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Post-Exercise Recovery Strategies in Basketball: Practical Applications Based

on Scientific Evidence

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DOI: 10.1007/978-3-662-61070-1_63

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 Post-Exercise Recovery Strategies
in Basketball: Practical
63
Applications Based on Scientific
Evidence

Thomas Huyghe, Julio Calleja-Gonzalez,
and Nicolás Terrados

level in 213 countries [1]. During the last decade,

Chapter Objectives elite basketball has become more competitive, with
1.
Describe up-to-date evidence-based increasingly condensed game schedules. Top play-
methods to optimize player recovery ers must deal with many national and international
specifically following basketball com- championships, with on average a game played
petition and/or practice(s); every 2.5  days [2]. In addition, the new rules
2. Provide primary and secondary post-
introduced in 2000 by Federation International
exercise recovery protocols applicable Basketball Association (FIBA) had a profound
to an elite basketball setting; effect on the game. In particular, the game became
3. Highlight novel post-exercise recovery more dynamic as the shot clock was reduced from
strategies in elite basketball with sug- 30 seconds 24 seconds, and the time allowed to
gestions for future research. 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
63.1 Introduction demands, players regularly train intensively, with
not enough time to fully recover between sessions
Basketball is the second most popular sport in the [5]. Therefore, how to recover faster after basket-
world with over 450 million athletes regularly play- ball training and competition becomes a central
ing the game either on a competitive or recreational question [6].
Complete recovery (return to homeostasis)
has been shown to result in the restoration of
T. Huyghe (*) organic and psychological states [7]. Recovery
Filou Oostende, Oostende, Belgium
from competition or training is dependent on the
J. Calleja-Gonzalez exercise, and it is thus essential to understand the
Physical Education and Sport Department, University
of Basque Country (UPV-EHU), specific mechanisms of fatigue and influences
Vitoria-Gasteiz, Spain from external factors. The demands placed on
N. Terrados basketball players during practice and matches
Unidad Regional de Medicina Deportiva, Avilés and are short, and explosive accelerations, decelera-
Instituto de Investigación Sanitaria del Principado de tions, change of directions, jumps, and contacts
Asturias (ISPA), Oviedo, Spain among players which could potentially create
e-mail: [email protected]

© ESSKA 2020 799

L. Laver et al. (eds.), Basketball Sports Medicine and Science,
https://doi.org/10.1007/978-3-662-61070-1_63
800 T. Huyghe et al.

trauma [8]. Players are also typically character- 63.2 Monitoring Post-Exercise
ized by a relative tall body and long limb length, Fatigue
which in turn could influence their susceptibil-
ity to fatigue compared to smaller athletes [9]. The recovery process in elite basketball may
Therefore, it is important to establish procedures take up to 48  h during regular practices and
to reduce injury risk, aid recovery, and optimally games [48] and is challenging to manage
train basketball players [10], as these become considering the multiple contextual factors
central questions in current basketball practice. involved (e.g., travel direction, travel duration,
In the scientific literature, a considerable num- individual chronotype, activity type, playing
ber of methods used to enhance recovery have been position, playing style, variation of total play-
discussed [11]. Their use depends on the type of ing time, time distribution of playing time, and
activity performed, the time until the next training physical qualities of the player). These vari-
session or event and equipment, coaching, or medi- ables together determine how players respond
cal staff available. The main recovery methods to game load and play an important role in their
practically used by teams include rest and sleep, ability to recover from that load. Therefore,
nutritional practices (CHO, proteins, fats, vitamins, monitoring the individual load from games and
minerals), hydration practices, ergogenic aids, practices in combination with markers of per-
cool-down strategies, phychological strategies, and formance and fatigue (internal response) is cru-
manual therapy techniques (Fig.  63.1). However, cial in elite basketball.
there is a lack of consensus on the benefits of many In order to prescribe recovery strategies cus-
of these approaches in the scientific community. tomized to each player individually, both objec-
While several reviews about recovery methods tive markers (e.g., blood parameters, salivary
have been published in other team sports, such biomarkers, heart rate parameters, sleep param-
as soccer [12] and rugby [13], to our knowledge, eters, performance tests) and subjective mark-
there has been no practical review or report about ers (e.g., questionnaires, and conversations with
recovery in basketball. Therefore, this chapter players) are used to monitor the time course of
will focus on specific recovery processes in bas- recovery from basketball training and games. For
ketball and will attempt to give practical informa- instance, the counter movement jump (CMJ) is
tion for coaches, clinicians, and practitioners. a commonly used neuromuscular performance

