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How to Enhance Recovery Beyond Nutrition

Today’s guest post comes from Kamal Patel and the team at Examine.com.  If you haven’t heard of Examine.com just yet, you’ve been missing out!  Examine.com is the web’s best resource for evidence-based information on nutrition and supplementation.  They are completely unbiased and only report on scientific fact, not speculation.  The nutrition and supplement fields are filled with anecdotal information, false beliefs, and downright inaccurate claims about efficacy.  Examine.com helps us sort through what is fact and fiction.  Be sure to check out the special offer from Examine.com at the end of this article.

 

How to Enhance Recovery Beyond Nutrition

Training sounds pretty simple on paper. Just eat right, sleep well, and lift a little bit more weight every workout. But every workout takes place in real life, and real life can make training pretty hard.

To improve at the rate that you read about on internet forums – hitting a 315 pound squat or 225 pound bench press after a year of training – you need to train like an athlete. That doesn’t just mean going to the gym three times a week and downing a protein shake afterward. Optimal training only occurs when daily life doesn’t get in the way.

Training like an athlete while working a full time job or going to school is not easy, but fixing weak points in your habits and lifestyle can help avoid training setbacks and plateaus.

Alleviating Soreness and Joint Pain

Exercise causes muscle and joint pain. The severity of the soreness and how long it takes to recover depends on diet and lifestyle, as well as the kind of exercise performed.

The basics

A high-carbohydrate diet is the first step to alleviating post-workout joint pain. A low-carbohydrate diet, while potentially useful for fat loss, is not ideal for resistance training.

People on a low-carb diet should eat the majority of their carbohydrates in the post-workout period. Going into a workout with low glycogen is not ideal for strength training, but if joint pain is interfering with exercise, fixing the problem should be a priority.

Magnesium deficiencies can also exacerbate joint pain and cause muscle cramping in athletes. The lack of other electrolytes, like potassium, can contribute to pain. Potassium deficiencies must be alleviated through dietary changes, since too much potassium on an empty stomach can cause potentially fatal cardiac arrhythmia.

 

Troubleshooting Joint Pain

If dietary changes don’t alleviate persistent joint pain, anti-inflammatory supplements may be able to help.

Anti-inflammatory supplements are not as potent as pharmaceuticals like aspirin, acetaminophen, and aleve. However, curcumin and fish oil are both used to alleviate joint pain in athletes. Though the research on these two supplements is done in the context of arthritis, the benefits should theoretically extend to athletes as well. More research is needed to confirm this effect.

Cissus quadrangularis can alleviate the joint pain that results from specific injuries. If your post-exercise joint pain has persisted for years, you may want to consider consulting with a physiotherapist.

Do not supplement high amounts of anti-inflammatory supplements to dull injury pain. Continuing to work out after an injury can exacerbate tissue damage and increased recovery time, leading to overuse of pain-reducing supplements and permanent damage.

 

Alleviating Fatigue and Lethargy

There’s nothing like proper rest and nutrition to facilitate training, but sometimes you can’t avoid staying up late to finish a paper or getting up extra-early to beat the boss to the office.

 

The basics

Running a caloric deficit is great for weight loss, but not as great for energy levels. Though some people can go for long periods of time on reduced calories, a crash is inevitable. If your diet is interfering with your daily energy, consider a less drastic deficit.

The occasional all-nighter won’t have a long-term effect on gym performance, but consistently poor sleep will. Aim for six to 10 hours of sleep every night, and make sure your sleep environment doesn’t affect your recovery.

A healthy sleep environment is:

  • A slightly cool room tends to facilitate sleep, while a puddle of sweat is awful to wake up in.
  • Smart phones and tablets just before bed will disrupt melatonin secretion, leading to a more difficult time falling asleep.
  • Ears don’t close like eyes do. Even if you sleep through the night, loud noises can still impair sleep quality.
  • Caffeine-free. Any compounds that impair sleep will lower sleep quality, even for veteran coffee drinkers that can drink a pot of coffee at 8:00 p.m.
  • Where you sleep and how long you sleep for should be the same from night to night.

A good sleep environment actually makes it easier to get out of bed in the morning, since improved sleep quality leaves you feeling more rested.

 

Troubleshooting sleep quality

Some sleep issues can be alleviated through supplementation. People that have issues with sleep latency, meaning they have trouble falling asleep, can supplement melatonin or lemon balm.

Melatonin is a hormone that regulates sleep, but people with no difficulty falling asleep will not experience any further sleep benefits.

Lemon balm is a light sedative used to alleviate intrusive thoughts that can interfere with sleep.

Supplements that improve sleep quality, as opposed to sleep latency, include glycine and lavender.

About three grams of glycine taken thirty minutes before bed will improve sleep quality, but the supplement becomes less effective after prolonged use. To use glycine in the long term, avoid taking it daily.

Lavender, used in aromatherapy, is associated with improved sleep. Rubbing lavender oil on a pillow before bed can also improve sleep, but some people may experience skin irritation due to long-term exposure of skin to oil.

