Journal of Sports Sciences, June 2005; 23(6): 619 – 627

The use of recovery methods post-exercise

THOMAS REILLY1 & BJORN EKBLOM2

1
Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK and 2Department of
Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden

(Accepted 24 July 2004)

Abstract
Competitive soccer engages many of the body’s systems to a major extent. The musculoskeletal, nervous, immune and
metabolic systems are stressed to a point where recovery strategies post-exercise become influential in preparing for the next
match. Intense activity at a 7-day training camp causes participants to experience lowered concentrations of non-killer cells
and T-helper cells. Two consecutive games in 24 h produce disturbances in the testosterone – cortisol ratio. When
competitive schedules are congested, the recovery process should be optimized for performance capabilities to be restored to
normal as soon as possible. There is evidence that glycogen stores are reduced near to depletion at the end of a soccer game
and that a diet high in carbohydrates can aid recovery. Water alone is not the best means of restoring body fluids, since
carbohydrate-electrolyte drinks display better intestinal absorption and reduce urine output. Some relief from muscle
soreness may be achieved by means of a warm-down. Deep-water running regimens can replace conventional physical
training in the days after competition. Massage, cryotherapy and alternative therapies have not been shown to be consistently
effective. It is concluded that optimizing recovery post-exercise depends on a combination of factors that incorporate a
consideration of individual differences and lifestyle factors. The procedures to facilitate recovery processes should start
immediately the game or training finishes. Match administrators and tournament planners should consider the stressful
consequences for players in periods of congested fixtures and alleviate the physiological strain as far as possible by allowing
72 h between competitive games. This frequency of competition is unlikely to be sustainable in the long term.

Keywords: Carbohydrates, competition, lifestyle, overload, stress

The strain on players in the first team squad of

Introduction
The habitual activity of soccer players during the
competitive season entails a cycle of training, taper,
competition and recovery over a period of one week.
At the top level this weekly cycle is perturbed by
irregularities in the competitive fixture list, match
day being not necessarily consistent from one week
to another. Professional players in the top clubs may
have additional commitments, such as cup and other
knock-out matches, playing for their club in con-
tinental leagues or representing their country in
international matches. The repetitive and seemingly
unrelenting fixture schedule, the hassle and stress of
travel (Waterhouse, Minors, Waterhouse, Reilly, &
Atkinson, 2002) increase the risk of ‘‘over-reaching’’
or ‘‘burn-out’’, whereby players lose ‘‘form’’ and
enter an underperformance spiral (Parry-Billings,
Matthews, Newsholme, Budgett, & Koutedakis,
1993).
professional clubs has been acknowledged indirectly
in various ways. Some national leagues in Europe
contain a mid-season break; the rationale is that the
intermission enables players to recover from the
rigours of the first half of the season at a time when
climatic conditions in Europe are usually at their
worst. The best and richest clubs in the European
leagues tend to have the largest squads, allowing
scope for the rotation of players. The suggestion that
players accumulate ‘‘fatigue’’ as the season pro-
gresses gained credence during the summer of 2002
when several of the favoured teams (notably Argen-
tina, France, Italy, Portugal and Spain) performed
poorly in the World Cup. The tournament in Korea
and Japan had taken place shortly after the comple-
tion of the domestic league season on the European
continent. The argument can be countered by the
better performances of England, Germany and
Turkey, whose players would also likely accumulate

Correspondence: T. Reilly, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, The Henry Cotton Campus, 15 – 21 Webster
Street, Liverpool L3 2RT, UK. E-mail: t.p.reilly@livjm.ac.uk
ISSN 0264-0414 print/ISSN 1466-447X online ª 2005 Taylor & Francis Group Ltd
DOI: 10.1080/02640410400021302
620 T. Reilly & B. Ekblom
similar levels of fatigue over the same competitive
season.
Coaches can now use certain players sparingly in a
game, basing substitutions on tactical grounds so
that key individuals are not exhausted at the end of
the match. At most three outfield players may be
replaced during the game, so that most are obliged to
compete for the full 90 min plus stoppage time. Rule
changes in the 1990s, together with an increased
emphasis on fitness training and a high work-rate,
have contributed to a high tempo of match-play
(Williams, Lee, & Reilly, 1999). The outcome is that
competitive engagements take participants to the
verge of exhaustion, from which they must recover
quickly to be prepared for the next game. When
competitive fixtures are congested, the recovery
process should be optimized and some of the
strategies for doing so are considered in this review.
