Recovery That's Worth the Effort

M UCH Ol- THE WORK ON RECOVERY after either rhythmic or sus­tained exercise has focused on recovery of strength. Stull and Kearney assessed the recov­ery of submaximal (50% maximum volun­tary contraction) isometric endurance af­ter recovery intervals ranging from five seconds to 42 minutes. 40 seconds, in twenty-two men with a mean age of 21.8 years.1 An isometric griptlexion device was used to test each subject eleven times, with at least three days between successive trials. Recovery was 20% com- plete in five seconds, 50% complete in 80 seconds, and 87% complete in 42 minutes, 40 seconds. Inspection of the data suggested that the pattern of recovery was exponential. Analy­sis of percentage of recovery at various intervals indicated that the pattern of submaximal isometric endurance recovery fol­lowed a three-component exponential curve. Exercise hyperemia is insufficient to satisfy the metabolic demands of the muscles. Although adenosine triphosphate levels probably remain reasonably constant, levels of creatine phosphate apparently fall significantly during sustained con­tractions at 30-50% of maximum. Accumulation of lactate and lowering of pH have also been documented. There may also be potassium ion imbalances and an efflux of phosphate ions. These reactions almost certainly have a negative influence on ability of the contractile apparatus to generate force. Consider- ably more work is needed to elucidate the physiologic mecha­nisms responsible for recovery. Physiologic Response to Weights Traditional weight training has been shown to improve strength and muscular power and endurance, and traditional circuit training improves cardiovascular endurance. Wilmore, el al., hypothesized that placing weight training into a circuit training format would promote significant changes in most ma­jor components of performance, thus identifying an ideal off­season conditioning activity for many sports.2 In circuit weight training, the subject lifts a weight represent­ing 40-60% of his maximum strength for that lift as many times as possible in a defined period and, after a short rest interval, proceeds to the next lift. A ten-week program of circuit weight training was evaluated in twenty-four female and twenty-six male college students. Three 7'/2-minute circuits were com­pleted each day, three days a week. Each circuit consisted of ten stations, with thirty-second work periods and fifteen-sec­ond rest periods. No significant changes in weight or fat weight were observed, but lean body weight increased significantly in both men and women, and relative fat decreased in women. The only significant change in girth measurements was that of flexed biceps girth, which increased in both sexes. Treadmill time to exhaustion im­proved by about 5% in men. Women showed significant increases in maxi­mum oxygen consumption and treadmill time to exhaustion. Flexibility measures showed significant improvement only in women. Men exhibited significant gains in strength for some lifts. Women made gains in strength that were identical to or greater than those made by men. Circuit weight training appears to be a mode of training for altering body composition, strength, endurance time to exhaus­tion and, to a limited extent, flexibility. Use of this approach for off-season conditioning programs has been advocated for sports that require high levels of strength, power and muscular endurance, and cardiovascular endurance capacity to a lesser degree. However, circuit weight training may not be the best choice for off-season conditioning. It is often difficult to motivate many patients to perform the necessary endurance training to achieve cardiovascular fitness. The emphasis in training programs for most rehab patients seems to favor increasing strength with weight training, which may. in fact, not be the appropriate emphasis. Circuit weight training has been an appealing form of endurance training for individu­als. However, there is probably no one program that will meet GETTING THE (REHAB) JOB DONE by Kim D. Christensen, D.C, C.C.S.P., C.S.C.S., D.A.C.R.B all the requirements of strength, flexibility and endurance. Strength, flexibility and endurance types of exercise must be included in a well-rounded rehabilitation program. Generally, it has been thought that a single portion of the program must not be ovcrstressed at the expense of the rest of the program. How­ever, this concept needs to be questioned. Perhaps simple recovery of function is more important, with time better spent, than is isolated muscle strength exercise. Exertional Headache Rehabilitative activities, especially aerobic movements, may produce effort or exertional headache, which is often associ­ated with nausea and vomiting and has many features suggest­ing that it is migrainous.' The headache is aggravated by heat and high humidity. The causes of effort headache are unclear, but it is similar to the headache of acute mountain sickness or altitude headache, in which cerebral vasoconstriction, edema, and subsequent hypoxia may account for the symptoms.4 Ef­fort headache can occur at any age and in both sexes. Strenu­ous exertion may induce vascular headache, even in persons with no history of or susceptibility to head pain. Intracranial disease must be considered in patients with a picture of effort headache, but recognition of the possibility of benign exertional headache may spare some patients from ex­pensive, potentially harmful studies. Exertional headache may occur in patients with various known intracranial lesions, such as subdural hematoma, unruptured cerebral aneurysm or vas­cular anomaly, or basilar impression. Subarachnoid bleeding from a ruptured aneurysm may follow effort. Diamond studied fifteen patients who had prolonged, benign exertional headaches. The eight females and seven males had a mean age of forty-five years.5 Headaches occurred only during physical effort in five patients; the others also had headaches during maneuvers, such as coughing and stooping, that in­crease intrathoracic pressure. The site of headache was vari­able, but it was quite consistent within patients. It was bilateral in nine patients. Headaches lasted a mean of four hours. Both throbbing and stabbing pains were common. Three patients had extremely severe headaches. Two patients also had cluster headaches, and four had nonclassic migraine. Two patients had muscle contraction headaches independent of those oc­curring during exertion. Benign exertional headaches occur during maneuvers that increase intrathoracic pressure and in other circumstances in which the blood pressure may suddenly increase, such as ex­cessive exercise. The prognosis appears to be fairly good, although many patients have these headaches for some time. In many cases, no explanation for the headache is found. All patients with prolonged exertional headache should have a complete neurologic examination, cervical spine and skull roent-genography. and computed tomography with infusion. Hyper­tensive patients should undergo catecholamine studies. Kim D. Christensen. DC. CCSP. CSCS. DACRB. founded the Sports Medicine & Rehab Clinics of Washington. He is a popular speaker, and participates as a team physician and consultant to high school ami university athletic programs. Dr. Christensen is currently a postgraduate faculty member of numerous chiropractic colleges and is the president of the American Chiropractic Association (ACA) Rehab Council He is a "Certified Strength and Conditioning Specialist. " certified by the Na­tional Strength and Conditioning Association. Dr. Christensen is the author of numerous publications and texts on inusculoskelelal rehabilita­tion and nutrition. He can be reached at Chiropractic Rehabilitation Assoc. 18604 NW 64th Avenue. Ridgefield. WA 9S642 or by email at [email protected]. References Stull GA, Kearney JT. Recovery of muscular endurance following submaximal. isometric exercise. Med Sci Sports 1978; 10(2): 109- 1 12. Wilmore JH, Parr RB, Girandola RN, et al. Physiological alter­ ations consequent to circuit weight training. Med Sci Sports 1978; 10(2):79-84. Massey EVV. Effort headache in runners. Headache 1982; 22(3):99- 100. Roach RC, Hackett PH. Frontiers of hypoxia research: acute moun­ tain sickness. ./ Exp Biol 2001; 204(Pt 18):3 161-3170. Diamond S. Prolonged benign exertional headache: its clinical char­ acteristics and response to indomethacin. Headache 1982; 22(3):96- 98.