Therapeutic magazine: Recovery strategies in football by NAQI Belgium

F O U N D AT I O N

THERAPEUTIC MAGAZINE

RECOVERY STRATEGIES

THERAPEUTIC MAGAZINE

MAGAZINE BOARD

CONTENTS

GREET CLAES

EDITOR’S LETTER

M S c (D e n t i s t r y), D D s (D e r m a t o - Co s m e t i c S c i e n c e s) H e a d o f R & D N AQ I ® nv, B e l g i u m

ED GARD M. GE YSKENS,

GERARD GREEN M S c (M a n i p Phy s i o), M M AC P, M C S P, P G Ce r t H E d C l i n i c a l M e n t o r U n i v e r s i t y Co v e n t r y, M S c M a n u a l T h e r a p y St u d e n t s , H a r b o r n e Phy s i o N AQ I ® I n s t r u c t o r

E D I T O R N A Q I F O U N D AT I O N

FO OT BA L L R E COV E RY S T R AT E G I E S GRÉGORY DUPONT, MATHIEU NÉDÉLEC, ALAN MCCALL, SERGE BERTHOIN AND NICOLA A. MAFFIULET TI

6-21

JOOST MENTINK M S c (B i o l o l o g y) CEO of MSP education center and Massage Network

PAUL VAN LOON

THE NUMBER OF SPRINTS PER GAME INCREASES BY T WO TO THREE PERCENT EVERY YEAR PHILIPPE ROSIER,

PHYSIOTHERAPIST, PSYCHOPEDAGOGIST, LEC TURER,

HEALTH & PERFORMANCE MANAGER WITH THE ROYAL BELGIAN FOOTBALL ASSOCIATION

22-27

M S c ( Phy s i c a l T h e r a p y) P a u l Va n L o o n S p o r t s c l i n i c s , St a b r o e k & A n t w e r p N AQ I ® M a i n I n s t r u c t o r

EDITOR EDGARD M. GEYSKENS M S c (E co n o my), M S c ( A p p l i e d Eco n o my & H e a l t h E co n o my) M S c (B u s i n e s s A d m i n i s t r a t i o n), M S c (F i n a n c e) C E O N AQ I ® G r o u p

WRITER WESLEY MUYLDERMANS

WHEN GAMES QUICKLY SUCCEED ONE ANOTHER, WE SEE A DROP IN PHYSICAL PREPAREDNESS JAN VAN DAMME, SPORTS PHYSIOTHERAPIST

POWER TRAINING FOR THE UPPER BODY GIVES A HORMONAL BOOST J O C H E N D E CO E N E ,

S P O R T S P H Y S I O T H E R A P I S T

Spor ts Journalist & writer

ART DIRECTOR ISABEL VERELLEN Master of Ar ts A r t D i r e c t o r N AQ I ® nv, B e l g i u m

SUBSCRIPTIONS I N FO @ NAQ I FO U N DAT I O N .CO M

ADDRESS NAQI FOUNDATION - NICHOLAS HOUSE - RIVER FRONT ENFIELD, MIDDLESEX EN1 3FG - UNITED KINGDOM

28-33

34-39

N AQ I ® R E CO V E R Y G E L

4 0 - 43

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EDITORâ&#x20AC;&#x2122;S LETTER FOOTBALL RECOVERY STRATEGIES EDGARD M.GEYSKENS Editor NAQI Foundation

ecovery strategies have become an integral part of soccer because of the increased frequency of matches, game intensity and internationalization of the sport. Scientists from the University of Lille Nord de France and of the Neuromuscular Research Laboratory in Zurich (Switzerland) have provided an interesting overview of the effects of a congested schedule on physical performance and injury rate. They emphasize on the required time for full recovery and indicate the related fatigue mechanisms. To blend the practical aspects of science and reality they propose a soccer-related recovery protocol. Philippe Rosier, PhD Social Sciences, Physical Therapist, and Health & Performance Manager of the Belgian Soccer Federation and of the Belgian National Football Team Red Devils underlines the complexity of how to balance physical and mental recovery. He refers to the scientific evidence based clinical recovery path of each individual Red Devil player. Jan Van Damme, Sports Physiotherapist, the co-founder of the Belgian Football Doctors & Associates and head physiotherapist at Club Brugge, the Belgian national champion 2018, explains how they tackle recovery with games rapidly succeeding one another. He underlines the importance of an adjusted nutrition program for recovery and the evidence based detailed follow up of the players with programmes like the Groin Bar and the Shape in the Club laboratory. Jochen De Coene, head Physiotherapist of RSC Anderlecht confirms the scientific recovery approach for the injury prevention of each player on an individual level. With his 6 years experience as physiotherapist of Shenhua Football Club and the Chinese National team he advises that a critical success variable of football is the team spirit, a stable medical staff and youth players.

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– by Grégory Dupont, Mathieu Nédélec, Alan McCall, Serge Berthoin and Nicola A. Maffiuletti –

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Practical aspects of blending science and reality

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FOOTBALL RECOVERY STRATEGIES

PRACTICAL ASPECTS OF BLENDING SCIENCE AND REALITY DEMANDS OF THE GAME In elite soccer, the number of competitive matches per season, including domestic, continental and international matches, can be very high for successful teams. Some players can play up to 70 competitive matches per season. In these conditions, the number of weeks with two matches per week is greater than the number of weeks with one match per week. A single match leads to acute fatigue, characterised by a decline in maximal muscle strength1, which requires several days to fully recover. When the schedule is congested (i.e. two matches per week over several weeks), the repetition of matches can lead to a persisting chronic fatigue among the players who play regularly, as the recovery time between two successive matches may be too short. FIFA recommends at least 2 days between two matches, but this is not a rule, it is solely a recommendation. Anecdotal interviews from managers and head coaches frequently reveal that the players are exhausted by repeated matches. Are these subjective statements justified by scientific evidence? In this instance, a congested schedule can be associated with a decrement of physical performance and with a higher injury rate.

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This aspect will be addressed in the first part of this article. The second question is: How much time does a professional player need to fully, recover?

The fourth question concerns the recovery strategies available to reduce the magnitude of fatigue and to accelerate the time to full recovery. This will be addressed in the fourth part of the article.

The repetition of

EFFECTS OF A CONGESTED

matches can lead

PERFORMANCE AND INJURY

to a per sis ting chronic f atigue among the player s who play re gularly... This aspect will be addressed in the second part of the article. The third part will deal with the actions performed during a match which may lead to fatigue and the potential mechanisms involved.