FATIGUE
MONITORING
SECONDARY RECOVERY STRATEGIES

ERGOGENIC AIDS
PRIMARY RECOVERY STRATEGIES
Substances or treatment that directly or
REST AND SLEEP indirectly improve performance or removes
constraints of which may limit performance.
A state of mind and body in which the
eyes are closed, postural muscles PHYSICAL STRATEGIES
relaxed, and consciousness practically
suspended. Activities or modalities implemented after
intense activity to allow the body to gradually
NUTRITION transition to a resting or near-resting state.
The nourishment or energy that is
MENTAL STRATEGIES
obtained from food consumed.
Mental processes used to calm the athletes
HYDRATION brain activity or to stimulate them.
The supply and retention of adequate
water in biological tissues. THERAPEUTIC INTERVENTIONS

The use of skilled hand movements to

RECOVERY manipulate tissues of the body to restore
movement, alleviate pain, promote general
health, or induce relaxation.

Fig. 63.1  Individualization of post-exercise recovery strategies in elite basketball

63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 801

test which may serve as an indication of recov- cluded that improvements in specific measures
ery throughout the course of a basketball season. of sprint time, shooting accuracy, and free throw
In particular, flight time:contraction time tends percentage occurred after sleep extension (mini-
to be a more sensitive measure of recovery com- mum of 10 h of sleep with optional daytime nap-
pared to jump height [49]. Alternatively, a 10-m ping), thus indicating that optimal sleep (8–10 h
sprint test may also be used where baseline val- of nocturnal sleep) is beneficial in allowing ath-
ues have been recorded 48 h after simulated bas- letes to reach their peak athletic performance
ketball games [50]. However, despite the value [45]. In the last season after the lock-out in the
behind performance tests, players may return to NBA, interviews with players revealed that they
baseline performance levels while still not being were not doing much to compensate for the loss
fully recovered. Therefore, performance tests of sleep and instead were feeling the effects of the
should be analyzed alongside biochemical mark- condensed season. This issue remains in today’s
ers in order to identify precise muscle damage in NBA environment, perhaps due to frequent social
each player. Common biochemical markers that media usage, as late-night tweeting (between
reflect muscle recovery include creatine kinase 11:00 pm and 7:00 am) 1 day prior to the game
(CK) and cortisol (C) which may take up to 72 h has demonstrated to impair next-day game per-
to return to baseline levels, despite recovery of formance [51]. In particular, NBA players sig-
physical performance after 48 h [48]. This slow nificantly spent 2 fewer minutes on the court,
decrease in CK and C suggests that although shot 1.7% less accurate, as well as experienced
performance may already be at optimal pregame negative returns on total rebounds, points, fouls,
values, the muscles may need significantly more and turnovers following late-night tweeting [51].
time to recover. Hence, high-performance practi- An investigation conducted by Steenland and
tioners should take this into consideration when Deddens (1997) analyzed the effect of travel and
preparing players during specific phases of the rest on performance over 8.495 regular season
season (either allowing or avoiding cumulative games (each team) in the NBA across eight sea-
fatigue at that time). sons and found that more time between games
Although “fatigue monitoring” is not the significantly improved performance [44]. This
prime emphasis of this chapter, high-­performance finding was consistent throughout the 8-year
practitioners should be aware that the sugges- observation [44]. This suggests that the NBA
tions given regarding recovery within this chapter travel schedule induces misalignments in circa-
should always be modified toward the individual dian rhythm that cannot be avoided. In order to
needs of each player as well as the situation at resynchronize the circadian rhythms of players,
hand in order to stimulate optimal adaptations it is recommended to apply blue light exposure in
(Fig. 63.1). the morning and red light exposure in the evening
[52, 53]. Other strategies may include the inges-
tion of a high-carbohydrate, low-protein meal in
63.3 Primary Post-exercise the evening, which may enhance serotonin pro-
