See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/344503648 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence Chapter · October 2020 DOI: 10.1007/978-3-662-61070-1_63 CITATIONS READS 0 206 3 authors: Thomas Huyghe Julio Calleja Gonzalez Universidad Católica San Antonio de Murcia Universidad del País Vasco / Euskal Herriko Unibertsitatea 10 PUBLICATIONS 10 CITATIONS 292 PUBLICATIONS 2,319 CITATIONS SEE PROFILE SEE PROFILE Nicolás Terrados Unidad Regional de Medicina Deportiva and Instituto de Investigación Sanitaria d… 175 PUBLICATIONS 3,159 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Recovery in Sport Sciences View project Tow main projects: 1) Physiology and fatigue of Basketball,. 2) Exercise prescription in primary care units View project All content following this page was uploaded by Thomas Huyghe on 08 October 2020. The user has requested enhancement of the downloaded file. Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 63 Thomas Huyghe, Julio Calleja-Gonzalez, and Nicolás Terrados Chapter Objectives 1. Describe up-to-date evidence-based methods to optimize player recovery specifically following basketball competition and/or practice(s); 2. Provide primary and secondary postexercise recovery protocols applicable to an elite basketball setting; 3. Highlight novel post-exercise recovery strategies in elite basketball with suggestions for future research. 63.1 Introduction Basketball is the second most popular sport in the world with over 450 million athletes regularly playing the game either on a competitive or recreational T. Huyghe (*) Filou Oostende, Oostende, Belgium J. Calleja-Gonzalez Physical Education and Sport Department, University of Basque Country (UPV-EHU), Vitoria-Gasteiz, Spain N. Terrados Unidad Regional de Medicina Deportiva, Avilés and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain e-mail: [email protected] level in 213 countries [1]. During the last decade, elite basketball has become more competitive, with increasingly condensed game schedules. Top players must deal with many national and international championships, with on average a game played every 2.5 days [2]. In addition, the new rules introduced in 2000 by Federation International Basketball Association (FIBA) had a profound effect on the game. In particular, the game became more dynamic as the shot clock was reduced from 30 seconds 24 seconds, and the time allowed to cross half court was reduced from 10 seconds to 8 seconds. Consequently, a greater total time is spent in high-intensity activities and a greater number of actions take place per game [3, 4]. In addition, to successfully cope with ever increasing demands, players regularly train intensively, with not enough time to fully recover between sessions [5]. Therefore, how to recover faster after basketball training and competition becomes a central question [6]. Complete recovery (return to homeostasis) has been shown to result in the restoration of organic and psychological states [7]. Recovery from competition or training is dependent on the exercise, and it is thus essential to understand the specific mechanisms of fatigue and influences from external factors. The demands placed on basketball players during practice and matches are short, and explosive accelerations, decelerations, change of directions, jumps, and contacts among players which could potentially create © ESSKA 2020 L. Laver et al. (eds.), Basketball Sports Medicine and Science, https://doi.org/10.1007/978-3-662-61070-1_63 799 T. Huyghe et al. 800 trauma [8]. Players are also typically characterized by a relative tall body and long limb length, which in turn could influence their susceptibility to fatigue compared to smaller athletes [9]. Therefore, it is important to establish procedures to reduce injury risk, aid recovery, and optimally train basketball players [10], as these become central questions in current basketball practice. In the scientific literature, a considerable number of methods used to enhance recovery have been discussed [11]. Their use depends on the type of activity performed, the time until the next training session or event and equipment, coaching, or medical staff available. The main recovery methods practically used by teams include rest and sleep, nutritional practices (CHO, proteins, fats, vitamins, minerals), hydration practices, ergogenic aids, cool-down strategies, phychological strategies, and manual therapy techniques (Fig. 63.1). However, there is a lack of consensus on the benefits of many of these approaches in the scientific community. While several reviews about recovery methods have been published in other team sports, such as soccer [12] and rugby [13], to our knowledge, there has been no practical review or report about recovery in basketball. Therefore, this chapter will focus on specific recovery processes in basketball and will attempt to give practical information for coaches, clinicians, and practitioners. 63.2 Monitoring Post-Exercise Fatigue The recovery process in elite basketball may take up to 48 h during regular practices and games [48] and is challenging to manage considering the multiple contextual factors involved (e.g., travel direction, travel duration, individual chronotype, activity type, playing position, playing style, variation of total playing time, time distribution of playing time, and physical qualities of the player). These variables together determine how players respond to game load and play an important role in their ability to recover from that load. Therefore, monitoring the individual load from games and practices in combination with markers of performance and fatigue (internal response) is crucial in elite basketball. In order to prescribe recovery strategies customized to each player individually, both objective markers (e.g., blood parameters, salivary biomarkers, heart rate parameters, sleep parameters, performance tests) and subjective markers (e.g., questionnaires, and conversations with players) are used to monitor the time course of recovery from basketball training and games. For instance, the counter movement jump (CMJ) is a commonly used neuromuscular performance FATIGUE MONITORING SECONDARY RECOVERY STRATEGIES ERGOGENIC AIDS PRIMARY RECOVERY STRATEGIES Substances or treatment that directly or indirectly improve performance or removes constraints of which may limit performance. REST AND SLEEP A state of mind and body in which the eyes are closed, postural muscles relaxed, and consciousness practically suspended. PHYSICAL STRATEGIES Activities or modalities implemented after intense activity to allow the body to gradually transition to a resting or near-resting state. NUTRITION The nourishment or energy that is obtained from food consumed. MENTAL STRATEGIES Mental processes used to calm the athletes brain activity or to stimulate them. HYDRATION The supply and retention of adequate water in biological tissues. THERAPEUTIC INTERVENTIONS RECOVERY Fig. 63.1 Individualization of post-exercise recovery strategies in elite basketball The use of skilled hand movements to manipulate tissues of the body to restore movement, alleviate pain, promote general health, or induce relaxation. 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence test which may serve as an indication of recovery throughout the course of a basketball season. In particular, flight time:contraction time tends to be a more sensitive measure of recovery compared to jump height [49]. Alternatively, a 10-m sprint test may also be used where baseline values have been recorded 48 h after simulated basketball games [50]. However, despite the value behind performance tests, players may return to baseline performance levels while still not being fully recovered. Therefore, performance tests should be analyzed alongside biochemical markers in order to identify precise muscle damage in each player. Common biochemical markers that reflect muscle recovery include creatine kinase (CK) and cortisol (C) which may take up to 72 h to return to baseline levels, despite recovery of physical performance after 48 h [48]. This slow decrease in CK and C suggests that although performance may already be at optimal pregame values, the muscles may need significantly more time to recover. Hence, high-performance practitioners should take this into consideration when preparing players during specific phases of the season (either allowing or avoiding cumulative fatigue at that time). Although “fatigue monitoring” is not the prime emphasis of this chapter, high-­performance practitioners should be aware that the suggestions given regarding recovery within this chapter should always be modified toward the individual needs of each player as well as the situation at hand in order to stimulate optimal adaptations (Fig. 63.1). 63.3 Primary Post-exercise Recovery Strategies in Basketball 63.3.1 Rest and Sleep The amount of sleep an athlete gets appears to have a large impact on sports performance through a variety of direct and indirect pathways (e.g., immune system, mood, focus, motivation, reaction time, glucose metabolism, muscle growth and repair, etc.) [43]. Mah et al. con- 801 cluded that improvements in specific measures of sprint time, shooting accuracy, and free throw percentage occurred after sleep extension (minimum of 10 h of sleep with optional daytime napping), thus indicating that optimal sleep (8–10 h of nocturnal sleep) is beneficial in allowing athletes to reach their peak athletic performance [45]. In the last season after the lock-out in the NBA, interviews with players revealed that they were not doing much to compensate for the loss of sleep and instead were feeling the effects of the condensed season. This issue remains in today’s NBA environment, perhaps due to frequent social media usage, as late-night tweeting (between 11:00 pm and 7:00 am) 1 day prior to the game has demonstrated to impair next-day game performance [51]. In particular, NBA players significantly spent 2 fewer minutes on the court, shot 1.7% less accurate, as well as experienced negative returns on total rebounds, points, fouls, and turnovers following late-night tweeting [51]. An investigation conducted by Steenland and Deddens (1997) analyzed the effect of travel and rest on performance over 8.495 regular season games (each team) in the NBA across eight seasons and found that more time between games significantly improved performance [44]. This finding was consistent throughout the 8-year observation [44]. This suggests that the NBA travel schedule induces misalignments in circadian rhythm that cannot be avoided. In order to resynchronize the circadian rhythms of players, it is recommended to apply blue light exposure in the morning and red light exposure in the evening [52, 53]. Other strategies may include the ingestion of a high-carbohydrate, low-protein meal in the evening, which may enhance serotonin production to promote drowsiness and sleep [52], or the ingestion of a high-protein, low-carbohydrate meal in the morning, which may increase the uptake of tyrosine and its conversion to adrenaline, which elevates arousal and promotes alertness [52] (Table 63.1). Recently, the consumption of tryptophan-rich protein (e.g., milk) has gained popularity as it induces changes in bedtime core body temperature improving sleep quality [54, 55]. Furthermore, tart cherries have also been suggested to enhance post-exercise recovery as 802 T. Huyghe et al. Table 63.1 Practical recommendations to optimize post-exercise recovery in elite basketball players (primary recovery) Primary post-exercise recovery strategies Rest and sleep Nutrition Carbohydrates (CHO) and proteins Light exposure ∙ Include CHO in rehydration ∙ Avoid blue light exposure (e.g., beverages late-night social media usage) ∙ Include rapidly absorbed CHO and between 11:00 PM and 7:00 AM hydrolyzed whey protein in recovery [51] drinks, using 3–4/1 ratio, being 1 g/ ∙ Promote blue light exposure in the kg the amount of the recommended AM and red light exposure in the CHO [15] PM to facilitate optimal arousal ∙ During the season, CHO, maintain levels and a stable circadian protein and leucine intake (doses: rhythm [52, 53] 0.3 g/kg of CHO, 0.2 g/kg of protein ∙ Consider body