Ensuring recovery between matches
Most of the body’s organs and systems are stressed
during a soccer game. These include energy systems
(liver and muscle glycogen, muscle tryglycerides),
the musculoskeletal system, the endocrine and
nervous systems. Not only are the glycogen deposits
of players’ liver and skeletal muscles exhausted at the
end of a game (Saltin, 1973), they also feel mentally
drained of their ‘‘nervous energy’’, although sub-
jective states are mediated by the outcome of the
match. Various factors influence the rate of recovery
between games, particularly when competitive fix-
tures are scheduled twice in one week.
The issues to be addressed in this overview include
warm-down, restoring fluid levels and restoration of
energy levels. The immune system may also be
compromised by competitive stress (Gleeson, Blan-
nin, & Walsh, 1997); whether it is possible to boost
the body’s resistance to infection or damage is also
briefly addressed.
Warm-down
Active recovery removes lactate from the blood more
quickly than does passive recovery. The clearance of
lactate from the circulation is related directly to the
exercise intensity (Bond, Adams, Tearney, Gresham,
& Ruff, 1991; Monedero & Donne, 2000) up to
about 50% of maximal oxygen uptake (V_ O2max). It
also facilitates a smoother decline in body tempera-
ture and blood flow than when activity is terminated
abruptly, as core temperature continues to rise for a
few minutes once the participant stops exercising
(Reilly & Brooks, 1986). A warm-down also helps to
damp activity in the nervous system, which promotes
sleep afterwards: sleep could be adversely affected
after a match due to a maintained elevation in the
level of arousal of the central nervous system (Smith
& Reilly, 2004). There is also a suggestion that a
warm-down can benefit the immune system, as the
individual might otherwise be vulnerable to minor
infections for some hours after finishing hard
exercise if the drop in body temperature is too
abrupt.
Reilly and Rigby (2002) examined the efficacy of
an active warm-down in two groups of university
soccer players. One group did an active warm-down
after a first match and a controlled recovery regime
the week after before completing a second game in
which no formal warm-down was conducted. The
procedure was reversed in a second group to balance
the order of administering the experimental warm-
down. The active warm-down consisted of three
phases: (1) 5 min of jogging, (2) 5 min of stretching
and (3) a further 2 min lying prone with legs raised
and ‘‘shaken down’’ by another player. In the
corresponding control recovery, the participants
returned to the changing rooms and rested (seated)
for 12 min. A series of physical performance tests
was conducted after the game and over the following
3 days and compared to a reference pre-game
condition. Performance in vertical and broad jumps
was impaired in both groups, but less so in the group
that had warmed down. This group recovered to pre-
match values more quickly than the inactive partici-
pants, whose performances were still below reference
levels 48 h post game. A similar trend was evident in
a 30-m sprint, the deterioration being almost 50%
greater in the control than the experimental group.
Performance in a sprint-fatigue test consisting of
seven 30-m sprints (with 20 s for active recovery in
between sprints) was unaltered in the experimental
group 48 h after the game, whereas a marked
difference from baseline values was observed in the
control participants. Muscle soreness ratings had
almost abated 48 h after playing in the individuals
who had warmed down in contrast to the increased
ratings with successive days in the control group.
The trends in the data indicated that players
warming down after a midweek match could be
adequately recovered for a weekend game 72 h later.
This expectation would not apply to the inactive
group playing on Saturday after a Wednesday match,
as the performance profiles had not fully recovered to
baseline values by this time. It is unclear what
mechanisms are implicated in the delayed recovery
process associated with the absence of a warm-down
immediately following match-play.
Deep-water running
Stretch – shortening cycles of muscle actions occur
frequently during match-play and training, leading to
the phenomenon of delayed-onset muscle soreness.

This type of soreness may be compounded by bruises
and contusions following contact with other players
in the course of contesting possession of the ball. In
novice and recreational players, severe soreness is
induced by soccer actions such as kicking the ball,
accelerating and decelerating, jumping, turning and
tackling. The microtrauma suffered by the muscles
engaged is later reflected in a leakage of substances,
notably creatine kinase and myoglobin, from the
muscle into the blood (Armstrong, Warren, &
Warren, 1991).
