afsupplements yamamoto allnutrition sfd iafstore atlhetica alldeynn blog Is there a best training for hypertrophy? Volume vs Intensity

Is there a best training for hypertrophy? Volume vs Intensity

Introduction

Overload training, used in many disciplines such as Bodybuilding, cross Training and Powerlifting, is certainly one of the most effective means of stimulating muscle hypertrophy and improving strength. By correctly manipulating the training variables, including:

  • the order of the financial years;
  • intensity;
  • volume and duration;
  • frequency of sessions and rest periods.

We can change the type and intensity of stimulus we provide to the musculoskeletal system by combining mechanical and metabolic stresses.

Often it tends to identify the best training in terms of volume of work done or intensity (often compared to the high percentage of load used), trying to identify a method of work “better than the other.

From the point of view of scientific research we know that as the intensity of the exercise increases with the use of overloads (resulting in an increase in the activation of muscle fibres with rapid contraction), greater emphasis is placed on mechanical stress (1).

On the contrary, high-volume programmes, with a relative reduction in workload – oriented to a greater number of repetitions concomitant with the use of short rest intervals -, physiologically create greater metabolic stress (2).

What is essential to trigger the mechanism of hypertrophy is a minimum intensity, often identified with a load greater than 50% of 1 MRI, intensity precisely necessary to trigger the mechanism of muscle hypertrophy.

The increasing scientific research on overload training, given its undoubted health benefits to individuals, has also led to large international organizations, such as the American College of Sports Medicine, to create guidelines trying to identify the best strategies and combinations between load and volume, to achieve the most efficient results at the hypertrophic level.

A repetition range between (6-12 RM) has been considered among the most effective for hypertrophy training, representing a sufficient balance of mechanical and metabolic stress to the trainee (2).

Hypertrophy and strength, always looking for new stimuli

Other schools of thought and lines of research indicate that inducing greater mechanical stress, increasing the load and its intensity, can induce recruitment of muscle fibres with higher rapid contraction and provide a greater stimulus for muscle hypertrophy – compared to metabolic stress associated with high volume training (3) -.

Studies comparing high-intensity training programs to high volume oriented ones, in people with experience in overload training, are actually few at the moment. This makes it difficult to identify the best strategy.

From most of these studies, it emerged that high-intensity training is certainly more advantageous for strength improvement, but almost similar to high volume training protocols to improve muscle hypertrophy (4.5)

By making a more in-depth analysis, we can safely say that there is a clear relationship between the volume of training carried out and muscle hypertrophy (6, 7) while to a lesser extent on the increase in strength (8, 9)we also know that increasing the volume of work alone, especially not taking into account the age of experience of the athlete, can be counterproductive (10).

If we consider simplistically the amount of work done with increased hypertrophy and strength, we could erroneously conclude that making as much volume as possible in each training session, would be the optimal way to achieve maximum hypertrophy.

However, it is often forgotten that a workout is useful when you have the ability and time to recover from this, thus creating an adaptation, represented by the quantitative and qualitative increase in muscle mass, as demonstrated by the study above.

A huge volume of work that you are not used to in a single session can negatively affect performance up to 72 hours. To this must be added the concept of periodization of training that, it has been seen – through the organization in micro and mesocycles and its progressive increase in load -, be more effective to achieve an improvement in performance.

On the other hand, an excessively intensity-oriented training and therefore the management of a high load, not carried out in a progressive and organized way, can have negative effects on performance, from excessive stress on the central nervous system, through excessive stress on the joints, to a possible increase in the risk of muscle injury.

Let us remember that, also on the relationship between muscular damage and triggering of the hypertrophic mechanism although related, there is no direct proportion. We know that training-induced muscle damage plays a key role in muscle growth (9), but some studies have shown that by increasing the volume more than one is considered already profitable for hypertrophic purposes, there is no increase in results but rather a slowdown .

Conclusion

In conclusion, this short article gives us a further demonstration of what often happens when we cross scientific research and practical experience: it is not possible a single answer to the question “what is the best method to obtain muscle hypertrophy?”.

From a scientific and also practical point of view, both a more volume-oriented training, and one on intensity, have been shown to obtain results on the increase of hypertrophy but only if organized in the correct way, that is, by evaluating the type of subject to which they are proposed, and always remembering that the theoretical model does not obtain infinite results,- demonstrating once again that the alternation of the stimulus, and the correct planning of training, are the best solution to achieve long-term results, even with athletes with greater experience in using overloads for hypertrophic purposes -.

