When we set up this blog we both agreed to keep the posts short. I failed to keep this one short, but thank you for your patience in reading. As a mark of our thanks we have produced a detailed Excel spreadsheet that outlines all of the recovery recommendations within this post, it can be downloaded for free here.
Recovery: A return to a normal state of health, mind or strength
Oxford English Dictionary
The English Premier League winter break argument rumbles on. Despite evidence that it takes roughly 5 days to fully restore normality following a competitive game (1) and that injury risk significantly increases when less than 4 days separates two games (2, 3, 4), Premier League players will again be exposed to a flurry of festive fixtures this season.
Premier League Christmas Schedule! pic.twitter.com/10GTYiMYyf
— James Yorke (@jair1970) December 15, 2017
Such short periods between games (2 – 5 days) places an increased emphasis on recovery methods. Nutrition plays a key role in recovery and thankfully there has been some great research in this area in recent years (1, 5, 6), including a recent paper from former colleague Joel Dawson (7). However I believe I can add value to the current evidence-base by way of practical recommendations. So within this post I’d like to comment on my experiences within team sports – primarily football – over the festive fixtures and games with <5 days recovery. Now I’m not naïve enough to think that my refined strategy is by any means the best. I just happen to have one that has worked for me within most team-sports (rugby union, league and 7’s, and basketball) and has served me well since, across multiple continents, with a few tweaks here and there.
The harsh reality is that even with 100% compliance to the most evidence-based recovery strategy it’s highly unlikely that a player is going to be fully recovered between games played within 2 – 5 days. However, despite the doom and gloom of reality, we must do all we can to accelerate the recovery process.
It’s impossible to recover fully in 2 days. I find that the second game is played at a slower pace and I personally have to adapt my game knowing that I’ve still got some aches/pains from the previous game
Ryan Shawcross, Stoke City FC Captain
A competitive football match will deplete energy stores, dehydrate and result in a degree of muscle damage. So from a nutrition perspective recovery is dependent upon the players ability to restore energy levels with dietary carbohydrate and a lesser extent fat (intramuscular triglycerides), rehydrate with fluids, repair muscle with protein, antioxidants and possibly omega-3. However too much of an emphasis is placed on protein in recovery in my opinion. If you’re lucky 1 – 2g of a single 40g dose of protein will end up as muscle protein. The growth, repair and adaptation of muscle takes months or years. The influences of energy and carbohydrate intake are far more significant to recovery following intense exercise. Supporting the recovery processes with sufficient energy is the priority, failing to meet energy requirements will further increase glycogen breakdown, and will reduce immune function (8) and rates of muscle protein synthesis (9).
It’s the chronic effect of meeting energy requirements that counts, so the days and weeks leading up to and following the game are just as important to recovery as the acute period following. Although it’s beyond the scope of this post to delve beyond the acute period (1 – 8-hours) following a game I will state that athletes should be maintaining a caloric surplus (~5 – 10%) to create an anabolic environment alongside high-carbohydrate intakes (8 – 12 g/kg/day) (10, 11). Such elevated carbohydrate intakes are known to improve exercise performance when only 24-hours separates two glycogen depleting events so are highly recommended (12).
I personally use ‘meal templates‘ whereby I calculate the individual requirements of each player, account for preferences, intolerances, likes/dislikes and then translate them into realistic meals across the day. This method at least provides the player with an idea of the quantity of food required and serves as an extremely useful tool. In the example provided you’ll notice I accommodated for the players favourite Italian restaurant and a pre-match meal that he’s consumed consistently throughout his career.
It is possible to restore glycogen within 24-hours after cycling exercise, although the muscle damage from eccentric contractions (decelerations) and potentially from collisions during team sports results in structural alterations to the muscle tissue, particularly the glucose transporter GLUT4, which significantly impairs rates of muscle glycogen resynthesis (13, 14, 15). Meaning it may take around 72-hours to completely restore muscle glycogen after a competitive football match. Furthermore the player is unable to ‘carb load’ to the same extent prior to the next game within that time. In the first 3-hours of recovery glycogen stores in slow twitch muscle fibres occur significantly faster than fast twitch muscle fibres, leading to the suggestion that the more explosive players within a team (wing backs, wingers, centre forwards) are likely to be effected most in the second game. But assuming there is at least 48-hours between each game there shouldn’t be much difference.
