college anthropology professor taught her a term for the explanations people come up with to account for their data – “just-so” stories. The name is derived from Rudyard Kipling’s imaginative animal tales for children, such as the camel getting its hump as punishment for laziness. These stories are enticing because they neatly explain the data that’s been gathered. However, they are not necessarily true, since they are intentionally constructed to fit the data. It’s fine to think about plausible explanations for scientific findings, as these stories provide context and help us evaluate the plausibility of the results.
Nevertheless, it’s crucial to avoid getting too attached to these untested explanations. A good scientist always keeps in mind what is based on evidence and what is mere speculation. However, maintaining a clear boundary between the two can be difficult because we are drawn to stories that sound accurate. When the story matches what we want to believe, it’s simple to ignore its flaws.
It may appear impolite to look for flaws or sources of uncertainty in a well-intentioned study like ours. But the most crucial questions that scientists should ask about any study are: How could these results be incorrect? What aspects are we certain of, and which are still uncertain?
Important Takeaways from this experience:
The important lesson Christie took away was that it’s crucial to ask whether a study is really measuring what it’s supposed to and whether that measurement translates to something you care about in real life.
During the experiment, she discovered that it’s remarkably easy to tip the results in one direction or another. Some of these inadvertent nudges come directly from the researchers themselves. You also need to keep your eyes open to ways that researchers (and athletes) might unwittingly fool themselves into thinking that they’d found some recovery magic, especially if it was something they really wanted to believe. She knew this could happen, because she’d nearly done it herself.
She also discovered that it’s not enough to ask “Does this thing work?” First, you have to start with more fundamental questions: How would we know if it’s working? What are the benefits this gizmo or ritual is supposed to deliver, and how would we measure them?
CHAPTER 2 Be Like Mike
Sprinkle an appealing idea with a dash of science, and it can seem more powerful or true than the evidence really shows. What’s worse, good luck overturning an idea once it’s become part of sporting lore. That was a lesson I would learn soon enough.
Creating sporting lore – The Story of Gatorade:
The age of the athlete-endorsed sports drink began on a Florida football field in the mid-1960s. Back then, most coaches and athletes didn’t give much thought to fluid replacement during practice or competition.
But in 1965 a University of Florida football coach came to Dr. Robert Cade and his team of university doctors, complaining that his players were “wilting” in the heat. (He also wondered why his players never urinated during games.) After some investigation, Cade and his colleagues concluded that two factors were causing the players to fall victim to the heat—they weren’t replenishing the fluids and salts they were sweating out, nor were they restoring the carbohydrates their bodies were burning for fuel.
Cade figured he could solve the problem by helping players replace these lost resources, so he stirred together some sodium, sugar, and mono-potassium phosphate with water to create a drink soon dubbed Gatorade, after the University of Florida’s nickname: the Gators.
What followed was a national campaign to sell the public on the idea that exercise caused dehydration, the cure was Gatorade’s specially developed drink, and this tonic was critical for sports performance—it was created by a doctor and tested in studies, after all.
In a stroke of genius, Gatorade turned the drink’s sodium, phosphorus, and potassium into a special selling point by rebranding these ordinary salts with their scientific name—“electrolytes,” which is simply the scientific term for molecules that produce ions when dissolved in water.
Gatorade may not have been the first to use this term, but they’re the ones that landed electrolytes in the public lexicon. Because electrolytes weren’t (yet) a household word in the early days of sports drinks, people could mistake them for special compounds that needed to be taken in a sports drink’s magical formula if you were to replenish the fluids lost during exercise.
Gatorade wasn’t alone in promoting the benefits of drinking before, during, and after exercise. Other sports drink manufacturers, such as the drug companies Novartis (makers of Isotar) and GlaxoSmithKline (Lucozade Sport), also pointed to science when marketing their products. Lucozade, for example, established a “sports science academy” to promote its drink.
It was no longer sufficient to simply drink some water and eat a meal after exercising. The idea these marketing campaigns fostered was that physical activity created extraordinary nutritional needs, and these specially formulated beverages were the best way to meet them. This was science speaking.
They also paid for athlete endorsements such as a famous campaign with Micheal Jordan. The meaning of Gatorade changed. To drink Gatorade wasn’t just to mimic a sports hero, it was to imagine a causal relationship—Jordan drank Gatorade, then made all those slam dunks, so the one must have had something to do with the other. Psychologists call such thinking the “illusion of causality,” and it’s so powerful that it has spawned an entire genre of advertising—the celebrity endorsement.
The Irish have a saying, “An umbrella accompanies the rain but rarely causes it.” The same could be said of product endorsements and athletic greatness. Still, our minds are quick to connect the dots in the wrong direction.
Do we need sports drinks to replenish our electrolytes?
Your body maintains some reserves of the vital ions that it can tap into as needed to keep your body’s fluid and salt balance in check. We do lose electrolytes through sweat, but even when you exercise continuously for many hours you will simply correct any losses via your normal appetite and hunger mechanisms.
You can replenish your electrolytes with food instead. In a study involving ten men who were trained cyclists or triathletes, researchers found that it didn’t really matter whether they drank plain water, a sports drink, or a milk-based beverage after an hour of hard exercise. As long as they drank some liquids along with a meal, they restored their fluid levels just fine.
Do Sports Drinks Work?
When a team of medical researchers trained in the evaluation of scientific findings had a look at the research underpinning the boom in sports drinks, they reached a startling conclusion. “As it turns out, if you apply evidence-based methods, 40 years of sports drinks research does not seemingly add up to much,”
Carl Heneghan and his colleagues at the University of Oxford’s Centre for Evidence-Based Medicine wrote in a 2012 analysis published in the British Medical Journal (BMJ).12 When Heneghan’s team gathered and examined all of the available evidence on sports drinks (they even consulted sports drink manufacturers to ask them for their supporting studies, though not all complied), they found what amounted to a bunch of preliminary or inconclusive evidence packaged as more definitive proof.
The Problems with the studies:
The first, almost universal, problem among these studies was that they were too small to produce meaningful results.