SCHEDULE ON PHYSICAL R AT E Soccer involves many activities such as sprinting, changing direction, jumping, shooting, passing, tackling and physical contact, which lead to fatigue. In such a case, fatigue is characterised by a decline in physical or muscle performance induced by exercise. During a match, fatigue occurs temporarily after short-term intense periods in both halves; towards the end of the match and after the match. Many non-contact injuries occur during the latter stages of each half Â˛,3, suggesting that fatigue can be a risk factor of injur y. However, fatigue can also com e f rom the rep etition of the matches. During periods where the schedule is particularly congested (i.e. two matches per week over several weeks), the

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recovery time between two successive matches can be between 2 and 4 days, which may be insufficient to restore normal homeostasis. As a result, players may experience acute and chronic fatigue potentially leading to underperformance and/or injury. Ekstrand et al4 investigated the relationship between exposure of footballers in European clubs to match play in the months before the FIFA World Cup 2002 and their injuries and performance during that World Cup. They found that 60% of the players who had played more than one match a week before the World Cup incurred injuries or underperformed.Dupont et al5 also studied match-related physical performance and injury rate when playing either one or two matches per week during two seasons on 32 professional soccer players in a top-level team participating in the UEFA Champions league. Physical performance during official matches, characterised by total distance covered, high-intensity distance, sprint distance and number of sprints, was not significantly affected by the number of matches per week (1 vs 2), while the injury rate was more than six times higher (P <0.001) when players played two matches per week (25.6 injuries per 1000 hours of exposure) compared to one match per week (4.1 injuries per 1000 hours of exposure). Bengtsson et al6 confirmed these results with a study involving 27 professional teams over 11 seasons. Total injury rates and muscle injury

rates were increased in league matches when the recovery time was less than or equal to 4 days compared with matches where the recovery time was more than or equal to 6 days. The present data highlight the need for improved recovery strategies to maintain a low injur y rate during periods with congested match fixtures. However, before focusing on recovery strategies, it is necessary to identify the time course of recovery, to determine the fatigue mechanisms as well as the actions in a match that may l ea d to fatigue. The knowledge of these mechanisms should allow the application of appropriate and rationalised recovery strategies.

TIME COURSE OF RECOVERY After a soccermatch, physical performance is impaired and requires several days to fully recover. Sprint performance over 20m is impaired immediately after a match by -37 to -9%1. Thereafter, the recovery of sprint performance differs largely between studies with complete recovery occurring between 57 and 96 hours⁸. When tested immediately after a match, jump performance decrements range from no decrement⁹ to -12%1. The time for jump performance to completely recover is between 48 hours⁸ and more than 72 hours after the match⁷,1. The post-match decline in knee flexors maximal voluntary strength ranges from -7%1⁰ to -15%1,11 and requires 51 hours⁷ to

more than 72 hours1,11 to fully recover. Although the validity of biochemical markers for muscle damage is questionable1², creatine kinase concentrations are frequently used to investigate the underlying physiology of the recovery process. Immediately after a match, rises in creatine kinase concentration range from +75%11 to +250%1. Creatine kinase concentrations peak at 24 to 48 hours after the match and return to baseline between 697 and 120 hours⁸ following the match. The differences between studies regarding the magnitude of performance decline and the subsequent time course of recovery could be explained by the fact that the recovery process was tracked during the post-football match period 1,7,8,11. Several studies 5,13 have pointed out the high variability and poor reliability of physical performance such as high-intensity running distance during soccer m a t c h e s , w h i c h dep ends not only on the f itness level but also on the match s tatus (i.e. whether the team is winning, losing or drawing), qualit y of the opp onent (s trong or weak ) and the match lo cation (i.e. playing at home or away). Se condly, some e x trinsic f ac tors may also inf luence players’ work rate such as the climatic conditions and t y p e of pitch (e.g. grass y, muddy, ar tif icial). A s a conse quence, the amount of f atigue induce d during dif ferent so ccer matches may var y greatly and af fe c t the time

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course of re cover y. T his inherent variabilit y to a so ccer match makes it dif f icult to translate f indings f rom one s tudy to another. In summar y, so ccer- relate d physical p er formance is impaire d imme diately af ter the match and re covers gradually to pre - match levels . Several s tudies f aile d to obser ve a normalis ation of physical p er formance within the 3 days conse cutive to a so ccer match1 ,7 ,1 ,14, su g g es tin g that p er formance can b e impaire d for 72 hours and more. W hen playing t wo matches p er we ek , the 3- day re cover y time b et we en t wo successive matches may consequently b e insuf f icient to f ully re cover. T his long - las ting re duc tion in physical per formance testifies the presence of some f atigue pro cesses that re cover slowly af ter the match.

FATIGUE MECHANISMS Let us focus on the mechanisms that contribute to post-match fatigue. The decrement in performance characterises post-soccer match fatigue. A challenge for exercise physiologists is to identify the factors and mechanisms involved in this post-match fatigue. Lo n g - las tin g f atigu e may b e c aus e d by b oth imp aire d e xci t atio n co nt r a c tio n co up lin g an d s t r u c t ur al dama g e1 5. Acco rdin g to R amp inini et al1 6, f atigu e in s o ccer is d eter min e d by a co mb inatio n o f cent r al an d p er ip h er al f a c to r s b oth imm e diatel y af ter th e match

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an d w i thin h o ur s o f re cover y. Cent r al f atigu e s e ems to b e th e main c aus e o f th e d e clin e in ma x imal vo lunt ar y co nt r a c tio n an d sp r intin g ab ili t y, w h ereas p er ip h er al f atigu e s e ems to b e m o re relate d to in creas e d mus cl e s o ren ess an d th erefo re may b e linke d w i th mus cl e dama g e an d inf lammatio n .

A challenge for e xercise physiologis t s is to identif y the f ac tor s and me chanisms involve d in this pos t-match f atigue. Fatigu e o ccur r in g in th e las t quar ter of a match is char a c ter is e d by a d e clin e in th e am o unt o f high - intensi t y r unnin g an d may b e in du ce d by th e d ep l etio n o f gl yco g en s to res1 7.

Alth o u gh this f atigu e o ccur s tow ard th e en d o f th e match, i t c an als o af fe c t th e p os t- match f atigu e, as mus cl e gl yco g en rep l etio n af ter a high - l evel s o ccer match re quires b et we en 2 an d 3 day s w h en a sp e ci f ic nu t r i tio n p lan is p rov id e d . D ehydr atio n an d thir s t co ul d b e a d di tio nal f a c to r s invo l ve d in th e f atigu e o bs er ve d in th e las t quar ter o f th e match . Af ter a match p laye d in a h ot env iro nm ent (31. 2 to 31. 6Â° C ), M o hr et al1 8 rep o r te d a n et f lui d l oss o f m o re than 2% o f ini tial b o d y mass . T h ey fo un d a signi f ic ant co r relatio n (r= 0.73; P < 0. 05) b et we en th e n et f lui d l oss dur in g th e match an d th e f atigu e in d e x in a p os t- match sp r int tes t . H owever, i t is likel y that d ehydr atio n p lay s a limi te d ro l e in p os t s o ccer match f atigu e as th e tim e to rehydr ate is relati vel y sh o r t (6 h o ur s) w h en guid elin es are resp e c te d1 9. Mus cl e dama g e is likel y a majo r f a c to r to co nsid er in an at tempt to e x p lain p os t match f atigu e. T h e rep eti tio n o f chan g es o f dire c tio n, a ccel er atio n an d d e cel er atio n thro u gh o u t a s o ccer match may in du ce mus cl e dama g e. Mus cl e dama g e is char a c ter is e d by mus cl e s o ren ess , in creas e d p assi ve mus cl e s ti f f n ess , mus cl e s wellin g, m o r p h o l o gic al chan g es su ch as disr uptio n an d dis o rganis atio n o f s arco m eres , s arco l emma an d t r ans ver s e tub ular s y s tem an d a p ro l o n g e d re du c tio n in ma x imal mus cl e fo rce p ro du c tio n 2 0. M ent al f atigu e is an a d di tio nal f a c to r to consider in the at tempt to