If stress is causing reduced sleep quality or poor sleep latency, supplements called adaptogens can help the body adapt to stress, resulting in fewer stress-related side effects, like fatigue and anxiety.

The most popular adaptogens are ashwagandha, Rhodiola rosea, and Panax ginseng. Ashwagandha is sometimes supplemented by athletes because it may improve cardiovascular performance and muscular strength. Siberian ginseng is another adaptogen option for people that get sick often, though it has very little effect on physical performance.

Breaking through plateaus

There’s a lot of factors to keep track of during long term training. Hitting a plateau can be frustrating because it takes time to isolate the factor responsible.

 

The basics

Daily caloric intake is the biggest influence on physical performance. Carbohydrates are more effective for strength training than fatty acids, but both are necessary for busting through plateaus.

Addressing general energy levels, fatigue, and joint pain is also a vital aspect of breaking through a plateau.

 

Troubleshooting plateaus

Supplements that improve physical performance can be useful for breaking through training plateaus. Creatine is the go-to recommendation, while caffeine (400mg) can be used once or twice a week as a pre-workout supplement.  Please note that although 400 mg is listed as a low dose in some studies, this would be a relatively high dose for someone who is caffeine naive.

There is preliminary evidence that suggests cholinergics like CDP-choline and Alpha-GPC may improve physical performance in a non-stimulatory way, but more research is needed to confirm this effect.

 

Identifying Lifestyle Weaknesses

To facilitate effective training, learn to isolate the weak points in your habits and work to improve them. Start with obvious factors, like staying up too late, and address others as they arise, whether in training, at work, or in life.

 

Examine comKamal Patel is a nutrition researcher with an MPH and MBA from Johns Hopkins University, and is on hiatus from a PhD in nutrition in which he researched the link between diet and chronic pain. He has published peer-reviewed articles on vitamin D and calcium as well as a variety of clinical research topics. Kamal has also been involved in research on fructose and liver health, mindfulness meditation, and nutrition in low income areas.

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Toys, Health and Fitness Books, and Acupuncture

This week’s Stuff You Should Read comes from The New York Times, Nick Grantham, and Greatist.com.

 

ShoulderSeminar.com Update

If you missed it, I announced a huge discount on my 7-week online CEU program for the shoulder at ShoulderSeminar.com.  Sign up by the end of October for a huge $150 off and also get FREE access to RehabWebinars.com.  This is a huge deal on my critically acclaimed program worth 20 CEUs!

 

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Inner Circle Update

This months webinar on my 5 Tips to Enhance Hip Exercises is going to be great tomorrow AM (Friday 9/28/12 at 10:00 EST).  I enjoy this topic and hope these simple little tweaks can help set you apart from the crowd.  The recording will be up in the Inner Circle dashboard if you can’t maker the live event.  I will announce next month’s webinar topic soon, I’m still trying to decide between a few.  Learn more about my Inner Circle here.

 

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RehabWebinars.com Update

Another great topic this week on the Role of Eccentric Exercise by Bob Mangine.  Bob is one of the godfathers of sports medicine in my mind and has been a huge influence on how I think about rehab.  This is a great topic that also discusses a bit of the concept of tendonitis vs. tendinosis that is so important to grasp.  There are a bunch more great topics coming this month, stay tuned!  Learn more about accessing this and all the other webinars at RehabWebinars.com

 

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Acupuncture for Chronic Pain

The New York times published an interesting article about a recent meta analysis published in the Archives of Internal Medicine.  This is a pretty big study funded by the NIH and includes over 18,000 patients.  Interesting results that will surely spark some debate, especially by those interested in the mechanism of pain relief.

 

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Don’t Rely on Toys

Short and sweet one from Nick Grantham, who offers his advice about what equipment you should (or shouldn’t) be spending your cash on.  Well said, Nick.

 

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27 Must Read Health, Fitness, and Nutrition Books

I thought this would be a great topic after discussing on Facebook the recent USA Today report that 36% of USA is obese and on pace to be 50% by 2030.  That is crazy.  Here is a list of good books to get started on America, thanks Greatist.com.

 

Cardio for Fat Loss, Health Benefits of Tea, and Managing Training Stress

This week’s stuff you should read comes from Alwyn Cosgrove, Greatist.com, and T Nation.

 

Inner Circle Update

My next Inner Circle webinar on ‘My Top 5 Tweaks to Enhance Hip Exercises” will be on Friday September 28th at 10:00 AM EST.  Don’t worry if you can’t attend, I will post a recording ASAP, however the more the better for the live webinar, it really enhances the Q&A at the end.  Log in to the Inner Circle dashboard to register for the live webinar or click here to learn more about joining my Inner Circle program.

 

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RehabWebinars.com Update

The new webinar of the week was Strength and Conditioning for Young Athletes by Brandon Beckett, ATC, CSCS and Mike Ryan ATC, CSCS.  Still a ton more coming, making this the most exceptional educational value on the internet!  Learn more about RehabWebinars.com.

 

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How Long Should We Do Cardio For Fat Loss?

