Category — Research Review

Pain is a rather complex event that is perceived in the brain through a variety of inputs coming from both the internal and external environment. It does not happen in isolation as many commonly think, rather, it is composed of many variables and has a strong psychological component, so much so that there can even be a perception of pain/threat without any nociceptive input.

Training can oftentimes lead to delayed-onset of muscle soreness (DOMS) which is an increased amount of muscular pain and soreness lasting anywhere form 12-48hrs following a bout of new, unfamiliar, or overly strenuous exercise. DOMS can often lead to impairments in performance as the intense amount of soreness causes the athlete to decrease their muscular output in an effort to prevent painful sensation. Additionally, there is a strong psychological component attached to this scenario in the form of fear-avoidance.

Fear-avoidance may explain why some athletes develop chronic pain conditions following musculoskeletal injuries. The fear-avoidance model works in the following way:

• Injury leads to disability and a functional limitation
• This limitation is followed by a cycle of increased pain interpretation and hypervigilence to pain sensation
• Due to the increased pain sensation the athlete may begin to avoid activities that they fear will cause them more pain, ultimately leading to an inability to regain function and return to competitive form in a healthy manner (both physically and psychologically)

A recent study published in the journal Pain, by Trost, et al., set out to examine the relationship between pain-related fear and physical performance utilizing a DOMS protocol for the trunk extensors in healthy subjects.

The subjects, thirty in all (16 male/14 female) ages 18-24, were healthy, free of back pain, and were not currently engaged in a low-back resistance training program (to ensure that the DOMS protocol would be sufficient).

A variety of questionnaires were used at both baseline and post exercise (24hrs later) to determine the effect that the exercise program had on the subjects psychological state, muscular strength, and impairments in daily activities.

Baseline strength was conducted on a back exercise machine in the form of 3 maximum isometric back extensions.  The DOMS protocol was conducted on the same machine where the subjects performed 25 repetitions of eccentric back extension (rep tempo = 4 seconds per repetition) with a load of 75% of their peak extensor performance.

Twenty-four hours following the exercise program the subjects returned to the lab to re-test their back extension strength and fill out the questionnaires again.

The researchers reported that following the exercise induced DOMS, pain-related fear was predictive of perceived disability.  Additionally, pain-related fear was able to predict decreases in muscular performance.  These findings led the researchers’ to state that “pain-related fear is associated with perceived disability at an early stage of injury.”  Finally, two of the key points the researchers made in the paper were that:

1. “Avoidant behavior patterns among high fear individuals may persist even in the absence of initially triggering pain stimuli, setting the stage for a range of potentially deleterious physical and psychosocial consequences.”

 

2. “Following DOMS induction, higher fear participants may be hypervigilant to pain sensations and may experience difficulty disengaging or using cognitive strategies to cope with pain or distressing pain cognitions.”

Wrapping up

As stated earlier, pain is highly complex and it is something that athletes deal with throughout their competitive career.  Many things can influence threat perception and pain and as strength coaches or therapists, we should be aware of these influence to ensure that we meet the athlete’s individual needs and help them perform to their highest abilities.

This study was conducted on healthy subjects who are were not elite level athletes (or athletes at all), however, it does give a glimpse into the psychological and physiological aspects of pain and fear-avoidance, which are often overlooked in athletes who are in pain as many tend to only focus on the functional limitations the athlete is displaying following injury or pain.  While returning the athlete back to function and ensuring they can meet the physiological demands of their sport is critical, we should also take into consideration the entire person and be aware of their psychological state and perceptions.

Patrick

patrick@optimumsportsperformance.com

Reference

Trost Z, France CR, Thomas, JS. Pain-related fear avoidance of physical exertion following delayed-onset muscle soreness. Pain 2011; 152: 1540-1547.

Recovery is an important component of any good training program given the fact that if you can’t recover from the training stress you won’t be able to make any progress (in fact you will more than likely begin to slide backward).

Thus, athletes have sought out various recovery strategies to help improve their ability to adapt to the training load and one such method that has been proposed in the past has been stretching regimens (Siff, 2003).

Of course stretching has come under a lot of fire over the years:

• “Should I stretch before or after training?”
• “Does stretching decrease power?”
• “Does stretching really improve muscle length?”
• “Can stretching really help stave off injuries?”

