Professional triathlete Dr Hannah Wells says sleep and good nutrition are key to recovering from intense training and races. Photo / George Novak
Recovering from sports training and events used to be simple: drink water, eat food, stretch, sleep.
Today, recovery is a growing business sector estimated at hundreds of millions of dollars worldwide.
With so many options, it's easy to spend time and money on products and activities whose benefits are unclear.
What works? What doesn't?
Bay of Plenty Times Weekend reporter Dawn Picken talked to locals buying into and benefiting from the business of recovery.
Hannah Wells shows us a small slice of her training programme while running on a treadmill at The University of Waikato Adams Centre for High Performance in Mount Maunganui.
Music blares at live concert volumes as a half-dozen other athletes lift weights or ride exercise bikes, Wells pounds the deck, pumping muscled arms and legs.
The Tauranga 28-year-old won Challenge Wanaka earlier this month and took first at the Tauranga Half Ironman in January.
These days, the professional triathlete is tapering from high-intensity training after seven months of building towards peak performance. Her competition calendar is clear for several months.
"Last week was the biggest recovery week I've had in a long time," Wells said.
"I was just swimming, but that's very unusual. I had quite a big season. It started at the end of August, training solidly all the way through to Challenge Wanaka."
After exercise and events, Wells focuses on nutrition.
"I get a good meal in with plenty of protein, recovery smoothie or eggs."
She stretches her muscles and uses a foam roller several times per week. She gets massages, uses the sauna at the gym and once tried cupping at the suggestion of her physiotherapist.
"Everyone is different, and different things work for different people."
The market for recovery has exploded the past few years.
No longer is it enough to stretch your hamstrings after a run or rugby training, you can now roll, freeze, shock and squeeze your way to supposed wellbeing.
Other gadgets such as Halo Sport headphones (which fire a mild electrical current to the brain) and the HyperVolt portable massage device (resembles a gun and uses a strong percussive force on the muscle to increase blood flow) are designed to improve performance and recovery - for a price.
A new set of Halos costs around $430 NZD; the HyperVolt, about $500 (both available from overseas websites).
Much cheaper: foam rollers, sold in New Zealand starting around $12.
A Google search on "foam rolling" produces about 74 million results.
Tutorials on YouTube show people using their own body weight to press into soft tissue.
The goal is to increase flexibility, reduce soreness, and eliminate muscle knots. Rolling is meant to be uncomfortable but not painful, according to physiotherapists and sports scientists. Other products for applying gentle sustained pressure into connective tissue include massage rollers, typically applied against a soft tissue with the upper extremities, and tennis balls.
Does it work? A study cited in UK publication The Conversation last year found volunteers engaged in foam rolling for research at the University of Stirling were better able to perform leg extensions than those who did not foam roll each day.
The article states, "Foam rolling has also shown promise as a way of recovering from exercise, by reducing muscle soreness."
Previous studies have shown foam rolling has no negative effect on athletic performance short-term, though researchers can't say for sure it has no long-term effects.
Also, experts said there's not enough evidence to say how best to use foam rollers. When in doubt, keep sessions short.
Samantha Sinclair has just driven home to Cambridge from Rotorua when we talk on the phone.
The Silver Fern and Waikato Bay of Plenty Magic midcourter has just played back-to-back games in Hamilton, the last one Monday night.
Her voice is scratchy and she's recovering from a cold. Despite this, she'll train again about an hour after we speak.
"I think we're on the bikes today and not on our feet so it will be quite nice."
Sinclair trains about 11 hours each week. Immediately afterwards, the team warms down with walking and static stretching. After a game, the women take an ice bath.
"A big reason for us is because often we play late at night. The adrenaline is pumping so we need to cool our core temperature so we can go sleep better."
She has protein and carbs after exercise. Her post-game drink of choice is milk. She said the team has a 100-point recovery list to complete within 48 hours after a game. Sleep counts as 20 points. Massage, swimming, foam rolling, stretching and wearing compression garments are also on the list.
"The big two are sleep and nutrition."
Sinclair aims for nine hours of sleep each night.
Sinclair said the weirdest recovery activity she ever tried was a vacuum-like device that sucked skin.
"It brought up bruises. It's meant to get out the bad stuff, but I felt nauseous immediately afterwards and haven't done it again since then."
She said one recovery activity won't heal your body; it's about getting the right combination for the right person.
Centres devoted to healing sore muscles and improving performance have sprouted in America with names like Pure Sports Recovery.
Auckland has at least one such facility called Athlete Recovery Lounge. It offers 24-hour access to members who pay a $25 weekly fee, or more limited hours for casual users for $30 per visit.
