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THE MOST IMPORTANT THINGS FOR A GOOD RECOVERY ARE SLEEP, HYDRATION AND NUTRITION
– Xavier Troessaert –
Holder of a sports physical therapy diploma awarded by ULB in 2011, Xavier Troessaert quickly became involved in the medical supervision of hockey club Royal Racing Club de Bruxelles. This team plays at the highest Belgian level with players from various national teams (Belgium, Canada, France, Ireland, etc.). Due to his sporting past in volleyball, Troessaert always felt particularly attracted to competitive sports. Setting up the most efficient framework possible is his way of contributing to the team’s performance. His motto is: players must be at their best every day, so we should try to do the same!
Mr Troessaert, how do you deal with the recovery aspect within the club where you work?
First of all, it is important to clarify exactly what we mean by recovery. The work and performance of an athlete is a continuous effort. Truly empty moments between matches, training sessions, sessions in the gym, and so on are extremely rare. So I prefer to speak of ‘load management’. Indeed, depending on the work being done, the body will be challenged in some way to generate a benefit at the end of the period required for this adjustment. And this certainly includes the mental aspect. It is therefore necessary to clearly indicate which structure (nervous system, cardiovascular system, joints, muscles, etc.) is to be addressed and in what way (volume, intensity, aggressiveness) in each of the scheduled working sessions. Depending on this, we can estimate/ monitor the time the body needs to adapt. This is where the concept of ‘optimal loading’ comes into play, which we try to put into practice every day in physical development but also in rehabilitation.
So, adequate monitoring is very important?
That’s right. And we use various tools to monitor all this, because we want to know how the athlete reacts to the different applied stresses (physical or even mental). First and foremost we have the ‘Daily Morning Report’, a daily collection of data relating to sleep (quality/quantity), pain, fatigue, stress, etc
We compare these data with the usual values of the athletes (because they are different for each person). In addition, there is a report of ‘internal load’, i.e. a collection of the intensity felt by an athlete at the end of a training session. These data can vary greatly between two athletes doing the same training, because one of them may have greater difficulty adapting to the total load his body is exposed to (e.g. related to a problem of sleep, diet, stress, insufficient recovery, ...). And finally, there is an analysis of the external load, i.e. the load to which the athlete is exposed. By using GPS, heart rate monitors or others, we can collect a considerable amount of information. This information sometimes enables us to identify variations in performance, which may be caused by a workload problem or poor recovery.
So what is the result of combining these three approaches?
Together, these three approaches allow us to oversee the load an athlete is exposed to and how he adapts to it. However, this only makes sense if a link is made to the planning, which has been made in view of the required performance peaks. Close cooperation between the physical coach, the coach and the medical staff is therefore essential. However, a big difference complicates our task. Every athlete is different in his adaptation to training. Monitoring and adjusting training is therefore not so easy to manage for a team of twenty or more athletes. Moreover, the available resources and people are limited.
And that is when you can really get to work ...
Once the various working sessions have been planned, we can indeed look at the content and draw up the appropriate management strategies. If we assume a ‘normal’ competition, we know that it will take 48 to 72 hours for the athlete to regain all his performance capacity (strength, speed, etc.). This is unrelated to any recovery strategies. If we do not repeatedly respect this time frame, we increase the risk of injury. The same applies to certain types of specific training, such as maximum running speed and plyometrics, which require the affected structures to be relieved for a certain period of time. The strategies for recovery, for facilitating adaptation, must be worked out individually and in accordance with the work done. The management of a hockey team is organised around one game a week (or even two). The development of certain physical parameters is adjusted accordingly and we prepare a weekly schedule. This is clearly different from a national team which works towards one match or one tournament. In those circumstances, the periods between matches are almost exclusively devoted to maintaining performance and therefore to the maximum recovery of all these parameters over a short period of time.
What techniques are used to promote recovery ?
Our approach can be broken down into two strategies. First of all, there is a greater need for recovery between two efforts that come in close succession. For example, when two matches are played in the same weekend (often Friday evening and Sunday). As already indicated, it is not possible to speed up the ‘natural’ recovery period of 48 to 72 hours. But we can use different strategies/techniques to make the athlete feel better. There is the ‘cold strategy’, for example an ice bath or cooling-compression devices. This is how we manage the inflammatory response related to muscle damage. We can also apply the compression technique (e.g. compression stockings), which facilitates venous return and counteracts the intra-tissue pressure/stasis of fluid, which causes discomfort especially in the lower limbs. Active recovery is of course also a possibility. In that case we use low-impact activity performed 24 hours after training. This may include cycling, elliptical trainer or swimming. It allows the body’s own regulatory systems (cardiovascular, hormonal, nervous, etc.) to ‘function’.