irradiation with red and 0.01 g/kg of leucine) per day, light to players experiencing immediately after training or games difficulties falling asleep [46] [16] Nutritional interventions ∙ During the season, maintain daily ∙ Consume a high-­carbohydrate, macronutrient ratio of amino acids low-protein meal in the PM and a (14.5%), proteins (12.7%), and CHO high-protein, low-carbohydrate (12.7%); however, individual needs meal in the AM [52] and differences should be taken into ∙ Promote tryptophan-rich protein consideration before any (e.g., milk) and melatonin-­rich prescriptions [17] foods (e.g., 2× servings of 30 mL Individualization tart cherry concentrate) prior to ∙ Use blood or salivary to identify bedtime [54, 55] individual vitamin and mineral status ∙ Avoid alcohol, caffeine, or large and individual needs throughout the meal or fluid consumptions prior season [64] to bedtime [57] Food selection Education and Awareness ∙ Promote foods high in vitamins C, ∙ Facilitate opportunities for players vitamins E, carotenoids, and to learn about topics such as sleep flavonoids [19, 22] quality and quantity, time zone ∙ Promote magnesium-rich foods (e.g., shifts, travel fatigue, circadian nuts, seeds, fatty fish, legumes, whole rhythm, caffeine, alcohol, grains) napping, sleep apnea, and acute ∙ When inadequate Mg levels are vs. chronic sleep deprivation reported or when going through Lifestyle Habits and Environment intense periods, 400 Mg/day of mg, ∙ Maintain a regular sleep–wake in the form of Mg lactate, may be cycle/routine [45, 57] considered as ergogenic aid [63] ∙ Ensure a comfortable, quiet, dark, ∙ Promote vitamin D-rich foods (e.g., and temperature-controlled fatty fish) especially when sunlight bedroom [57] exposure is limited [61] ∙ Consider taking a warm bath to ∙ If inadequate vitamin D serum levels lower core body temperature prior are reported, vitamin D to bed [57] supplementation may be considered ∙ Design a “to-do” list or diary to as ergogenic aid [58–60] avoid over-thinking and manage Nutrient timing work-related stress [57] ∙ Refuel and rehydrate within 30 min ∙ Use relaxation/breathing after exercise to help muscles recover techniques after high-intensity faster [16] training sessions or games [57] Education and Awareness ∙ Facilitate opportunities for players to learn about topics such as food choices, timing of meal consumption, and short-term vs. long-term unhealthy/healthy food choices Hydration Education and Awareness ∙ Facilitate opportunities for players to learn about euhydration, dehydration, and monitoring hydration status [17] ∙ Ensure consistent beverage availability throughout the day [17]. Individualization ∙ Monitor hydration status in each player throughout the day through their thirst, changes in body mass, and/or their urine color [17] Lifestyle Habits and Fluid Selection ∙ Promote electrolyte-rich foods and fluids including sodium, potassium, chloride, and magnesium [69] ∙ Consider 2.5–3.0 L of high-alkaline water during high-intensity anaerobic exercises [65] 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence well as sleep due to its anti-inflammatory and antioxidant properties as well as high concentrations of melatonin [54]. In particular, a recent study investigated the effect of tart cherry juice (2 × 30 mL concentrate) on sleep enhancement, sleep duration, and sleep quality in healthy subjects in which the intervention group significantly increased their total melatonin content, increased time in bed (+24 min), increased total sleep duration (+34 min), improved sleep efficiency (82.3%), and reduced daytime napping (−22%) [56]. Finally, recent research demonstrated the effectiveness of body irradiation with red light in improving the quality of sleep of elite female players and offered a non-pharmacologic and noninvasive therapy to prevent sleep disorders after training [46] (Table 63.1). Nevertheless, the effects of tryptophan-rich protein, tart cherry consumptions, and other promising alternatives (e.g., napping, sleep education, chrononutrition) on sleep and recovery in elite basketball players warrant further investigation, especially considering sleep disturbances may occur due to a player’s unique lifestyle, and thus results derived from sleep intervention studies in the general population may be limited in their applicability to elite basketball players [57] (Table 63.1). 63.3.2 Nutritional Strategies 63.3.2.1 Carbohydrates and Proteins Carbohydrates should be included in rehydration beverages to improve palatability and to aid in the immediate restoration of muscle glycogen stores [11]. From a nutritional point of view, basketball players use carbohydrates (CHO) as the primary source of fuel during exercise, given the type of training they perform and the characteristics of competition [4]. After a training session or match, muscular stores of carbohydrate are depleted, and thus consuming CHO and protein during recovery has been shown to positively affect subsequent exercise performance and could be of benefit for athletes involved in multiple training or competition sessions on the same or consecutive days [14]. The ideal combination will be of rapidly absorbed CHO together with 803 hydrolyzed whey protein, using 3–4/1 ratio, being 1 g/kg the amount of the recommended CHO [15] (Table 63.1). Eating and drinking the right kind of fuel after exercise is important for restoring energy levels and repairing muscle damage. Refueling with CHO, protein, and fluid within 30 min after exercise will help muscles recover faster. Within this context, it has been established that consumption of macronutrients, particularly CHO and possibly a small amount of proteins and leucine (doses: 0.3 g/kg of CHO, 0.2 g/kg of protein and 0.01 g/kg of leucine), in the early recovery period after practice can enhance muscle glycogen resynthesis [16], per day during the season (Table 63.1). For instance, in an analysis on the daily consumption of dietary supplements on 55 professional basketball players from seven different teams of the First Spanish Basketball League (ACB), 12.7% of players consumed on average 10.3 g protein per day, 14.5% of players consumed 1.9 g amino acids per day, and 12.7% of players consumed 16.2 g carbohydrates per day [17]. However, future studies should analyze the ingestion of CHO in combination with protein in different dosages to determine which dose will enhance recovery specifically for basketball players. 