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 (www.gobenevia.com), 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. 

The Benefits of Sun

For today's post, I want to write about the benefits of sun. Before I get to that, however, I should probably touch upon the downside of sun.

There are real downsides to sun- mainly skin cancer. I take this seriously.

Back when I was a medical student, and not yet familiarized with death, one of the most traumatic experiences I had was when the young wife of one of my friends, Sabra, was diagnosed with melanoma. She was in her early 20s, and was a wonderful woman. Ever since then, I have been somewhat hypervigilant to the risk of skin cancer.

To that extent, I want to mention a non-profit that was dedicated to Sabra's honor, called Be Sun Sensible.

http://besunsensible.org/

What I would like to discuss, though, is the upside to sun. I think at this point, my perception is that my patients are now more aware of the downside to sun exposure than they are to the upsides.

For example, I have a friend who wears a solar-powered watch. It only requires 7 minutes of sun exposure every 6 months to remain operational, but periodically it stops. That is a pretty vivid example of just how little sun exposure many of us get. As sympathetic as I am to the very real risks associated with excessive sun exposure, we also do need sun.

So, here are some of the benefits of sun:

1. Being active. In my opinion, by far the best reason to have sun exposure is because it gets you outside, and if you are outside, you are more likely to be active, and probably the single biggest thing that most people can do to improve there overall sense of health and well-being is to stay active.

2. Staying happy. One of the unfortunate effects of limited sun exposure is Seasonal Affective Disorder. Our mood is largely regulated by external cues, and one of the most potent of these cues is sun exposure. This is most obviously true in northern regions of the world, where they have very limited sun exposure in the winter months, and entire communities experience the malaise of Seasonal Affective Disorder. I suspect this is much more widespread than is generally appreciated. So 5 minutes of sun exposure daily will probably go a long way in improving your mood.

3. Bone health. One of the main ways the body produces Vitamin D is through sun exposure. This is especially important for females, who are more prone to diseases related to bone metabolism, specifically osteopenia and osteoporosis.

4. Decreasing musculoskeletal pain. One cause of generalized musculoskeletal pain is Vitamin D deficiency. It's something many physicians are not cognizant of, but if you actually check the Vitamin D levels of patients with diffuse pain throughout their muscles, Vitamin D deficiency is surprisingly common. And, as noted above, one of the best ways to increase Vitamin D levels is through sun exposure.

So, having listed some of the benefits of sun exposure above, what is an appropriate approach to staying sun smart and sun healthy. Here are some common sense guidelines:

1. Be active. I think this is by far the most important rule to follow. Try not to let climate deter you from staying active.

2. Don't burn. A significant part of the risk of sun exposure is from burning. So if you are in a situation that will require prolonged sun exposure (e.g., at the beach, a long bike ride, gardening, etc), where the appropriate sunscreens and sun-protective clothing to prevent sun burns.

3. Don't go without sun for prolonged periods. If it's been more than a week since you've seen daylight, that's probably an indication that you need some sun exposure. I am certainly guilty of this- the pressures of work and family sometimes keep us in buildings or cars for more than we may want. But if it's been more than a week, try to find some excuse to get outside for 5 minutes at lunch, just to make sure you get some sun exposure.