Bibliography

 1.Henneman, E., G. Somjen, and D. O. Carpenter. 1965. Functional significance of cell size in spinal motoneurons. J. Neurophysiol. 28:560–580.

 2.Ratamess, N. A., B. A. Alvar, T. K. Evetoch, T. J. Housh, W. B. Kibler, W. J. Kraemer, et al. 2009. American college of sports medicine position stand. Progression models in resistance training for healthy adults. Med. Sci. Sports Exerc. 41:687.

 3.Clarkson, P. M., K. Nosaka, and B. Braun. 1992. Muscle function after exercise-induced muscle damage and rapid adaptation. Med. Sci. Sports Exerc. 24:512–520.

 4.Brandenburg, J. E., and D. Docherty. 2002. The effects of accentuated eccentric loading on strength, muscle hypertrophy, and neural adaptations in trained individuals. J. Strength Cond. Res. 16:25–32.

5.Schoenfeld, B. J., N. A. Ratamess, M. D. Peterson, B. Contreras, G. T. Sonmez, and B. A. Alvar. 2014. Effects of different volume-equated resistance training loading strategies on muscular adaptations in well-trained men. J. Strength Cond Res. 28:2909–2918.

6. Krieger, J.W., Single vs. multiple sets of resistance exercise for muscle hypertrophy: a meta-analysis. J Strength Cond Res, 2010. 24(4): p. 1150-9

7. Schoenfeld, B.J., D. Ogborn, and J.W. Krieger, Dose-response relationship between weekly resistance training volume and increases in muscle mass: A systematic review and meta-analysis. J Sports Sci, 2017. 35(11): p. 1073-1082.

8. Krieger, J.W., Single versus multiple sets of resistance exercise: a meta-regression. J Strength Cond Res, 2009. 23(6): p. 1890-901.

9. Robbins, D.W., P.W. Marshall, and M. McEwen, The effect of training volume on lower-body strength. J Strength Cond Res, 2012. 26(1): p. 34-9.

10. Gonzalez-Badillo, J.J., et al., Moderate resistance training volume produces more favorable strength gains than high or low volumes during a short-term training cycle. J Strength Cond Res, 2005. 19(3): p. 689-97.

Dr. Massimiliano Febbi PhD

afsupplements yamamoto allnutrition sfd iafstore atlhetica alldeynn blog Recovery as a new science at the service of the athlete

Recovery as a new science at the service of the athlete

Training recovery is recognized as one of the most important aspects of physical activity and overall well-being. As we examine the myriad of recovery strategies and their varying levels of scientific support, it’s important to remember that both scientific and anecdotal evidence point to the value of an appropriate recovery plan to encourage adaptation, well-being and performance.

To understand recovery well, you need to start getting familiar with certain concepts. Homeostasis is a state of equilibrium within the body that occurs when variables in a system (eg, pH, temperature) are regulated to keep internal conditions stable and relatively constant (Pocari et al. 2015) .

Stress is a stimulus that exceeds (or threatens to exceed) the body’s ability to maintain homeostasis.

Recovery is the body’s process of restoring homeostasis .

An intense and acute attack of physiological stress followed by adequate recovery, which allows adaptation and restores homeostasis, is generally considered healthy (Sapolsky 2004). However, physiological stress that is not followed by adequate recovery can, over time, compromise homeostasis and immune function, increasing the likelihood of injury, disease, and the occurrence of overreaching or non-functional overtraining .

Sleep, good nutrition and hydration are certainly a good start. But today, especially for athletes who both at an amateur and professional level subject their body to great stress, it might not be enough.

The term that is used by sports science to define the right amount of overload is functional overreaching or ” functional overeaching ” ( FOR ). This is what occurs when there is a short-term decline in performance towards the end of a training “lockout” period, without causing significantly adverse effects on the athlete’s health, mood and immune capacity, and which allows simply put have all the benefits of the supercompensation process. Athletes are certainly stronger and more resistant after a short period of recovery from FOR.

The opposite of FOR is known in scientific literature as non-functional overreaching ( NFOR ): in this case there is no progress from the training load carried out and the negative aspects illustrated above tend to become chronic, reducing the progress that should be from correct programming of the workout .

A great start to monitoring our recovery process is to evaluate our heart rate variability (HRV). This simple parameter can provide valuable insight into the dominance of our sympathetic nervous system (SNS) or parasympathetic nervous system (PNS), the latter of which is responsible for rest, repair and recovery.

