When this article first appeared in AB Today on Tuesday, it contained incorrect information regarding the functionality of Cryo Innovations equipment. Cryo Innovations cryotherapy chambers utilize liquid nitrogen. The editors regret the error.
One takeaway from baseball's steroid era is that performance-enhancing drugs themselves didn't bulk up Barry Bonds, but their recuperative properties allowed Bonds to hit the weight room more frequently — and hit home runs at a record clip. Later, the oft-injured Ryan Braun would turn to PEDs as a way to not necessarily enhance performance, or so he claimed, but at least secure his place in the lineup by slowing the process of his body breaking down.
The good news is that myriad methods exist that allow everyone from elite athletes to avid exercisers to mend their muscles cleanly — without the need for needles. Technology targeting recovery and rehab won't suddenly infuse its users with superhuman strength but will nonetheless assist in each individual's pursuit of peak performance.
Here's a look at some key technology categories:
Water has long been employed in the athletics realm because the buoyancy it affords the human body reduces stress on injured joints, it provides compression to mitigate swelling, it lends resistance to movement, and it serves different functions given its temperature — warm water assists in the pre-exertion loosening of muscles, while a cold plunge helps purge muscles of waste built up during exertion.
Most team training rooms employ both warm (around 100 degrees Fahrenheit) and cold (50 degrees) pools, with enough room in each to accommodate perhaps dozens of football players at a time. But today's training room pools can provide much more than mere space and temperature control.
SwimEx launched 32 years ago primarily to offer a home-exercise modality, but within five years the company's compact current-generating pools caught the attention of those in the commercial athletics market. "We started working with Ron O'Neil, who at the time was the head athletic trainer for the New England Patriots, and we were able to start really developing some different features of the pool that could be used in the rehab and recovery process for athletes," SwimEx president Suzanne Vaughan says. "That's where we ended up coming up with all the different work stations that we offer."
Work stations include treadmills integrated into the pool floor, running pads angled at 40 degrees, step-up platforms at varying heights, and angled platforms along the pool sides to allow side-to-side bounding exercises. All exercises can be performed in static water or against a current programmed at a range of speeds — 99 different settings in all. According to Vaughan, the SwimEx paddlewheel technology is capable of moving up to 25,000 gallons of water per minute in pools sized to hold as many as eight individuals. A light current may assist in reestablishing range of motion in an injured shoulder, while heavy currents allow athletes to swim, walk, run or bound in the face of what Vaughan describes as "a wall of water."
"The water allows you to unload the joint or the injured area, and with the hydrostatic pressure, it helps to reduce swelling," she says. "It can also be used for conditioning. You can increase your aerobic capacity on land by incorporating water workouts into your routine."
There are other means to ease pain and reduce swelling, and few go as far back in the sports timeline than the icepack. But even that tried-and-true solution has seen upgrades.
During a visit to the Los Angeles Lakers locker room, Andrew Katz couldn't help but notice Kobe Bryant struggling to keep a bag of watery ice positioned where he needed it on his body. Katz founded Hyperice in 2011 to provide athletes and everyday exercisers alike with targeted cold therapy by enclosing frozen cells within neoprene wraps tailored to different body parts — left and right shoulders, knees, back and a utility model suitable for elbows, wrists, shins and ankles. The removable ice cells feature a patented valve that allows air to escape for more effective treatment.
"It's always a tight ice cast, as opposed to the bag filling up with air and falling off the part of the body you're treating," says Hyperice sales and key account representative Ellen Chapman. "The neoprene really keeps it tight on the body, in addition to the air-release valve that continues to compress the excess air, so it's just super tight and right on the part of the body that you're trying to treat."
Cryotherapy (full body)
For those looking to expedite recovery of the entire body — or at least from the neck down — cryotherapy chambers have seen increasing penetration in athletic training facilities and even private health clubs. "Cryotherapy has been around for decades, but it only started getting big with athletes and celebrities eight to 10 years ago," says Keith Scheinberg, president of Cryo Innovations, which at less than three years old represents one of only two cryotherapy chamber manufacturers in the United States. "Now it's available to everyone. You go in once and it works. It's not like you need 10 sessions to really feel the benefits. You walk out and you feel reborn. You're ready to run another lap around the gym."
