June 2021

Recovery and Regeneration Strategies for Foot Performance: Part II

By Antonio Robustelli, MSc, CSCS

In the first article of this series, I provided a general overview of the concepts of recovery and regeneration as well as terminological and methodological differences. I called it a necessary consequence of the stresses relating to training and performance. Since then, recovery has come out of the shadows. The most recent episode, Rafael Nadal’s recent decision not to participate in The Championships, Wimbledon, and the Tokyo Olympics, made front-page news, bringing to the attention of the general public the importance and role of recovery in general, but also as it relates to extending an athlete’s career.

In this article, I will explain why we target 3 different levels when it comes to foot recovery and regeneration, and I will outline some of the protocols we use.

The foot is a complex structure with a highly precise level of function: It must maintain proper Center of Pressure (CoP) in order to adjust for any Center of Mass (CoM) imbalances while ensuring adequate power output for performance.

The high demands of modern sport require the implementation of recovery strategies to support the daily needs of an elite or high performance athlete. Some of the effects of the stress imposed on the musculoskeletal system by this level of training and exercise are swelling, decreased range of motion, temporary decrease in force production, muscle soreness, rise in passive tension, and increase in intramuscular proteins in blood.1,2  To maintain a high-level performance, athletes’s bodies must undergo a recovery period that addresses these stresses. Recovery done right leads to higher training volumes and intensities without risking overtraining and its adverse effects.

Understanding the concept of accelerating recovery is a necessary step before acritically adopting any recovery methods and strategy: In fact, the main goal of a recovery technique is to facilitate and accelerate the process of adaptations and not to interfere with its natural biological path. A second necessary step is understanding the considerable individual variability of each athlete and that each exercise/training/performance bout presents.

Our regeneration protocols for the feet have 3 levels:

Functional Recovery (functional capacity recovery): This level aims to restore the full capacity of both autonomic function and movement efficiency.

The first step is to provide a solid foundation for the brain to eliminate the perception of threat from the sympathetic nervous system (SNS) and start increasing the parasympathetic tone of rest (PNS). We start this process as part of the cool-down to give the input to slow down and put a brake (PNS) on the gas pedal (SNS) and remodulate muscle tone. Our protocol uses active recovery delivered with a blend of movements and electrical neuromuscular stimulation.

Structural Recovery (tissue recovery): The main goal of this level is to progressively improve the tolerance ability of tissues to handle mechanical stresses as well as accelerate the remodeling process.

In a recent paper on the role of recovery after exercise,  Peake3 observed that the overall goal of recovery, as an essential element of the training-adaptation cycle, is to regain homeostasis by replenishing fluids and substrates, restoring cardiovascular function and body temperature, and repairing the damaged tissues. Tissue remodeling activity during the recovery process promotes protein synthesis thanks to the biological mediation of muscle tears and damage.4 Timing and type of intervention are fundamental to promote faster recovery without disrupting long-term biological adaptations.

We accomplish this process using a specific technique called negative pressure (LymphaTouch®, Helsinki, Finland) together with specific compression socks to be used overnight.

Sensory Recovery (skin): The sensory aspect relates to the fundamental role of the cutaneous receptors in the feet and their control and regulation of both human stance and locomotion.5

Cutaneous afferents of the foot are characterised by a high sensitivity and specificity to mechanical deformation of the skin. These deformations, whether they are caused by vibration, pressure, or stretching of the skin surface, are being transmitted through the tissue to the cutaneous afferent mechanoreceptor endings that interact with the central nervous system to modulate the excitability of motor neurons.6 We use topical applications as well as foot baths with electrical stimulation to amplify the sensorial activation.

In the next article, I will guide you through specific details of each protocol and appropriate timing for each of the 3 levels.

To see the references associated with this article, please visit www.lermagazine.com.

Antonio Robustelli is a professional sports performance consultant and elite coach from Italy. He is also a member of the LER Editorial Advisory Board and can be reached at  Antonio.robustelli@omni-athlete.com.

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