Another way to monitor recovery is to check blood test parameters . The most common markers are those that analyze specific hormones such as cortisol and testosterone by comparing them to each other, or cortisol with ACTH , or even more non-specific indicators such as CK ( creatine kinase ), LDH ( lactated deidogenase ) and protein C-Reactive , which have a good correlation with the stress produced by training (although unfortunately they lack the specific sensitivity to make them reliable in many sports and certain types of athletes).

Energy balance plays the most important role in the recovery process. When you’re in an energy deficit, the deficit itself is the main trigger for catabolism . Calorie restriction reduces muscle protein synthesis and key cell signaling pathways for survival and activates AMPK and cytokines, which sidetrack mTOR activity in muscle building and increase protein turnover (Cassandra, M.Mciver).

Regarding the minimum amount of energy for recovery, the International Society of Sports Nutrition recommends 50-80 kcal/kg/day for strength athletes and team sports. The recommendation for female athletes is instead a minimum of 40-45 kcal/kg/day (Tomas, Erdman).

If you don’t recover, you won’t be able to perform at a high level.

Tailoring total energy intake (and the balance of protein, carbohydrates and fats) to your individual needs, training block and ultimate goals is the goal of any sports nutritionist.

Protein is a building block for life. They promote recovery in many ways, chief among them being muscle repair and improved immune function . If you are a bodybuilder or a physique-focused athlete and for the cutting phase you create a calorie deficit for a certain period, it becomes even more important to increase your protein consumption .

Carbohydrates are a critical fuel for recovery from intense workouts and in preparation for future performance. Many athletes don’t fully understand how important carbohydrates are to the recovery process. Athletes need carbohydrates to perform high-intensity workouts, to prevent fatigue, to fight colds and flu (carbohydrates are a big factor in immunity), and to prevent the catabolic cascade of events that occur through energy deficits that they can cause various problems and possible injuries (Francis. Holway).

Now let’s review some of the most popular methods for post-workout recovery.

Active Recovery

One study found that active recovery after repeated intense exercise resulted in a more rapid return to homeostasis than passive recoveries using no movement (Ahmaidi et al. 1996). Another study found that after high-intensity work with active recoveries performed at 60-100% lactate threshold, these helped muscles recover faster than they did plus passive recoveries performed at intensities below 0-40%. % of lactate threshold (Menzies et al. 2010).

Massage

One study found that massage performed immediately after exercise resulted in reduced blood flow and reduced removal of lactate and hydrogen ions from muscles, thereby slowing recovery (Wiltshire et al. 2010). Conversely, other researchers have found increased muscle activation and proprioception and a reduction  in delayed onset of muscle soreness (DOMS)  with massage (Shin & Sung 2014).

Compression

Miyamoto et al. examined markers of muscle damage (eg, creatine kinase, interleukin-6) and found no clear evidence of attenuation of these markers with compression, which would indicate accelerated recovery rates (Miyamoto et al. 2011) . While there is somewhat minimal research into the true effects of compression, there appear to be some small recovery benefits with little concern for harmful side effects (Hill et al. 2014).

Cryotherapy

Cryotherapy temporarily reduces muscle temperature, stimulating vasoconstriction and reducing inflammation and pain. Critics of cryotherapy point to a general slowdown of normal regenerative inflammation and an increasing risk of further injury due to prolonged exposure of the skin and nerves to cold temperatures (Schaser et al. 2007).

Conclusions

Surely the science of recovery represents an extremely interesting field of knowledge and specialization for professionals in the sector, new research or studies are opening up new frontiers for us to work on, also thanks to the help of technology, allowing us more and more to identify the right relationships between workload and rest times in order to maximize our sporting performance and the prevention of any injuries.

Bibliography

Pocari, JP, Bryant, CX and Comana, F., 2015. Exercise physiology. Philadelphia: FA Davis.

Sapolsky, RM 2004. Why zebras do not get ulcers (3rd ed). New York: Holt Paperback.

Cassandra M. McIver, Thomas P. Wycherley, and Peter M. Clifton, “MTOR signaling and ubiquitin-proteosome gene expression in the preservation of fat free mass following high protein, calorie restricted weight loss,” Nutrition and Metabolism 9, no. 1 (2012), https://doi.org/10.1186/1743-7075-9-83; Tyler A. Churchward-Venne et al., “Role of protein and amino acids in promoting lean mass accretion with resistance exercise and attenuating lean mass loss during energy deficit in humans,” Amino Acids 45, no. 2 (2013), https://doi.org/10.1007/s00726-013-1506-0.