Designed to show results:
Another common shortcoming was that the studies were often designed in a way that almost assured that they’d find a benefit from sports drinks. Instead of comparing a product to what athletes would otherwise consume, they compare some new nutritional product against exercising on empty. Cohen argues that’s not a fair test of the product’s benefits in real-world conditions.
Some of the dazzling powers that sports drinks display in the studies touted by their makers may be nothing more than the placebo effect. When people volunteer for a study to test a new sports drink, they come to it with an expectation that the product will have some performance benefit.
Not applicable to real world performance:
The BMJ analysis also concluded that many of the measures made in these studies may have looked good on paper, but aren’t things that matter when it comes to real-world performance. Very few athletes ever compete in events where the purpose is to keep going until you can’t. Instead, most of us care more about the answers to questions like, Does it help me perform better or feel less fatigue? “Worryingly, most performance tests used to assess sports drinks have never been validated,”
Heneghan and his team concluded that claims about sports drinks rely on small studies with comparison groups that rig the studies in favor of the products being studied, a lack of rigorous blinding so that participants were likely nudged to perform better while taking in the sports drinks, and measurements of effectiveness that might not be meaningful in real life.
Where marketing meets science (a big theme of this book):
The marketing around sports drinks rests on a fundamental, seemingly scientific premise—that even minor dehydration raises health risks and hinders athletic performance and recovery—but this idea appears overstated. It’s more marketing than science.
Furthermore, athletes who lose the most body mass during marathons, ultramarathons, and Ironman triathlons are usually the most successful, which suggests that fluid losses are not as tightly linked to performance as sports drink makers claim. Instead, the results imply that there must be some tolerable range for dehydration that doesn’t impair performance.
You’ve got well-meaning researchers looking for ways to help athletes cope with the heat, and they find a related, but different, problem that over time becomes the new centre of attention. Good intentions, nudged, perhaps, by commercial interests, come together to create a paradigm that holds hydration as paramount.
Electrolyte supplements “have become another easy way for people to make money off of vulnerable athletes— by selling them something that costs virtually nothing to make,” Hoffman says.
Is that most of what we hear about hydration comes from companies and researchers with a vested interest in making it all seem complex and highly scientific. (The ACSM, NSCA, and NATAA all receive funding from sports drink makers, and so do some of their members.)
From a biological perspective, it’s hard to imagine that the human body is so delicate that it can’t function properly without scientists (or football stars) swooping in with calculators to tell us how to keep it running properly.
How to Hydrate:
Athletes are told to drink before they’re thirsty, because they lose fluids through sweat before their thirst will compel them to drink, and even small amounts of fluid loss seem detrimental to health and performance.
The problem with this model of hydration is that it overlooks basic physiology. It turns out, your body is highly adapted to cope with losing multiple litres of fluid, especially during exercise. When you exercise, you lose fluid and salts through sweat, and that translates into a small change in what’s called your “plasma osmolality”—the concentration of salts and other soluble compounds in your blood.
“People always worry they’re going to be dehydrated, when the reality is, it’s much easier to over-hydrate, because our bodies are so good at conserving water,” Hyndman says. “Being a little dehydrated is not a bad thing. Our bodies can handle it.” Because of the way the body adapts to fluid loss, the common advice to drink lots of fluids in advance of a big event like a marathon may actually backfire. If you drink a bunch of excess water leading up to a competition, you prime your body to become less adept at holding on to precious fluids,
When you’re very hydrated, your body doesn’t need to activate many aquaporins, and over time it reduces the number in reserve, meaning that you’ll have fewer of these water straws at the ready when you need them.
On the other hand, if you have practiced conserving water by waiting until you’re feeling pretty thirsty to drink, your body will adapt by directing more aquaporins to stand by. Instead of prehydrating, Knepper says it might actually be better for athletes to practice conserving water in training and continue to simply drink to thirst before an event, rather than trying to top off their fluids.
Pee colour charts:
You can also forget those pee charts that look like paint swatches for urine, and ignore anyone who says that yellow pee is a sign you need to drink more water. If you think about hydration from the standpoint of what’s going on inside your body, it’s easy to see why urine hue isn’t helpful. The color of your pee is essentially just a measure of how concentrated your urine is. If it’s got more waste than water, it looks dark, and if it’s mostly water, it’s light or almost clear. But that’s not what’s important. What you really want to know is what’s going on in your blood, and your urine can’t tell you that.
CHAPTER 3 The Perfect Fuel
The Rise of Recovery Shakes
To recover from their extended efforts, cyclists riding the Tour needed carbohydrates to replenish their muscle glycogen stores, protein to help repair muscle damage, and calories—lots of calories.
In 1998, a New Jersey company called PacificHealth Laboratories began touting a study that purported to show that their sports drink improved endurance performance by 55 percent compared to Gatorade. Not only that, the product was also said to improve recovery and might even protect against exercise-induced muscle damage.
While Gatorade had been sold as a beverage to quaff during exercise to maintain performance and hydration, Endurox R4 was presented as a new kind of replenishment—a beverage to boost recovery after exercise. The drink was the brainchild of PacificHealth Laboratories founder Robert Portman and another sports scientist, John Ivy from the University of Texas.
It was already well known that exercise depleted the muscle’s energy, stored in the form of glycogen, and consuming carbohydrates after that exercise was important to help replenish it. But starting in the 1980s, Ivy’s research had implied that this recovery process could be enhanced if carbohydrate was ingested immediately after exercise, instead of waiting until later.4 “The rate of glycogen storage was twice as fast when you provided it immediately postexercise,” Ivy says, because muscles become extra sensitive to insulin following exercise. As a result, they seemed to take up carbohydrate and store it as glycogen much more effectively immediately after a workout. That was Ivy’s first insight. The second centred on the need for protein too.
The metabolic window of opportunity:
At least one study had suggested that taking protein supplements after exercise increased the rate of amino acid uptake and resulted in a faster rate of muscle protein synthesis. Giving exercisers protein immediately after a bout of intense exercise instead of waiting several hours seemed to speed its uptake in a manner similar to what they’d seen with carbohydrate. The lesson seemed clear: timing mattered.