Recovery Strategies duction to promote drowsiness and sleep [52], or
in Basketball the ingestion of a high-protein, low-carbohydrate
meal in the morning, which may increase the
63.3.1 Rest and Sleep uptake of tyrosine and its conversion to adrena-
line, which elevates arousal and promotes alert-
The amount of sleep an athlete gets appears ness [52] (Table 63.1). Recently, the consumption
to have a large impact on sports performance of tryptophan-rich protein (e.g., milk) has gained
through a variety of direct and indirect pathways popularity as it induces changes in bedtime core
(e.g., immune system, mood, focus, motiva- body temperature improving sleep quality [54,
tion, reaction time, glucose metabolism, muscle 55]. Furthermore, tart cherries have also been
growth and repair, etc.) [43]. Mah et  al. con- 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 Hydration
Light exposure Carbohydrates (CHO) and proteins Education and Awareness
  ∙ Avoid blue light exposure (e.g.,   ∙ Include CHO in rehydration   ∙ Facilitate opportunities for
late-night social media usage) beverages players to learn about
between 11:00 PM and 7:00 AM   ∙ Include rapidly absorbed CHO and euhydration, dehydration,
[51] hydrolyzed whey protein in recovery and monitoring hydration
  ∙ Promote blue light exposure in the drinks, using 3–4/1 ratio, being 1 g/ status [17]
AM and red light exposure in the kg the amount of the recommended   ∙ Ensure consistent
PM to facilitate optimal arousal CHO [15] beverage availability
levels and a stable circadian   ∙ During the season, CHO, maintain throughout the day [17].
rhythm [52, 53] protein and leucine intake (doses: Individualization
  ∙ Consider body irradiation with red 0.3 g/kg of CHO, 0.2 g/kg of protein   ∙ Monitor hydration status
light to players experiencing and 0.01 g/kg of leucine) per day, in each player throughout
difficulties falling asleep [46] immediately after training or games the day through their
Nutritional interventions [16] thirst, changes in body
  ∙ Consume a high-­carbohydrate,   ∙ During the season, maintain daily mass, and/or their urine
low-protein meal in the PM and a macronutrient ratio of amino acids color [17]
high-protein, low-carbohydrate (14.5%), proteins (12.7%), and CHO Lifestyle Habits and Fluid
meal in the AM [52] (12.7%); however, individual needs Selection
  ∙ Promote tryptophan-rich protein and differences should be taken into   ∙ Promote electrolyte-rich
(e.g., milk) and melatonin-­rich consideration before any foods and fluids including
foods (e.g., 2× servings of 30 mL prescriptions [17] sodium, potassium,
tart cherry concentrate) prior to Individualization chloride, and magnesium
bedtime [54, 55]   ∙ Use blood or salivary to identify [69]
  ∙ Avoid alcohol, caffeine, or large individual vitamin and mineral status   ∙ Consider 2.5–3.0 L of
meal or fluid consumptions prior and individual needs throughout the high-alkaline water during
to bedtime [57] season [64] high-intensity anaerobic
Education and Awareness Food selection exercises [65]
  ∙ Facilitate opportunities for players   ∙ Promote foods high in vitamins C,
to learn about topics such as sleep vitamins E, carotenoids, and
quality and quantity, time zone flavonoids [19, 22]
shifts, travel fatigue, circadian   ∙ Promote magnesium-rich foods (e.g.,
rhythm, caffeine, alcohol, nuts, seeds, fatty fish, legumes, whole
napping, sleep apnea, and acute grains)
vs. chronic sleep deprivation   ∙ When inadequate Mg levels are
Lifestyle Habits and Environment reported or when going through
  ∙ Maintain a regular sleep–wake intense periods, 400 Mg/day of mg,
cycle/routine [45, 57] in the form of Mg lactate, may be
  ∙ Ensure a comfortable, quiet, dark, considered as ergogenic aid [63]
and temperature-controlled   ∙ Promote vitamin D-rich foods (e.g.,
bedroom [57] fatty fish) especially when sunlight
  ∙ Consider taking a warm bath to exposure is limited [61]
lower core body temperature prior   ∙ If inadequate vitamin D serum levels
to bed [57] are reported, vitamin D
  ∙ Design a “to-do” list or diary to supplementation may be considered
avoid over-thinking and manage as ergogenic aid [58–60]
work-related stress [57] Nutrient timing
  ∙ Use relaxation/breathing   ∙ Refuel and rehydrate within 30 min
techniques after high-intensity after exercise to help muscles recover
training sessions or games [57] faster [16]
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
63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 803