63.3.2.2 Vitamins and Minerals Oxidative stress occurs when the body does not have enough capacity to defend itself against free radicals. Reactive oxygen species are the main source of oxidative stress and play a major role in the initiation and progression of damage to the muscle fibers after exercise [18]. Several antioxidants have been introduced to protect the cells from free radicals such as vitamins C and E, carotenoids, and flavonoids [19]. Oxidative stress may be involved in the aging process, cell damage, muscular fatigue, and overtraining [20], especially during maximal exercise in basketball. Hence, playing competitive basketball may involve greater utilization of aerobic metabolism than previously expected, with values of VO2 of 33.4–4.0 and 36.9–2.6 mL/kg/min for females and males, respectively [21]. Within this context, the consumption of vitamins C and E may strengthen the antioxidant defense system T. Huyghe et al. 804 by decreasing reactive oxygen species involved in maximal- or high-intensity exercise [22]. Regarding the nutritional habits of players, it has been shown that multivitamins were the most frequently used supplements among these athletes (50.9%), followed by sport drinks (21.8%) [17]. Vitamin D serum levels has an impact on a player’s overall health and ability to train (e.g., bone mass density, overall immune system, exercise-induced inflammation, stress fractures, muscle recovery, and athletic performance) [58–60]. Professional basketball players may be at higher risk for hypovitaminosis D (vitamin D deficiency) after the season due to the amount of time spent indoors and often lack of sunlight exposure [61]. For instance, 57% (12 of 21) of professional Spanish basketball players from the same team were below the optimal standards serum vitamin D levels (<50 nmol/L) after wintertime during two consecutive seasons [61]. Another study confirmed these findings in players at the NBA combine (2009–2013) in which 79.3% (221 players) appeared to be vitamin-D-deficient or insufficient (<32 ng/mL) [60]. Consequently, adequate intake of dietary vitamin D is recommended if elite basketball players are to avoid low serum vitamin D, especially when sunlight exposure is limited. For instance, an adequate consumption of fish at least four times per week promotes the maintenance of a healthy status of vitamin D serum levels (>60 ng/mL) in athletes [61]. If athletes dislike fatty fish (or consume limited amounts), ergogenic supplementation should be considered to avoid vitamin D deficiency [61] (Table 63.1). Magnesium (Mg) is another vital mineral for the body’s function, specifically regarding energy metabolism, transmembrane transport, muscle relaxation and contraction [62]. Mg tends to be of increased demand in elite athletes [63]. Mg concentrations significantly decreased over time in 12 elite basketball players competing in the Asociación de Clubs de Baloncesto (Spanish highest professional basketball league) who were tested four consecutive times throughout the season (8 weeks between each test) [63]. Furthermore, Mg concentrations significantly dropped below the optimal norm at the third test [63]. Consequently, player education and awareness of magnesium-rich foods (e.g., nuts, seeds, fatty fish, legumes, whole grains) should be encouraged. During extremely intense periods (e.g., tournaments, playoffs), ergogenic supplementation of 400 mg/day of Mg, in the form of Mg lactate, may also be considered [63] (Table 63.1). 63.3.3 Hydration A frequent issue in elite basketball is the inadequate supply of water or other fluids both during periods of rest or activity. For instance, in a study by Osterberg (2009), 29 NBA players were tested for urine specific fluid and gravity. Approximately half of the players entered the game in a hypohydrated state [64]. Unfortunately, fluid intake during the game did not compensate for poor hydration status before games. Additionally, the NBA players who participated in this study also lost more than 2 L of sweat in approximately 20 min of game time [64]. In a study on fluid intake habits of 55 elite basketball players competing in the Spanish Basketball League (ACB), 44% of the players recorded not to drink before getting thirsty [17], which suggests the need for player education and awareness on (re)hydration throughout the day (Table 63.1). A dehydration of 1–2% may negatively impact focus, cognitive functions [65], reaction time [65], exercise tolerance [65], aerobic endurance [66], and jumping performance [67]. Subsequently, this may progressively deteriorate the ability to complete basketball skills during games such as sprinting, defensive slides, sprinting-defensive slides combination, repetitive jumping, and total number of shots [68]. Therefore, both pregame and in-game hydration strategies (e.g., player education, beverage availability) should be encouraged (Table 63.1). The hydration status of players can be monitored in a variety of ways such as their thirst, changes in body mass, or their urine color. However, once these variables have changed, dehydration has already occurred, which means it becomes too late to compensate for it. Therefore, it is recommended to approach players’ fluid 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence balance in a proactive manner throughout the day. Furthermore, it is essential to acknowledge that sweat loss includes vital electrolytes such as sodium, potassium, chloride, and magnesium [69]. Recently, high-alkaline water has been suggested to promote faster rehydration as well as delay muscular acidosis during anerobic excercise, prevent dehydration, and speed up the recovery process [65]. In particular, professional basketball players who consumed high-alkaline water during anaerobic activity showed a positive impact on their a­cid-­base balance with a significant increase in blood and urine pH which in turn may lower concentration of free radicals as well as the improvement of connective tissue condition [65]. More specifically, the daily intake of 2.5–3.0 L of highly alkalized water has been suggested during strenuous basketball games or practices [65] (Table 63.1). 