Portman and Ivy contended that after exercise, there is an interval they called “the metabolic window of opportunity,” when recovery could be accelerated by ingesting the correct nutrients. They dubbed this concept “nutrient timing,”
According to Portman and Ivy, taking in the right combination of nutrients during the anabolic phase could boost the rate of muscle glycogen storage, reduce muscle damage, raise the amount of protein taken up by muscle, and accelerate recovery. Portman was formerly an ad man, having previously founded two medical advertising and communications agencies, and he knew the power of marketing.
Endurox R4 appears to have been the first drink marketed specifically for recovery, and its makers used science to make their case. Their studies put volunteers through some form of intense exercise to deplete muscle glycogen stores, then had them drink either Endurox or water. After a period of rest, participants would be exercise-tested again. “What we saw was an immense improvement in the subsequent exercise,”
The new Recovery Paradigm:
With the marketing of PowerBar, Endurox R4, and similar products, a new paradigm emerged—if you wanted to achieve peak performance, you needed a special nutritional formula, delivered at precisely the right time.
Soon, athletes from a wide range of sports were rushing to refuel within the metabolic window, lest they miss out on a chance to enhance recovery and muscle adaptations.
Portman and Ivy’s book spread the notion of “nutrient timing,” but the idea was popularised and commercialised before all the details were worked out. The problem with nutrient timing is that it suggests a sense of urgency and precision that has not held up in subsequent research. That carbs and protein are important for recovery is pretty certain, but the optimal amount and timing is less so.
So does this window exist?
In 2013, Brad Schoenfeld, director of the Human Performance Lab at CUNY Lehman College in the Bronx, and his colleagues published a meta-analysis looking into the evidence behind the idea of the “post-exercise anabolic window.” They concluded that the evidence didn’t suggest the existence of a narrow window.
Part of the problem is that the original research looked at the response to a high dose of protein following exercise and compared it to a placebo. “That’s not a proper design,” Schoenfeld says. If your question is about the timing, you shouldn’t compare a dose of protein given at one time to no protein given at all. Instead, you need to compare the same doses of protein given at different times. When Schoenfeld’s team did that with a study looking at what happened if exercisers took protein right before versus right after a workout, they found no differences.10
There’s surely a period where your body needs protein to repair and build after a muscle-straining workout, particularly something like a max session in the weight room, a CrossFit WOD (workout of the day), or a high-intensity interval session. But it’s not so much an anabolic window, Schoenfeld says, “it’s an anabolic barn door.”
But nutrient timing wasn’t only about protein. Prolonged and/or intense exercise depletes glycogen stores in the muscles, and you need carbohydrates to restore them. Glycogen does seem to get replenished rapidly if you take in carbs immediately after a workout, says Schoenfeld. “But here’s the rub. If you’re not going to train again until the next day, there’s zero relevance.”
Schoenfeld’s analysis showed that as long as you take in some carbohydrates, your glycogen stores will be similarly replenished whether you consume those carbs 20 minutes after your workout or 3 or 6 hours later. On the other hand, if you’re training again in a few hours, then by all means replenish your energy ASAP, but know that the reason to do so is that you’re going to need that fuel again soon, not because waiting will impair your recovery.
Is there science of Recovery?
What makes the metabolic window of opportunity and recovery-branded products so appealing is that they promise to distill recovery to an exact scientific formula. But this precision is also what makes the claims dubious. The promises got ahead of the science. They’re not entirely false; they’re overstated.
This tendency to overstate is an ongoing problem in sports nutrition, says Louise Burke, head of sports nutrition at the Australian Institute of Sport. “I’m sure a lot of the people doing it aren’t being malicious or deliberately misleading, but often when we try to market ourselves to athletes—even for the best purposes—we add a bit of pizazz.”
When your muscles are hungry for fuel, they don’t care where the energy comes from, says Brent Ruby, the University of Montana scientist who supervised the cyclists study, done by his then-graduate student Michael Cramer. “The muscle could care less. If you’re dumping in carbohydrates, the muscle is going to be satisfied.”
Even so, we’re still left with the burning question: What should I eat after exercising? The easiest answer is: whatever your body is hungry for.
What becomes clear when you look at the history of sports nutrition is that what’s considered the perfect food to go with exercise is determined as much by culture and tradition as by science.
Today, Jennifer Maxwell says, those preferences have changed. “Natural” products and ones that appear less processed are favoured over ones that contain long ingredient lists and additives. Our definitions of what constitutes “healthy” and desirable foods have shifted over time. Sometimes this happens in response to new research, but food fads and changing marketing trends contribute too.
We all seem to be suckers for “superfoods.” Whether it’s an old standby like the PB&J, a rebranded staple like chocolate milk, or a newly “discovered” item like cherry juice, we’re all looking for the magic bullet—the special ingredient or compound that will give us an edge—and advertisers are standing by, ready to provide it.
The power of listening to your body:
In today’s world, athletes often rely on apps or scientific formulas to guide their diets, but it’s essential to develop the skill of listening to one’s body. Hunger, just like thirst, is an intuitive indicator of what the body needs. While more research is needed, periodising nutrition seems to be a promising approach, where emphasis is given to promoting adaptation during preseason and replenishment during the competition season.
Our bodies are adaptable machines, designed to maintain homeostasis by adjusting to changes in our environment. We don’t need to maintain a perfect balance of inputs; instead, we need to understand our body’s needs and adapt accordingly.
CHAPTER 4 The Cold War
RICE (Rest, Ice, Compression, Elevation)
Icing is a popular method for coping with pain, particularly in the sporting world. The practice gained traction after physician Gabe Mirkin introduced the term RICE (Rest, Ice, Compression, Elevation) in his 1978 book, The Sports Medicine Book. Icing is intended to speed up the body’s healing process by redirecting blood and inflammatory cells away from the injured area.
Today, ice packs and cold baths have become ubiquitous in athletic training facilities, sold in drugstores, and used by athletes in every sport. Despite the initial pain, icing is believed to reduce soreness and aid recovery. The discomfort associated with icing may add to its perceived effectiveness, in a culture that values grit and equates pain with gain.
The logic behind using ice baths and cold tubs for recovery is that the cold temperature activates your sympathetic nerve fibres, which signal the blood vessels in the treated area to constrict and redirect blood to your core to safeguard vital organs. This results in reduced blood flow to the treated area, slowing down metabolic processes, including inflammation. As a result, any potential swelling is reduced.