Amenities include a seven-seat spa; cryotherapy pool that can be set at low as 5 degrees Celsius; compression boots and arm sleeves; cold and foam rollers plus yoga mats and massage sticks. Physiotherapy and massage are available by appointment.
Bay of Plenty gyms and health clubs are equipped with rollers and yoga balls, while some add spa pools and saunas. Locally, athletes can also float in Epsom salt and water ($65 for 45 minutes at Zen Float); or use a hyperbaric oxygen therapy chamber ($85 for a 90-minute session at Pure O2).
Residents of most neighbourhoods in Tauranga have multiple options for massage therapists and physiotherapists. Acupuncture, acupressure, cupping and other therapies are available in the Bay, too.
Tauranga elite triathlete Brad Dixon owns a coaching and physiotherapy business called Everfit.
He teaches clients about what he calls "big rocks" of recovery: warming down, foam rolling plus gentle stretching, proper nutrition, hydration and sleep.
Dixon said too many athletes skip warm-downs like a gentle jog or cycle following intense training or racing.
Some don't stretch properly, pushing past 2 or 3 out of 10 on a pain scale.
"You create more damage. A lot of athletes are quite pain-tolerant and think any pain is good. I think pain is the enemy."
Dixon said sleep is the greatest, most underutilised performance booster.
"There's plenty of studies that show sleep is as good as EPO, the performance-enhancing drug."
Another mistake Dixon sees is people rewarding themselves with poor-quality food and too much alcohol.
"They really undo the good work of a session. You have to start questioning yourself, why are you doing it?"
The coach embraces a whole-food, plant-based diet.
As for pricey gadgets, services, pills and potions, Dixon said free and simple is best.
"I get really annoyed with people paying big money for these little pills and electrotherapy modality, all this stuff. If you just sleep, eat well, drink lots of water and warm down properly that's probably 90 per cent of it. There's no money to be made out of that, so there's no marketing for them."
Tauranga registered nutritionist Danelle Stevens said nutrition is individual, based on type and intensity of exercise and personal preferences and tolerances.
"Sports nutrition for females should also be matched to their menstrual cycle as hormonal changes over the month influence the types of fuel used, acua te recovery needs and metabolic rate."
Stevens, performance nutritionist for the Bay of Plenty Rugby Union and a trained diabetes educator, recommends refuelling with protein and carbohydrate following intense exercise longer than one hour.
She called milk a "near-perfect recovery drink" for prolonged or high intensity exercise, or exercise in hot conditions because it helps glycogen replenishment, muscle building and rehydration. But for events or training less than one hour, she said water is enough.
Consumers worldwide spend billions of dollars on beverages marketed as sports drinks, many of which are loaded with sugar.
Stevens said an isotonic sports drink [like Gatorade], which contains fluids, electrolytes and 6 to 8 per cent carbohydrates would benefit performance for events of moderate to high intensity longer than one hour.
"Electrolyte drinks are also suitable for those with high sweat rates. They are not appropriate for children."
She said some sports drinks are too low in sodium and their sugar concentration can cause gastric distress. Other issues include taking in too many extra calories and fluid retention if a drink contains too much sodium.
Mount Maunganui-based R-Line beverages are available online and at sporting events nationwide.
Company founder Phill Dromgool told the Bay of Plenty Times Weekend his drinks have the highest total electrolyte content of any product on the market.
R-Line's guava flavour has 28 grams of sugar per 500 millilitres, compared to 34 grams of sugar for the same amount of Powerade.
"We're a lot less sweet than a lot of other brands," said Dromgool.
In her new book, Good to Go: What the Athlete in All of Us Can Learn from the Strange Science of Recovery health journalist Christie Aschwanden writes athletes should be more concerned about overhydration - taking in so much fluid that blood sodium concentrations drop dangerously low.
"There's never been a case of a runner dying of dehydration on a marathon course," Aschwanden writes, "but since 1993, at least five marathoners have died from hyponatremia [overhydration] they developed during a race."
Many runners use ibuprofin - a non-steroidal anti-inflammatory before a race to try to stave off inflammation and pain.
Wells said it's not for her.
"It's bad for your stomach, so I wouldn't try it."
Other athletes take ibuprofen to try to alleviate delayed onset muscle soreness, or DOMS, muscle pain and weakness that starts up to a day after exercise.
A 2003 review about DOMS cited on the website painscience.com concluded, "Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms."
Other unconvincing treatments, based on studies, include light exercise, glutamine and arginine supplements, stretching, icing (which is possibly harmful, according to studies), Epsom salts, drinking extra water, cherry juice, compression garments, massage and vitamin D supplementation.