Alwyn Cosgrove examines a recent journal article that demonstrated that performing 30 minutes of cardio was more beneficial for weight loss than 60 minutes.  Sure does make you think doesn’t it?  Again, this is a topic that I have talked about from the Abs Diet and why I still think it is a great book.

 

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Health Benefits of Tea

Greatist.com has a nice summary of the many health benefits of drinking tea.  I love their nice website and links to research articles, they do a good job at Greatist.com.

 

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Managing Training Stress

Eric Auciello writes a nice article on T Nation about managing training stress.  This is an often overlooked topic for strength and performance training.  I thought it was nice to see info on this topic.

 

 

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Food as Medicine

Several months ago I was really taken aback by a TED talk by Dr. Terry Wahls, who discussed food and our diet’s role in our health.  Dr. Wahls was diagnosed with multiple sclerosis in 2000 and was soon in a wheelchair.  After years of medication and treatment with minimal improvement, she radically changed her diet in an attempt to give her body the nutrients it needed to help itself.  Within a year she was out of her wheelchair.

Here is a link of here motivating and thought provoking TED talk:

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You can read more about Dr. Terry Wahls at her website.  It goes to show, we really don’t know as much as we think we do about the human body.  How can we go to the gym, workout, and pretend we are being healthy, then grab some food from a box or a bag.

The more I learn about nutrition, they more that I think we need to avoid processed foods as much as possible.  And heck, sometimes we think we are eating healthy when we aren’t!  Core Performance has a nice article on 10 food items that are more processed than you probably realize.  If you eat things from a bag or a box, you are probably not feeding your body as well as possible.

We talk a lot of sports medicine and performance here, but shouldn’t we all be putting our bodies in the best position to succeed?

 

The Use of Glucosamine and Chondroitin Sulfate for Knee Arthritis

A recent review from the January 2009 issue of the Journal of Arthroscopy reviewed the use of glucosamine and chondroitin sulfate for knee osteoarthritis.  Considering the vast amount of people suffering from knee arthritis and the increasing cost of medical care for these patients, the use of any type of supplement to reduce symptoms is welcome.

Research into the efficacy of glucosamine and chondroitin sulfate is certainly not new with studies dating back to 1969.  However, the literature has been filled with many poorly controlled studies, some of which were funded by glucosamine manufacturers!This particular paper reviewed the results of 23 studies that involved double-blind, placebo-controlled, randomized control trials as well as several meta-analyses.

The effectiveness of Glucosamine and Chondroitin Sulfate

The overall results of the review show that there are inconsistent results, but that the results do favor improvement of pain and joint function in patients with arthritis.  The authors also note that one of the most consistent trends between studies involved the length of use of the supplement.  The best results from glucosamine appear to occur after several months of use.  Studies are referenced that show positive results in 3-6 months and even up to 9 months.

In general, if you looked hard enough, you could probably find more articles that say that the use of glucosamine is effective than you could find saying it is not effective.  I realize and agree that there is not overwhelming evidence in support of glucosamine or outlined the exact mechanism of symptom improvement.  However, when we start to run out of options for our patients, I would say there is enough evidence to support it’s use, as long as the supplement is safe.

The Safety of Glucosamine and Chondroitin Sulfate

A potentially more important finding of the current review was that the use of glucosamine and chondroitin sulfate appears to be safe, at least as safe as placebo supplementation.  To me, this is the most important finding for me clinically.  If we are going to recommend the use of a supplement with inconsistent findings, as long as the supplement is safe I have no problem recommending a patient try glucosamine.

Recommended Use of Glucosamine and Chondroitin Sulfate

I have spent a lot of time over the last several years trying to find a consensus statement on the use of glucosamine and chondroitin sulfate.  Unfortunately, this does not appear to exist.  I have taken information from many sources, including the excellent recommendations of noted orthopedist Dr. Frank Noyes of Cincinnati Sports Medicine and information from the Osteoarthritis Research Society International to provide the following information.  I recommend that you read Dr. Noyes’ recommendations, it is a great resource.  Also, realize that you should consult with your own personal physician before taking any supplements and that glucosamine may not be indicated for you personally.  The below information are just basic guidelines for healthcare providers when considering the use of glucosamine:

  • Cosamin DSGlucosamine should be taken with chondroitin sulfate to maximize it’s effectiveness
  • Supplements that include magnesium and vitamin C may help the absorption rate of glucosamine and chondroitin sulfate.
  • To date, the specific brand that has received the highest recommendations appears to be Cosamin DS.
  • Dosage should vary based on body weight:
    • If less than 120 lbs: G 1000mg + CS 800mg
    • Between 120-200 lbs: G 1500mg + CS 1200mg
    • If greater than 200 lbs: G 2000mg + CS 1600mg
  • Supplements should be taken for at least 3 months for noticeable results.  If no response within 6 months, may discontinue.

I have found decent results from the use of glucosamine in my patients, have you?

C VANGSNESSJR, W SPIKER, J ERICKSON (2009). A Review of Evidence-Based Medicine for Glucosamine and Chondroitin Sulfate Use in Knee Osteoarthritis Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25 (1), 86-94 DOI: 10.1016/j.arthro.2008.07.020

Image by scottfeldstein