Deep-water running is promoted in physical
training programmes, particularly during rehabilita-
tion from injury and as light recovery sessions
immediately after or the day following competitive
games. The exercise is conducted in the deep end of
a swimming pool with the body kept up by means of
a buoyancy belt. This mode of exercise is employed
as a means of preventing soft-tissue injury in the
lower limbs, as impact with the ground is avoided,
reducing the load on skeletal structures (Dowzer,
Reilly, & Cable, 1998).
In a study of 30 previously untrained individuals,
deep-water running proved to be superior to other
putative methods of reducing muscle soreness and
restoring muscle strength following ‘‘plyometric
exercise’’ (Reilly, Cable, & Dowzer, 2002). The
plyometric stretch – shortening regimen employed to
induce soreness consisted of drop jumps from a
platform 50 cm in height once every 7 s until
voluntary exhaustion. Exercise on the three subse-
quent days consisted of running for 30 min at 70 –
80% of heart rate reserve. The methods of recovery
examined were: (1) rest on all days; (2) rest on day 1,
deep-water running on remaining days; (3) rest on
day 1, treadmill running on later days; (4) treadmill
run on all days; and (5) deep-water running on all
days. The most effective recovery was when deep-
water running was incorporated in the training
programme for all 3 days following the plyometric
regimen. Deep-water running failed to prevent
delayed-onset muscle soreness but appeared to speed
up the process of recovery for muscle strength
(determined using isokinetic dynamometry) and
perceived soreness. Creatine kinase concentrations
peaked 24 h earlier and at a lower value in the group
employing deep-water running compared with the
other groups. Soreness was eliminated while partici-
pants were running in deep water but returned post-
exercise, having allowed exercise to proceed pain-
free. The deep-water running strategy also enabled
participants to maintain range of motion at the hip
joint while they were experiencing soreness. These
factors could be linked with the smaller decline in leg
strength that occurred when deep-water running was
employed. Although professional soccer players are
more accustomed to stretch – shorten cycle exercise
The use of recovery methods post-exercise 621
than the participants in this study, the results
nevertheless highlight possible advantages to the
use of deep-water running as a recovery strategy to
reduce impact stresses. This form of exercise in
water can provide a training stimulus for the oxygen
transport system with suitably designed exercise
programmes (Dowzer, Reilly, Cable, & Nevill,
1999).
Restoration of energy
By the time a game or a prolonged training session
ends, those players who had played for the entire
duration are likely to have almost depleted their
glycogen stores in active muscles and liver. Blood
glucose may also be lowered in some players.
Ekblom (1986) reported blood glucose concentra-
tions of 3.8 mmol × l71 in players of the Swedish First
Division at the end of a game, three individuals
displaying values in the range 3.0 – 3.2 mmol × l71. It
is thought that such below-normal glucose concen-
trations could contribute to cognitive impairments
towards the end of a game (MacLaren, 2003).
Players who train hard the day before a match
experience fatigue earlier than those who rest, the
lower muscle glycogen concentrations being asso-
ciated with an impaired work rate, notably less
sprinting ‘‘off-the-ball’’ (Saltin, 1973). Unless glyco-
gen concentrations are restored to normal, players
may be ill-prepared for continuing their training
programmes to prepare them for the next competi-
tive encounter.
The optimal time for beginning the replacement of
energy is in the first 2 h after cessation of exercise, as
the enzymes associated with glycogen synthesis are
most active during this period (Ivy, Karz, Cutler,
Sherman, & Coyle, 1988). There is also evidence of
increased glucose sensitivity and muscle GLUT4
expression in the early post-exercise period (Dohm,
2002). Nutritional guidelines suggest a carbohydrate
intake of 1.5 g × kg71 body mass over the first 30 min
of recovery: this figure would amount to 120 g
carbohydrate for a player weighing 80 kg. The
glycogen resynthesis rate is itself limited (Coyle,
1991), suggesting that an intake exceeding 50 g
carbohydrate every 2 h post-exercise provides no
extra benefit. As appetite tends to be suppressed after
strenuous exercise, a concentrated carbohydrate
beverage can be influential in initiating the restora-
tion of energy. For individuals expressing mental
fatigue, solid foods with a high glycaemic index are
advocated and can be provided in the dressing room
for eating after showering (Reilly, 1998). The
inclusion of essential amino acids along with
carbohydrate provides a significant means of enhan-
cing protein synthesis, especially if ingested 1 – 3 h
post-exercise (Rasmussen, Tipton, Miller, Wolfe, &
622 T. Reilly & B. Ekblom
Wolfe, 2000). Net protein gain is the important
factor, since protein degradation may also be
increased after exercise (Tipton & Wolfe, 2001).