63.4 Secondary Post-exercise Recovery Methods in Basketball 63.4.1 Ergogenic Aids and Supplements An ergogenic aid can be broadly defined as a technique or substance used for the purpose of enhancing performance. 63.4.1.1 Creatine Since 1992, the interest in creatine (Cr) as a nutritional supplement has dramatically increased. Over the past two decades, the main focus of research has been on the ergogenic value of Cr and its underlying mechanisms (resynthesis of ATP) [23]. Creatine is a naturally occurring nutrient, consumed through food intake and synthesized in the body. In basketball, Shi et al. [24] (2005) concluded that supplementation of CHO and Cr could promote the recovery of physical performance, demonstrating its efficacy in a sport like basketball characterized by highintensity efforts [24]. In this sense, data from top-level Spanish players showed that low-dose supplementation with Cr monohydrate did not produce laboratory abnormalities for the major- 805 ity of the health parameters during three competition seasons [25]. Besides the benefits of Cr on physical performance in elite athletes, supplementation of Cr has also demonstrated to have a positive impact on brain energy homeostasis and improved cognitive function in athletes suggesting the need for a holistic approach to future studies on creatine supplementation in elite basketball players [70]. According to a recent systematic review and meta-analysis on elite soccer players, creatine supplementation with a Cr loading dose of 20–30 g/day, divided 3–4 times per day, ingested for 6–7 days, and followed by 5 g/ day for 9 weeks or with a low dose of 3 mg/kg/ day for 14 days seem to be optimal for improving anaerobic performance [71] (Table 63.2). Furthermore, the International Society of Sports Nutrition (I.S.S.N.) supports a Cr loading dose of approximately 0.3 g per kg per day for at least 3 days [72]. Consequently, although the existing evidence behind the benefits of Cr, future studies in elite basketball players are warranted to confirm optimal Cr dosing strategies. -Alanine and Sodium β Bicarbonate β-alanine supplementation has become a common practice among different sports. Although the mechanism by which chronic β-alanine supplementation could have an ergogenic effect is widely debated, the popular view is that β-alanine supplementation augments intramuscular carnosine content, leading to an increase in muscle buffer capacity, a delay in the onset of muscular fatigue, and a facilitated recovery during repeated bouts of high-intensity exercise [26]. β-alanine supplementation has been shown to improve high-intensity exercise performance and capacity [27]. However, its effect on recovery is not clear, but some authors indicated that β-alanine supplementation in highly-trained athletes could be of importance [27]. However, nowadays there is no scientific evidence about the ergogenic effect of β-alanine in team sports (including basketball). Among the most recent investigations, the focus has been on the effect of β-alanine supplementation and sodium bicarbonate on high-intensity efforts, but these studies have been performed predominantly on endur63.4.1.2 T. Huyghe et al. 806 Table 63.2 Practical recommendations to optimize post-exercise recovery in elite basketball players (secondary recovery) Secondary post-exercise recovery strategies Ergogenic aids Cooldown strategies Active recovery Creatine ∙ Consider 7 min of low-­intensity monohydrate exercise after strenuous exercise ∙ During intense [13] periods, consider consumption of Stretching + massage ∙ Consider the combination of 20–30 g/day of stretching + massage <2 h after β-alanine (0.3 g training or games [34] per kg body weight), divided Hydrotherapy ∙ Consider hydrotherapy as a 3–4 times per recovery modality 24–72 h after day, for exercise; however, account for 6–7 days, individual differences in followed by 5 g/ physiological status, body mass day for 9 weeks and body composition [35] or with a low ∙ Consider full-body cold-water dose of 3 mg/kg/ immersion <5 min after practices day for 14 days or games, with 5 bouts of 2 min [71] immersions of the lower limbs in Sodium bicarbonate cold water (11.8 °C), separated by ∙ For highly 2 min rest in ambient air (sitting, trained players, room temperature of 20.8 °C). consider Add ice at regular intervals to consumption of maintain water temperature at 0.2 g kg−1 of 11 ± 0.78 °C [35, 36] sodium ∙ Consider full-body contrast water bicarbonate therapy in which warm water (NaHCO3) 90 (40–42 °C; 3 min) and cold water and 60 min prior (8 ± 1 °C; 1 min) are altered for a to high-intensity 20-min period [76] practices or Compression clothing games [73] ∙ Wear full-length or lower limb compression garments and/or medical-grade compression socks during travel or rest periods; however, customize garments to individual size/fit and account for differences in sensitivity to blood flow changes [37, 38, 78] Cryotherapy ∙ Consider cryotherapy for 2–4 min of extreme cold air (−110° to −140 °C) during strenuous periods of the year; however, take into account the increased sensitivity for athletes with a relative low BMI [74, 79] ance exercise [28]. Nevertheless, the results of a recent study by Ansdell et al. revealed that the supplementation of 0.2 g kg−1 of sodium bicarbonate (NaHCO3) 90 and 60 min prior to commencing a simulated basketball game may Psychological strategies Wellness and Recovery Surveys ∙ Collect wellness and RPE scores on a daily basis to gain specific insight into psychological status of each athlete [42] Mental recovery breaks ∙ Use short rest breaks between training sessions as an opportunity to cultivate and explore optimal mental recovery routines including: – Relaxation techniques [83]; – Breathing