well as sleep due to its anti-inflammatory and hydrolyzed whey protein, using 3–4/1 ratio, being
antioxidant properties as well as high concen- 1  g/kg the amount of the recommended CHO
trations of melatonin [54]. In particular, a recent [15] (Table  63.1). Eating and drinking the right
study investigated the effect of tart cherry juice kind of fuel after exercise is important for restor-
(2 × 30 mL concentrate) on sleep enhancement, ing energy levels and repairing muscle damage.
sleep duration, and sleep quality in healthy sub- Refueling with CHO, protein, and fluid within
jects in which the intervention group significantly 30  min after exercise will help muscles recover
increased their total melatonin content, increased faster. Within this context, it has been established
time in bed (+24  min), increased total sleep that consumption of macronutrients, particularly
duration (+34  min), improved sleep efficiency CHO and possibly a small amount of proteins
(82.3%), and reduced daytime napping (−22%) and leucine (doses: 0.3  g/kg of CHO, 0.2  g/kg
[56]. Finally, recent research demonstrated the of protein and 0.01 g/kg of leucine), in the early
effectiveness of body irradiation with red light recovery period after practice can enhance mus-
in improving the quality of sleep of elite female cle glycogen resynthesis [16], per day during the
players and offered a non-pharmacologic and season (Table 63.1). For instance, in an analysis
noninvasive therapy to prevent sleep disorders on the daily consumption of dietary supplements
after training [46] (Table  63.1). Nevertheless, on 55 professional basketball players from seven
the effects of tryptophan-rich protein, tart cherry different teams of the First Spanish Basketball
consumptions, and other promising alternatives League (ACB), 12.7% of players consumed on
(e.g., napping, sleep education, chrononutrition) average 10.3 g protein per day, 14.5% of players
on sleep and recovery in elite basketball players consumed 1.9 g amino acids per day, and 12.7%
warrant further investigation, especially con- of players consumed 16.2  g carbohydrates per
sidering sleep disturbances may occur due to a day [17]. However, future studies should analyze
player’s unique lifestyle, and thus results derived the ingestion of CHO in combination with pro-
from sleep intervention studies in the general tein in different dosages to determine which dose
population may be limited in their applicability will enhance recovery specifically for basketball
to elite basketball players [57] (Table 63.1). players.

63.3.2.2 Vitamins and Minerals

63.3.2 Nutritional Strategies Oxidative stress occurs when the body does not
have enough capacity to defend itself against
63.3.2.1 Carbohydrates and Proteins free radicals. Reactive oxygen species are the
Carbohydrates should be included in rehydration main source of oxidative stress and play a major
beverages to improve palatability and to aid in role in the initiation and progression of damage
the immediate restoration of muscle glycogen to the muscle fibers after exercise [18]. Several
stores [11]. From a nutritional point of view, bas- antioxidants have been introduced to protect the
ketball players use carbohydrates (CHO) as the cells from free radicals such as vitamins C and E,
primary source of fuel during exercise, given the carotenoids, and flavonoids [19].
type of training they perform and the character- Oxidative stress may be involved in the aging
istics of competition [4]. After a training session process, cell damage, muscular fatigue, and over-
or match, muscular stores of carbohydrate are training [20], especially during maximal exercise
depleted, and thus consuming CHO and protein in basketball. Hence, playing competitive bas-
during recovery has been shown to positively ketball may involve greater utilization of aerobic
affect subsequent exercise performance and metabolism than previously expected, with val-
could be of benefit for athletes involved in mul- ues of VO2 of 33.4–4.0 and 36.9–2.6 mL/kg/min
tiple training or competition sessions on the same for females and males, respectively [21]. Within
or consecutive days [14]. The ideal combination this context, the consumption of vitamins C and
will be of rapidly absorbed CHO together with E may strengthen the antioxidant defense system
804 T. Huyghe et al.