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explain postsoccer match fatigue. When the competitive fixture list is congested, there may be insufficient time in between matches for players to recover psychologically, potentially leading to lack of motivation and mental burnout. A congested schedule can be associated with a lot of travelling, which may lead to the disruption of circadian rhythms (jet lag or arrival during the night) and increase the level of stress induced by restricted motion, unfamiliar sleeping patterns and poorer quality of sleep. In summary, central fatigue seems to be the main cause of the decline in maximal voluntary contraction and sprinting ability, whereas peripheral fatigue seems to be more related to increased muscle soreness and therefore seems very likely linked to muscle damage and inflammation. Postmatch fatigue may be associated with glycogen depletion, muscle damage and mental fatigue.

RECOVERY STR ATEGY According to Bishop21, the general consensus is that the translation of sports science research to practice is poor. In order to reduce this gap between research and practice, a survey on the recovery strategies currently used in professional soccer teams was performed22. Thirty-two clubs responded that the aspects they took into account for the recovery of their players concerned nutrition and hydration (97% of the clubs) and sleep (95% of the clubs); while the recovery strategies used after the matches or during the following days were cold water

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immersion and contrast water therapy (88% of the clubs), active recovery (81%), massage (78%), stretching (50%), compression garments (22%) and electrical stimulation (13%). Following this survey, the level of scientific evidence justifying these recovery strategies was reviewed. For this review, the level of scientific evidence focused on the effects of the recovery strategies on change in the measured physical performance.

" During periods

NUTRITION AND H Y DR ATION

re cover y time

Rehydration, carbohydrate and protein consumption after a match are effective recovery techniques for replenishing water and substrate stores and optimising muscledamage repair. However, guidelines including quantity and timing are required in order to maximise their effectiveness. Complete restoration of fluid balance after a match is an important part of the recovery process as loss of intracellular volume reduces rates of glycogen and protein synthesisÂ˛3. After match-induced dehydration (~2% of body mass), full rehydration status will take 6 hours, if a high-sodium (61 mmol.l--1, about 3Ă&#x2014; higher than the sodium concentration found in many commercial sports drinks) drink with a volume greater than 150 to 200% of the sweat loss is consumed19. The addition of sodium to rehydration beverages (500 to 700 mg/L of water) is recommended as it promotes fluid retention, stimulates the thirst while delaying urine production and increases glucose

where the sche dule is par ticularly conges ted, the bet we en t wo successive matches can be bet we en 2 and 4 days, which may be insuf f icient to res tore nor mal home os tasis. "

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absorption in the small intestine²4. As a high rate of post exercise fluid consumption also results in a faster fluid balance restoration compared to a low rate of fluid intake25, it is recommended to drink a large volume of fluid after the match instead of small quantities gradually. However, a small volume of fluid should be prescribed after this initial large consumption of fluid. Addition of a small amount of carbohydrate into the water can also be advised as it stimulates fluid absorption in the gut and improves palatability²4. In a survey conducted on a professional team from the Italian Serie A followed over 5 years, 66% of the players reported being regular drinkers of alcoholic beverages²6. However, alcohol consumption should be avoided after a match as it delays the ability to recover. Firstly, alcohol has diuretic properties, which increases urinary output and consequently the level of dehydration24.

Secondly, it delays the muscular recovery process. The decline in maximal strength at 36 hours post-exercise was associated with muscle damage and was significantly greater in the alcoholic beverage condition (1g. kg-1 bodyweight ethanol as vodka and orange juice) compared to an isocaloric nonalcoholic beverage condition27. Thirdly, it impairs sleep efficiency28, a vital function in the recovery process. The time course of muscle glycogen repletion after a high-level soccer match is between 2 and 3 days. Without specific guidelines, muscle glycogen concentration in top-level players was about 50% of the pre-match value 2 days after a match29. To optimise the resynthesis of muscle glycogen stores, an intake of ~1.2 g carbohydrate. kg--1. hour-1 with a high glycemic index immediately after a match and at 15 to 60 minutes intervals for up to 5 hours afterwards3⁰. This enables maximum resynthesis of muscle glycogen stores.

As exercise stimulates muscle protein synthesis and muscle protein breakdown, the absence of protein intake after exercise can lead to a negative net protein balance. A positive muscle protein balance is required to repair exercise-induced muscle damage following a soccer match. Although, the quantity, type and timing of protein ingestion to maximise post-exercise muscle protein synthesis remains a topic for debate, a consumption of ~20 g milk protein or an equivalent of ~9 g essential amino acids seems to be sufficient to stimulate muscle protein synthesis rates during the first 2 hours of post-exercise recovery³1. A high-protein diet after exercise can also improve subsequent muscle function³2 and cycling exercise performance33. Flavoured milk, which is an easily accessible and relatively inexpensive dairy product, is an effective beverage for post-exercise recovery.

RECOVERY PROTOCOL Figure 1: An example of a practical recovery protocol based on scientific evidence.

End of the match

Hydration

Tart cherry juice

Chocolate milk

Sleep

Compression garments

Fi g u r e 1:

Meal

An example of a p r a c t i c a l r e c o v e r y p r o t o c o l b a s e d o n s c i e nt i f ic e v i d e nce.

Cold bath

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It contains carb ohydrate and proteins in similar amount s to those use d in s tudies demonstrating improved p os t- e xercise re cover y. Many s tudies have also conf irme d the signi f ic ant ef fe c t s o f p os te xercise cho colate milk supplementation on subse quent e xercise p er formance34 , 3 5. Some juices such as tar t cherr y juice, tomato juice or b err y juice are also re commende d for enhancing the re cover y pro cess . T hese juices have a high antioxidant capacit y, which re duces oxidative s tress and inf lammation. T he inges tion of these juices prior to and following e xercise - induce d muscle damage is able to accelerate muscle s trength re cover y 3 6 , 3 7. In conclusion, imme diately af ter a match, players should drink a large volume of f luid (ab out 150 % of the s weat loss) with a high concentration of so dium (ab out 50 0 to 70 0 mg /L of water), f lavoure d milk and tar t cherr y or b err y juice. T hen, they should eat a meal containing high - glycaemic inde x carb ohydrate and protein within the hour following play (Figure 1).