techniques [83]; – Mental imagery [83]; – Powernaps [83]; – Debriefing [83]; – Mental detachment [83]; – Restorative environments [83]; – Music [ 83]; – Caffeine [ 83] Manual therapy Acupuncture ∙ Consider acupuncture stimulation after strenuous exercise, however, based on personal preferences [47] Dry needling ∙ Consider dry needling of the fibularis muscles in players with a history in lateral ankle sprains, however, based on personal preferences [85] Massage ∙ Consider 10 min of full-body effleurage in a room with temperature of 25–26 °C, however, based on personal preferences [87] promote recovery through slowing down the rate of post-game fatigue occurrence by protecting contractile elements of the muscle fibers [73] (Table 63.2). Acknowledging the role of β-alanine and NaHCO3, it could be interesting 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence to further investigate the effects of these supplements in basketball since it is an intermittent sport with a variety of multidirectional movements such as running, dribbling, and shuffling at variable velocities and jumping [29]. 63.4.2 Physical Recovery Strategies Cooldown is a widely accepted practice after training sessions, used to reduce heart rate back to resting rate, stretch muscles, remove lactate concentration, resynthesize high-energy phosphates, replenish oxygen in the blood, body fluid, and myoglobin, and support the small energy cost to sustain an elevated circulation and ventilation [30, 31] (Table 63.2). However, despite being considered as essential for optimum performance, there is no investigation that has identified the optimum cooldown process in basketball. 63.4.2.1 Active Recovery Although the dearth of scientific research, active recovery may be beneficial for athletes through enhanced blood flow in muscle tissue, which facilitates the removal of metabolic waste, and may contribute to a reduction in muscle lesions and pain [74]. Active recovery may have a larger effect on delayed onset muscle soreness (DOMS) than perceived fatigue in athletes [74]. However, the prescribed protocol seems play a role in the impact of active recovery. For instance, after a rugby contest, 1 h of low-intensity aquatic exercise did not alter creatine kinase (CK) concentrations [75], but 7 min of low-intensity exercise enhanced CK clearance [13] (Table 63.2). Considering the practicality of active recovery for athletes [32], future investigations should further analyze the physiological and psychological effect of this cooldown method, particularly in elite basketball players. 63.4.2.2 Stretching Post-event cooldown strategies relying on stretching techniques should not be done with the goal to drastically improve flexibility. Dynamic stretching has gained popularity, due to a number of studies showing an increase in high-intensity 807 performance compared to static stretch modalities [33]. However, post-competition, static stretching is not recommended as a way to improve flexibility and reduce adhesions caused by physical activity [11]. In basketball, little research has been reported about this concept, Delextrat et al. 2014 demonstrated that female basketball players benefit slightly more from the combination treatment (massage + stretching) than men, and therefore this type of recovery intervention should be adopted by physiotherapists especially in women’s teams within 2 h after training or matches, in particular during tournaments where matches are played daily [34] (Table 63.2). Both recovery procedures improved perceptions of overall fatigue and leg soreness, with greater benefits of the combination on leg soreness [34]. 63.4.2.3 Hydrotherapy One method gaining popularity as a means to enhance post-game or post-training recovery is immersion in cold water. Much of the literature on water immersion as an intent to improve athletic recovery appears to be based on anecdotal information, but it is suggested that this method can improve recovery 24–72 h after exercise [35]. In this study, the cold-water immersion occurred within 5 min of the completion of the match and consisted of five 2 min intermittent immersions of the lower limb (up to the iliac crest) in a cold-water bath (11.8 °C), separated by 2 min rest in ambient air (sitting, room temperature of 20.8 °C). Ice was added to the bath at regular intervals to maintain water temperature at 11 ± 0.78 °C (Table 63.2). In basketball, few articles have analyzed the effect of water immersion on recovery. They demonstrated that it is more useful than massage in the recovery from basketball matches [36]. It has been shown that a tournament elicited small to moderate impairments in physical performance, and that cold-water immersion appears to promote better restoration of physical measures, such as 20-m acceleration, than CHO and stretching routines or compression garments [8]. Contrast water therapy (CWT) or changing from cold to warm water immersion and/ or vice versa is another recovery method gaining popularity in recent years. This method has 808 demonstrated to significantly reduce the perception of pain at 24, 48, and 72 h post-eccentric exercise [74] due to peripheral vasoconstriction and vasodilation as this reduces the formation of edema after exercise, alters acute inflammatory responses, and reduces blood CK concentrations, suggesting less muscle damage [74]. In particular, altering warm water (40–42 °C; 3 min) and cold water (8 ± 1 °C; 1 min) for a 20-min period has demonstrated to improve recovery (specifically hematological and physical components) compared to passive recovery in university-level rugby players [76] (Table 63.2). However, future studies are needed to identify the reliability of this recovery protocol at various times throughout the season in elite basketball players. 