Finally, we also use myofascial release therapy and mobilisation. Through stretching exercises, slow mobilisation and large amplitudes, we work on releasing muscular hypertonicity caused by the inflammatory processes that arise from muscle breakdown (DOMS mechanism). This also allows a mobilisation at the articular and other levels that allow a return to metabolic balance (homeostasis). And there’s also what we call the ‘Time Line’ approach, which is important for ‘natural’ recovery. Emphasis is placed on myofascial release and amplitudes (same technique) and the implementation of preventive strategies (mobility/stability/quality of movement). An enhanced recovery strategy can be implemented individually if the monitoring parameters are not good enough. Hence the importance of monitoring. Active recovery is also part of this accompanying process of natural adaptation. Apart from all these elements, which represent a specific strategy, it is important to note that the most important components of a good recovery are sleep, hydration and nutrition. The latter can be achieved in particular by integrating post-exercise recovery shakes and specific supplements (amino acids, antioxidants, creatine, caffeine, vitamins, etc.).
Are some recovery techniques specifically used in hockey ?
There are different techniques used across different sports. However, hockey generates a fairly heavy load on the lower limbs. This is particularly illustrated by the number of injuries to these parts of the body. If we look at the GPS information with regard to the efforts made, we can easily compare hockey with football. However, given the small size of the stick and the large number of movements where the stick has to be placed completely on the ground, we see an even greater strain on the thighs and buttocks. Therefore, the development of these muscles is very important to ensure that they are adapted to the workload. In addition, braking for basic movements (push, flat, flick, etc.) is carried out with the left leg forward. So there is an increased tax on this limb. It is therefore necessary to pay special attention to the gluteal and quadriceps muscles. The adductors and hamstrings are also particularly well looked after, as they are the most commonly injured muscles in hockey. Finally, certain movements, such as the “DragFlick”, are only practised by a few athletes. But when practised intensively, it is a movement that can be very taxing on the body, especially in the hips. We must therefore pay particular attention to these athletes.
Do you also use cooling ?
Cooling strategies are regularly used to help manage the inflammatory processes associated with muscle breakdown. However, scientific studies have shown that the chronic use of these strategies hinders the muscle adaptation we strive for. The inflammatory process that follows the muscle breakdown of the work is what comes before reaching the strengthening we aim for. It is also for this reason that anti-inflammatory drugs (NSAID) are not recommended in the 72 hours after a muscle injury. In efforts that follow in close succession, and where we are looking for ‘comfort’ for the athlete, we use local strategies coolingcompression devices or more global strategies (ice bath or GR Full Leg). The development of whole-body cryotherapy is also an interesting strategy. However, it is more of a systemic approach that focuses less on the lower limbs.
It is rare for clubs to have all the equipment within their infrastructure to organise all the possible care, collective recovery or physical preparation. Therefore, partnerships with local fitness centres are set up, which sometimes causes logistical problems. All the more so because, although more and more players are professionals, many hockey players are still students or have a job in addition to their sport. Strength training therefore often comes down to a programme that the athlete carries out according to his or her individual schedule. As far as the medical/paramedical follow-up is concerned, someone is stand-by during the training sessions. But as far as I am concerned, the most essential care is best carried out in a private practice. Ideally, it should not be far from the club. As for the preventive and other monitoring, outside the testing periods (screening and others), this will be communicated to the athlete in the form of a programme, to be executed individually by each athlete. This will obviously create problems in terms of follow-up, quality, etc. So this approach still involves a lot of compromise. But the gradual integration of professionalism will make it possible to improve all this in the near future. That is for sure.
In hockey, unlike in football for example, the players are not constantly at the club. What is the biggest challenge for the medical staff in this regard?
photo: Colas Lefevre
Given the limited medical staff within a hockey club, how are injury prevention and recovery programmes developed ?
It is clear that in hockey we are still a long way from the number of staff that the big football clubs have at their service. Many football clubs have at least four to seven therapists (doctors, physiotherapists, osteopaths, etc.) to look after one team of thirty players. We are often alone to fulfil all these roles. In our team, we have twenty-seven players and we don’t have a lot of resources for medical assistance. We do this work in addition to our jobs where we really earn our living, and especially because we love the ‘fieldwork’. What particularly appeals to me are all the elements of team assistance that you don’t find in traditional physiotherapy consultations. A more professional framework in hockey is necessary in the near future, especially if we want to further develop performance in the Belgian league. But for that to happen, it is important that clubs can spend more of their budget on high level medical and paramedical support.
In an ideal world, how would you develop the medical environment ?
Hockey clubs can rarely count on the significant presence of a doctor. The physical therapist will usually be the front line, often for problems or concerns that are not directly within his field of expertise. A greater ‘medical presence’ is therefore required. In addition, every club should be able to employ at least someone part-time to ensure the adequate follow-up of injuries, but also to be proactive in developing strategies for control and prevention. Subsequently, this professionalism should also be developed in the national youth teams as well. A professional framework often comes too late, when the athletes are already between 19 and 21 years old. This should actually be three or four years earlier. In this way, young talented hockey players will arrive at the national senior teams much better prepared. Finally, the infrastructures within the clubs (areas for physical preparation and rehabilitation) must be such that they allow us to gradually recover from an injury until we return to action. This is a great challenge for clubs that currently do not have the financial means or the space to realise this.