The pattern of fluid intake with a carbohydrate-
electrolyte solution during 4 h recovery from run-
ning at 70% V_ O2max was examined by Wong,
Williams, Simpson and Ogaki (1998). After 4 h
recovery, the participants continued running at the
same speed to voluntary exhaustion. The results
suggested that drinking a prescribed volume of the
experimental solution (6.9% carbohydrate, osmol-
ality = 300 mOsm) after 90 min exercise, calculated
to replace body fluid losses, restores endurance
capacity to a greater extent than rehydration ad
libitum, even though the total volumes ingested were
the same. The benefits would apply to glycogen
resynthesis as well as rehydration. The aim should be
to help maintain energy balance as well as restore
glycogen stores.
The process of restoring energy must be continued
next day to become effective. The protocol may
entail ingesting 8 – 10 g × kg71 or more of carbohy-
drate over the day, representing a carbohydrate
intake that represents 60% of the daily energy intake.
Rehydration
Core body temperature has been reported to rise to
over 398C during the course of a game (Ekblom,
1986). The rise in core temperature is influenced by
the intensity of exercise as well as by environmental
temperature, with both ambient dry bulb tempera-
ture and relative humidity being relevant. Globe
temperature should also be taken into consideration,
as games are played outdoors and solar radiation is a
relevant factor. In environmental temperatures in the
range 20 – 258C, Ekblom (1986) observed mean
rectal temperatures of 39.58C for players in the
Swedish top division, whereas values recorded for
players from the lower divisions were 39.2 – 39.48C.
To offset heat gain, the body’s heat loss mechanisms
come into play. The main avenue for heat loss during
exercise is by evaporation of sweat from the skin
surface, this route of heat exchange with the
environment being impeded when relative humidity
is high. The type of clothing (loose or tight fit, long
or half-sleeve, shirt material, and so on) could
restrict the effective evaporation of sweat from the
skin surface. During exercise corresponding to an
average intensity of 75% V_ O2max, as is seen during a
soccer game, players may lose sweat at a rate
approaching 2 litres per hour (Reilly and Cable,
2001). Mustafa and Mahmoud (1979) reported fluid
losses amounting to 3.1% of body mass during a
game played in a temperature of 338C and humidity
of 40%. Similar losses were found when the air
temperature was 26.38C but humidity was 78%.
Ingestion of fluid during competition cannot keep
pace with this amount of fluid lost and so a deficit in
body water is incurred. Since physical performance
capability is impaired when water losses exceed 1%
of body mass, it is important that the player starts the
game already euhydrated and that the fluid deficit is
minimized. To do so requires periodic drinking in
the natural breaks that occur during the game and
more substantial fluid intake at the half-time inter-
mission. Gastric discomfort constitutes a practical
limitation when trying to restore fluid balance by
drinking in the half-time interval. A rough guideline
is contained in the schedule employed by Clarke,
Drust, MacLaren and Reilly (2004). A total volume
of 1065 + 76 ml (administered at 0, 15, 30 min,
half-time, 60 and 75 min) given in six equal small
volumes eliminated feelings of gut fullness that were
evident when the same total amount of fluid was
given in two drinks, before the game and at half-time.
Burke and Ekblom (1982) examined the effect of
dehydration and rehydration on precision in a ball
game. In the test performed before and after 2 h of
tennis play, the player was instructed to return a
tennis serve cross to a target zone. When drinking
nothing at all or just plain water, the number of balls
in the net or outside the target zone increased,
whereas an electrolyte-carbohydrate (7.5%) solution
reduced this loss of precision as a consequence of
intense match-play. These observations are also
likely to be relevant to the game of soccer, even
though the work was carried out on tennis play.
