Sunday, June 20, 2010

Under Recovery

My colleague Brian White, a PM&R physician based out of Cooperstown, NY, has an expression that I really like- "There is no such thing as over-training.  It's under-recovery."

Probably the most common sports injuries I see are what I call chronic overuse injuries.  Whether it is patellofemoral syndrome, tibial stress fractures, tennis elbow- all of these are examples of not allowing the body to sufficient time and creating an optimal environment for recovery.

The body needs a few things to recover properly:
1. Rest
2. Nutrients
3. An optimized endocrine environment

Taking these 1 at a time:
1. Rest
These refers to both sleep and muscle recovery.  It's important for athletes to get enough sleep to recover.   There are indicators that let you know you are not getting enough sleep.  One is that you should feel refreshed when you wake up.  The second is that if you wake up with an elevated heart rate, your body is telling you need more time to recover.

Another form of rest is cross-training.  For example, many age-group triathletes need more time to recover between workouts than they did when they are younger.  A good indicator that you are not allowing for optimal recovery is that you feel muscular fatigue at the beginning of your workout.

2. Nutrients
The body needs building blocks to recover.  For muscle in particular, the most important resources are amino acids, which are the building blocks for recovery.

Not all proteins are created equal.  Some are more bioavailable than others.  This will be a separate post in the future, but the general hierarchy is that essential amino acids are better than whey protein, and whey protein is better than soy protein.  The commercial products I generally recommend are Benevia Strength & Energy (, or the Whey Protein formulations available at Sam's Club and Costco (which are high quality and affordable).

3. Endocrine Environment
A growing body of research shows that in order for your body to recover appropriately, you needs hormonal signals to let it know that it is safe to recover.

When the body is breaking down, this is called catabolism.  During times of stress or overwork, the body will break itself down to make sure that building blocks are available in the bloodstream.  When the body is building itself back up, it's called anabolism.

There are 3 common endocrine syndromes I see that inhibit recovery- one in women, another in men, and a third in both sexes.

The endocrine issue that affects women is called the female athlete triad.  Technically, the female athlete triad refers to fractures, absent periods, and an eating disorder, but the way I view it clinically is that the female athlete is not taking in sufficient nutrient content for her caloric expenditure.  Women's bodies are very well calibrated, and the body will not allow itself to have a period unless there are sufficient nutrients to support both the female athlete and a potential baby.  So if you are a female athlete and do not have a regular period, you should have this evaluated by a health professional familiar with the female athlete triad.

The endocrine issue that affects men is hypogonadism.  This under-recognized disorder is when a man's body reduces it's natural production of testosterone because it is under stress.  If you find that you have decreased energy, loss of muscle bulk, difficulty with recovery, it's possible that your testosterone level has dropped in response to the repeated stresses of exercise.  This is especially true if you have a decreased libido, which is more common in hypogonadism than in similar appearing conditions like hypothyroidism and depression.

The final endocrine issue, which can affect both women and men, is Vitamin D deficiency.  The body can get Vitamin D through both diet and sun exposure.  Vitamin D deficiency may be especially common in areas that have lots of cloud cover, including my home town of Pittsburgh.  Therefore, in patients who are not recovering as well as anticipated, Vitamin D deficiency is one of the first things I check for. 

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