by decreasing reactive oxygen species involved awareness of magnesium-rich foods (e.g., nuts,
in maximal- or high-intensity exercise [22]. seeds, fatty fish, legumes, whole grains) should
Regarding the nutritional habits of players, it has be encouraged. During extremely intense peri-
been shown that multivitamins were the most fre- ods (e.g., tournaments, playoffs), ergogenic
quently used supplements among these athletes supplementation of 400  mg/day of Mg, in the
(50.9%), followed by sport drinks (21.8%) [17]. form of Mg lactate, may also be considered [63]
Vitamin D serum levels has an impact on a (Table 63.1).
player’s overall health and ability to train (e.g.,
bone mass density, overall immune system, exer-
cise-induced inflammation, stress fractures, mus- 63.3.3 Hydration
cle recovery, and athletic performance) [58–60].
Professional basketball players may be at higher A frequent issue in elite basketball is the inad-
risk for hypovitaminosis D (vitamin D defi- equate supply of water or other fluids both during
ciency) after the season due to the amount of time periods of rest or activity. For instance, in a study
spent indoors and often lack of sunlight exposure by Osterberg (2009), 29 NBA players were tested
[61]. For instance, 57% (12 of 21) of professional for urine specific fluid and gravity. Approximately
Spanish basketball players from the same team half of the players entered the game in a hypo-
were below the optimal standards serum vitamin hydrated state [64]. Unfortunately, fluid intake
D levels (<50  nmol/L) after wintertime during during the game did not compensate for poor
two consecutive seasons [61]. Another study con- hydration status before games. Additionally, the
firmed these findings in players at the NBA com- NBA players who participated in this study also
bine (2009–2013) in which 79.3% (221 players) lost more than 2  L of sweat in approximately
appeared to be vitamin-D-deficient or insufficient 20  min of game time [64]. In a study on fluid
(<32 ng/mL) [60]. Consequently, adequate intake intake habits of 55 elite basketball players com-
of dietary vitamin D is recommended if elite bas- peting in the Spanish Basketball League (ACB),
ketball players are to avoid low serum vitamin 44% of the players recorded not to drink before
D, especially when sunlight exposure is limited. getting thirsty [17], which suggests the need for
For instance, an adequate consumption of fish player education and awareness on (re)hydration
at least four times per week promotes the main- throughout the day (Table 63.1).
tenance of a healthy status of vitamin D serum A dehydration of 1–2% may negatively
levels (>60  ng/mL) in athletes [61]. If athletes impact focus, cognitive functions [65], reac-
dislike fatty fish (or consume limited amounts), tion time [65], exercise tolerance [65], aerobic
ergogenic supplementation should be considered endurance [66], and jumping performance [67].
to avoid vitamin D deficiency [61] (Table 63.1). Subsequently, this may progressively deterio-
Magnesium (Mg) is another vital mineral rate the ability to complete basketball skills dur-
for the body’s function, specifically regarding ing games such as sprinting, defensive slides,
energy metabolism, transmembrane transport, sprinting-defensive slides combination, repeti-
muscle relaxation and contraction [62]. Mg tive jumping, and total number of shots [68].
tends to be of increased demand in elite athletes Therefore, both pregame and in-game hydration
[63]. Mg concentrations significantly decreased strategies (e.g., player education, beverage avail-
over time in 12 elite basketball players compet- ability) should be encouraged (Table 63.1).
ing in the Asociación de Clubs de Baloncesto The hydration status of players can be mon-
(Spanish highest professional basketball league) itored in a variety of ways such as their thirst,
who were tested four consecutive times through- changes in body mass, or their urine color.
out the season (8 weeks between each test) [63]. However, once these variables have changed,
Furthermore, Mg concentrations significantly dehydration has already occurred, which means it
dropped below the optimal norm at the third becomes too late to compensate for it. Therefore,
test [63]. Consequently, player education and it is recommended to approach players’ fluid
63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 805