The technology has gained increasing traction among teams in all major professional sports and Division I collegiate athletics. Not everyone has warmed to the idea of subjecting the body to negative-220-degree temperatures for one to three minutes at a time, but Scheinberg contends the benefits are well worth the investment ($60,000 for the chamber, $5 per session), particularly for those seeking quick recovery. "We have people who use it twice a day, and they've gotten great results from it," he says. "You can use it as much as you want, because it's a healthy remedy. It's a holistic-style repair of your body. You're putting your body into fight-or-flight mode. It rushes all the blood out of your capillaries and to your core, as a normal fight-or-flight scenario would, and the healthy part comes when you get out. All that blood that rushes back to your extremities is clean, it's filtered, it's re-oxygenated, which is very healthy for you."
The health benefits exist in any circumstance, but are particularly pronounced after exertion. "When you're working out, you're tearing tissue," Scheinberg says. "Inflammation is just what the body does to protect itself. It puts the tissues in a cocoon, but that delays repair. The cryo prevents that inflammation from coming on, and it actually repairs your tissues faster."
How fast? "You can literally come out of a training session, jump in a cryo chamber, and you're not sore anymore," says Scheinberg. "The inflammation is completely gone. And with the endorphin release you feel like, 'Hey, I can go work out again.' "
Kobe inspired another innovation when Hyperice's Katz caught sight of the future Hall of Famer awkwardly working a foam roller across a Power Plate vibration machine. Foam rollers, the low-tech floor massage tool, and Power Plates, designed to send vibration through an upright body, are extremely effective rehab modalities when used separately, but Katz envisioned combining their concepts into one product, and with the help of an aerospace engineer the Viper was born. "That's the product that put us on the map in professional sports, athletic training rooms, D-I locker rooms," says Chapman, who played D-I volleyball at the University of Wisconsin from 2011-15. "Today, we're in almost every professional NBA, NFL, NHL, MLS locker room, which is cool."
Full-body vibration is a category that also includes VibraGenix, a system that generates sound frequencies and sonic resonance in an upright machine situated within an oxygen-saturation chamber. According to company president Caroline Stites, the technology is designed to trigger the four keys to recovery: increased blood circulation, increased lymph drainage for a cleaner bloodstream, un-clumped red blood cells, and increased cellular energy.
Smaller, portable vibration products also are gaining favor as tools targeting specific trouble spots — between shoulder blades or along the bottoms of feet, for example — and hand-held vibration tools afford the luxury of sideline treatment during games. Capable of providing three hours of continual use on one charge, the Hypervolt by Hyperice features adjustable speeds and interchangeable heads in varying shapes for different muscle applications.
Moreover, the same neoprene wraps that facilitate targeted icing of key body parts can be fitted with vibrating pods that add an additional element — heat — to the treatment process.
Heat (full body)
Few wellness modalities can match the longevity of saunas, which had become common throughout Europe by the Middle Ages. Today, athletes everywhere are realizing their rehabilitative benefits.
"In Europe, athletes have long incorporated saunas in their regular training routine, before and/or after competition," says Beatriz von Ungern-Sternberg of Am-Finn Sauna and Steam. "Here in the U.S., the awareness of the health benefits of regular sauna use for athletes is just settling in. A good example is the football training facility at the University of Washington. After having our Am-Finn saunas in coaches locker rooms, the athletic trainer felt the need to have a sauna for the football players. Despite their several hot/cold treatment pools, the routine turns old, and trainers are finding that diversification of heat-treatment methods is key. The new sauna brings a whole new level of training and recovery to their routine."
Though centuries old, saunas continue to evolve. Units containing panels or entire walls made of Himalayan salt boast the enhanced ability to relieve stress and inflammation, as well as allergies and other respiratory problems.
One or two 10- to 15-minute sauna sessions per day at the standard 170 degrees can serve any number of healthful purposes — from energizing muscles first thing in the morning to soothing the body just before bed. "A sauna relaxes the muscles and the joints, eliminates toxins from the body and alleviates stress," von Ungern-Sternberg says, adding that the benefits for athletes don't end there. "Due to the intense heat, the sauna increases heart rate equal to a light-to-medium workout. Studies have shown that the short, deep-core heat treatment experienced in a sauna can also improve athletic performance."