63.4.2.4 Compression Garments Compression garments are articles of clothing such as socks or leggings that provide support. For instance, small-to-moderate benefits of inflight compression socks have been reported on systolic blood pressure, right calf girth, CMJ height, mean velocity, and relative power in elite volleyball players after long-haul travel, compared with a passive control group [86]. The utilization of compression garments has also been adopted for athletes due to their potential benefits for physical performance and recovery [37]. Compression garments apply mechanical pressure to the body, and they compress and support underlying tissues [38]. The garments can come in varying degrees of compression and therefore enhance recovery. In a recent systematic review (with meta-analysis) conducted by MarquésJiménez et al., evidence concluded the benefits of compression garments on exercise-induced muscle damage, specifically in reducing perceived muscle soreness and swelling while improving neuromuscular power and strength [77]. Although controversy in optimal pressure, time of treatment and type of garment to maximize these benefits, Brown et al. suggested the largest benefits resulted from compression garments applied 2–8 h and >24 h after strength training sessions [78] (Table 63.2). Nevertheless, future studies are warranted in basketball players participating in a variety of exercise modalities, dif- T. Huyghe et al. ferent recovery period lengths, length of applied compression, amount of pressure applied, and place of applied compression (upper limbs, lower limbs, or whole body) in order to prescribe more specific protocols to each player. Finally, individual differences in sensitivity to blood flow changes may also impact the rate of recovery when wearing compression garments [74]. 63.4.2.5 Cryotherapy Whole-body cryotherapy is an expensive recovery method which typically includes short exposure (2–4 min) to extreme cold (−110° to −140 °C) induced by air (Table 63.2). Due to the numerous cryostimulation methods used by researchers and practitioners, the impact of cryotherapy on DOMS and fatigue remain inconsistent. However, whole-body cryotherapy (WBC) could reduce DOMS after an exposure of 3 min at −140 and −195 °C in recreational participants [79]. This cooldown method may also improve muscle fatigue, pain, and well-being (DOMS and self-perceived fatigue) [74] although the effects on DOMS seem to occur shortly after exercise (<6 h after exercise), while not after 24 h or later [74], and multiple cryostimulation treatments are required to experience positive benefits on recovery. Furthermore, in elite basketball players competing at the European Championship, 3 min of cold exposure (at −130 °C) significantly improved their mean thermal sensation score during partialbody cryostimulation (PBC) exposure in athletes [80]. However, large inter-individual differences were reported mainly due to differences in body mass index (BMI) [80]. Although future studies are needed on the effects of WBC and PBC on recovery and sensation in elite basketball players, a 3-min exposure seems to be well tolerated by athletes in general, and may be most effective during the heaviest training or competition periods of the year. In physically active men, 3-min WBC in the evening after training has recently demonstrated to improve both objective and subjective sleep quality, thus WBC may be considered for that particular reason as well [81]. However, special attention should be given to female athletes with a low BMI as they seem to be significantly more sensitive to cold air exposure [80]. 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 63.4.3 Mental Recovery Strategies To ensure that athletes maximize the benefits from demanding training sessions and remain robust enough to cope with multiple performances, it is vital that individual athletes have the ability to recognize when and how they need to recover. Burnout is defined as a state of mental, emotional, and physical exhaustion brought on by persistent devotion to a goal in which its achievement is dramatically opposed to reality [40]. Recently, it was demonstrated that an increase in self-control could reduce negative anxiety effects and improve player’s performance under pressure [41]. Furthermore, mental fatigue may play a significant role in technical performance of elite basketball players [82], suggesting the need for a holistic approach to recovery encompassing both physical and mental strategies. Results from recent studies indicated that session Ratings of Perceived Exertion (sRPE) seems to be a viable tool in monitoring internal load. These responses might help coaches to plan appropriate loads, hence maximizing recovery and performance [42]. Recently, short rest periods during the day (between subsequent training sessions) have been suggested as vital opportunities for mental recovery interventions and may help in assisting players to return to baseline levels of mental abilities (e.g., concentration, vigilance, attention) and restoration of mental energy [83]. For instance, relaxation techniques (e.g. yoga, meditation, and autogenic training), breathing techniques (e.g., pranayama), mental imagery (e.g., focusing on the upcoming performance, imagination of positive and confidence-boosting atmospheres, positive self-talk, and goal-setting), powernaps, debriefing (e.g., in-person posttraining and post-game evaluations, distancing and reorientation from previous experiences and feelings), mental detachment (e.g., disengaging from work-related topics), restorative environments (e.g., immersion into natural settings such as fascinating landscapes), post-exercise music (e.g., slow and sedative music), and controlled consumption of caffeine have all demonstrated to serve as beneficial psychological recovery strategies in elite athletes [83] (Table 63.2). However, 809 basketball-­specific research on mental recovery strategies and their impact on player mental status is lacking. 