It is recommended, therefore, that the fluid deficit
incurred during the game is reversed as soon as
possible afterwards. Ingestion of pure water in the
period after finishing the game lowers plasma
osmolality and plasma sodium; the effects are a
reduction in thirst and an increase in urine produc-
tion, both of which tend to delay effective
rehydration (Maughan, 1991).The inclusion of
electrolytes, notably sodium, in the drink facilitates
absorption of water through the intestinal wall. Since
the electrolyte content of sweat varies between
individuals, some players may be in particular need
of electrolyte replacement, notwithstanding that
sweat tends to be hypotonic. The major electrolytes
lost in sweat are sodium and chloride (Maughan,
1991). If these electrolyte losses are not restored,
part of the fluid ingested is lost again in the urine. As
body water content begins to fall, the secretion of
vasopressin (a posterior pituitary hormone) stimu-
lates renal retention of fluid while the adrenal glands
secrete aldosterone in an attempt to preserve sodium.
However, the body’s total electrolyte reserve can
handle some short-term losses without any evident
effect on physical performance. In addition, most
meals that cover the daily energy expenditure also
include enough electrolytes to compensate fully for

losses during training. Despite that, some extra salt
does not have a negative influence on the player’s
performance. As there is a marked variation between
individuals in the sodium concentration of sweat and
in the amount of sweat lost, some additional salt
(added to food or in drinks ingested) may be needed
for those players incurring high salt losses.
Water loss during exercise (dehydration), although
not so easy to observe, rapidly reduces performance
in training and match-play. Since the satiation of
thirst is a poor indicator of the restoration of body
water, players should be encouraged to drink more
than they feel is needed. The deficit may carry over
into the following day and affect performance in
training. The imbalance may become acute when
matches or training are held in hot conditions, or in
the days following air flight. In addition, the dry air
on board the aircraft causes increased respiratory
evaporative water loss and has been reflected in
reduced urine volume in athletes travelling across
five time zones to a warm-weather training camp
(Reilly, Edwards, & Waterhouse, 2003). In such
circumstances, monitoring urine osmolality or its
conductance can provide a good indication of
hydration status (Pollock, Godfrey, & Reilly, 1997).
Shirreffs (2000) concluded that there was no current
‘‘gold standard’’ measure of hydration status,
although a urine osmolality greater than about 900
mosmol × kg71 could reasonably be taken to indicate
a hypohydrated state. The urinary measures were
deemed preferable to blood markers and urine
osmolality was the preferred measure (see Table I).
More simple measurements could include monitor-
ing of body mass (in the morning) or assessment of
urine colour (Armstrong et al., 1998).
Overload
There are occasions when the time intervening
between matches is inadequate for recovery. Such
Table I. Potential markers in urinary and blood indices of
hydration status considered by Shirreffs (2000)
Urinary indices of hydration status
Urine volume
Osmolality
Specific gravity
Colour
Haematological and circulatory indices
Haemoglobin
Haematocrit
Alteration in pulse rate
Alteration in blood pressure
Plasma osmolality and sodium concentration
Plasma hormones (testosterone, noradrenaline, atrial natriuretic
peptide)
The use of recovery methods post-exercise 623
overload can arise when fixtures are congested for
adult players, in tournament play at the end of a
season or during intensive training camps for young
players. Competitive games cause stress hormones to
increase and lead to elevated concentrations of
various substances known to influence the function
of leucocytes, whose number and functional capa-
cities are reduced post exercise (Gleeson et al.,
1997). Natural-killer cells fall in number and activity
below pre-exercise levels. Other changes in immune
function contribute to a weakening of the response to
pathogens and increase the vulnerability to infections
for some hours after exercise ceases – often described
as the ‘‘open window’’.
Soccer players may also suffer if the time allowed
between strenuous training sessions is inadequate for
normal homeostasis to be restored. In such circum-
stances, catabolic processes may dominate over
anabolism, resulting in under-performance. The
immune system may also be compromised, leading
to upper respiratory tract infections and other
ailments. After studying Japanese soccer players
during a period of training for 2 h each day,
Nakamura, Akimoto, Suzuki and Kono (2004)
recommended monitoring secretory immunoglobulin
A conventrations in saliva samples as a useful method
for managing risk of upper respiratory tract infection.