The Case Against Ice:
Initially, icing was thought to be beneficial as it could suppress inflammation. However, in recent years, there has been a change of perspective, and some experts now denounce the method they once championed. Dr Gabe Mirkin, a populariser of the RICE method, now believes that instead of promoting healing and recovery, icing might actually impair it. This change of heart was due in large part to the work of Gary Reinel, who argues that inflammation is the body’s way of healing and that icing only delays this response.
Muscle soreness after an intense workout is a common and painful aftereffect that triggers a repair response in the body. The cleanup and repair process is essentially the inflammation process, which is necessary for healing. Reinl argues that icing delays the healing response, as it only slows down blood flow to the area without halting it indefinitely. Once the icing stops and the blood flow returns to normal, whatever process the icing was trying to hinder will proceed again, and the swelling will continue, and the inflammation will start.
Despite Reinl’s argument, icing remains popular, and new cooling devices, such as ice sleeves and cuffs, are being promoted on social media.
The case for Ice:
There are two competing theories about cold therapy and icing: one theory suggests that it could stunt the body’s adaptation to training by decreasing inflammation, while the other theory argues that it could reduce pain and soreness and allow athletes to train harder, sooner. It is not yet clear which theory is correct and it may depend on the specific circumstances.
Experts suggest that recovery may be most effective when done in a periodised manner, matching recovery techniques to the goals of specific training. Based on current evidence, ice baths are not recommended after strength training or during a building phase of training. However, they may be useful for short-term recovery in between events when long-term adaptations are not a concern.
Although cryotherapy enthusiasts claim that it can significantly cool down the body, a study found that the temperature drop recorded on the skin during whole-body cryotherapy was only between -4°C and -14°C, despite temperatures of -180°C at the device outlet. Muscle temperature cooled even less, around -1.1°C. The study concludes that the differences in temperature are smaller than those experienced with an ice pack or cold tub. Therefore, despite the low temperatures, cryotherapy is more tolerable (which may explain it’s appeal) than an ice tub because it does not actually cool the body down as much.
CHAPTER 5 Flushing the Blood
Increasing blood flow:
Every recovery trick or product is a little different, but a vast number of them aim to boost blood flow. That’s with good reason. Blood is the body’s great delivery system. It helps get recovery done. It’s what shuttles the metabolic by-products of exercise away from the tissues and brings the inflammatory molecules that help with repairs to the sites that need fixing. Blood also delivers oxygen to cells and glycogen to depleted muscles. The circulatory system is like a big city’s transportation network—it allows things to get from one part of the body to another.
The theory behind training and recovery boils down to this: you stress your body, and it responds by fortifying its resources to better handle the stress. You put strain on your muscle by lifting a weight, and it fixes this minor damage by reinforcing the muscle fibre so it’s stronger for next time. How quickly you rebound from the strain of training by building strength and endurance depends on the amount of stress you experience and the resources you have available to work with.
The new focus on recovery recognises that training is only as good as the recovery that follows it.
It’s common to think that the soreness generated in your muscles when working out is a build of lactic acid. But that thinking was wrong, says Michael Joyner, a Mayo Clinic exercise scientist. Lactic acid, which is made up of lactate and an acid molecule, is produced in your muscles during heavy exercise, but it turns out that it’s probably not responsible for the burn you feel in your legs.
In fact, research by George Brooks of the University of California–Berkeley showed that lactate may actually provide a source of fuel for muscles in some cases and may even help trigger the production of new mitochondria, the structures in cells that produce energy. While it’s still true that exercising hard increases lactate levels and lactate buildup appears related to fatigue, the idea that lactate needs to be flushed from the muscles after a workout is misguided, Joyner says. “Lactic acid is removed from muscle very quickly during active recovery. It’s gone in less than an hour. Even if you do nothing it will go down fairly fast.”
There is only one published study that explores the use of infrared saunas for recovery, which is a small exploratory study from Finland. The study tested the use of a far-infrared sauna following strength exercise and running and found a slight improvement in a specialised jump test compared to the control group. However, this measure may not be relevant to most people, and without further studies, it’s not convincing.
The terms “infrared” and “far infrared” are popular buzzwords in the recovery world, often used to describe cold lasers, massage beds, and even expensive pajamas endorsed by football star Tom Brady. However, these claims are mainly based on small studies, some of which are conducted on lab animals. None of these supposed benefits have been definitively confirmed.
Some of the claims for infrared saunas, such as reducing swelling, inflammation, and associated pain, and expelling toxins from the body, are so unfounded that the FDA has ordered manufacturers making these statements to stop. While infrared radiation is a real thing, the term is often used to give an impression of space-age science to products that are otherwise ordinary.
Massage is a popular recovery method among athletes, but the evidence for its effectiveness is limited. According to Paul Ingraham, a massage therapist and publisher of PainScience.com, most of the popular reasons for why massage is good are unsupported. While it may help with anxiety and depression, there is little evidence that it improves performance or recovery. However, Shona Halson, an Australian recovery expert, suggests that massage may be effective for short recovery periods of up to ten minutes.
Research conducted by Butterfield on rats suggests that massage shortly after exercise may increase protein synthesis in muscles by providing a mechanical signal to the cells, which could help promote repairs via protein synthesis. This finding is yet to be confirmed in human studies. Despite the limited evidence, many athletes still find that getting a massage helps them become more self-aware and in tune with their bodies.
Foam Rollers and Massage Balls:
What about those painful massage balls and all the foam rollers that seem to be in all gyms? Many athletes swear by self-massage techniques like foam rolling, which are said to target fascia, the connective tissue that wraps around muscles and tissues like plastic wrap.
Anatomists used to consider fascia as passive tissue that only provided protection, but recent research has shown that it can actively contract and become stiff. It is possible that the stiffness we feel upon waking up in the morning is due to the fascia, although this is just a hypothesis at the moment.
The theory behind foam rollers is that they loosen up muscles and may address adhesions between layers of fascia. By pressing and massaging a muscle group with a foam roller, it is thought to work out these adhesions. However, this theory has not been proven yet.