SLEEP Play in g a s o ccer match at night (8 to 9 p m) invo l ves high p hy sic al an d m ent al l o a d, as well as a high em otio nal s t ress .

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In a d di tio n, p os t- match ro u tin es (m e dic al c are, re cover y s t r ate gi es , m eal an d retur n t r ip) f re qu entl y l ea d to a ver y late b e d tim e, w hich may als o alter sl e ep quali t y an d quanti t y. Sl e ep l oss is ass o ciate d w i th re du c tio ns in en dur an ce p er fo r man ce, ma x imal s t ren g th an d co gni ti ve p er fo r man ce 3 8. Cl os e link s als o e x is t b et we en sl e ep an d th e immun e s y s tem .

Long-las ting f atigue may be caused by both impaire d e xcitationcontrac tion coupling and s truc tural damage Co h en et al Âł 9 sh owe d that subj e c t s w i th l ess than 7 h o ur s o f sl e ep p er night in th e we ek s p re ce din g e x p osure to r hin ov ir us are ab o u t thre e tim es m o re likel y to d evel o p a

co l d than th os e w i th 8 h o ur s o r m o re o f sl e ep. A high - gl yc a emic in d e x m eal, w hich is re co mm en d e d fo r r ap i d res to r atio n o f mus cl e gl yco g en s to res , signi f ic antl y re du ce d sl e ep o ns et laten c y co mp are d w i th a l ow - gl yc a emic in d e x m eal4 0 an d w as m os t ef fe c ti ve w h en co nsum e d 4 h o ur s b e fo re b e d tim e co mp are d w i th th e s am e high gl yc a emic in d e x m eal gi ven 1 h o ur b e fo re b e d tim e. S o m e oth er nu t r i ent s su ch as th os e co nt ainin g t r y pto p han o r m elato nin 41,4 2 are als o re co mm en d e d to d e creas e sl e ep o ns et laten c y an d /o r to imp rove sl e ep quanti t y an d quali t y. Tr y pto p han - co nt ainin g fo o ds in clu d e milk , m eat , f ish, p o ult r y, e g gs , b eans an d l eaf y gre en ve g et ab l es , w hil e high co n cent r atio ns o f m elato nin are co nt ain e d in t ar t ch er r i es . A p o o r night â&#x20AC;&#x2122;s sl e ep may b e co mp ens ate d by a sh o r t p os t- lun ch nap. Water h o us e et al4 3 fo un d that a nap, fo ll owe d by a 30 - minu te re cover y p er io d, imp rove d al er tn ess an d asp e c t s of m ent al an d p hy sic al p er fo r man ce fo ll ow in g p ar tial sl e ep l oss . T h e ab ili t y to nap fo r sh o r t p er io ds dur in g th e day may b e a us ef ul sk ill fo r p layer s esp e ciall y dur in g a co n g es te d s ch e dul e. An oth er s t r ate g y to imp rove p hy sic al p er fo r man ce co ul d b e to e x ten d sl e ep quanti t y over multip l e we ek s . Acco rdin g to Mah et al4 4, e x ten d e d sl e ep

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17 CreditsÂŠPhilippe Crochet/Photo News

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STRATEGIES

beyond oneâ&#x20AC;&#x2122;s habitual nightly sleep contributes to improved athletic performance, technical skills, reaction time and daytime reduces sleepiness in basketball players. Other recommendations for sleep induction include benefiting from a dark and quiet environment by using eyeshades and earplugs, listening to relaxing music and adopting regular sleep-wake schedules. Conversely, consumption of caffeine prior to the match for performance enhancement, alcohol as a means of celebrating after the match and hyper-hydration could lead to sleep disturbance.

Sleep is an essential part of recovery management, as sleep disturbances after a match are common which may negatively impact on the recovery process.

COLD -WATER IMMER SION Several meta-analyses have confirmed the positive effects of cold-water immersion on recovery of performance45,46. Cold water immersion post- exercise provided worthwhile benefits on anaerobic performances i.e. maximal strength, sprint ability and countermovement jump47,48.

In a meta-analysis focusing on the effects of cold-water immersion on muscle soreness, Bleakley et al49 found that this strategy was effective to reduce onset of muscle soreness. The percentage of performance change associated with cold-water immersion would be considerably smaller in nonweight-bearing sports (swimming, cycling) compared to weightbearing sports (running, weight training, eccentric muscle damage models). The positive effects of cold-water immersion on recovery of performance are higher when body contacts leading to damage are involved50.

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FOOTBALL RECOVERY STRATEGIES

The following protocol could be recommended to optimise the effects of cold-water immersion on recovery of performance: whole-body immersion lasting 10 to 20 minutes at a temperature of 12 to 15Â°C45,51 immediately after the match or a hightraining load session51.

ACTIVE RECOVERY This strategy involves running, biking or swimming at low intensities for durations of 15 to 30 minutes. This recovery strategy is often implemented after soccer match, as active recovery, performed between 30 and 60% of maximal oxygen uptake and lasting at least 15 minutes, enhances blood lactate removal53 in comparison with passive recovery. However, lactate removal should not be the criterion used to test the quality of recovery. Faster lactate removal does not necessarily involve better performance during subsequent exercise. In several studies aimed at comparing active and passive recovery modalities, exercise performance after active recovery did not improve, despite lower lactate concentrations54,55, while other studies showed that passive recovery improved performance in subsequent exercise56,57. In addition, some studies have reported that active recovery performed immediately after high-intensity exercises significantly impaired glycogen synthesis 58,59. In a set of studies on recovery between two soccer matches separated by 3 days in elite female players, Andersson et al7,60 investigated the effects of 1 hour of

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active recovery (low-intensit y c ycling and resistance training) per formed at 22 and 46 hours af ter the first match. Results showed that active recover y had no ef fects on the recover y pat tern of physical per formance markers (i.e. countermovement jump, 20 -m sprint per formance, maximal isokinetic knee f lexion and ex tension), perceived muscle soreness and biochemical markers (i.e. creatine kinase, urea and uric acid), oxidative stress markers and antioxidants. According to these results, active recover y per formed af ter a match does not present any benefit for soccer-related physical per formance.

MASSAGE

In terms of recover y of per formance, most studies have failed to find a significant beneficial ef fect of massage on subsequent exercise af ter local exercises61 or global exercises62. Massage therapy at tenuate inf lammator y signalling af ter exercise-induced muscle damage63 and presents psychological benefits. Massage decreased the subjective symptoms of delayed onset muscle soreness and increased perceptions of recover y 6 4. In conclusion, benefits of massage are still lacking regarding recover y of per formance. Conversely, the majorit y of the evidence points towards massage being ef fective in alleviating muscle soreness and improving perceptions of recover y.

