In today’s episode, Tommy will address a question from Anne about how to stay active and minimize the negative health effects from an injury. In this episode, he covers the following topics:
Protein targets for muscle maintenance
The influence of “muscle memory” on recovery
The “cross-education” effect with one sided training
Blood flow restriction training
Electrical stimulation techniques
Visualization techniques
How to balance muscle and joint recovery
Nutrients for tendon and connective tissue health
Here is the question from Anne in Leeds, England:
“What exercises are possible after a minor knee injury, given the inability to engage in typical activities like running, walking, or weightlifting. How do you minimize the negative effects of reduced physical activity?”
To watch us answer this question, just click on the above video. To listen to it, click on our podcast feed below. To read it, just keep on scrolling…
Edited Transcript
Tommy: So this is a great question and I think there are a few different options we can think about. It's gonna depend slightly on the injury, but hopefully across all of these areas, there's something you can think about doing. the first thing to mention is that yes, once you stop using a limb physically, its function does decline over time.
If you go complete bed rest, you can start to lose muscle and strength within days. For most people who maintain some mobility and maybe just stop training, you start to lose fitness and strength within a couple of weeks.
But they can be recovered quite quickly. There's a fair amount of research on things like what we call muscle memories includes aspects of muscle satellite cells, which muscle stem cells and those with a history of training are more able to quickly regain muscle and strength compared to what it would take to gain new muscle and strength.
One thing to think about first is that you lose fitness and strength relatively slowly. It's not like you don't train for a week and all of a sudden everything is undone. Even if you do lose significant portions of muscle and strength, you can gain that back more quickly than it took to gain it in the first place.
Proper Nutrition, Especially Protein, Supports Muscle Maintenance During Injury
So then if you are injured for some reason I think the first thing that's important is you can think about some nutritional aspects. The most important probably being protein. So making sure that you're getting adequate protein can be difficult, depending on the nature of the injury.
If it involves significant trauma, you may have issues with hunger and appetite. That certainly has happened to me when I had a significant injury in the past. So just, you focusing on protein as much as you can is going to be beneficial.’
From various meta analyses, we know that you can improve muscle and strength in the absence of training up to probably around 1.5 to 1.6 grams per kilo of protein of body weight per day.
That's 0.7 to 0.8 ish grams per pound of body weight, which is probably just what would be my general recommendations anyway, for most people, but really try and make sure you hit those targets. If you are injured, any physical activity you can do is going to be broadly beneficial, bothin a general sense, as well as in a more targeted sense.
So if you are able to do some kind of low level aerobic activity using other parts of the body, outside of the one that is injured that's going to be beneficial. So if you've injured a leg, but you're still able to do some kind of upper body cycling or you're still able to get around. If you're able to do some kind of low level aerobic activity using the other limbs that will be beneficial.
Cross-Education Effect Supports Recovery by Training the Opposite Side
Then the next part of that is there's quite a lot of evidence to suggest that there is something called a cross education effect, which says that if you train just one side of the body, you will also see benefits on the other side of the body.
And this is the case for both aerobic training and resistance training. If you've injured one leg, you can train the other leg and you will see some carryover to the injured leg even though it's not being trained. This is probably related to myokines so that when we exercise the muscle you have broader effects beyond that muscle.
Similarly if you injured both lower legs, if you did some kind of upper body resistance training or you weren't able to train your legs, you can train your upper body. The effect size is obviously bigger in the area that's being trained, but there does seem to be this cross education effect that's probably systemically driven by the various factors released during exercise.
Blood Flow Restriction and Electrical Muscle Stimulation Can Help Preserve Muscle Strength
Then we can think about other things that can be done either with the injured limb or that require less effort or movement that we know have beneficial effects. I'm thinking about blood flow restriction and electrical muscle stimulation.