Interestingly, it’s now common for players to partake in active recovery methods after a game, but this actually results in hormonal alterations that lead to glycogen breakdown. So from a nutrition perspective the promotion of sedentary behaviours or limiting the duration of active recovery to <20-mins would be advised, especially with very limited time between games (<72-hours) (16). That said, the slower rates of recovery will ultimately lead to a marked drop in intensity in the second game, potentially requiring alterations to tactics or style of play, particularly as the high-intensity, pressing style of play is becoming more prevalent.
From my experience it really helps to play the second game at home. Mentally the support of the fans can make a big difference. Although, obviously they can’t prevent muscle strains in the last 30-minutes of a game. As a coach I would play more offensively at home and more defensively away. I would also work closely with the sports science team to quantify factors such as aerobic fitness, player load and high speed running distances. Based on this information I’d look to rotate players if necessary.
Jan van Winckel (ex-Assistant Coach to Marcelo Bielsa)
Phase 1: Final Whistle
Rather than delving into the fine details I’ll just comment on the practical application. Starting immediately – don’t wait (17) – the goal is to provide frequent dosages of carbohydrate. I’d recommend providing a carbohydrate-rich recovery beverage as the player walks off the pitch to take advantage of the ‘rapid phase’ of glycogen resynthesis. The total quantity of carbohydrate is the most important factor and the optimum dosage for maximal rates of glycogen resynthesis is 1.2 g/kg (18), although this is often difficult to attain in liquid form as it generally tastes awful and requires a massive amount of fluid (10% solution). It is possible to stimulate muscle glycogen resynthesis to a similar extent with a lower carbohydrate dosage (0.7 – 0.9 g/kg) and the addition of a protein source such as whey protein (0.2 – 0.4 g/kg) (19). It may also be worthwhile using a blend of glucose (for muscle glycogen) and fructose (for liver glycogen) in a 2: 1 ratio to minimise gastrointestinal issues (20), a fructose-maltodextrin blend may also work (49). I would also add a teaspoon (3 – 5 g) of creatine monohydrate and an electrolyte blend (~200 mg sodium) to the mix.
Although the research shows no difference between liquid or solid forms of carbohydrate on glycogen resynthesis and the rate of gastric emptying does not impede the process, recovery drinks are more practical at this stage. It’s easy to prepare, individualise and manage the dosages, distributing bottles immediately after the game is easy, it’s easy to consume and generally well tolerated by the players. We’ve played around with different flavoured drinks, varying flavours to accommodate for player preference, but I’ve found that cola flavour is relatively well received.
A dosage of 1.2 g/kg carbohydrate is likely excessive for a player who comes off at half-time, so I work closely with Jace and other members of the performance team to determine if a player has ‘earned’ the energy, tailoring the dosage relative to playing time and distance covered.
As I mentioned above, certain components of recovery can be supported well before the final whistle. For instance a growing body of evidence now supports the fact that pre and during exercise carbohydrate intake plays a pivotal role in maintaining immune function during periods of intensified training/competition by stabilising blood glucose and the stress response (21). Ensuring the player is consuming an adequate, carbohydrate-rich pre-match meal and roughly 90 g/game from a variety of fluids, gels and snacks is vital (22).
One of the biggest difficulties in implementing any recovery strategy is dealing with players after a loss. Obviously with the next game in mind recovery is massively important, but following a loss emotions are high, frustration and anger can result in players slipping through the system without even a sip of water. Dealing with such situations is something I’m still working on personally. In my opinion it comes from the culture developed within the club, from the Head Coach and management down. It’s easy to say you should treat wins and losses in the same way, but in the real world we know it doesn’t work like that. In many ways it’s easier to implement recovery nutrition strategies following away games, thanks to companies such as Eavesway chefs and nutritionists can prepare foods/snacks on the coach and players literally cannot escape and have nothing better to do than eat. But following a loss at home my current strategy is to prepare or provide players with two large recovery beverages with a similar composition to the one described above, so in the event of them deciding to disappear quickly they have something. But again, this is something I’m still working on.
Phase 2: Changing Rooms
Ideally you would aim for the same 1.2 g/kg body weight carbohydrate dosage roughly every 1 – 2-hours for the first 6-hours following the game, but it’s likely the players will disappear after an hour so preparing carbohydrate-rich post-match snacks in the changing room is vital. This is where I have run into some issues.