T. Thomas, K. A. Erdman, and L. M. Burke, “American College of Sports Medicine joint position statement. Nutrition and athletic performance,” Medicine and Science in Sports and Exercise 48, no. 3 (2016), https://doi.org/10.1249/MSS.0000000000000852; J. S. Volek, “Nutritional aspects of women strength athletes,” British Journal of Sports Medicine 40, no. 9 (2006), https://doi.org/10.1136/bjsm.2004.016709.

Francis E. Holway and Lawrence L. Spriet, “Sport-specific nutrition: practical strategies for team sports,” Journal of Sports Sciences 29, Supplement 1 (2011), https://doi.org/10.1080/02640414.2011.605459; P. D. Balsom et al., “Carbohydrate intake and multiple sprint sports: with special reference to Calcium (soccer),” International Journal of Sports Medicine 20, no. 1 (1999), https://doi.org/10.1055/s-2007-971091.

Menzies, P., et al. 2010. The clearance of lactate in the blood during active recovery after an intense running encounter depends on the intensity of active recovery. Journal of Sports Science, 28 (9), 975–982.

Shin, MS and Sung, YH 2014. Effects of massage on muscle strength and proprioception after exercise-induced muscle damage.  Journal of Strength and Conditioning Research, 29 (8), 2255–2260.

Hill, J., et al. 2014. Compression clothing and recovery from exercise-induced muscle damage: a meta-analysis. British Journal of Sports Medicine, 48 (18), 1340–1346.

Schaser, KD, et al. 2007. Prolonged superficial local cryotherapy attenuates microcirculatory failure, regional inflammation and muscle necrosis after closed soft tissue injury in rats. American Journal of Sports Medicine, 35 (1), 93–102.

Dr. Massimiliano Febbi PhD

18y6afsupplements yamamoto allnutrition sfd iafstore atlhetica alldeynn blog Open water swimming between training, nutrition and supplementation

swimming between training, nutrition and supplementation

The bottom swimming it includes all swimming events that take place in open waters such as rivers, lakes and seas (for this reason it is also called  open water swimming ).

It is divided into four categories: mid-country swimming (up to 5 km), cross- country swimming (up to 15 km), long-distance swimming ( up to 25 km) and marathon (over 25 km). Its popularity has also grown thanks to the spread of ultra-endurance events such as ultramarathon, ultra-cycling and in particular ultra-triathlon, among which also well-known competitions, such as the Ironman, stand out. The fact of taking place in open waters adds considerable difficulties to the athlete, mainly related to the environment in which the performance takes place.

Different places have changing environmental conditions , including water, temperature, humidity, solar radiation and unpredictable tides or currents. Furthermore, the duration of most events (which normally ranges from 1 to 6 hours) creates unique physiological challenges for thermoregulation, hydration status and also for muscle “fuel” reserves.

swimming nutrition and supplements

Diet

Current nutritional recommendations for open water training and competition are an extension of pool swimming recommendations or are extrapolated from the study and observation of other athletic populations with similar performance patterns. In these disciplines, competition nutrition should focus on optimizing pre-competition hydration and managing glycogen stores .

On a purely theoretical level, swimmers should be able to rely on energy sources and fluids consumed before competitions, at least for the shorter events: for longer races, when over 10km distance or more, integration of fluids and energy sources can instead occur when tactically appropriate, in order to support the performance at best for its entire duration.

During longer races, up to 90 g / hour of carbohydrates from easily consumable and transportable sources, such as gels and drinks , should be used in order to maintain and restore muscle glycogen stores .

Exposure to variable water conditions and ambient temperatures will also play a significant role in determining nutritional strategies to best face the race. Per example, in extreme environments, thermoregulation can be assisted by manipulating the temperature of the fluids ingested : a simple but functional strategy.

Work out

Training for open water swimmers focuses on improving endurance skills , especially by enhancing aerobic capacity ; in fact, in analyzes carried out on training fields used by elite competitors, over 85% of the training was undertaken at intensities focused on the development of these abilities, with less than 2% dedicated instead to anaerobic training or training at ” submaximal ” speeds (VanHeest et al., 2004).

This similarity of the work done suggests that the nutritional requirements for training open water swimmers are consistent with and similar to the recommendations for distance swimmers in pool events during high-volume training periods.

From an anthropometric point of view, the data collected on open water swimmers have shown that they are on average lower, with a lower body weight and with a lower percentage of lean muscle mass compared to “pool” swimmers (Carter & Ackland, 1994; VanHeest et al., 2004; Zamparo et al., 2005).