Blood flow restriction is a way to get enhanced activation of some of these processes that generate muscle fitness and strength with much lower loads. You can do this on an injured limb during rehabilitation or if you had significant restrictions in movement, you could do it even if bed bound, you could do blood flow restriction of, of any of the limbs that are unaffected.
And again, it should have some systemic effect. You put a cuff around the top of the arms or the top of the legs. You can also put them at the top of the calves if you're just doing the lower portion of the legs. Then you would do some kind of resistance training movement.
This can be with weights it can be with body weight, it can be with bands. The idea is generally that you accumulate something like 75 to 100 repetitions within a few minutes so it's generally quite lightweight, like 20 to 30 percent of what your maximum lift might be of that type.
The most common protocols tend to break this down into a first set of 30 repetitions and then three to four further sets of 15 to 20 repetitions with 30 second breaks in between. So you get to 30. You can't do any more. You take 30 seconds break and then you do 50 to 20 and you do that until you get sort of 75 to 80 reps, you know, 75 to a hundred reps again, depending on how all that breaks down, it's, it's often very difficult to get.
You ideally would get to the point where you cannot do any more reps before you rest. So maybe it's like 32 and then 17 or 18 and then a rest. And then the next one is 14 or 15, something like that. But you know, in that sort of 75 to 100 rep range within 4 to 5 sets. And then you would move on to the next body part that you work.
You can get blood flow restriction bands. Pretty much anywhere. They can be very simple elastic bands. The main thing you want to do is get them as tight as you can, but without restricting blood flow to the limb. So you can like on the, on the upper limbs, you can check like Normally you would have a pulse at your wrist, the radial pulse, you know, just make sure you can still feel that pulse.
In the research and with more advanced systems you can change the pressure more accurately. A company called be strong, is an example. There are several others where it looks more like one of those blood pressure cuffs that you get at the doctor and you can pump it up.
And then you can, you, then you know exactly how much pressure is in each one. These are more expensive, but probably safer because you know exactly how much pressure you're putting on the limb at the time. So that's certainly an option as well. Although I, for several years, just used the cheap ones and they work just fine.
So, the next thing is electrical muscle stimulation, which doesn't require any significant movement of the limb.
Several years ago, I was bitten by a snake. I had a relatively long recovery process because I had an abscess that had to be drained from the calf on my right leg. I couldn't put any weight on that leg. And I certainly couldn't do squats or anything like that in the gym.
So one of the things that I did use was electrical muscle stimulators. These are electrodes that you put directly on the muscle that you're trying to train. You can put them on the quads, the hamstrings, the calves, biceps, abs, chest, wherever. the electrodes stimulate a contraction of that muscle as if you were lifting a weight.
But without you actually having to load the joint So as long as the muscle is healthy and even if the injury is in the muscle and you're trying to recover that muscle, things like blood flow restriction with some very light resistance with a band or something, and then some electrical muscle stimulation could help regain strength and function of that muscle as you recover.
These are things you can use both during the injury and during the recovery process. both have been used, in Individuals who are frail or bed bound to improve muscle strength and function. Some options for these electrical muscle stimulators, they generally come with these pre defined programs.
Because, as you might imagine, how the electrical stimulus comes in, the strength of the current, the shape of the wave that stimulates the muscle is going to be different depending on what you're trying to stimulate that muscle to do. Companies have essentially done that hard work for you. I have used a product called PowerDots.
It was recently bought out by Therabody. So the Therabody Power Dots are these little pods that connect to your phone via Bluetooth and then you just connect the pods to the, to the stimulators. So it's, it's kind of like a hands free thing and you run everything from your phone. Compex is another company that has a bunch of different options and has its own handheld unit that is wired to the electrode.
So that can be beneficial in other settings where it's a pain to manage the Bluetooth and the stuff on your phone. If you would rather just like a wired unit, that's a good option. For more recovery type things rather than trying to replace some aspect of weight or resistance training the Mark Pro is another company that makes units focused on muscle recovery, but could also be used in the recovery from an injury process.
