Some thoughts about passive recovery methods

I was inspired to write this blog after a conversation on a hike today. We like to exercise and educate! The gist of the question was about the efficacy of passive recovery modalities like massage. Passive recovery modalities include anything where something is being done to you. This includes massage, cupping, Estim, cryotherapy etc. 

The research generally dictates that the best forms of recovery are adequate sleep, proper nutrition, load/stress management and active recovery. There is little support for passive modalities such as massage, cupping, E-stim, cryotherapy etc. Despite what the research says, people still use these modalities in an attempt to enhance recovery. We see it all the time with our favorite athletes using XYZ to get back on the field or platform. Athletes may choose certain modalities because it makes them feel good or they think it's going to work which does hold some weight. However, many times specific passive modalities are touted as THE MUST DO for your next session to be your best session.

If you know the research and still want to spend your money, that's fine. But think about this first: Recovery from exercise is an internal biochemical process so how would external modalities assist in that? During recovery from exercise, the body will replenish depleted stores like glycogen, metabolites and water, remove metabolic waste products, repair tissues, reduce inflammation etc. You may be thinking that massage or other recovery modalities increase blood flow which can help remove metabolites but this isn't necessarily the case. If massage does increase blood flow, it is very superficial and wouldn't be to a greater level than gentle exercise like walking or cycling. Cryotherapy is a newer form of recovery but it also has not been substantiated in the research. We have long thought that reducing inflammation will enhance recovery but it may have the opposite effect and slow down recovery. The inflammation is there for a reason and it doesn't seem to be the best idea to get rid of it prematurely.

Many of these modalities seem to be effective in reducing the perception of soreness and fatigue but without any changes in performance measures. Does this mean that when we feel less sore and tired, that we can perform harder on our next session even if we may not be recovered at the tissue level? I don't know, maybe. Maybe not. I do know that the psychological aspect of treatment, exercise and recovery are big factors and can influence our perceptions and expectations of what a treatment/recovery modality will do. As a clinicians, we are must inform our patients/clients of the risks, benefits, and alternatives to our chosen treatments. I also think it's important to inform the patient/client on the current research of said treatment so they can make a completely informed decision about their care. I have found that many times patients/clients don't care what the research says as long as they like the modality and it makes them feel better. I'm ok with that as long as they are aware of what's going on. There are some that will choose not to have the treatment which is also fine. 

A substantial benefit of passive modalities like massage could be a reduction in stress levels. High stress levels will affect our ability to recover and also our pain experiences. Some basic benefits of massage (or other passive modalities) are relaxation, a time for self care (which we don't do enough of) and massages just make you feel good. All of these benefits can lower your stress levels because you aren't stressed when you are relaxed! There is also the positive impact of a caring touch.  

If you like your chosen recovery treatment because of all these perceived benefits, then do it, for these reasons, not some magical recovery benefit that doesn't exist. If you prefer to take a nap, take a nap. Read. Go for a walk. Talk to a friend. Watch your favorite show. Do whatever it is that decreases your stress levels but don't feel obligated to spend money on unproven treatments because you think they are going to help your recovery for XYZ reason. If your sleep, nutrition, programming, stress levels and active recovery are on point then these other passive modalities will probably help you very little aside from potentially reducing stress levels.

In summary, if it makes you feel good, you think it will help and believe in it, it will probably have psychological effects which may or may not translate into physiological effects. If you think your chosen form of passive recovery have all these fancy effects on the recovery process, they probably don't and you can save your money and put your energy into sleep, nutrition, programming, stress levels and active recovery. 

Kelley Henry