STRETCHING Elite soccer teams devote a substantial amount of training and match preparation time to stretching. Dadebo et al65 reported that the English Premiership clubs allocated almost 40% of total training time to flexibility training. Stretching exercises are performed for several reasons: to improve range of motion, to reduce musculotendinous stiffness, to prevent injury, as well as to promote recovery. However, there is no substantial scientific evidence to support the use of stretching to enhance the postexercise recovery of soccer players. In a metaanalysis including 12 studies, Herbert et al66 reported that stretching is not clinically worthwhile in reducing muscle soreness in the days following exercise. Recovery of physical performance is not improved after stretching67.

COMPRESSION GARMENTS The principle of compression garments is to increase the pressure on the ankle and to decrease it on the mid-thigh in order to improve the venous return and thus reduce venous stasis in the lower ex tremities. A meta-analysis on the ef fec ts of compression garments on recover y following damaging exercise was led by Hill et al68. Data were ex tracted from 12 studies, where variables were measured at baseline and at 24, 48 or 72 hours post-exercise. Results indicated that the use of compression garments had a moderate ef fect on recover y of

football issue 2 2018

muscle strength, muscle power, creatine kinase and in reducing the severity of delayed onset muscle soreness. As studies did not have a placebo condition (i.e. using a garment but no compression), a placebo effect due to wearing the garments should not be excluded. Another potential limitation of studies on compression garments is that the actual pressures applied by the garments to subjects are not measured. In conclusion, the use of compression garments may provide an easy-to-use recovery strategy in a team. They could be useful during air travel, especially during long flights, to reduce the risk of deep vein thrombosis69.

ELEC TRIC AL S TIMUL ATION Electrical stimulation involves the transmission of electrical impulses via surface electrodes to peripherally stimulate motor neurons thus eliciting muscular contractions. Transcutaneous electrical nerve stimulation and low-frequency electrical stimulation are the modalities most frequently used for recovery purposes. The effects of electrical stimulation on the recovery of strength production capacity and on the reduction of muscle soreness were reviewed by Babault et al70 . Among the 12 studies reviewed, 11 studies

failed to find a significant effect of electrical stimulation on the ability to maintain performance after exercise, while three out of nine studies reported a significant effect of electrical stimulation on the reduction of muscle soreness. In conclusion, while electrical stimulation is often used for recovery purposes, no scientific evidence exists regarding its ability to maintain physical performance. The level of scientific evidence concerning the effect of electrical stimulation on subjective ratings such as muscle soreness is also limited.

CreditsÂŠPhilippe Crochet/Photo News

NAQI Foundation

conclusion In summary, some recovery strategies such as hydration, diet, sleep, cold-water immersion and compression garments are effective to accelerate the recovery process. An example of a practical recovery protocol based on scientific evidence is proposed in Figure 1. As described in the Figure 1, the recoveryprotocol includes six steps and should start immediately after the match:

1 The first step is hydration; the mass of the players should be measured and compared to the pre-match body mass in order to propose the appropriate quantity of fluid to drink (150% of body mass lost). The fluid should contain a combination of water and a large amount of sodium (500 to 700 mg/L of water). 2 The second step consists of drinking a tart cherry juice and chocolate milk in order to restore glycogen, to reduce oxidative stress and inflammation, to stimulate muscle repair and to promote quality and quantity of sleep. 3 The third step is the cold bath. The players should immerse themselves up to the neck at a temperature between 12 and 15Â°C for 10 to 20 minutes to accelerate the recovery process. 4

The fourth step is to wear a compression garment until bedtime.

5 The fifth step is to eat a meal high in carbohydrate with a high-glycaemic index and protein within 1 hour of the end of the match (for example soup, well-cooked white pasta or mashed potatoes, chicken or fish, yogurts or cake). 6

The final step is to have a good nightâ&#x20AC;&#x2122;s sleep.

NAQI Foundation

football issue 2 2018

Scientific evidence for the other strategies reviewed, such as active recovery, stretching, massage and electrical stimulation is still lacking in the ability to accelerate the return to the initial level of performance. This does not mean that these strategies do not help recovery, but that the protocols implemented up until now were unable to accelerate the recovery of physical performance. In the survey on recovery administered to the professional soccer teams, practitioners revealed that recovery strategies are combined in recovery protocols. Although it remains important to isolate each strategy to determine its effects in the future research, it would also be interesting to analyse the interactions between the techniques. Longitudinal research protocols should also be led to take into account the chronic effects of cellular to molecular adaptations.

Source, Aspetar Sports Medicine Journal, volume 4, targeted topic 6, January 2015, p.20-26 GrĂŠgory Dupont, Mathieu NĂŠdĂŠlec, Alan McCall, Serge Berthoin, University of Lille Nord de France, France Nicola A. Maffiuletti, Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland References, Available at www.aspetar.com/journal

NAQI Foundation

HEALTH & PERFORMANCE MANAGER WITH THE ROYAL BELGIAN FOOTBALL ASSOCIATION

The number of sprints per game increases by two to three percent every year. " - Philippe Rosier -

hilippe Rosier is a physiotherapist, psychopedagogist, lecturer and last but not least, Health & Performance Manager with the Royal Belgian Football Association. In that capacity, he ensures the Red Devils are fit and healthy, gearing them up for the upcoming FIFA World Cup in Russia and giving them the best chances of earning that coveted top spot. He has a PhD in Social Sciences and specialised in Psychopedagogy. His research focused on the impact of fasciatherapy on the physical and mental recovery of top athletes. In a nutshell, there is no one who can give us a better insight into the recovery of top footballers. 22

NAQI Foundation

football issue 2 2018

Dr Rosier, what are the greatest challenges in post-match recovery?

h e greates t chall en g e is to f in d th e r ight b alan ce b et we en p hy sic al an d m ent al re cover y. In re cent year s we have gain e d a ccess to qui te a few s ci enti f ic to o ls to b o os t th e p layer sâ&#x20AC;&#x2122; p hy sic al re cover y. We k n ow w hat th ey sh o ul d eat an d dr ink to p ro m ote a b et ter re cover y, we k n ow e x a c tl y h ow co l d an ice b ath sh o ul d b e, w h eth er o r n ot th ey sh o ul d b ath e th eir entire b o d y an d s o o n . We are als o aw are o f th e e f fe c t s o f mass a g es an d s t retchin g . A l ot o f res earch has b e en co n du c te d into th e p hy sic al sid e o f thin gs . T hat b ein g s aid, s t renu o us a c ti v i t y an d p lay in g fo otb all un d er p ressure als o result in a l ot o f s t ress . An d that is a maj o r chall en g e. H ow d o we ke ep p layer s fo cus e d an d f resh m ent all y? I wo ul d d e f ini tel y argu e fo r a greater fo cus o n an d m o re res earch into m ent al re cover y, linke d w i th th e imp l em ent atio n o f s t r ate gi es b as e d o n this res earch .

And of course, modern football is quickly evolving...