So I think that's everything. There are a lot of different options, depending on what's injured and what you're working around. Even if you're training other aspects of the body, you are still supporting the part of the body that is injured and most of those things can come into play as you try and rehab that area of the body as well.
Any questions or follow ups from any of that, Josh?
Combining Visualization With Physical Techniques May Enhance Recovery Outcomes
Josh: That was great. I'll have to keep this handy for the next time I'm down and out with something. And yeah, I think there are two main goals. when this happens, one is to mitigate the impact on our overall physical health from just the reduction in activity.
And then there's also mitigating the functional impact of whatever area is affected. One other thing I thought about is there's been some impressive data on visualization for you know, for people muscle for risk kind of resist visualizing resistant training and not actually having benefits.
And I think there's some data on that improving recovery outcomes as well and people who were doing some kind of visualization protocol. I think the data there, which fits mechanistically with what we would expect is that the benefits are largely neural.
You may be increasing the input to the muscles themselves maybe improving recruitment and so forth. So getting strength gains without, direct changes in the muscle it occurs to me that combining visualization with something like blood flow restriction or electrical stem, could be a way of getting everything right.
The electrical, the blood flow restriction, you're not getting the neural factors to the same degree unless you're combining it with some kind of visualization protocol. So that would be a curious experiment. I don't know if that sort of thing has been attempted. But given all that you've said I'd probably try something like that.
The only other thing I wonder about is if you're, able to preserve muscle, strength to a degree is there a possibility of a mismatch between what the joints are capable of supporting, the other connective tissue elements that are deteriorating and could that potentially create its own problems?
Tommy: that's a great question. There are some very nice studies on where they randomize people to no exercise, actual exercise, and then visualizing the exercise. in terms of strength gains, those who do the visualization, see significant improvements over those who don't do any training at all.
If you do some kind of light electrical muscle stimulation or blood flow restriction, and then spend some time imagining contracting that muscle as hard as you canthat would be very interesting to try,
I also think there's potential benefit from combining blood flow restriction with electrical muscle stimulation if you're not actually able to move the joint. But again I actually been in conversation with some guys at NASA about doing some studies on that because when you don't have gravity to work against.
It's associated with significant decreases in physical functioning. So they're trying to figure out ways to do that in space. And that combination is something they're thinking about.
Josh: you mentioned the phenomenon where if you train one side there's, there still more general benefits that occur from that. So is that, is it, is it specific to the homologous area on the other side?
So if I'm training my right biceps with my left arms immobilized, is that benefit going to be. particularly in my left bicep, or is it going to be more broadly distributed throughout my muscles
Tommy: Yeah, generally, when they do those studies, they train, say, the biceps or the quadriceps on one side, and then look at the strength on the other side.
There are also some studies, particularly if you train the lower body, you can see some improvements in strength in the upper body as well. Some of it is thought to be, if you're working those neural pathways, a lot of the pathways that go down one quadricep, they're involved in coordinating with the other side as well.
You're training, but, but essentially some of those pathways together. But then I think some of it is also gonna be, you know, related to myokines like we talked about.
So if that's the case, the more muscle you stimulate or move the greater the demand you can create if you work your quadriceps hard you're more likely to have a systemic effect that way.
Josh: So what I hear you're saying is basically we can just do biceps curls
Tommy: that's the solution to everything. Of course.
Josh: Anything else?
Gradual Rehabilitation and Proper Nutrition Are Essential for Joint and Tendon Health
Tommy: Oh, I remember what your question was. It was about the differential effects on muscles versus joints and some mismatch between those, If you're only doing certain types of training which I think is a really good question.
Most of the benefits of the things that I talked about are more related to the musculature rather than the joints and other aspects of soft tissue. tendons and ligaments, particularly if you're not loading a joint and you're only doing much lighter exercise around that because it's the joint that's injured.