Another theory is that applying compression to muscles with a foam roller sends a signal to the brain, which tells it to decrease muscle excitability and relax muscle tone. This could lead to a better range of motion in the muscle. While there is some evidence that foam rolling after exercise reduces muscle soreness, it is unclear whether this is due to a change in perception or a physiological change in the muscle.
As research continues, we may gain a better understanding of the physiology behind why massage and foam rolling make us feel better.
How to facilitate blood flow:
Many believe that athletes require specialised tools to improve their blood flow. However, as athletes are already active, their blood flow is typically good. In fact, exercise is one of the easiest and most effective methods of enhancing blood flow.
To promote blood flow and help tired muscles recover, it is recommended that athletes engage in gentle exercise, such as the easy spinning on trainers that Tour de France riders do after races. This technique is known as “active recovery” or a “warm-down,” as it aids in clearing out by-products of intense exercise, such as lactate.
CHAPTER 6 Calming the Senses
Optimal recovery requires a certain state of mind—one that doesn’t always come naturally to highly driven athletes. I once had a coach tell me, “Any fool can go train more. It takes courage to rest.”
Common problem among athletes, who tend to be a self-motivated bunch. They get antsy and anxious when we aren’t out doing our sport. It feels good to push ourselves, and we’ve been taught that hard work translates into success. It’s tempting to conflate resting with quitting or going soft. But as Nystad explained to me, sometimes the path to performance requires doing less, not more.
Initially, scientific models of training, recovery, and adaptation did not consider the role of psychological stress in the process. According to Jonathan Peake, a sports scientist at Queensland University of Technology in Brisbane, Australia, the psychological aspects of recovery have been overlooked while the focus has been mainly on the physical aspects. Peake believes that general feelings of health and wellness play an essential role in how individuals recover and adapt to training. This could be the exciting frontier of recovery research. Psychological stress not only impairs recovery but also blunts the body’s ability to adapt to training.
Athletes tend to think of recovery only in terms of planned physical exercise and ignore the emotional strains on their bodies. It is not only about running or performing exercise, but what is done after the workout is also critical. The emotional content of a potential stressor and how stressful it feels are what matters when it comes to stress. How stressful it feels depends mainly on expectations, personal circumstances, genetics, and upbringing, and these inclinations are not fixed.
Achieving real recovery necessitates nurturing a recovery mindset, one that fully acknowledges the body’s need to recuperate and knows when to relax. This attitude can be challenging to cultivate in a culture that constantly bombards us with messages to “go hard or go home.” We are conditioned to push through the pain and do one more mile or one more set. Streakers who run every day for years are celebrated, but if the body is not recovering and adapting to those runs, then the athlete is only logging junk miles that wear them down instead of building them up.
CHAPTER 7 The Rest Cure
Time to Sleep:
The benefits of sleep cannot be overstated. It’s hands-down the most powerful recovery tool known to science. Nothing else comes close to sleep’s recovery-enhancing powers. You could add together every other recovery aid ever discovered, and they wouldn’t stack up.
“Most of the time when someone says they only need five or six hours of sleep, what that means is that their ability to tolerate sleep deprivation is better than most,” says Meeta Singh, a sleep specialist at the Henry Ford sleep laboratory. “They’re actually walking around with sleep debt, and have forgotten what it feels like to be awake and alert.”
You might be able to do rote memory tasks on five hours of sleep, but anything that requires trouble-shooting or complex thoughts will become increasingly difficult.
Skimping on sleep is like showing up to the game drunk. “If you only get six hours of sleep, you double or triple your normal reaction times,” Singh says. She points to a study in which researchers subjected volunteers to either doses of alcohol or sleep deprivation and then gave them a battery of tests on attention, reaction time, and sleepiness.7 The results showed that people who’d only spent six hours in bed were as impaired as those who’d consumed two to three beers, while four hours of rest was equivalent to about five or six beers. Staying up all night was like throwing back ten to eleven beers and then trying to function normally.
If you’re forced to pick between some extra shut-eye or an extra workout, it’s wiser to pick the sleep, Singh says. Sacrificing an hour of sleep to make a morning workout is totally self-defeating.
Don’t over fixate on the metrics of sleep:
Measuring exactly how much quality sleep you’re getting is difficult outside of a lab setting. Although lots of fitness trackers and phone apps promise to measure sleep duration and quality, these gadgets aren’t very reliable. “They claim to estimate deep sleep and light sleep, but there’s no way you can do that unless you’re measuring the electrical activity of the brain,”
Rather than relying on an inaccurate measure, Bender prefers to simply ask athletes how satisfied they are with their sleep quality. When athletes feel unsatisfied with their sleep, that’s usually a sign that something is off. She also likes to have athletes track when they go to bed and when they get up to see if they’re spending enough time in bed to get the sleep they need.
Fixating on one night’s poor sleep is unhelpful. Bender tells athletes to think of their sleep in terms of a weekly budget so that they don’t stress out over one bad night.
“If you need to, take a longer nap one day or sleep in on another. Focus on your weekly need, rather than being concerned about eight hours every single night.”
How you actually slept, in other words, may be less important than how well you believe you slept, for cognitive-related performance anyway.
It’s more important to have good sleep the week leading up to a competition than the single night before an event. “If you get good sleep the four or five previous nights, then one bad sleep the night before won’t impact you so much.” Ideally, athletes should aim for good sleep every night, but realistically this isn’t always possible.
The power of Naps:
Napping was once a ritual reserved for kindergarteners, but it’s become a common habit among elite athletes. Some NFL teams also have nap rooms, and afternoon napping has become so prevalent in the NBA that “Everyone in the league office knows not to call players at 3 p.m. It’s the player nap,” league commissioner Adam Silver told the New York Times.
“Naps are really important for athletes,” says Amy Bender, the Canadian sleep scientist. “We know that naps improve alertness, they improve motor performance, and they improve productivity.” The ideal time for naps is during the body’s natural dip in the afternoon, she says, sometime between 1 and 4 p.m., and they should be scheduled in as a part of the normal training routine.
There’s a reason so many teams and performance centres are starting to provide nap rooms for their athletes. Sleep is the number one thing that athletes can do to bounce back from their training. It’s like the cake of recovery. Everything else is just icing.