Ekblom (2002) reported the adverse effects
experienced by young players when full competitive
matches were played on consecutive days and within
20 h of each other. Measurements were made
leading up to the first game and up to 72 h after
the second game. These measurements included
energy balance, endocrine responses, markers of
immune function determined by means of flow
cytometry, and lymphocyte receptors. The players
incurred an energy deficit as a result of the
congestion of matches. The findings point again to
the value of drinking beverages containing carbohy-
drates where possible during training and after
intensified soccer training. Testosterone concentra-
tions were 50% of normal values 12 h after the
second match and were still reduced 72 h afterwards,
suggesting a reduction in anabolic processes. Corti-
sol concentrations were reduced, although the
importance of this change was not clear. The
populations of natural-killer cells and T-helper cells
were also decreased, representing a negative effect on
the body’s immune system. Compared with rest, the
numbers of cells in all natural-killer subpopulations
showed a consistent reduction of 20 – 60% from
immediately after the second match: the numbers of
CD57 + , CD56 + , CD16 + , CD57 + and CD3- cells
were still decreased at 72 h (see Figure 1). The
alterations in these markers of immune function
would lend support to the ‘‘open window’’ hypoth-
esis, whereby it is thought that individuals are more
624 T. Reilly & B. Ekblom
Figure 1. Change in natural-killer cell numbers from before to after two soccer games: &, CD57 + ; &, CD56 + , CD16 + , CD57 + , CD3 7 ; ,
CD57 + , CD3 7 ; , CD56 + , CD16 + , CD57-. * Significant difference from 0 (t-test, P 5 0.01). Reproduced with permission from Malm et
al.(2004).
susceptible than normal to risk of minor infections at
about 6 h after strenuous exercise.
In a further analysis of their data, Malm, Ekblom
and Ekblom (2004) identified a delayed phase 48 h
after the second game, in which the expression of
both adhesion and signalling molecules increased on
lymphocytes and monocytes. These changes in
adhesion and signalling molecules at 48 h were
negatively correlated with the participants’ V_ O2max.
This finding suggested a more marked immunologi-
cal response to similar exercise in players with lower
aerobic power.
In a separate study, Ekblom (2002) examined the
extent to which young players experience adverse
reactions during a 7-day training camp. Despite
supervision of their diet, the players displayed a
negative calorie balance of 2.0 – 2.8 MJ × day71. Signs
of ‘‘over-reaching’’ included a decreased appetite,
alterations in mood and reduced stamina. The
inability to recover from the exertions of daily training
demonstrates the need to build in recuperative
components to the programme of activities for young
players attending camps for specialist training.
The training content of week-long camps is likely
to expose participants to oxidative stress and the
potentially damaging effects of oxygen free radicals
(Packer, 1997). The sources of oxidative stress
include mitochondrial superoxide production,
ischaemia-reperfusion mechanisms and auto-oxida-
tion of catecholamines. Antioxidant defence
mechanisms are located in body water pools and in
the body’s lipid stores. Vitamin C is the major
antioxidant vitamin in aqueous environments,
whereas vitamin E is the main antioxidant vitamin
in lipid environments, which works by breaking the
chain of lipid peroxidation. However, there can be a
negative effect of supplementation of lipid soluble
antioxidants. Malm, Svensson, Ekblom and Sjödin
(1997) explored the beneficial effects of supplemen-
tation with ubiquinol (co-enzyme Q10), a substance
with lipid antioxidant properties. Contrary to ex-
pectations, those players using the supplement fared
worse than a placebo group when the training load
was elevated. The players using supplementation
were inferior to the control group on selected
exercise performance tests, showed greater muscle
damage and slower rates of recovery after the period
of elevation in training load. The mechanisms
underlying the delayed restoration of normal perfor-
mance capability could not be deduced from the
study, although the production of free radicals does
not seem to have been linked with the transient
fatigue induced by the training regimens.