balance in a proactive manner throughout the ity of the health parameters during three compe-
day. Furthermore, it is essential to acknowl- tition seasons [25]. Besides the benefits of Cr on
edge that sweat loss includes vital electrolytes physical performance in elite athletes, supple-
such as sodium, potassium, chloride, and mag- mentation of Cr has also demonstrated to have
nesium [69]. Recently, high-alkaline water has a positive impact on brain energy homeostasis
been suggested to promote faster rehydration as and improved cognitive function in athletes sug-
well as delay muscular acidosis during anerobic gesting the need for a holistic approach to future
excercise, prevent dehydration, and speed up the studies on creatine supplementation in elite bas-
recovery process [65]. In particular, professional ketball players [70]. According to a recent sys-
basketball players who consumed high-alkaline tematic review and meta-analysis on elite soccer
water during anaerobic activity showed a posi- players, creatine supplementation with a Cr load-
tive impact on their a­cid-­base balance with a ing dose of 20–30 g/day, divided 3–4 times per
significant increase in blood and urine pH which day, ingested for 6–7 days, and followed by 5 g/
in turn may lower concentration of free radicals day for 9 weeks or with a low dose of 3 mg/kg/
as well as the improvement of connective tissue day for 14 days seem to be optimal for improv-
condition [65]. More specifically, the daily intake ing anaerobic performance [71] (Table  63.2).
of 2.5–3.0 L of highly alkalized water has been Furthermore, the International Society of Sports
suggested during strenuous basketball games or Nutrition (I.S.S.N.) supports a Cr loading dose
practices [65] (Table 63.1). 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
63.4 Secondary Post-exercise in elite basketball players are warranted to con-
Recovery Methods firm optimal Cr dosing strategies.
in Basketball
63.4.1.2 β  -Alanine and Sodium
63.4.1 Ergogenic Aids Bicarbonate
and Supplements β-alanine supplementation has become a com-
mon practice among different sports. Although
An ergogenic aid can be broadly defined as a the mechanism by which chronic β-alanine sup-
technique or substance used for the purpose of plementation could have an ergogenic effect is
enhancing performance. widely debated, the popular view is that β-alanine
supplementation augments intramuscular car-
63.4.1.1  Creatine nosine content, leading to an increase in muscle
Since 1992, the interest in creatine (Cr) as a nutri- buffer capacity, a delay in the onset of muscular
tional supplement has dramatically increased. fatigue, and a facilitated recovery during repeated
Over the past two decades, the main focus of bouts of high-intensity exercise [26].
research has been on the ergogenic value of Cr β-alanine supplementation has been shown
and its underlying mechanisms (resynthesis of to improve high-intensity exercise performance
ATP) [23]. Creatine is a naturally occurring nutri- and capacity [27]. However, its effect on recov-
ent, consumed through food intake and synthe- ery is not clear, but some authors indicated that
sized in the body. In basketball, Shi et al. [24] β-alanine supplementation in highly-trained
(2005) concluded that supplementation of CHO athletes could be of importance [27]. However,
and Cr could promote the recovery of physi- nowadays there is no scientific evidence about
cal performance, demonstrating its efficacy in the ergogenic effect of β-alanine in team sports
a sport like basketball characterized by high- (including basketball). Among the most recent
intensity efforts [24]. In this sense, data from investigations, the focus has been on the effect
top-level Spanish players showed that low-dose of β-alanine supplementation and sodium bicar-
supplementation with Cr monohydrate did not bonate on high-intensity efforts, but these studies
produce laboratory abnormalities for the major- have been performed predominantly on endur-
806 T. Huyghe et al.