While these are all good questions, I think one component that is not addressed with any of them is the potential role that stretching may play in relaxation and recovery.  Perhaps, instead of focusing on what stretching does or does not do to our power output or our muscles, we can look to various stretching programs as a method to aid the athlete in getting into a more relaxed stated, performing these stretching programs later in the day, maybe several hours after training or near bed time, or on a separate day when the goal of training is to recover from harder training sessions the day(s) prior.  Anecdotally, some athletes feel more rested following a short stretching program; however, I will say that the coach should determine what the athlete should be stretching and setting the ground rules for how long each stretch should be held, sets, reps, etc, instead of just letting them do whatever they want.

A recent study published in the Journal of Strength and Conditioning Research by Fariatti et al (2011) evaluated the response that stretching had on Heart Rate Variability (HRV) in subjects with low flexibility. 

Note: I have talked about HRV in a few previous blog posts - Using Heart Rate Variability to Measure Stress: There’s an app for that! and Massage, Stress, and HRV.

What They Did And What They Found

The authors took 10 male subjects, approximately 23yrs of age, who had at least 1yr of strength training background, and had low flexibility (classified in percentiles 10-40 on the sit-and-reach test according to the ACSM standards).

During the study the subjects performed three stretches – right hurdler stretch, left hurdler stretch, and butterfly stretch – each held for 30sec at maximum end range, with 30sec rest between sets, for 3 sets, and one minute rest between each exercise.  The total session lasted approximately 10min.

The heart rate of the subjects was recorded for 30min. before the stretch program, during the stretching program, and for 30min. after the stretching program.  To evaluate HRV changes, the last 10min. of each testing period (pre, during, post) were used to for this measurement.

The subjects had increased their heart rate during the stretching session; however, their heart rate did decline during the recovery period to a value significantly lower than their pre-exercise heart rate.

The researchers also found that the 10min. stretching sessionincreased post exercise vagal tone, as evident by a decrease in low frequency to high frequency power during the recovery period following its increase during the stretching session (although it was still higher than it was at rest, during the pre-stretching session).  Thus parasympathetic activity improved (HRV improved).  This paper was in agreement with a previous paper that the authors cited, showing increases in HRV following a 15min. stretching routine performed by athletes over a 28 day period.

One of the unfortunate things was that the study did not include a control group.  For example, what would the HRV and heart rate response been for a group of low-flexibility individuals who lied on a table for 70min. during the entire testing and stretching session period?  Additionally, what would have been the results of the study if the subjects had been individuals with adequate flexibility?  Would there have been the same changes in heart rate and HRV?  What if the subjects were high level athletes?  Of course these are all things that will hopefully be looked at in future studies; however, I think this information might be a good start in helping us formulate more ideas to assist athletes in recovering from hard training sessions or competition.

Practical Application

As stated earlier in this post, recovery modalities can be utilized following training (commonly a brief period after training or even later in the day, as a second session) or on the day following a hard training session.

About 6 or 7 years ago, when I realized that I couldn’t kill myself in the gym every single day, I purchased the book Real Men Do Yoga: 21 star athletes reveal their secrets for strength, flexibility, and peak performance by John Capouya.  I figured it would be a good idea to supplement my training with some sort of flexibility regimen.  Slowly, over the years, the book worked its way to the bottom of a large pile of other books, and I forgot about it, until I read this paper and decided to pull it out.  However, one of the limitations of yoga is that taking a large class at a gym/fitness facility usually has some drawbacks. 

First, the stretches being performed are not specific to you and your needs.  They are just a sequence that teacher tends to favor, so perhaps, specific limitations that you bring to the table may hinder your ability to perform some of these movements or potentially cause you injury. 

Second, it is hard to get help or instruction when you are in a large group like that; as the teacher is commonly in the front of the room and the first few rows of the class are dominated by the women who take the class 10 times a week and can perform every pose perfectly.  Those of us who are not as flexible or who lack competency in the poses tend to move towards the back of the room where we will be less embarrassed or feel like we are less in the way.

Finally, the teacher dictates the flow of the class and there are many forms of yoga.  If you are attempting to recover from hard training, it may be difficult to locate a class or teacher that understands those needs and the class may be more aggressive than what you really need.

What to do?!?!