CHAPTER 8 Selling Snake Oil
The FOMO of Nutrition:
When teaching his introductory nutrition course at McMaster University, Stuart Phillips asks his students if they take multivitamins. Most of them raise their hands and when he asks why, they typically answer, “to make up for what I might be missing.” This fear of missing out (FOMO) is a key driver of the marketing surrounding sports nutrition products, especially supplements. The marketing emphasises the message that “you might be missing something!”
Phillips explains that if your diet is generally healthy, you do not need to worry about taking special vitamins or nutrients after exercising. However, because most people believe that their nutrition is inadequate, supplements are marketed to exploit this anxiety.
Although the CDC reports only refer to the minimum amount required for good health, athletes do not take supplements merely because they fear they may be deficient in a certain vitamin. Their aim is to become superhuman by optimising their body’s inner workings and enhancing their performance, much like doping, but legally.
The idea that exercise creates extraordinary nutritional needs doesn’t make a lot of sense when you consider that the body was made to move (being sedentary is what throws our nutritional needs off-kilter). Yet we are told again and again that our bodies need special nutritional coddling when they’re active.
The International Society of Sports Nutrition:
Jose Antonio, the CEO and cofounder of the International Society of Sports Nutrition and an editor for the society’s journal, is a renowned supplement guru and stand-up paddle boarder based in Florida. He has worked for several companies in the supplement industry, written multiple books about supplements, and previously served as the science editor at Muscle and Fitness magazine.
According to Antonio, the supplement industry faced considerable skepticism from the research community 20 years ago, as supplements were considered snake oil. However, instead of attempting to convince academic sports scientists, Antonio and his associates formed their own field of research by creating their own research society and academic journal to establish legitimacy.
While presenting a lecture on supplements, Antonio and his colleagues faced criticism from some audience members who accused them of promoting quackery without any evidence to back up their claims. Despite the pushback, Antonio and his colleagues believed that very few people had genuine expertise in sports nutrition and that there was a need for a group that would support their interests and knowledge in the field. Consequently, they formed the ISSN as a rebel group that would challenge traditional academic societies.
Antonio asserts that the ISSN has been instrumental in legitimising the use of sports supplements and the field of sports nutrition. Prior to 2000, journals were hesitant to publish anything that suggested supplements might be beneficial, but the ISSN created its own journal as an outlet for supplement studies. Antonio describes the ISSN as a “speed boat” compared to other academic societies, which he likens to paddling a dinghy across the Hudson Bay.
So what does Antonio Recommend?
When Jose Antonio was asked about his recommended supplements for recovery, he emphasised the importance of sleep, noting that there is extensive data supporting its restorative effects. He also advised consuming 20 to 40 grams of protein after exercise and replenishing muscle glycogen with carbohydrates if you are an endurance athlete. Antonio believes that sticking to these basics is sufficient for most people, but the challenge is that many individuals struggle to do even that.
According to Antonio, people often seek a secret to success when it comes to recovery, but his advice is to focus on the fundamentals: training hard, getting adequate sleep, eating well, and repeating this regimen consistently. Antonio also recognises the importance of rigorous scientific research, stating that a single study does not necessarily prove anything and must be viewed as part of a larger body of work.
The problems of the supplement industry:
Incentivised by marketing not truth:
Antonio suggests that when a supplement manufacturer makes a claim, you should ask them for the published science on their product. If they cannot provide it, it does not necessarily mean their product claim is wrong. However, it indicates that they have not taken the time to fund a study to back up their claim scientifically, which is a red flag.
In an ideal world, science is supposed to pursue the truth and follow wherever the evidence leads. However, in practice, studies may be used as marketing tools by designing them to support claims. This is the problem with many supplement studies, which are not scientific searches for truth, but rather a way to market their products. Similar criticisms have been made of trials sponsored by pharmaceutical companies, which is why clinical studies must follow stringent rules.
Researchers running drug studies in the United States must now register their plans and protocols in advance at ClinicalTrials.gov and report and share all findings, regardless of the results. A 2015 analysis revealed that after the launch of ClinicalTrials.gov in 2000, the proportion of trials showing a positive benefit dropped significantly. Before 2000, 57% of large randomised, controlled trials sponsored by the National Heart, Lung, and Blood Institute showed positive results.
No such regulations or standards apply to nutritional studies, which means that supplement companies and the researchers they fund can look for positive results until they find the results they are seeking and bury the negative ones. Null results, which do not demonstrate any effect from the supplement, can also be hidden away in a file drawer. To be fair, the so-called file drawer problem may occur not because researchers are doing anything underhanded, but because journals favour positive results.
The peer review process implemented by most journals aims to eliminate studies that are too flawed to provide substantial information. However, the competition to get published in high-ranking journals is intense, and some journals may appear to be legitimate but do not subject papers to rigorous scientific standards or peer review.
Under such circumstances, researchers can manipulate their study to obtain the desired outcome, and can easily get their “scientific proof” published by submitting it to one of these journals, without the need for peer review, as long as they are willing to pay the publishing fees. Moreover, if the study does not yield the expected results, it can simply be abandoned.
Between 2012 and 2017, Jeffrey Beall, a librarian at the University of Colorado, maintained a blog that listed predatory publishers. Although he shut down the blog in early 2017, he published a paper that shared his findings. According to Beall, “Predatory publishers pose the greatest threat to science in the 21st Century. They jeopardise research by failing to distinguish authentic science from unsound science, allowing counterfeit science like alternative and complementary medicine to masquerade as genuine science, and enabling the publication of activist science.”
Who’s regulating supplements?
The reason why the FDA cannot ensure the safety and purity of supplements before they are sold is due to the Dietary Supplement Health and Education Act (DSHEA) of 1994, which prevents the FDA from requiring manufacturers to prove the safety and efficacy of their products. Instead, supplement companies are responsible for ensuring the safety of their products, and the FDA can only demand a recall if it can demonstrate that a supplement is harmful.
Efforts to grant the FDA more power to safeguard consumers have been thwarted by the nutrition and supplement industry, which spent $4 million on lobbying in 2014 and donated another $1.1 million to political candidates and groups.