The question remains as to whether supplementa-
tion with other antioxidants benefits recovery
processes after a competitive match. Thompson et
al. (2003) tried to determine whether post-exercise
supplementation with 200 mg of vitamin C influ-

enced recovery from 90 min of shuttle running
designed to correspond to the average exercise
intensity of playing soccer. The group receiving
supplementation was no different from a placebo
group in the rate of recovery over the 3 days
following exercise. Serum creatine kinase activities,
myoglobin concentrations, muscle soreness, and
recovery of muscle function in the leg extensors
and leg flexors were similar between the groups.
Although plasma concentrations of malondialdehyde
(reflecting oxidative stress) and interleukin-6 in-
creased post-exercise, there was no difference in
responses between the placebo and supplemented
groups. The observations were interpreted as sug-
gesting that either free radicals are not involved in
delaying recovery from such exercise protocols, or
that the consumption of vitamin C wholly after
exercise is unable to deliver an antioxidant effect at
the appropriate sites with sufficient expediency to
improve recovery. This interpretation ties in with
that of Packer (1997), who suggested that the
benefits of antioxidant supplementation may be for
the long term rather than the short term.
Delayed-onset muscle soreness
Delayed-onset muscle soreness was referred to ear-
lier when the relevance of deep-water training was
discussed. Locomotion during match-play entails
frequent stops and starts, angled runs and deceptive
side-steps. Musculoskeletal control of these move-
ments incorporates stretch – shortening cycles of
muscle actions, the eccentric components of which
lead to the phenomenon of delayed-onset muscle
soreness. Such actions are also implicated in kicking,
which stretches the hamstrings, and jumping, which
stretches the calf muscles and the quadriceps. The
microtrauma in the muscles is later reflected in the
leakage of creatine kinase, myoglobin and other
substances through the sarcolemma into the blood.
Creatine kinase concentrations usually reach a peak
about 24 – 48 h post-exercise, and precede the high-
est subjective soreness.
There is evidence that plyometric training offers
protection against delayed-onset muscle soreness,
known as the ‘‘repeated bouts effect’’ (Cleak &
Eston, 1992). It appears that a single session of
plyometric training has a protective effect that lasts at
least 3 weeks. Except during pre-season training,
professional players are likely to experience less
muscle soreness of this type than novice or recrea-
tional players inexperienced in training utilizing
stretch – shortening cycle exercises (Foley, Jayara-
man, Prior, Pivarnik, & Meyer, 1999). Nevertheless,
experienced players would be advised to eschew
plyometric training in the days following matches
until soreness has passed its peak and should be
The use of recovery methods post-exercise 625
omitted when players have games in midweek and at
the weekend in the same week.
There is no easy method of avoiding delayed-onset
muscle soreness other than strength and conditioning
work to reduce its impact (see Table II). This type of
soreness may even be compounded by suffering
contusions and bruises due to physical contact while
competing. Pharmacological means (such as non-
steroidal anti-inflammatory drugs) of treating muscle
soreness due to eccentric exercise have proved largely
ineffective (Gleeson et al., 1997). Massage and
ultrasound may be effective therapy for other muscle
complaints but have not proved beneficial for this form
of soreness. Eston and Peters (1999) reported only
limited benefits of cold-water immersion and no effect
on the perception of tenderness or strength loss
following damage-inducing eccentric exercise of the
elbow flexors. Their cryotherapy technique entailed
submersing the exercised arm in a plastic tub of iced
water for 15 min. Similarly, Howatson and van
Someren (2003) found that although ice massage
reduced the appearance of creatine kinase, it had no
other effect on the signs and symptoms associated with
exercise-induced muscle damage. Contrast bathing,
alternating immersion up to the trunk in barrels of cold
water with warmer water or air, is currently being
practised by Australian Rules players, but without
convincing evidence of its benefits (Dawson, 2002).