Photo of Philippe Rosier

hat 's r ight . T h e intensi t y an d th e numb er o f gam es is in creasin g, an d th ere is a l ot o f t r avel invo l ve d . T hat p u t s th e p layer s un d er en o r m o us s t r ain ... In th e p as t , p layer s wo ul d t r ain fo r gam es o r champ io nships at th e s easi d e. N ow a day s , th ey t r ain o n th e oth er si d e o f th e wo r l d . T hat 's w hy re cover y is b e co min g in creasin gl y imp o r t ant . Ten year s a g o, th e intensi t y o f th e gam es w as mu ch l ower, s o th ere w as n o n e e d to fo cus o n re cover y as mu ch as we d o to day. N ow th e numb er o f sp r int s p er gam e is in creasin g by t wo to thre e p ercent ever y year, s o over a ten - year p er io d, we are t alk in g ab o u t m o re than t went y p ercent . T h erefo re, cus to mis atio n o f th e p ro cess an d a th o ro u gh s ci enti f ic ap p ro a ch are a mus t ..

" Three night s of bad sleep double the risk of injur y. "

NAQI Foundation

CreditsÂŠPhilippe Crochet/Photo News

football issue 2 2018

How do you deal with the recovery of the Red Devils?

e have a d o pte d an ev id en ce - b as e d ap p ro a ch . T h e s t r ate gi es we us e are s ci enti f ic all y tes te d an d we ap p l y th em in a s ci enti f ic mann er to o. Fo r e x amp l e, qui te a few p e o p l e like to us e ice b aths . Bu t h ow co l d sh o ul d that b ath b e, h ow s o o n af ter th e ef fo r t sh o ul d yo u t ake i t an d fo r h ow l o n g? If yo u ans wer th es e qu es tio ns co r re c tl y, yo u w ill us e ice b aths co r re c tl y an d th ey w ill have a b en ef icial e f fe c t . If yo u f ail to ans wer th em co r re c tl y, yo u w ill p ro b ab l y en d up c ausin g dama g e. We o f fer a w h o l e r an g e o f re cover y s tr ate gi es . S o m e are o b ligato r y fo r th e w h o l e team, su ch as a c ti ve re cover y, w hich is un d o ubte dl y ver y imp o r t ant . Two e x amp l es are c yclin g an d co mp uls o r y yo ga s essio ns . Ap ar t f ro m th es e, we als o o f fer o ptio nal s t r ate gi es . T h e p layer s c an a c t uall y d evel o p th eir ow n p er s o nal re cover y p ro gr amm e. T h ey c an o pt to have a mass a g e o r v isi t th e os te o p ath, th ey c an ch o os e th e f lavo ur o f th eir re cover y dr ink an d s o o n . N e e dl ess to s ay, ever y thin g is cl os el y m o ni to re d an d dis cuss e d .

What is the impact of a bad recovery on performance and the risk of injury?

any s t u di es have b e en co n du c te d o n this mat ter. R es earch sh ow s that w h en a p layer in dic ates h e has sl ept b a dl y fo r m o re than thre e night s , th e r isk o f injur y d o ub l es . S o i t is ver y imp o r t ant to m o ni to r th e p layer sâ&#x20AC;&#x2122; sl e ep p at ter ns , p ar ticular l y th e w ay th ey e x p er i en ce th eir sl e ep. T h ere are similar s t u di es o n th e e f fe c t s o f hydr atio n an d fo o d . Many sub asp e c t s o f re cover y have b e en anal y s e d an d i t t ur ns o u t that w h en yo u d o n ot re cover well, yo u are at greater r isk o f injur in g yo ur s el f. Yo ur p er fo r man ce als o dro ps , as d o es yo ur ab ili t y to quick l y rea c t to di f ferent s timuli . M o re over, yo ur s t amina an d sp e e d are n e gati vel y af fe c te d . Yo ur immun e s y s tem is als o co mp ro mis e d, mak in g yo u m o re p ro n e to illn ess .

" It is mainly a chronic workload that can eventually have a negative impac t. " People sometimes say, "They're pros... How can they be tired playing two games a week?â&#x20AC;? Is this too short-sighted?

d eall y, yo u wo ul d have 72 h o ur s in b et we en gam es . It is imp o r t ant to make a dis tin c tio n b et we en an a cu te an d a chro nic (wo r k )l o a d . Play in g a few mid - we ek gam es is n ot n e cess ar il y a p ro b l em . H owever, i t is th e sum o f th os e ef fo r t s - th e chro nic l o a d - that c an b e co m e p ro b l ematic over th e co ur s e o f an entire s eas o n . Pe o p l e r arel y s e e w hat g o es o n b ehin d th e s cen es . T h e R e d D ev ils , fo r example, are in the midst of their periodisation* fo r th e FIFA Wo r l d Cup in Russia . D ur in g th e event , th ey w ill b e p lay in g a gam e in K alinin gr a d at 8 p m, m eanin g th e p layer s wo n' t b e in b e d b efo re 3 o r 4 am . T hat is a ver y sh o r t night , s o th e fo ll ow in g day is d e dic ate d to re cover y. W hat 's m o re, a m ere 4 8 h o ur s later th ey w ill b e p lay in g a gain . Fo r that n e x t gam e, th ey n e e d to tr avel f ro m K alinin gr a d to M os cow an d th en f ro m M os cow th ey w ill b e h ea din g els ew h ere. T hat is a l ot o f t r avellin g! S o th ere is mu ch m o re to i t than jus t k ick in g aro un d a b all, hav in g a p int at th e b ar an d th en h ea din g b a ck h o m e to sl e ep. It is a ver y co mp l e x p ro cess .

NAQI Foundation

" We use GPS tracking to collec t that same data f rom training sessions. That gives us data f rom both training sessions and games for ever y player, which we then pour into algorithms. "

CreditsÂŠNico Vereecken/Photo News

NAQI Foundation

football issue 2 2018

CreditsÂŠJimmy Bolcina/Photo News

And then there are the different clubs and competitions the players are involved in...

ll gam es in co mp eti tio ns are t r a cke d, s o we k n ow h ow many a ccel er atio ns an d h ow many chan g es o f dire c tio ns a p layer has ma d e, an d h ow many k il o m et res h e has r un . We us e GPS tr a ck in g to co ll e c t that s am e dat a f ro m t r ainin g s essio ns . T hat gi ves us dat a f ro m b oth tr ainin g s essio ns an d gam es fo r ever y p layer, w hich we th en p o ur into al g o r i thms . T hat gi ves us an insight into th e p layer sâ&#x20AC;&#x2122; e x ter nal load. B as e d o n that , we d evel o p a highl y cus to mis e d p ro gr amm e. S o m e p lay fo r teams w i th ver y intens e t r ainin g s essio ns , an d th ey have a l ot o f p i tch tim e. W i th th em, we n e e d to fo cus s tro n gl y o n re cover y. T h ere is n o n e e d to b o os t th eir co n di tio n . Sp eak in g o f w hich, th e b es t w ay fo r p layer s to imp rove th eir co n di tio n is to p lay gam es . Player s w h o are m os tl y o n th e b en ch an d th erefo re have l ess p i tch tim e are at greater r isk w h en th ey su d d enl y s t ar t p lay in g m o re, p ar ticular l y w h en th eir chro nic l o a d is over 110 % o f w hat th ey are us e d to. T h os e p layer s re quire sp e ci f ic assis t an ce. * Periodisation, reference: NAQI THERAPEUTIC MAGAZINE: The Olympic Issue 2/2016, Training periodisation p.11-19

NAQI Foundation

SPORTS PHYSIOTHERAPIST AND THE CO-FOUNDER OF BFDA

"When games quickly succeed one another, we see a drop in physical preparedness.â&#x20AC;? - Jan Van Damme -

an Van Damme is a sports physiotherapist and the co-founder of BFDA, Belgian Football Doctors & Associates, an association that brings together the medical staff of Belgian professional football to pool and share knowledge. But above all, Van Damme is head physiotherapist at Club Brugge. Day in, day out, he works with professional footballers who need to be physically and mentally prepared for a series of strenuous efforts. Needless to say, a good recovery is essential in this process.