To Tory Lindley, senior associate director of athletics for health, safety and performance at Northwestern University, nothing is more important to athlete recovery than sleep. That's why Northwestern employs in-bed sensors to monitor via an app the quantity and quality of sleep each of the university's student-athletes experiences on a nightly basis.
"It's hard to deny that sleep is the number-one recovery modality," says Lindley, the current president of the National Athletic Trainers' Association. "When you consider what college athletes are also trying to do academically, especially at a place like Northwestern, the importance of the complete brain reboot and the body having a chance to be rebuilt while sleeping is critical."
Extensive film preparation during the week of a big game, approaching mid-term exams — these are factors that can wreak havoc on a student-athlete's sleep patters. "It's about total sleep throughout the day, and so we encourage naps, if it's the right length of nap, so that can also be added into the system," Lindley says. "We have those conversations versus just having it be an afterthought. 'If I get six hours? Great. If I get four? Oh, well. I'll try to make it up.' Well, you never can. That's not how the body works physiologically."
All of these technologies are designed to expedite the rehab and recovery processes, but there's no getting around nature's greatest healer — time. Whether an athlete adheres to the promise of a three-minute cryo session or commits to six hours of solid sleep, time is an unavoidable investment when it comes to caring for the body. "It's not always an easy solution, where you take a shot or you take performance-enhancing drugs and that solves the problem," says Chapman, who was the only member of her Wisconsin volleyball teams who never missed a match or practice due to injury. "It takes time. It's not just like you snap your fingers and you feel better. You actually have to go through the steps to better your body and feel the effects of the recovery tools. Everyone's kind of looking for that magic bullet that will cure their issue, but you still have to take the time to actually use the recovery products and go through the recovery regimen after you work out or compete."
One College's Careful Take on Tech
Northwestern University's athletic training operation is headquartered in the new state-of-the-art Ryan Fieldhouse & Walter Athletic Center, but not everything at the disposal of Tory Lindley and his staff is cutting edge.
"We try to make it as much evidence-informed as we can and not just based purely on what the literature tells us, because sometimes it takes three, four, five years for the published research to back up what new technology says it's going to do," says Lindley, NU's senior associate director of athletics for health, safety and performance, as well as the current president of the National Athletic Trainers' Association. "Evidence-informed means reaching out to other colleagues across the country who have utilized the technology even on a demo basis. That means not only other peer institutions, but professional sports, because that's typically where a lot of the new technology lands."
Here's where Northwestern lands on a short list of rehab and recovery modalities: • Sleep monitoring — In-bed sensors and an app gathering data on nighttime sleep and naps, co-managed by a third-party sleep specialist. • Hydrotherapy — HydroWorx equipment with integrated treadmills. • Vibration — Hyperice handheld and roller equipment, Power Plate machines. • Cryotherapy — No full-body chamber available to student-athletes at this time. • Massage therapy — NU employs between five and seven licensed massage therapists with access to six tables total in Ryan Fieldhouse. • Intermittent pneumatic compression — NormaTec boots available to student-athletes to passively stimulate post-workout blood flow. • Repetitive-pulse motor-nerve stimulation — Available to student-athletes to create repetitive muscle firing and passively simulate cool-down exercise.
This list is neither complete nor stagnant. "We have a very comprehensive recovery and wellness program and a lot of great rehabilitation technology available to our sport performance staff and our athletic training staff," says Lindley, who had a say in outfitting more than 17,000 square feet of the 96,000-square-foot Ryan Fieldhouse. "From a technology standpoint, we're able to do the things that we feel are important to our program now, but then we'll also be able to adjust to what's going to come in the future and have a facility that's adaptable."
This article originally appeared in the January | February 2019 issue of Athletic Business with the title "Emerging technologies fuel athlete rehab, recovery." Athletic Business is a free magazine for professionals in the athletic, fitness and recreation industry. Click here to subscribe.