This may be due to the fact that less absolute Energy is required to successfully complete open water events than sprint events (50 and 100m), or simply that in this type of sporting event participation is greater for non-professional athletes. .

From a metabolic point of view, the maximum oxygen consumption (VO2max), which has always been identified as a performance index for open water swimmers (80 and 66 ml / min / kg for male and female swimmers, respectively), has been reported to be more high (VanHeest et al., 2004) than those observed in swimmers of shorter distances (Capelli et al., 1998), but similar to that found in other “land” endurance athletes.

Supplementation

Given that the training undertaken by open water swimmers consistently involves large volumes of work with a strong development of aerobic capacity (Van Heest et all 2004), it is very likely that similar training volumes constantly draw on muscle glycogen stores, highlighting the need for nutritional strategies focused on glycogen replacement for prolonged or high intensity sessions, particularly during the high volume phases.

Failure to sufficiently replenish glycogen stores between training sessions can impair the open water swimmer’s ability to complete the high intensities and training volumes necessary for lasting success (see review by Shaw et al., 2014) . Carbohydrate intake during a workout can also contribute to the total daily carbohydrate requirement, provide additional fuel to support performance in a particular session (see Shaw et al., 2014), and allow for the practice of feeding tactics that will then be used. in competitions.

Another important factor to consider are the responses of the immune system , which can be compromised when exposed to extreme environmental conditions (such as water temperature) and worsen when they are added to the stress hormone, the release of which is associated with high intensity / high volume training, particularly when sessions are completed with low carbohydrate availability (Pyne et al., 2014).

Due to the extended nature of bottom swimming, extended workouts are often undertaken in warm conditions, during which proper hydration strategy must be considered . Although the reported values ​​for unrelated fluid loss to urine during swimming and daily body fluid turnover in these athletes are not as high as for land-based activities, losses of ~ 0.5 L / hr can be expected ( Cox et al., 2002a; Leiper et al., 2004; Lemon et al., 1989).

Therefore, open water swimmers should consider hydrating fluids even in the form of energy drinks during extended sessions.

The ergogenic aids that swimmers can obtain through the use of specific supplements and that allow the athlete to improve performance have been examined by many authors, including Derave and Tipton (2014). Here are those with the most scientific evidence.

  • Caffeine : Caffeine has been shown to be beneficial for swimmers competing in long-running pool events (i.e. 1,500m; MacIntosh & Wright, 1995) in moderate doses, and can improve performance in sporting events lasting longer than 90 min (Cox et al., 2002b). Caffeine supplementation protocols include intakes of up to 3 mg / kg in the hour prior to short open water events or smaller doses consumed in combination with carbohydrates during long duration competitions.
  • Beta alanine : supplementation with b-alanine, which is the limiting component in the rate of formation of the muscle dipeptide carnosine, has been shown to increase peak Energy and average Energy during the final sprint in a simulated road cycling race (Van Thienen et al., 2009.): this can certainly be useful in certain competitive phases also in endurance sports such as open water swimming.

Conclusions

A sport loved by everyone, swimming is complete and very technical: in the water the body is supported and is in a situation of reduced gravity, allowing better weight control. Despite this, its complexity and the difficulty in managing all the variables related to the surrounding environment and the duration of the performance should not be underestimated. Optimizing training and nutrition is therefore crucial to complete even the most difficult challenges, and the correct integration can provide the support that can make a difference.

Bibliography

VanHeest, J.L., Mahoney, C.E., & Herr, L. (2004). Characteristics of elite open-water swimmers. Journal of Strength and Conditioning Research, 18, 302–305. PubMed

Carter, J.E.L., & Ackland, T.R. (Eds.). (1994). Kinanthropometry in aquatic sports: A study of world class athletes. Champaign, IL: Human Kinetics.

Zamparo, P., Bonifazi, M., Faina, M., Milan, A., Sardella, F., Schena, F., & Capelli, C. (2005). Energy cost of swimming of elite long-distance swimmers. European Journal of Applied Physiology, 94, 697–704. PubMed doi:10.1007/ s00421-005-1337-0

Capelli, C., Pendergast, D.R., & Termin, B. (1998). Energetics of swimming at maximal speeds in humans. European Journal of Applied Physiology and Occupational Physiology, 78, 385–393. PubMed doi:10.1007/s004210050435

Pyne, D.B., Verhagen, E.A., & Mountjoy, M. (2014). Nutrition, illness, and injury in aquatic sports. International Journal of Sport Nutrition and Exercise Metabolism, 24, 460-469.