NAQI Foundation

football issue 2 2018

NAQI Foundation

With games succeeding one another extremely quickly, it cannot be easy to get and keep all players fit...

hat 's r ight . W h en wo r k in g un d er n o r mal circums t an ces , s o w i th o u t Euro p ean o r cup gam es , we have ab o u t si x day s to re cover f ro m a match, an d we a d o pt a f air l y s t an dard s t r ate g y. T hat reall y gi ves th e p layer s en o u gh tim e to re cover th o ro u ghl y. O f co ur s e th e greates t chall en g e is to h elp th e p layer s re cover b et we en t wo gam es that are cl os er to g eth er. We have n otice d - an d th ere are v ar io us s t u di es co nf ir min g this - a dro p in p hy sic al p rep are dn ess w h en gam es quick l y su cce e d o n e an oth er.

How do you tackle recovery concretely?

e have a s et re cover y r i t ual af ter th e gam e, b u t in reali t y i t all s t ar t s w h en th e p layer s are s till o n th e p i tch, b e c aus e we alw ay s make sure th ey dr ink en o u gh . We even us e a cus to m ap p ro a ch, w i th is oto nic dr ink s a dapte d to ea ch p layer. T h e s alt co ntent o f th es e dr ink s is a djus te d b as e d o n th e (s weat) tes t s th e p layer s have un d erg o n e. T h os e w h o ten d to s weat m o re o bv io usl y n e e d m o re s alt . T h e quanti t y o f thir s t- qu en ch er is als o d eter min e d usin g this s am e ap p ro a ch . Imm e diatel y af ter th e gam e, we gi ve o ur p layer s a ' f ull re cover y shakeâ&#x20AC;&#x2122; - a p rotein shake co nt ainin g all th e n e cess ar y c ar b o hydr ates . It is als o imp o r t ant fo r th e p layer s to co nsum e a d e quate am o unt s o f p rotein w i thin th e f ir s t hal f h o ur af ter th e en d o f th e gam e. We have a r an g e o f di f ferent f lavo ur s to m e et ever yo n e's p er s o nal p re feren ces . It is reall y ess ential that th ey dr ink th es e shakes , s o th e entire s t af f s t r ic tl y m o ni to r s th e p layer s . Af ter th ey have ha d a sh ower, th e p layer s h ea d fo r th e p layer sâ&#x20AC;&#x2122; h o m e, w h ere th ey have a m eal co nt ainin g th e n e cess ar y c ar b o hydr ates , su ch as p as t a .

NAQI Foundation

football issue 2 2018

"Our recover y protocol goes beyond jus t the f ir s t few hour s af ter the game."

Photo Credits@byaksel NAQI Foundation

CreditsÂŠNico Vereecken/Photo News

You are mainly discussing diet-related efforts, but do you use any other recovery techniques too?

or home games, we can use our ice bath. Unfortunately that does not always work for away games. We do have a portable bath, but experience has taught us it is not the most practical solution. It needs to be filled, we need to make sure we take enough ice with us, we need to get the temperature right and so on. That's why we hardly ever use it. For European games, the opponent sometimes gives us access to their ice bath, but in Belgium we have not reached those levels yet. We also always make our players wear compression socks after games, especially if they have a long bus trip ahead of them and they need to sit still for a long time. Many players also wear them overnight.

So that is what happens in the hours after a game. But of course you go beyond that...

hat's right, our recovery protocol extends into the following days. We carry out biochemical analyses in which we check the players’ urine and saliva. They also undergo a series of physical tests, for example with the 'groin bar', a device to test the muscles around the hip joints, the adductors and abductors.

NAQI Foundation

"If the high-intensit y metres are high, the player s have a harder time recovering. " We carry out this test the second day following the game. First, the players cycle for fifteen minutes and then we ask them to come to the groin bar. We measure how many Newtons the muscles can push and we compare the ratio between the adductors and the abductors. Then we check whether the previously set benchmark - a standard so to speak - has been reached. Based on these results, we can determine whether or not a player has fully recovered. After the groin bar test, the players also do a ‘counter movement jump'. At the beginning of the season - when the players are still at their peak - we ask them to jump, to establish their maximum jump count. We then look at the percentage of the maximum they can reach. This is once again a good indicator to determine to which extent they have recovered.

In modern football, a massive amount of data is collected during games. Do you use this data to boost the players’ recovery?

bsolutely. We analyse all the GPS details, which tell us, on average, how many kilometres our players have run during each game and with which intensity. Training sessions are monitored too and about an hour after, all the data has already been uploaded by the Physical Coach.

In doing so, we adopt a very detailed approach and we even look at the accelerations and decelerations of each player during both training sessions and games, or simply put, how often they speed up and slow down. The evolution of those parameters also allows us to properly estimate the players’ recovery potential. The more details we collect, the better our insights. We can accurately check each player's average actions and running track record, and monitor their performance during periods with a lot of games. But above all, it helps us understand how they recover.

Eventually, all the pieces fall into place and we get a better understanding of the physical preparedness of every player. We then discuss the results with the coach and jointly draw up a training programme the players should follow.

football issue 2 2018

If a player himself says he is tired, what's the next step?

ll players have an app on their smartphone on which they need to answer seven questions every morning. We call it 'Shape'. These questions focus on physical preparedness, how they slept, how they feel about the training session they had the day before and so on. Their answers are immediately sent to our Club lab - which we are incredibly proud of, by the way and if necessary, we can have a word with the player before the training session and possibly change the programme.

Concretely, what is the impact of a bad recovery on the team results?

hat partly depends on the types of games they are playing. Some games are high in intensity and require a lot of running. We have noticed that the higher the number of 'high-intensityâ&#x20AC;&#x2122; metres - at 21 km per hour or more - the harder it is for the players to recover. If there is a game on day three after the last one, some players start struggling. In these cases, an additional day to recover is very beneficial. We have tracked this in the past few years, comparing recovery and results, and we have found that we tend to lose slightly more points when there are just two or three days between two games.