Despite the appearance of legitimacy, there is no guarantee that a product has been inspected by a regulatory agency when it is on the shelves. The FDA lacks the ability to monitor what supplements are being sold.
Some companies make copycat products that hide the amount of the herb or vitamins actually present in the product by calling it a “proprietary blend,” which allows manufacturers to keep the amount of the ingredients a secret. The rule was intended to protect intellectual property, Roberts says. “Instead it allows manufacturers to ‘pixie dust’ their products with ineffective doses, and still get to claim they have the ingredient on the label.” Roberts suspects that the copycat products didn’t contain much of the herb, but who really knows?
The Magic of Supplements:
“Why do so many athletes still take supplements if they are so unproven?” asks Catherine Price, author of Vitamania, a book about vitamins and the supplement industry. “We just want to believe in magic,” she says. The supplement industry has been very successful in convincing us to believe in their products. John Swann, an FDA historian, notes that the growth in supplement use coincided with people taking more responsibility for their own health.
These marketing messages tend to resonate with people. It’s tempting to think that something as simple as a pill or a shake could provide us with an extra boost. With scientific-sounding claims backed up by marketing, these messages can seem both plausible and powerful. It’s not surprising that snake oil salesmen have been successful for centuries – people are eager to believe.
CHAPTER 9 Losing Your Zoom
Overtraining syndrome happens when an athlete is unable to adapt to the stress of training, leading to a persistent state of fatigue. Carl Foster, director of the Human Performance Laboratory at the University of Wisconsin-La Crosse and co-author of the 2013 joint consensus statement on overtraining syndrome from the American College of Sports Medicine and the European College of Sport Science, explains that athletes with overtraining syndrome “lose their zoom” and can’t perform at their best. Simply resting for a few days or a week won’t bring back their performance level. However, there is no definitive test or criteria to diagnose the syndrome, as symptoms overlap with those resulting from hard training such as muscle soreness, extreme fatigue, sleep problems, and mood disturbances.
During blocks of hard training, athletes push their bodies beyond their current abilities to induce a training adaptation, entering a state of overreaching. Although athletes in this state will feel tired and unable to perform at their best, they will usually recover after some rest. The difference between overreaching and overtraining can only be seen in retrospect, by noting how long they endure. Factors such as insufficient sleep, inadequate rest between hard efforts, poor nutrition, a cold virus, or psychological stress can hinder the body’s ability to recover.
Stress, whether it comes from a hard workout, competition, romantic breakup, or final exams, can affect the body’s ability to recover. Foster notes that athletes on the verge of overtraining syndrome often make things worse by pushing themselves harder in response to their fatigue and declining performance. At this point, what they really need is a break.
CHAPTER 10 The Magic Metric
Signs of Recovery:
The amount of effort versus rest that athletes should apply is a constant concern. How can they discern whether their bodies are becoming stronger or if they are straining themselves too much? Is fatigue an indication that they need more rest, or a sign of progress?
Sands, who has spent twenty-five years monitoring gymnasts, discovered that athletes respond to stress differently. Each athlete’s response to a new stressor is unique and can be displayed in several ways. For instance, what may be seen as a sore throat in one athlete may manifest as mood swings, soreness, or a headache in another.
Although researchers have attempted to establish a precise metric to predict or prevent overtraining, it remains elusive. A single measure is challenging to interpret unless the figures are tracked regularly over an extended period. Without a larger context, the numbers do not provide much insight.
Although there is no clear-cut method for identifying overtraining syndrome, a growing number of companies are now providing blood tests to athletes who want to gain insight into their body’s internal workings. While companies like Orreco typically work with elite teams, others such as Inside Tracker and Blueprint for Athletes offer blood tests to any athlete seeking to “take a selfie from the inside” and learn crucial information about their health.
However, some question whether these companies are approaching the issue correctly. Rather than examining overtraining syndrome and searching for effective solutions, they appear to be searching for new markets for existing technologies. This approach is similar to a drug company seeking the most lucrative problem to treat with their drug instead of focusing on a disease and finding the most effective treatments.
Athletes’ anxiety is driving them towards these tests, as they fear not knowing if they are training at an optimal level. Athletes want to ensure they are at their best and don’t want to wait until they don’t feel healthy. The rise of an industry aimed at making healthy people anxious about their bodies seems to be a reflection of our current times.
Vinay Prasad, a hematologist-oncologist at the Oregon Health & Science University, argues that the emergence of blood tests marketed to athletes reveals a fundamental difference between tech industry “innovators” and medical experts. While the tech nerds believe that more information is always better, Prasad emphasises that information is not the same as knowledge. “Just because you have a number doesn’t mean it’s helpful,” he warns. These blood tests are a classic example of the McNamara fallacy, which suggests that “not everything that counts can be measured, and not everything that can be measured counts.”
By marketing these tests to athletes, companies are essentially teaching athletes to “read their bodies” by paying attention to numbers that may or may not be relevant. This approach is akin to teaching to the test rather than encouraging athletes to listen to their bodies and understand when they need rest. In essence, these tests draw attention away from subjective factors, such as how an athlete feels, and towards objective data that may not be truly meaningful in terms of improving performance.
Training Load Errors:
According to Drew, so-called “overuse injuries” are more accurately described as “training load errors,” where the training stress put on an athlete’s body is the training load. When someone becomes ill or suffers a minor injury and misses some of their training, instead of gradually ramping back up to their previous training load, they push themselves to the same level as before (or even higher) out of fear of falling behind. This pattern can lead to a cycle of injury and illness.
High training loads are not necessarily dangerous as long as they are reached gradually. However, the risk of injury and illness increases when the training load spikes.
Psychologist Jack Raglin, who began studying overtraining in the 1980s, says that the idea that psychology could play a role in overtraining was initially dismissed. However, Raglin’s mentor, William Morgan, published ten years’ worth of data in 1987 that tracked the mood of competitive swimmers. Morgan and his colleagues at the University of Wisconsin-Madison’s sport psychology lab found that mood disturbances, such as tension, depression, and anger, increased as the swimmers trained more and then returned to baseline levels when their training decreased.
