This article was originally published by FirstEndurance.com here.
I was a triathlete by trade, but was brought up in an environment that was very scientific and physiology-oriented by education. My degree from UC San Diego was in Biology with an emphasis on microbiology.
In other words, I entered the sport of triathlons two years after graduating college with my brain still at least half full of bio-info that before racing seemed to have little relevance to my day-to-day life. I knew about what went on in the body that was smaller than the eye could see, but that in the bigger picture of health we would certainly be able to see the impact of.
One of the most basic concepts that I knew as it related to sports was that we don’t get more fit and stronger from working out directly. We build the adaptations that make us into perfect athletes when we recover from our workouts.
Here’s the interesting part about that. As you know if you read the first piece in this three part series, our body knows where the repair and rebuild processes need to take place because those areas get inflamed. Inflammation is both good and bad, one just needs to learn how and when to manage it. In fact, it is the inflammation in our tired muscles that are the signposts signalling all the repair mechanisms that these are the spots to go to work on. Without the inflammation, the internal repair crew that cruises around inside your body at night while you sleep will keep on moving. It needs inflammation to stop and repair. It’s basic biology. Basic science.
Once the repair is completed the opposite process has to take place. The body needs to reduce its inflammation to signal that the job has been accomplished and the area is ready to function normally again*.
So what’s all the noise about anti-inflammatories?
Are there situations where therapies should be applied that do reduce inflammation?
Is flushing the muscle and generating blood flow the same as anti-inflammatory measures?
Let me take these on one by one.
Without inflammation we don’t get a really good adaptive response in the body. So if you do a stellar strength session in the gym or a long run that leaves your legs feeling pretty torn up, your muscles need to be rebuilt. That process is made possible through the inflammation that takes place in the damaged muscles. It’s natural. It required. Anything that reduces that response is reducing your ultimate adaptation and ultimate fitness gains you can gain from those sessions.
What might inhibit that response? The most common is to take an anti-inflammatory. Another is diet related. If you don’t take in any saturated fats in your diet your body has a harder time creating an inflammatory response**. (NOTE: getting too little saturated fat in one’s diet is something that very few people have a problem with.) A less obvious inhibitor is Vitamin C. We think of this vitamin as doing only good things for our body. But science is beginning to show that large doses of it are anti-inflammatory in nature, which as an athlete means that it could inhibit natural repair and rebuild mechanisms. In a recent 2015 study in the Journal of Sports Sciences, the researchers found that standing or sitting in cold water does not provide benefit in promoting recovery following intermittent sprint exercise.
All that said, there might be times when it is critical to reduce inflammation. When would those be? The main one is anytime you can actually SEE the inflammation and are in need of minimizing or preventing overuse or injury. If your legs feel stuffed the day after a hard long bike, that doesn’t count. But if your knee has blown up like a balloon after a track session that is a critical situation where you can actually see the inflammation and it will be advised to do something to reduce it (ice, anti-inflammatories, etc.).
One of the keys to recovery, and again recovery is the ability to repair damage that occurs during training, is blood flow. The more blood that courses through a particular area during a unit of time, the better chance that the cells are going to be delivered the nutrients they need to rebuild. Inflammation can inhibit blood flow. That is the premise that all anti-inflammatory zealots hang their hat. However, the Holy Grail here is to keep enough inflammation around so that the body’s repair crews knows where to do their work yet at the same time try to increase the speed with which these repair crews gets to the spots in need.
Here in enters a whole new cast of not always clear-cut characters. If you stand in an ice bath after your long run, the cold will indeed cause increased blood flow as a natural response to the temperature differential created between the water and your legs. However, is this going to at the end of the day be more beneficial than just putting your legs up after a workout? Even Dr. Gabe Mirkin, who in 1978 came up with RICE (rest, ice, compression, elevation) as the golden rule for recovery, is now saying that this approach can delay healing. In other words, yes, the legs may feel better sooner due to reduced inflammation, but is this at the expense of better adaptation and full and complete recovery?
And if you have tendon issues, the situation can be even worse. Muscle is red because it has huge blood flow. Tendons are white because they do not have nearly as much access to this precious commodity. That is why when say a swimmer with a huge cardiovascular system enters the sport of triathlons, they more often than not have tendon issues related to injury rather then muscular issues. The tendons and ligaments just take much longer to adapt to impact training than the muscles that are pulling on them. If you compound this lack of blood flow with icing or cold baths, well, not a good idea. Heat those puppies up!
Let’s talk massage for a moment.
Blood flow is critical for recovery and repair. Inflammation is an essential ingredient. So what will work to improve blood flow without reducing inflammation? Massage! This practice is an art and not all massage therapists will understand how to apply their profession based on an athlete’s immediate recovery needs. But it is a great modality, if you are looking for one, to help increase the speed of recovery. A massage therapist if they are not working too deeply can flush muscles of EXCESS inflammation, yet improve blood flow via the application of external flushing. And I highlighted EXCESS inflammation because if you did something extreme like an ultra run or an Ironman, your legs will probably look like balloons. That will slow recovery until you get the fluid out. But for general weekly training, this is a great solution. (Side note: I found an easy 1,000-2,000 in the pool after a hard sessions that used your legs is a great way to also get the flushing and speed recovery.)
What about compression? It’s the craze. I don’t want to comment on whether it will improve your race times during competition. But there seems to be clear science that suggests that wearing compression tights between workouts day to day can get about a 1.2% improvement in workout effort in the day following a strong workout. I am not suggesting what that mechanism for improvement is. Some say it helps to restock muscles with essential carbs. Another hypothesis is that the compression gear helps clear metabolic waste. But neither concept is suggestion that it reduced inflammation.
Here are my nuts and bolts. I won 6 Ironman Hawaii World Championship titles. None of those were won while taking anti-inflammatories. None were won by doing religious icing or by standing in a cold river after rigorous training. All were achieved by addressing the real world amount of time it takes to recover from extreme training. And when my knee looked like a balloon…I took time off! GREAT!
*Unsaturated oils such as omega-3 and omega-6 oils are necessary to reduce inflammation. Omega-6 oils generally are found in plant sources (like canola oil, safflower oil, soy oil) and the omega-3 oils from cold-water fish and in beans and walnuts. It should be noted that even though omega-6 oils are unsaturated and anti-inflammatory in nature, if someone is under stress a huge portion of those oils will be turned into saturated fats in the body. So it is generally best to not have a large percentage of oils come from omega-6 sources. Olive oil is the most stable in the body of the unsaturated oils, and generally is the healthiest.
**Saturated fats are necessary to increase inflammation. Saturated fats are generally found in meats, dairy products, and some plant sources.