CreditsÂŠPeter Voecht/Photo News NAQIDe Foundation 33

SPORTS PHYSIOTHERAPIST

"Power training for the upper body gives a hormonal boost. â&#x20AC;? - Jochen De Coene -

ochen De Coene worked with AA Gent for ten years. When he was 27, he moved to China, where he assisted Shenhua Football Club and the Chinese national team for six years. In 1999 he joined RSC Anderlecht, where to this day, he draws up the medical assistance plans. His team ensures that the purple-whites feel great, both physically and mentally.

NAQI Foundation

football issue 2 2018

NAQI Foundation

Jochen, working with top clubs, like RSC Anderlecht, must come with some serious responsibilities...

ur task is clear and simple: we need to get the players fit again as soon as possible after a game. An Anderlecht player often has two or even three games a week, and an average of 70 to 80 games per season. Needless to say, a good and fast recovery is essential, not in the least because it prevents injuries. We offer the players a comprehensive package that includes massages, ice baths and the like, but we also focus a lot on nutrition and hydration. We check their urine to make sure they have had enough to drink and to adjust their intake if necessary. After all, the players are only human. They can feel overwhelmed from time to time, which can â&#x20AC;&#x2DC;breakâ&#x20AC;&#x2122; their body so to speak. The result? Annoying injuries that keep them off the pitch, sometimes for long periods of time. Our task is to prevent this, because we mustn't forget that every time a player skips a game, that translates as a financial loss for the club.

Times are changing and so is football. Scientific evidence is more important than ever before. This is presumably a blessing, both for you and for the players?

ears ago, recovery was largely pure guesswork. Everyone just did what they felt was best. But when you rely on your gut feeling when using a specific treatment or approach, you will not necessarily achieve the intended effects. An example? Today, we do upper-body power training one or two days after a game, which we never used to do in the past. This results in a hormonal boost, which, in turn, speeds up the recovery process. Nowadays, we have a more science-based approach. That's why the club has invested heavily in data collection too, because figures - black on white - can help us determine whether or not a player has sufficiently recovered. It is our job to coach the players on the pitch and beyond. We need to convince them to live like real pros, gearing their lifestyle to it.

CreditsÂŠVincent Kalut/Photo News

NAQI Foundation

football issue 2 2018

What are your preferred recovery techniques?

ny recovery technique, regardless of its intensity and timing, is important. However, a custom approach is also a must, because every player is different. An example? We administer food supplements based on blood tests to ensure a quick and optimal recovery after a major effort. This recovery is not only physical but mental too. These supplements contribute to a greater fat-free mass, for example, as well as additional muscle strength and a better muscle structure. Above all, they promote the repair of muscle damage following intense efforts. We also focus on active recovery the day after the game, ensuring the players train at the right heart rate. All of this contributes to a custom approach. CreditsÂŠNico Vereecken/Photo News

" Training at the right hear t rate, that too is a cus tom approach. " CreditsÂŠVincent Kalut/Photo News

NAQI Foundation

You often see footballers wearing compressions socks. Do you use them too? What is their purpose?

hat is underestimated far too often. If you are playing a Champions League game in Russia at 8.45 pm on Wednesday and on Sunday of that same week you are playing against Club Brugge, you will undoubtedly be more intrinsically motivated than for a match against Moeskroen, for example. Mentally, it is easier for players to prepare for a top-level match, and that is only human. But it is our job to give everyone a good motivational boost at all times.

What about the mental recovery?

es, our players wear those too, especially if the game is followed by a long bus journey. Intense efforts break down cellular tissue in the muscles, which negatively impacts microcirculation. Compression socks put more pressure on the muscle mass to push the excess moisture, including the waste products of the combustion process, back into the bloodstream. The decreasing pressure of the sock, from ankle to knee, ensures the blood is properly sent back to the heart.

"You don't need to motivate player s for a game agains t Club Brugge." As you said earlier, the greatest challenge is for the players to properly recover in between games. That is no easy feat for a club that plays at European level every season...

ur players are high-level professionals, of course. Their bodies have adjusted to intense efforts, and they can handle them. They can also count on professional medical assistance, which ensures they can usually be prepared for the next game on time. Of course no two players are the same. Some have greater speed and explosiveness than others, and so on. Every player also recovers in his own way and at his own pace.

NAQI Foundation

CreditsÂŠPhilippe Crochet/Photo News

"Ever y player also recover s in his own way and at his own pace. "

football issue 2 2018

NAQI Foundation

RECOVERY GEL ✔ Reduces muscles stiffness and cramps ✔ Improves the circulation and reduces waste materials ✔ Lightens heavy legs ✔ Cooling and analgesic effect

NAQI® Recovery Gel helps reduce muscle fatigue and stiffness after physical activity.

NAQI® Recovery Gel relaxes the muscles and helps reduce muscle fatigue after physical activity. It contains essential oils of eucalyptus, peppermint, cypress, arnica and juniper, and vanillyl butyl ether to stimulate blood flow and increase the supply of nutrients and oxygen to tired muscles. By speeding up the removal of waste materials built up in the muscles, you will enjoy a quicker recovery after intense workouts. As a result, NAQI® Recovery Gel helps boost your performance.

NAQI Foundation

football issue 2 2018

â&#x153;&#x201D; apply after sports

Airless Bottle

easy-to-use

USE: Rub into the skin immediately after sports and/ or physical activity. For external use only. Keep out of the reach of children. Avoid contact with eyes and mucous membranes. Do not use on broken skin. NAQIÂŽ Recovery Gel is easily absorbed, non-greasy and has an intense and prolonged effect.

NAQI Foundation

RECOVERY GEL ACTIVE INGREDIENTS Eucalyptus Globulus Leaf Oil Menthol and Mentha Piperita Oil Cupressus Sempervirens Leaf Oil Juniperus Communis Fruit Oil Arnica Montana Flower Extract Vanillyl Butyl Ether

Packaging 100ml airless tube 42

NAQI Foundation

football issue 2 2018

Enjoy a quicker recovery after intense workouts!

The skin Protects the skin barrier Moisturizer Softens the skin Non- greasy Soft warm feeling

NAQI Foundation

Prepare Protec t Per form Recover

F OUN D ATI ON

FOUNDATION

HYPOTHESIS: The hypothesis of the NAQIÂŽ Therapeutic Magazine is that the quality and the outcome of therapeutic care and sports performance will substantially increase if treatment is supported by skin therapy/care. The condition of the skin (ao scars, dry skin) can negatively influence therapeutic care and sports performance, even to a degree that skin care becomes a necessity before any other treatment.

FOUNDATION

NAQI FOUNDAT ION NICHOLAS HOUSE - RIVER FRONT ENFIELD, MIDDLESE X EN1 3FG UNITED KINGDOM

FOOTBALL ISSUE 2 2018: 28â&#x201A;¬

FOUNDATION

Therapeutic magazine: Recovery strategies in football

Articles inside

WHEN GAMES QUICKLY SUCCEED ONE ANOTHER, WE SEE A DROP IN PHYSICAL PREPAREDNESS