The protocol consists of alternating between standing
in a hot shower (* 458C) for 2 min with standing
waist deep in icy water (* 128C) for 1 min, repeated
until five hot and four cold exposures have been
completed. The England rugby union team used the
strategy of immersion in iced water following its
matches in the 2003 International Rugby Union
World Cup tournament. Such low water temperatures
contrast with the higher temperatures associated with
deep-water running, which are more compatible with
thermal comfort. As explained above, deep-water
Table II. Methods of alleviating delayed-onset muscle soreness
reviewed by Cleak and Eston (1992)
Stretching
Cold application
Ultrasound
Transcutaneous electrical nerve stimulation (TENS)
Application of anti-inflammatory creams
Pharmacological agents
Exercise
Massage
Training
Note: Although some success was found by a few authors using
stretch, TENS and topical anti-inflammatory creams to alleviate
delayed-onset muscle soreness, the majority view was that there
seemed to be no single effective way of reducing the soreness once
it had occurred. Prevention was best secured by training according
to the ‘‘repeated bouts effect’’.
626 T. Reilly & B. Ekblom
running has been shown to provide some relief in the
days following a hard plyometric exercise session,
without affecting the creatine kinase response (Reilly et
al., 2002). Such an exercise mode would therefore
facilitate training during the recovery days and help
avoid any detraining effects.
Lifestyle factors
Hastening recovery from strenuous exercise also
depends on lifestyle and habitual activities. These
important aspects include adherence to proper
nutritional strategies, including fluid and energy,
and moderation when drinking alcoholic beverages.
Reilly (1994) reported a value of alcohol intake for an
international player constituting almost 10% of daily
energy intake in the evening following a league game,
even though carbohydrates represented 60% of the
average daily macronutrient intake. Its diuretic and
depressant effects render alcohol an inappropriate
beverage for professional players, either leading up to
competition or recovering from matches.
Sleeping patterns should also be given due
consideration. While most individuals have a good
tolerance to sleep disruption, sleep loss following
match-play can interfere with performance in train-
ing on the following day (Reilly & Piercy, 1994). The
fall-off in performance was progressive within a
weight-training session as participants lost motiva-
tion to continue their more strenuous efforts (see
Table III). Although players may have a prolonged
sleep latency after a game, any loss of sleep is likely to
be compensated for the next night. An alternative is
to have a late afternoon nap on the recovery day to
exploit the recuperative properties of sleep.
The timing of kick-off, return travel schedules and
other external factors may cause disturbance in the
players’ normal sleep – wake cycle. Severe exercise
during the daytime is sometimes associated with
changes in slow-wave sleep and growth hormone
secretion during the following night (Waterhouse et
al., 2002). This observation supports the restorative
characteristics of sleep and since slow-wave sleep
predominates in the first half of the night, underlines
the benefit of getting to bed in reasonable time post-
competition.
Table III. Mean percentage decrease in weight lifted over 4 days of
partial sleep loss (data from Reilly & Piercy, 1994)
Order in Days Days Days
Exercise session 1–2 1–3 1–4
Biceps curl 1 2 5 10
Bench press 2 4 10 12
Leg press 3 3 10 14
Dead lift 4 1 13 17
Conclusion
Strenuous training and match-play place enormous
demands on the mental, physical and physiological
reserves of players. Individuals vary in their abilities
to cope and in their tolerance of competitive stresses.
In the course of adapting to these physiological
demands, additional stresses due to hard training or
other games in quick succession may overtax
individual capacities and cause impaired perfor-
mance or even increased injury risk. The emphasis
in training, therefore, must be on establishing the
appropriate balance between recovery and training
stimuli in the days intervening between matches.
In circumstances of multiple matches within a
congested schedule of engagements, the complete
recovery of physiological and psychological capaci-
ties is essential. Special consideration may be needed
to restore the self-confidence of players before the
next engagement and specific coaching to correct
tactical deficiencies in the event of defeat or poor
performance. In this review, the focus has been on
the processes associated with physical recovery,
excluding trauma deemed to constitute injury, and
restoration of normal physiological homeostasis.
The regeneration of normal metabolic reserves is a
priority and practices to promote recovery should
commence once the game (or formal training) is
finished. Replacement of fluid lost during exercise is
also an important consideration. The benefits of
physical therapy are unclear, except where minor
soft-tissue trauma has been incurred. It is prudent to
modify the training programme to take into account
the transient reduction in physical capacities and
design recovery sessions into the weekly regimen.
Unless recovery is achieved, the team will enter the
next contest with some of its players at a disadvan-
tage. To avoid this possibility, recovery strategies
should incorporate specific hydration, nutritional,
psychological, training and lifestyle factors.
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