Fast food actually outperforms sports supplements in restoring muscle glycogen in the 4-hour recovery period (23). Ideally this post-match snack would be fast, practical, finger foods like slices of pizza, burgers, sandwiches, potato wedges, or muffins, or tacos and burritos here in the USA. It’s not uncommon for teams to have Dominos pizza delivered to the changing room and I’ve been known to order Nando’s to airports on occasion, particularly after away games miles from home. But as players have become more health conscious in recent years and more aware of “fads” I’ve noticed they prefer “healthier options” and will opt to not eat over consuming the fast foods. Obviously the “healthiness” of a food is context specific, but in the heat of the battle there is no time to explain this. Furthermore the promotion of “fast foods” can detract from your overall ‘education piece’ within a club and may confuse players. So I would generally recreate “healthy” versions of the aforementioned foods, for example air-frying potato wedges, substituting turkey for beef, using pitta breads for pizzas, adding more vegetables, making fresh smoothies and milkshakes and just ‘cleaning up’ (excuse the pun) the overall look of the foods will help. Sushi has actually proven a hit in the changing rooms of late and meets all of the aforementioned requirements.
I hate to admit it but I’ve also been known to use popular “buzzwords” such as ‘gluten-free’ and ‘clean’; all in the name of getting them to eat something of course. This is where having a close personal relationship with the players helps as you know what they respond too. For example I know a player at Stoke who’s wife is – rightly or wrongly – into gluten-free cooking, so I’ll go out of my way to highlight such options to him. Providing take away boxes and encouraging the player to eat again on the way home is also advisable.
A structured rehydration protocol is only necessary if the player is competing again within 24-hours of if they have lost >3% body weight (24), although it can be achieved in as little as 6-hours with the right strategy (1.5 L fluid / 1 kg weight lost). Given the large inter-individual variability I would recommend assessing individual sweat rates, taking the average from 10 games and using that as an individual’s post-match fluid requirement. Assessing individual sweat sodium losses may also be useful as the sodium content of the drink should be greater than sweat sodium content to be restore fluid balance. From my experience that may take as little as 150 ml or as much as 3 L, and more following the Asian World Cup qualifiers. If the player is consuming electrolyte-rich foods then water is sufficient (25), but there is no harm in adding additional electrolytes to the carbohydrate drink provided immediately post-match and it probably makes it more palatable. Certain foods may help with rehydration; I like to include a fresh soup and potato wedges (seasoned well with salt), fresh smoothies and freshly made milkshakes. In regards fluid retention, at 2-hours following consumption milk actually outperforms still water and sports drinks (26). I would consider milk or yoghurt as an absolute necessity (for lactose-tolerant individuals) during recovery as it provides fluid, carbohydrate, protein, electrolytes and calcium to offset bone resorption.
As I mentioned previously protein has a limited effect on acute recovery. Although consuming roughly 0.4 g/kg protein (30 – 40g) (27, 28, 29) in the post-match meal/snack in the form of chicken or salmon skewers, sandwiches or milkshakes will help maximally stimulate muscle protein synthesis, and if consumed as part of a mixed meal will likely elevate insulin enough to offset muscle protein breakdown for 5-hours (30). Bare in mind that the ultimate goal is to rapidly refill glycogen stores, which will require large and frequent dosages of carbohydrate. Protein is extremely satiating, so providing smaller servings (skewers, meatballs or sandwiches) is recommended as this will encourage larger intakes of carbohydrate without impairing appetite.
Daily protein intake within the ‘meal templates‘ totals around 2.5 – 3 g/kg body weight split evenly across 4 – 6 meals, this level is known to maintain muscle and preserve immune function (31, 32, 33). I would also recommend including a pre-bed source of protein, preferably a dairy source as it’s extremely insulinogenic and will help elevate insulin to promote overnight muscle recovery and reduce glycogen breakdown (34).