Stellingwerff, T., Pyne, D.B., & Burke, L.M. (2014). Nutrition considerations in special environments for aquatic sports. International Journal of Sport Nutrition and Exercise Metabolism, 24, 470-479.

Cox, G.R., Desbrow, B., Montgomery, P.G., Anderson, M.E., Bruce, C.R., Macrides, T.A., . . . Burke, L.M. (2002b). Effect of different protocols of caffeine intake on metabolism and endurance performance. Journal of Applied Physiology, 93, 990–999. PubMed

Dr. Massimiliano Febbi PhD

afsupplements yamamoto allnutrition sfd iafstore atlhetica alldeynn blog Tactical athletes: injury prevention and functional recovery

Tactical athlete: injury prevention and functional recovery

Correct accident prevention arises from a deep knowledge of the biomechanical and physiological characteristics of the activity carried out, the type and incidence of accidents and from a correct application of the strategies identified.
Injuries that may occur inevitably affect the state of form and performance and can lead, over time, to significant health problems such as muscle stiffness and arthrosis.

Tactical athlete: who is?

An all-American term that indicates that particular category of people who find themselves carrying out jobs that require a great deal of physical effort, often in adverse environmental conditions.
Among them, for example, the Fire Brigade or the Special Maybe of the Army but also the professionals involved in rescues.
Tactical athlete who find themselves subjected to additional loads such as backpacks, weapons, fire extinguishers, etc. and high psycho-physical stress dictated by the situations in which they operate.
Very often, however, tactical athlete physical condition is not suitable for carrying out certain tasks and the percentages of a series of pathological and physical disorders they undergo are very high.
A targeted preventive approach and functional training programs for the prevention of problems are therefore essential for this category.

tactical athlete

How to intervene on risk factors for a correct preventive approach

The variety of tactical tasks and the physical effort required, combined with the operations variable, inevitably predisposes the TA to the risk of injury and injury.
When an injury occurs, the tactical athlete tends to be predisposed to further possibilities of injury and, the only way to interrupt this circle, is to work both at the level of prevention and recovery aimed not only at the resolution of the problem itself but, above all, on the restoration of total functionality.

tactical athlete

Musculoskeletal injuries are recognized by current scientific research as the largest health problem affecting military bodies

Suffice it to say that, for every 1,000 operators on duty monitored for a year, 628 reported a musculoskeletal injury (2).
Over 80% of injuries were classified as injuries due to the management of excessive mechanical stress or overload.
The knee appears to be the most affected anatomical site followed by the lumbar spine, ankle and foot.
Elements that demonstrate how important it is that the task of the physical trainer and physiotherapist in the TA field is oriented towards the prevention of such injuries in order to achieve a significant reduction.
Although many of these injuries are the inevitable consequence of harsh conditions and extreme movement requirements, optimizing the AT’s range of motion and work can reduce the risk of incurring these types of injuries. Having already suffered an injury is cited as a risk factor in incurring a new injury in the future (5, 6).
For this reason, the health staff and physical trainers of the tactical units should ensure that operators are screened for risk factors of possible injury, specific to their functions and for any past injuries that could compromise physical performance.
People considered at risk must be evaluated by expert doctors through in-depth analyzes aimed at finding the cause of the problem which, often, does not coincide with the finger of the lesion.

The inflammatory response

Faced with physical injury or trauma, the body’s first response is inflammatory to limit further damage and prepare for the healing process.
The classic signs of inflammation are redness, swelling, pain, warmth, and loss of function.
The acute inflammatory response lasts a couple of days while the signs of inflammation may persist for weeks due to various factors including the severity and location of the lesion, the effectiveness of initial therapeutic treatments and the individual response.
The goals of treatment during this phase are:

  • minimize pain and swelling protect the injured site from further damage
  • maintaining the resilience of movement and general physical conditioning

A useful acronym for the driving treatment, during the inflammatory phase, is PRICEM (Protection Rest Ice Compression Elevation Motion) ina variant that differs from the traditional RICE (Rest Ice Compression Elevation) for maintaining movement even in the acute phase respecting the parameters healing and insertion of the wound site protector.
Although clinicians and researchers recognize the paucity of quality evidence to support the use of RICE in sports medicine, this method is widespread and accepted with the caveat that physicians must evaluate the risks and benefits for each individual (7, 8).