I think the best thing you can do is find a coach/trainer that can assess your needs, assess your training program, and prescribe some things that you can do to help improve your mobility and in a sequence that is rather slow and controlled so that it can be performed on days in between hard training or later in the day following training to perhaps reap some of the benefits that the above paper is suggesting (improved parasympathetic state, decreased resting heart rate, etc).

One of the things that the book Real Men Do Yoga has is various stretching schemes which flow from one stretch to the next, which may be of value, and of course you can swap some of the stretches in these schemes that don’t fit into your needs for stretches that do.  When I look at some of these schemes, I am reminded of some of the mobility schemes that Gray Cook lays out in his book Athletic Body In Balance.  There ar a lot of similarities between these two books with regard to the movement sequences.  This is one of the reasons why I have often recommended to various yoga practitioners that they take the Functional Movement Screen course, to help drive their stretching routines for their clients.

Conclusion

Recovery is an important component of sports conditioning.  Stretching routines may be one aspect that can aid an athlete in getting into a more relaxed/parasympathetic state.

Before just going out and stretching, try and find a training, therapist, or yoga practitioner who understands assessment and can individualize a mobility/flexibility scheme to your needs.

Patrick
patrick@optimumsportsperformance.com

Massage can be thought of as a modality to help an individual relax and recover from competition or training. For this reason, it is commonly not a chosen modality to be used prior to competition, at a time when you want to be fully warmed up, the nervous system primed to compete, and in a more sympathetic state.

That being said, at the most recent Olympic Games in Bejing, Dara Torres, and other Olympic athletes, were shown on the massage table getting worked on – many times in the form of vigorous shaking and kneading type techniques – literally moments before heading out to competition. While the “shaking” and “kneading” techniques are more aggressive and thought to excite the nervous system more than “gliding” or “compression” techniques, what benefit might this serve?

A 2010 study in the Journal of Strength and Conditioning Research (Fletcher) on the effects of pre-comeptition on 20-meter sprint performance looked at the differences between those in a normal warm up group, a massage plus normal warm up group, and a massage only group. The massage only group – receiving a 9-minute massage consisting ‘superficial’ and ‘fast’ massage techniques – was shown to have slower times than the other two groups. The massage combined with normal warm up group did not out perform the normal warm up group, however they did not under perform them either. The author concluded that massage alone has a decrease on 20-meter sprint performance, although when combined with a normal warm up, massage does not appear to improve performance greater than a normal warm up alone.

More recently (2011) Arroyo-Morales published a paper looking at pre-event massage prior to isokinetic testing. As to be expected, the massage, which consisted of a variety of different techniques over a 20min. period, negatively affected muscle performance. The authors felt that this negative affect on performance was brought on by a greater shift towards a parasympathetic state following the massage, as the subjects saw increases in salivary flow rate, a decreased in tension sub-scale on a Profile of Mood States questionnaire, and decreased afferent input which lead to decreased motor unit activity.

This shift towards a parasympathetic state, while not necessarily what we are looking for prior to performance, is one beneficial aspect of massage post-competition, when you are attempting to influence the athletes rate of recovery.

Practical Application

So were do we go from here?

First, from the two papers above, it would appear that the length of the pre-competition massage and what sort of warm up (if any) is performed following the massage plays a role in what sort of response the athlete may see. In the first paper by Fletcher, the short duration followed by a normal warm up appeared to have a similar training effect to that of the group who performed only a warm up.  In the second study (Arroyo-Morales, et al) the length of the massage was 20min. which would probably cause the athlete to get more comfortable and more relaxed, ultimately having an effect on parasympathetic function and performance.

Second, the effects that massage has on parasympathetic function are important, and while a shift towards a more parasympathetic state is not exactly the goal of pre-event massage, I think that Arroyo-Morales’ paper shows some potential benefit for massage in general.  A key point to make here is the element of human touch.  In that paper, the placebo trial was a sham-ultrasound for 20min.  So, one would think that lying on table for 20min. getting placebo ultrasound would have a similar effect as a 20min. massage however it did not.  The human touch and interpersonal relationship between the therapist and the client appear to have a greater impact on relaxation and a movement towards a parasympathetic state.