Beyond this the only other potentially beneficial addition would be a polyphenol-rich fruit, and possibly omega-3 in supplement form or dietary sources. While it’s unlikely that polyphenol-rich fruits will significantly improve recovery or reduce muscle damage or soreness (50), such interventions have been adopted within elite sport with good buy-in from players (which is rare), so if nothing else can be utilised as a placebo. The required dosage of polyphenols is roughly equivalent of 45 tart cherries (~9 mg anthocyanins) or 30 ml concentrated cherry juice (36). I’d recommend consuming a dosage of 30 ml with the pre and post-match meal so the peak blood concentrations of anthocyanins coincide with the game and then the immediate recovery phase. A similar dosage again before bed for its potential sleep (melatonin) benefits wouldn’t hurt either (37). I’ve had success incorporating cherries into post-match granola bars, flapjacks and muffins. You can use other polyphenol-rich fruits but I favour tart cherry juice because the antioxidant capacity is higher as determined by the ORAC (Oxygen Radical Absorbance Capacity) scale and the practicality of the Cherry Active products. As a recovery aid beetroot juice is likely not as effective as cherry juice – but I would include it within the pre-match strategy.
“At this time I believe it’s the polyphenol content of the juice (beetroot and cherry) rather than nitrate, that’s important for the effects on recovery. So beetroot (nitrates) before and cherry (polyphenols) after would be the way to go”
Dr Andrew Jones
Caffeine has also been mentioned as research suggests it can expedite glycogen resynthesis (38, 39) although the required dosages are impractical and may ultimately interfere with sleep (40). It’s probably best suited for athletes competing again on the same day. Beyond this people have mentioned other ingredients such as bromelain and curcumin, commonly found in the spice turmeric. Unfortunately pure turmeric powder contains 3% curcumin by weight, so the hitting the required dosage without supplements is unrealistic (48).
Phase 4: Evening Meal & Before Bed
I would generally recommend the player eats out at a favourite restaurant with family or friends the evening following a game, although I’ll typically try and promote local Italian’s or Asian restaurants as both menus with likely expose the player to lower protein, carbohydrate-rich (and sodium-rich) options. This may also be used as a means of psychological recovery and serve as a trigger to refocus on the next game. Consumption of carbohydrate (1.2 g/kg) and protein (0.4 g/kg) is again recommended; as is fluid, particularly fruit juices and milkshakes although alcohol is definitely not (41).
Sleep is an extremely under appreciated part of recovery and certain nutritional factors can help to enhance sleep quality including carbohydrate and potentially cherry juice, while dairy protein can also enhance overnight recovery (42). I’d recommend consuming a large carbohydrate-rich meal before bed as this will increase serotonin production in the brain, potentially increasing sensations of lethargy and tiredness, which may improve sleep quality. If you wanted to get super detailed you’re best aiming for a 4: 1 ratio carbohydrate: protein (43). Something like porridge, granola or muesli with milk/yoghurt, bagels with honey or rice pudding with cherry jam would be ideal.
Supplements vs. Food
Beyond the immediate aftermath of a game (<1-hour) where supplements maybe beneficial to take advantage of the exercise-induced increase in glucose uptake, adopting a ‘food first’ policy is generally advisable. I’ve mentioned a few times throughout this post that in most circumstances food will generally outperform supplements.
For example milk will outperform sports drinks in rehydration, as will soup (44). Another useful addition is bananas; they can be consumed whole or incorporated into snacks such as banana bread or banana muffins. They’re a rich source of carbohydrate providing both glucose and fructose at close to 2: 1 ratio. Make sure they’re fully ripe though (at least 21 days) as their sugar content increases and starch content decreases as they ripen (45). Including cherries, blueberries and pomegranates for the polyphenols, salmon for the protein and omega-3, are other examples of functional recovery foods. There is a lot to say for familiar, palatable, flavoursome food.
After a game the biggest issue we face is simply accessing the player – especially following a loss – and ensuring they eat something. Ideally players would attend a compulsory team post-match meal although that’s a cultural battle that may or may not be worth fighting. Louis van Gaal famously copped some stick for something similar while at Manchester United (46).
Ultimately the primary aim immediately after the game is to provide dosages of carbohydrate every 1 – 2-hours after the game, supported by fluids, some protein and polyphenols. So utilising practical ‘grab and go’ snack-like solutions is critical. Understanding and catering to player preferences, personal rituals and habitual practices is also critically important.
Thankfully all of these recommendations have been condensed into a simple, user-friendly excel spreadsheet that you can download for free here.
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