Recovery phase: what to do

Recommendations for early recovery of movement after injury are increasingly supported by evidence of increasing quality from research (9,10).
Prescribed by the doctor or rehabilitation specialists, it promotes:

  • optimal healing that avoids atrophy and loss of tissue extensibility
  • quality and orientation of the fibers of the new fabric

Tactical athlete should commonly have basic information to apply PRICEM principles immediately after injury and specific knowledge of the excessive and unjustified use of non-steroidal anti-inflammatory drugs (NSAIDs).
Despite the lack of strong evidence to support their efficacy, in the short term (max 5 days) the use of NSAIDs is widely accepted and used when excessive inflammation causes symptoms related to pain and limitation of the ability to move after injury. (9).
However, using NSAIDs for chronic conditions and recent injuries without excessive inflammation likely carries more risks than benefits (9).
Side effects of NSAIDs are generally associated with their prolonged use and most commonly involve the gastrointestinal, cardiovascular and renal systems (9).
Their use inhibits bone healing (11) and, in the long term, is associated with harmful effects on cell growth and related metabolism (9).
For TAs concerned about the negative effects of NSAIDs on performance, occasional use is unlikely to negatively affect muscle growth and subsequent performance.
However, long-term use could limit muscle growth due to negative effects on satellite cell activity (12).

In the post muscle injury recovery phase, the quality of the final result largely depends on the quality of training during the remodeling phase. This healing phase corresponds to what is called the functional rehabilitation phase where the primary objective is to advance all training methods to a level commensurate with the physical needs of the tactical athlete.
During all phases of recovery from the injury it is important for the physical trainer to collaborate with the medical and rehabilitation staff in order to guarantee a physical form that is not excessively compromised.

tactical athlete

Types of injuries

The following can occur:

  • overload injuries
  • injuries to the muscle, tendon and bone structures

Overload injuries occur when cumulative stress, which we refer to as “mechanical stress” applied to muscle, tendon and joint structures, exceeds the ability to adapt to stress which, usually within certain limits, is a physiological condition.
Overworked or repetitive and overuse conditions include tendinopathy, stress fractures, and patellar hamstring syndrome (13).
Such conditions frequently occur among tactical athletes, especially in the military, for whom running for physical conditioning is associated with excessive use of the lower limbs (14) and then often linked to overloading for carrying gear and equipment.
A contributing factor to excessive tissue mechanical stress associated with overload injuries is scheduling training sessions and movement dysfunctions (13).
Training planning errors occur when the volume or intensity of training sessions is excessive for the individual and due to the excessive frequency and duration of distance running (distance traveled more than three times a week or for more than 30 minutes (15).
Limiting the frequency and duration of distance running is advantageous for beginner runners to limit the incidence of possible injuries.
Injuries affecting the muscle tendon and bone structures, on the other hand, are the second category of overuse injuries and represent the inability of the bone to repetitively resist mechanical load with consequent structural fatigue and localized bone pain (18).
This type of injury occurs when the cumulative effects of weight-bearing activity and physical training exceed the individual’s ability to manage the mechanical stress on the bone system.
It is a process that begins with stress reactions that can progress and lead to stress fractures or fractures proper.
Untrained individuals are particularly vulnerable to this type of injury, particularly at the beginning of an inadequately structured training program.
The primary symptom of bone stress injuries is activity-related pain with a gradual onset (19)
The pain is initially mild and, unlike a mild tendinopathy, it does not subside with warming or continuing activity (20).
If this activity continues after the onset of symptoms, the disease will progress and the symptoms will become more severe and localized (20). At the beginning of the bone stress injury process the symptoms subside as the load ceases.
However, in the later stages, symptoms often manifest themselves even at rest.

Dr. Massimiliano Febbi PhD

afsupplements yamamoto allnutrition sfd iafstore atlhetica alldeynn blog combat sports - integrated approach to injury treatment

Combat Sports: Integrated Approach to Injury Treatment

There are sports disciplines that expose those who practice them more to the risk of major injuries and trauma.
But which are the most common and who falls into the category of combat sports?

By the term combat sport we mean a match between two athletes fighting each other.
There are several disciplines that fall into this category:

  • Boxing
  • Kickboxing
  • Muay Thai
  • Judo
  • Fight

all disciplines which, due to their characteristics, differ enormously from each other.

Given the significant physical demands of combat sports, injuries are much more frequent than in other sports.
In MMA, for example, a number of studies found an injury rate of 24-29 per 100 combat participations.
This very high percentage implies that both prevention and treatment are a fundamental part of managing an athlete.

Injuries are very frequent and require targeted interventions to get to the cause that caused them and treat the damage caused to the athlete

The extremely complex performance model of these types of sports implies an extreme stress on the musculoskeletal system and makes clear the concept that managing such a situation can only be tackled with a team of professionals from different specialized fields: doctors orthopedists, anesthetists, radiologists, physiotherapists, occupational therapists, nurses, nutritionists and osteopaths who work in a multidisciplinary way.