Finally, while massage did show a decrease in performance, Arroyo-Morales et al, did discuss the potential benefit that this sort of work may have for athletes who are over anxious and overly excited prior to competition.  In the paper they talked specifically about how this can be the case in athletes who compete in single person events (IE, swimming, track and field, tennis, etc) rather than a team sport.  However, I would think that the same sort of idea could be applied to team sport athletes who suffer high amounts of performance anxiety.  They felt that in an athlete who is overly sympathetic before competition may benefit from some manual contact to help bring them back to a more relaxed state.

Conclusion

Pre-event massage appears to have a negative impact on performance, however, in certain instances it may serve a purpose (IE, calming an over anxious athlete prior to competition). Additionally, when followed by an active/dynamic warm up, which primes the nervous system, it appears that the “relaxing effects” of pre-event massage are minimal if not completely diminished – similar to how stretching pre-event is not as problematic when followed by a more dynamic warm up.

Another thing that I am sure will come up is, “What about foam rollering pre-competition”?  Again, I think this is similar to stretching or massage pre-event in that I would expect to see a more normal performance when followed with a dynamic warm up.  However, one thing I do often think about when it comes to foam rollers, is that there is no human contact.  Since you are using an implement, you are removing the interpersonal relationship between the therapist and the client and you are taking away human touch.  So I wonder if the psychophysiological results would be as powerful/beneficial?

Lastly, an important thing to keep in mind is that each athlete is different both psychologically and physiologically.  If they perceive something to be of benefit prior to competition, provided that it is not something which will harm them in anyway, then it should be considered in the pre-competition preparation, as the power of the mind can have a great effect on performance.

Patrick
patrick@optimumsportsperformance.com

I have another review up at Fitness Research Review Website for those interested:

The Relationship Between Forward Scapular Posture and Posterior Shoulder Tightness Among Baseball Players

Laudner KG, Moline MT, Meister K, American Journal of Sports Medicine 2010 (in press)

Some of the pertinent findings:

 - The dominant shoulder of both pitchers and position players were significantly forward compared to the nondominant shoulder.

- There is a relationship between posterior shoulder tightness, as measured by glenohumeral adduction, and forward scapular positioning.

- There was a negative relationship between glenohumeral adduction and forward scapular position. Those with greater posterior shoulder tightness had greater forward scapular position than those with less posterior shoulder tightness. 

- No significant relationships were found between scapular posture and glenohumeral internal or external rotation.

- Differences in internal and external glenohumeral rotation were noted between dominant and nondominant shoulders, with a tendency towards greater external rotation and decreased internal rotation in the dominant shoulder. However, the total arc of motion between the two arms was similar. These findings are consistent with other findings on baseball athletes (6).

If you would like to read the rest of the review, including some practical applications of how we can use the information in this paper to help us better prepare athletes, please log onto Fitness Research Review Website.

Patrick
patrick@optimumsportsperformance.com

I just wanted to let everyone know that my latest research review is up at Fitness Research Review Service on the topic of precompetition massage sprint performance (Fletcher IM., The Effects of Precompetition Massage on the Kinematic Parameters of 20-M Sprint Performance. Journal of Strength & Conditioning Research 2010; 24(5): 1179-1183.).  Here is a little information that I talk about in the review:

Intro

Proper warm up is important to training and competition and with so many differing opinions on appropriate warm up protocol, it makes this topic a highly debated one. Stretching and foam rolling have found their way into the warm up of many athletes despite the potential for these modalities to lower power output and performance (1,2,4). Decreased neurological output is one of the reasons cited as a factor of strength and power attenuation following a stretching or massage protocol during the warm up period (1-4). However, a few recent studies have indicated that this negative effect may be mitigated when stretching or massage are followed by a more neurologically active dynamic warm up (1,3). This study sought to test the result of three different warm up strategies – pre-event massage, traditional warm up, or pre-event massage combined with traditional warm up – on 20-m sprint times in college athletes.

Key Findings

• All subjects performed their slowest sprint times following the pre-event massage only condition.

 

• Traditional warm up alone led to a 2.74% decrease in sprint times compared to pre-event massage. This finding was significant.

 

• Compared to pre-event massage only group, there was a significant (2.44%) decrease in sprint time for the pre-event massage combined with warm up group.

 

• The difference between the warm up group and the pre-event massage combined with warm up group was not significant.

To read more of my review and the practical applications that I give, please log onto Fitness Research Review Service.

Patrick
patrick@optimumsportsperformance.com