Be Careful of “Objective Measures” when recovering:
We often consider objective measures to be more reliable or scientific than subjective ones. If we want to determine the speed of a car, the speedometer provides a more reliable indication than the driver’s subjective perception of the vehicle’s speed. However, recovery is a much more complex phenomenon than speed, as it is not a measurement of something the body is doing at the present moment, but a forecast of how prepared it is to perform at a given time.
We like to believe that hard numbers provide the most accurate data, but it appears that subjective measures outperform objective ones when it comes to measuring recovery. In 2015, Anna Saw, an Australian sports scientist, and her colleagues reviewed the published studies on metrics used to measure training load and response – from hormone levels to inflammation markers, blood cell counts, immune system markers, and heart rates. When they examined all the findings, they discovered that self-reported subjective measures were superior to objective ones.
What makes tracking and data analysis so alluring is also what makes it risky – it gives a sense of confidence that science is not yet capable of providing. The belief underlying the use of data to determine when to train and when to rest is that we comprehend the intricate ways in which the body processes stress and recovery and how various workouts affect individuals.
Listening to your body:
A native of Finland, Inkinen moved to Palo Alto in 2003 and started doing triathlons in 2004. He calls himself an “incurable data geek,” and says he loved “the excitement of figuring things out” regarding his training and performance.
As a numbers guy, Inkinen wasn’t just going to read a paper, he wanted to know how his body was responding. “I need to get objective data that I’m super-compensating and getting better every week,” he says. After years of tracking all kinds of information about himself, he’s concluded that “the best algorithm for taking in all those data points is our own brain.”
“The morning mood and feeling is probably the most accurate predictor of recovery—it factors in a lot of things: injuries, hormonal status, hydration, nutrition.” In isolation, single measures, like heart rate, HRV, or body weight, only represent a single dimension of recovery, he says. Blood markers don’t impress him. “A single biomarker at any given point is meaningless. If you feel like crap, that tells you something. We’re a long way from having a system of biomarkers that can surpass the human brain.”
Chapter 11 Hurts So Good
Christie has discovered that recovery aids exist along a continuum of evidence. At one end lies the most powerful recovery tool ever discovered – sleep – which is free. At the other end are faddish products such as hydrogen water and oxygen inhalers that are mostly useless. Most recovery modalities lie somewhere in the vast middle, promising but unproven.
Despite exploring a seemingly endless array of recovery aids, Christie found that research on most modalities is thin and incomplete. While some of them may work, it is difficult to determine their efficacy. When these aids do work, their benefits are typically small and do not add up to larger effects. Instead, the body seems to hit a capacity for improvement, suggesting that these treatments may be tapping into the same finite reserve.
David Martin believes that the mechanism behind these treatments may be the placebo effect.
The Placebo Effect:
Martin is an Oregon native and endurance athlete. Over the years, he’s worked with elite athletes from numerous sports, including Cadel Evans, Australia’s first winner of the Tour de France, and NBA center Joel Embiid. After decades of observing athletes and their habits, Martin has concluded that most popular recovery modalities work by exploiting the placebo effect.
He views it as an opportunity. This is real mojo, and instead of calling it the placebo effect he prefers the terms “anticipatory response” or “belief effects.” He uses these alternative names, because people tend to dismiss the word placebo as a synonym for ineffective, when, in fact, these effects are real, and in some cases can be as powerful as many drugs. The difference is that you’re gathering up your body’s own resources to create the benefit.
The takeaway, Martin says, is that expectations can create real biological effects.
It doesn’t matter if there’s science to back it up. If an athlete strongly believes that something works, the belief effect can overwhelm the real effect, Martin says. And the reverse is true too. If the athlete doesn’t believe in the modality, its benefits will be diminished or even erased.
How the placebos may work in the recovery context:
Christies has observed a tendency in people to dismiss evidence that contradicts their personal experiences. Surprisingly, in placebo studies, participants who receive a sham treatment don’t usually feel deceived for example.
Placebos can alter how we perceive sensory input, which can make a significant difference. If you anticipate feeling less sore or fatigued after a massage or icing, for example, you may perceive your soreness as diminished and actually feel less tired.
Many popular recovery methods seem to function as a kind of pacifier. Although they may not actually solve anything, they provide something to do while you wait for the body to heal itself. Research indicates that humans dislike waiting and will be happier if they have something to occupy their time, even if nothing else changes.
As it turns out, people are happier when they’re doing something – anything – rather than waiting. Stretching, icing, or foam rolling provide a sense of control and involvement, which studies suggest are active ingredients in placebos.
The four Categories of Placebos:
Christie has categorised recovery modalities into four groups based on their placebo-enhancing characteristics.
The first group is the “feels so good” category, which includes things that provide pleasure during and possibly after the activity, even if it doesn’t have any other benefits.
The second group is the “hurts so good” category, which includes things like icing that are painful but can create a sense of power and effectiveness.
The third group is the “it’s working, I can sense it” category of active placebos, which includes things like cupping that produce noticeable sensations and effects that aren’t necessarily pleasurable or painful.
Finally, the fourth group is the “blinded by science” category, which includes things like infrared saunas. These modalities appeal to people through jargon-filled scientific explanations that create a sense of futuristic power.
These categories are fluid—what falls into the “feels so good” bin for one person might be categorised as “hurts so good” or “it’s working, I can sense it” by another—but the ultimate effect is the same. The modality has some quality that triggers an expectation that it will work.
Recovery modalities can be seen as different expressions of a handful of approaches to recovery. These include methods that make you feel more comfortable, even if they don’t necessarily have a physiological impact, establishing a ritual for self-care that fosters a sense of autonomy and self-efficacy (often perceived as being proactive), and creating a structured space to focus on rest.
One of the key benefits of recovery modalities is providing athletes with a deliberate way to prioritise recovery.
If there is one thing Christie would tell her younger self, it would be to learn how to listen to her body and pay attention to its signals. Her susceptibility to injuries and overtraining hindered her progress, just as her aerobic capacity, long limbs, and fast response to training aided it.
Instead of ignoring the signs of fatigue or discomfort, she wishes she had taken a break when her body needed it. For too long, her initial reaction was to ignore it and keep pushing. But in reality, what her body needed was rest, even if her mind was resistant to accepting it.