Injuries in combat sports: what are and rehabilitation treatment

There are many pathologies that affect these athletes and, taking into consideration some examples of therapeutic intervention, it is possible to evaluate them.

Can posture cause any injuries?

Its often labeled as the cause of many injuries that affect athletes but the first question to ask is whether this is the result of functional adaptations and what may be its correlation with the onset of any injuries.
For example:

The impigement syndrome that affects the shoulder as well as from the hits with relative impact that occurs is also related to postures due to specific needs such as the guard position that is taught to athletes to protect the chin while throwing the jab.
Many athletes remain in this position, continuing to cover their chins, even outside of competitions, generating an abnormal positioning of the scapula over time which, in turn, will cause stress with possible injuries to the supraspinatus if no corrective work is done.

Some of the typical adaptations of the posture of athletes in combat sports are also:

shoulders put forward due to “dominant patterns” in specific types of combat sports such as wrestling, judo and jiu jitsu.
With these athletes, preventive work will focus on activating the core to improve the mechanics of the breathing and rotational patterns.
The first goal, at the rehabilitation level, is to completely normalize thoracic mobility capacityrib mobility and cervical mobility through manual interventions combined with therapeutic exercise by ensuring that patients normalize scapular movements by reducing stress on the ligament and muscle structures of the glenohumeral joint.

An assessment of lumbar and hip mobility and lumbo-pelvic stability is also important as many of these patients only use the upper body to power their fists instead of rotating through the hips and pelvic girdle.

Proposals for corrective exercise

Most of these combat sports athletes need a lot of glute work.
Some of them have very strong buttocks but cannot make the best use of this force due to the imbalance relationship with the hip flexors; result of the typical posture of fighters with respect to a lack of extension.
While being in extension may not be “sport specific” this is an integral part of the corrective exercises combat sports athletes must do outside of their skill training.

The “beneficial” training of the buttocks for:

Anterior hip pain

The decrease in glute maximal force production during hip extension is associated with an increase in anterior translation of the femur into the acetabulum (Lewis et al. 2007).
Increased anterior slipping of the femur could lead to increased shear forces and wear on the anterior joint structures of the hip.

Knee pain

Inhibited glutes can lead to poor femoral control with knee pain.
If an athlete does not have sufficient glute strength, a complete movement of the hip extension or poor control of the pelvic girdle, an overload of activation of the quadriceps results in a higher-than-normal job putting stress on the joint. of the knee (Rane, Bull 2016).

Weak glutes can also lead to an internally rotated femur or knee valgus position (putting tension and stress on certain ligaments and muscles).
Of course, following the kinetic chain downwards, this could potentially lead to a problem of functional overload of the ankle as well (Goo et al. 2016).

Muscle injuries: how to intervene

Injuries or ruptures of the musculotendinosus unit (MTU) can occur in combat sports and are due to taking some extreme positions in which the body is forced.
Its essential to work on a combination of static, dynamic and ballistic flexibility with an emphasis on the final range of motion and to perform strengthening and power exercises through the entire ROM, in particular, with strengthening exercises in the final ROM which are fundamental in the prevention of this type of injury.


Upon the occurrence of an injury and after a short period of immobilization, the athlete must work on dynamic neuromuscular stability exercises to help the muscles compensate for the instability of the ligaments and the capsule.
A conservative approach is used to maintain other physical abilities even during the immobilization period.

The patient performs cardio exercisesstrengthening exerciseslower limb stretchingcore exercisesshoulder bladesmaximum arm strength exercises and glenohumeral and rotator cuff joint exercises when the timing is appropriate.

In this specific sports sector, a large amount of hip flexor tendonitis is also observed as a result of repetitive kicks.
Usually, they are treated with dynamic stretching of the hip flexor, manual therapydry needling, and exercises focused on the abductor muscles with emphasis on the eccentric phase for the hip flexor muscles.

Another typical pathology is that of the rotator cuff tendonitis impingement syndrome.
For these injuries, as mentioned earlier, its important to work on the rotator cuff and the ability to move the scapula.
Crosstraining is one of the best ways to engage muscles and joints that combat sports athletes don’t use as part of their regular training regimen to reduce the risks of over-specialization.
Its important to choose another sport or movement that uses different muscle groups to improve muscle balance and overall stability.

Dr. Massimiliano Febbi PhD