63.4.4 Therapeutic Interventions 63.4.4.1 Acupuncture Acupuncture is a recovery method used in traditional Chinese medicine for many years in which thin needles are inserted into the body. Although the scarcity of scientific research on this method in elite basketball players, one interesting study indicated the positive effects of acupuncture stimulation (beginning 15 min prior to exercise and ending after player exhaustion) on the recovery abilities of university basketball players [47]. In particular, 30 university basketball players were randomly assigned to three groups: experiment group (acupuncture at the Neiguan (PC6) and Zusanli (ST36) acupoints), sham group (acupuncture 1 cm away from the PC6 and ST36 acupoints), and control group (no acupuncture) while heart rate (HRmax), oxygen consumption (VO2max), and blood lactate concentration were recorded in each group during the rest period and at 5-, 30- and 60-min after exercise [47]. Significantly lower levels of HRmax, VO2max and blood lactate concentration were reported in the experiment group compared to both sham and normal groups at the 30 min post-exercise test period while blood lactate concentration of the experiment group was the lowest at the 60-min post-exercise test period compared to all other groups [47] (Table 63.2). Hence, these findings suggest that acupuncture schemes may enhance the recovery ability in elite basketball athletes [47]. Tandya et al. also demonstrated the positive effects of acupuncture on lactate clearance following highintensity exercise in elite basketball players [84]. However, it should be noted that external factors (e.g., lifestyle, exercise preferences) were not taken into account and may have influenced these findings. Hence, future studies should aim to include these factors when possible. Moreover, many variations have accumulated over the years, and techniques vary depending on the country in which the acupuncture is performed, thus T. Huyghe et al. 810 future studies are needed to identify best-practice protocols in order to optimize recovery in elite basketball players. For instance, an alternative method described as “myofascial trigger point puncturing” (dry needling) has gained popularity in recent years. In a recent study on participants with a history in lateral ankle sprains, the authors concluded that dry needling the fibularis muscles may induce short-term improvements in strength and unilateral balance [85], though follow-­ up studies are needed with larger sample sizes and in basketball players specifically to substantiate these findings. Considering the current evidence on acupuncture, this recovery method can be safely applied as a complementary strategy to optimize the recovery of elite basketball players after strenuous exercise by enhancing the clearance of lactate levels in muscles. It is also a relative simple and well-tolerated method with little side effects reported in the literature. 63.4.4.2 Massage Many athletes consider sports massage as an essential part of their training and recovery routine. These athletes report that a sports massage helps them train more effectively, improve performance, prevent injury, and speed recovery. Massage is effective in alleviating DOMS by approximately 30% and reducing swelling [39]. However, Delextrat and colleagues (2005) demonstrated that massage did not have any effect on repeated sprint ability (RSA) [36]. Although massage alone may not impact RSA, another study found that stretching as an adjunct to massage may improve recovery from official matches in basketball players [34]. This study by Delaxtrat et al. (2005) was the first study to analyze the impact of massage on recovery in basketball [36]. Recently, Kaesaman et al. (2019) indicated that massage (specifically traditional Thai massage) is a more effective strategy than passive rest on recovery [87]. In particular, 16 basketball players were randomly assigned to either experiment group (10 min of traditional Thai massage throughout the body including biceps and triceps, deltoid, latissimus dorsi, thoracolumbar fascia, trapezius, and stretching muscles of hamstrings, rectus femoris, arms, and back, while the room was controlled at a temperature of 25–26 °C following basketball activity) or control group (10 min of rest following basketball activity) [87] (Table 63.2). Each player was required to perform 20 min of basketball simulation after which they were monitored on HRV and physical fitness, and monitored again after the intervention (massage or rest). The results indicated that traditional Thai massage can increase HRV, reduce sympathetic activity, and increase parasympathetic activity which contributes to the greater recovery rate in basketball players [87]. Nevertheless, more studies are needed to confirm the positive benefits of various massage techniques. Take-Home Message Recovery from training is recognized as one of the most important components of training regimen. To maximize year-round player recovery, primary recovery strategies (e.g., sleep, nutrition, and hydration) should be prioritized and encompassed by secondary recovery strategies (e.g., ergogenic aids, cooldown strategies, psychological strategies, manual therapy). Furthermore, daily fatigue monitoring is essential to understand and maximize the applicability, effectiveness, and efficiency of each of these recovery strategies at the individual level. Consistent high-quality sleep, food, and fluid consumption play a fundamental role in the recovery process following exercise in elite basketball players. Adequate sleep can be promoted and maintained through a variety of strategies, such as nutritional interventions (e.g., high-carbohydrate and melatonin-rich foods prior to bedtime), optimal timing of light exposure (e.g., blue light in the AM vs red light in the PM), and lifestyle habits (alcohol, caffeine, social media usage, pre-bed routines). High muscle glycogen restoration and status of euhydration can be achieved through highcarbohydrate consumption plus leucine and adequate proactive drinking immediately 63 Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence after exercise. Ergogenic aids may support the recovery process through metabolic alkalosis via bicarbonate ingestion plus beta-alanine. Hydrotherapy (e.g., coldwater immersion and/or contrast bath), cryotherapy, and compression clothes may also aid in player recovery by reducing DOMS and/or self-perceived fatigue 24 h after a game or strenuous training session. 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