The article states, "Generally speaking, there is a broad consensus that nothing really decisively helps DOMS, and the best way to prevent it is … just get it over with."
Back to what some call Vitamin I: painscience.com reports ibuprofen and other anti-inflammatory drugs have been shown to modestly reduce the pain of DOMS, but don't help reduce muscle weakness.
A 2006 study comparing pain and inflammation in runners who took ibuprofen during an ultramarathon (beyond 42.2 kilometres) with those who took a placebo showed the medication failed to reduce muscle pain or soreness. Blood tests revealed ibuprofen takers experienced greater levels of inflammation than those who didn't get the drug.
As for anti-inflammatory rubs and creams? Studies show they may be mostly ineffective, especially on big muscles, since the drug can't be absorbed into deep enough tissue.
A study published by researchers at the University of Auckland in 2017 found ice baths do nothing to help muscle recovery after exercise.
AUT Professor David Cameron-Smith said, "Our study found ice baths are no more beneficial than a simple low intensity warm-down at reducing inflammation and muscle damage after intense exercise".
Professor Cameron-Smith said some evidence suggests ice baths may be helpful in endurance training, and for tendon and ligament injuries.
"If you have a quick turnaround between games or events, ice baths may be useful to help you relax and provide short-term relief to muscle pain, but they're not going to reduce inflammation and will be detrimental to building muscle in the long run," he says.
"Apart from times when you need a quick wind-down, our advice would be drop them."
A 2016 University of Waikato study of 60 elite athletes found floating in a warm, saline-dense water tank for 45 minutes after training enhanced mood and reduced perceived muscle soreness, based on questionnaire results.
The authors stated, "FLOAT may be an effective tool for both physical and psychological recovery following training in elite athletes. Furthermore, napping in combination with FLOAT may provide additional benefits to enhance certain mood-state variables."
While some health claims made by flotation pod businesses have yet to be scientifically proven, studies using MRI scans have shown floating seems to quiet activity in the brain's centre of fear and anxiety.
Black Ferns Sevens captain and Bay resident Sarah Hirini said she floats once a week when she's in New Zealand at Zen Float in Mount Maunganui.
She told the Bay of Plenty Times Weekend she's been using floatation to overcome jet lag, give herself a mental break and improve muscle recovery.
She said she usually floats Thursday following three days of back-to-back training.
"My body has had it at this stage but after a float I feel so much better and can get more out of training on Friday and Saturday."
Hannah Wells said sleep is one of her best recovery strategies, and she doesn't need a gadget to do it.
"I'm pretty good with my sleep. If I wasn't so good then probably a sleep tracker app would be worthwhile."
Wells plans a break from official events the next few months, but will do a 550-kilometre relay through the desert from Los Angeles to Las Vegas called The Speed Project at the end of March.
"It's just a bit of fun with friends."
She said it's important her calendar includes peak periods and recovery time, during which her brain gets a break, too.
"Forcing yourself to work really hard day after day is fine for a certain amount of time. But after a while it gets pretty mentally taxing. It's probably just as important to have a mental break as well as physical, to step away from training and really freshen up."
Like Wells, Sam Sinclair said a favourite way to care for her body and mind costs nothing.
"That's my other recovery, actually, getting home to Rotorua with my family. A home-cooked meal from mum, nothing beats that."
Breakfast options include:
*muesli or oats with fruit and natural or Greek yoghurt with a high protein content.
*eggs on multigrain toast with added vegetables such as tomatoes, mushrooms or spinach.
*a serving of healthy fats from salmon or avocado.
Lunch:
*chicken and lentil or chickpea salads.
*baked potato with tuna and a side salad.
*wholegrain pita, wrap or sandwiches with a serving of protein (chicken, red meat or fish).
*salad vegetables and with a spread of healthy fats such as hummus.
*Add a serving of fruit for additional carbohydrate, fibre, vitamins and minerals.
Dinner:
*protein, either from animal or plant sources such as tofu or tempeh.
*Stir fry meals with colourful vegetables and an appropriate serving of wholegrain rice.
*Salads including those made from a base of buckwheat, quinoa or barley, mixed with vegetables.
Outside mealtime:
*Homemade smoothie with milk, yoghurt, oats and fruit.
*Creamed rice or yoghurts with a piece of fruit.
*Egg sandwiches.
*Tin of tuna or salmon and crackers.
From Danelle Stevens, registered Tauranga nutritionist
Jefferies and family will enjoy a leg of lamb with summer sides.