There will be some other aspects of the soft tissue that will be affected. I think for most people this is unlikely to be a major issue unlessthey have very strong muscles, right? So imagine you're a very competitive power lifter, you have very strong quadriceps and you work really hard to keep them strong while you're injured.
There are examples where that muscle when it contracts could rip the connecting tissue away from the joint, but you're gonna need a big mismatch there. imagine if you didn't train for some period because you'd injured your knee on that side, but you'd done some work on the quads to keep them functional while you were injured, if you're An average trainee, as you get back into loading that joint, those two things should come in parallel.
You should regain, the use of that limb in parallel with redeveloping aspects of the soft tissue. There is interesting data on, nutrition for improving ligament and tendon health, particularly tendon recovery.
Collagen, Vitamin C, and Eccentric Exercises Can Aid Tendon and Ligament Healing
Some studies on combining collagen with vitamin C that may accelerate some of that. I think there's still a lot to be done there, but this was really exciting a few years ago People haven't found quite the same results. So there's maybe some more work that needs to be done there, but you're making sure that you're getting some of the precursors to collagen.
I think it's important either supplement collagen, collagen, make sure you get enough glycine in your diet. we have a higher glycine requirement if we have a high level of physical activity. protein sources that are high in glycine, can be beneficial.
Vitamin C is important because it hydroxylates proline, which is one of the components of collagen, some nutritional supplementation there, and then something particularly good for recovering tendons can be eccentric exercises where you really load that tendon as it lengthens.
So this is something they do, in those who have Achilles issues, Achilles tendonitis, where you would go up on one side, and then on the affected side, you'd very slowly lower yourself down. So you're kind of doing this eccentric motion, which is contracting whilst the muscle is lengthening.
You could do that with the quad tendon as well. say if you went on a leg extension machine, you can raise the machine with both legs and then very slowly lower it on just one side. So you're actively working against that resistance. Of course, you'd start this at a relatively low weight rather than really loading it up and going for it, because that might cause some issues if you lower it very, very slowly, that's going to make it harder. I would make it harder by doing the movement more slowly rather than loading more weight.
Then you can more actively work some of those other aspects of the soft tissues they recover from some period of injury.
Josh: thank you, Anne, for that question. If you have any questions related to this topic or anything else in the realm of brain health and fitness, just send it our way.
Summary
Staying Active During Recovery: Maintaining some level of physical activity during an injury helps minimize fitness decline, even if it involves only the uninjured limbs.
Protein Intake for Muscle Maintenance: Adequate protein consumption (1.5-1.6 grams per kilogram of body weight per day) is essential for preserving muscle mass when regular exercise isn’t possible.
Muscle Memory and Recovery: Loss of muscle and strength happens gradually during injury, but previous training history enables quicker recovery once activity resumes.
Cross-Education Effect: Training the uninjured limb can help maintain strength in the injured side due to the cross-education effect, which benefits both sides of the body.
Blood Flow Restriction (BFR) Training: BFR is a useful method to maintain muscle strength without heavy weights, making it ideal during injury recovery.
Electrical Muscle Stimulation: Electrical muscle stimulation can help preserve muscle function without moving the injured joint, aiding recovery when mobility is limited.
Visualization Techniques: Mental visualization of muscle contractions has been shown to help maintain strength during periods of inactivity. Combining visualization with other recovery methods might improve overall outcomes.
Balancing Muscle and Joint Recovery: Focusing only on muscle maintenance during injury can create imbalances with tendons and joints, so gradual joint rehabilitation is crucial for a balanced recovery.
Nutrition for Tendon Health: Combining collagen and vitamin C may support tendon recovery, while eccentric exercises (lengthening under load) help rebuild tendon strength.
Better Brain Fitness Newsletter: The newsletter offers insights into brain and physical health, including guides for key nutrients and blood tests important for maintaining cognitive health.
Combining Techniques for Optimal Recovery: Using a combination of visualization, blood flow restriction, and electrical muscle stimulation might yield the best results for maintaining and regaining muscle strength during injury recovery.
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