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 Psychological strategies Manual therapy
Creatine Active recovery Wellness and Recovery Acupuncture
monohydrate   ∙ Consider 7 min of low-­intensity Surveys   ∙ Consider acupuncture
  ∙ During intense exercise after strenuous exercise   ∙ Collect wellness stimulation after
periods, consider [13] and RPE scores on strenuous exercise,
consumption of Stretching + massage a daily basis to gain however, based on
20–30 g/day of   ∙ Consider the combination of specific insight into personal preferences
β-alanine (0.3 g stretching + massage <2 h after psychological status [47]
per kg body training or games [34] of each athlete [42] Dry needling
weight), divided Hydrotherapy Mental recovery breaks   ∙ Consider dry
3–4 times per   ∙ Consider hydrotherapy as a   ∙ Use short rest needling of the
day, for recovery modality 24–72 h after breaks between fibularis muscles in
6–7 days, exercise; however, account for training sessions as players with a history
followed by 5 g/ individual differences in an opportunity to in lateral ankle
day for 9 weeks physiological status, body mass cultivate and sprains, however,
or with a low and body composition [35] explore optimal based on personal
dose of 3 mg/kg/   ∙ Consider full-body cold-water mental recovery preferences [85]
day for 14 days immersion <5 min after practices routines including: Massage
[71] or games, with 5 bouts of 2 min   – Relaxation   ∙ Consider 10 min of
Sodium bicarbonate immersions of the lower limbs in techniques [83]; full-body effleurage
  ∙ For highly cold water (11.8 °C), separated by   – Breathing in a room with
trained players, 2 min rest in ambient air (sitting, techniques [83]; temperature of
consider room temperature of 20.8 °C).   – Mental imagery 25–26 °C, however,
consumption of Add ice at regular intervals to [83]; based on personal
0.2 g kg−1 of maintain water temperature at   – Powernaps [83]; preferences [87]
sodium 11 ± 0.78 °C [35, 36]   – Debriefing [83];
bicarbonate   ∙ Consider full-body contrast water   – Mental
(NaHCO3) 90 therapy in which warm water detachment [83];
and 60 min prior (40–42 °C; 3 min) and cold water   – Restorative
to high-intensity (8 ± 1 °C; 1 min) are altered for a environments
practices or 20-min period [76] [83];
games [73] Compression clothing   – Music [ 83];
  ∙ Wear full-length or lower limb   – Caffeine [ 83]
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 promote recovery through slowing down the
a recent study by Ansdell et  al. revealed that rate of post-game fatigue occurrence by pro-
the supplementation of 0.2  g  kg−1 of sodium tecting contractile elements of the muscle fibers
bicarbonate (NaHCO3) 90 and 60  min prior to [73] (Table  63.2). Acknowledging the role of
commencing a simulated basketball game may β-alanine and NaHCO3, it could be interesting
63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 807

to further investigate the effects of these supple- performance compared to static stretch modalities
ments in basketball since it is an intermittent [33]. However, post-competition, static stretch-
sport with a variety of multidirectional move- ing is not recommended as a way to improve
ments such as running, dribbling, and shuffling at flexibility and reduce adhesions caused by physi-
variable velocities and jumping [29]. cal activity [11]. In basketball, little research has
been reported about this concept, Delextrat et al.
2014 demonstrated that female basketball players
63.4.2 Physical Recovery Strategies benefit slightly more from the combination treat-
ment (massage + stretching) than men, and there-
Cooldown is a widely accepted practice after fore this type of recovery intervention should be
training sessions, used to reduce heart rate back adopted by physiotherapists especially in wom-
to resting rate, stretch muscles, remove lactate en’s teams within 2 h after training or matches,
concentration, resynthesize high-energy phos- in particular during tournaments where matches
phates, replenish oxygen in the blood, body fluid, are played daily [34] (Table  63.2). Both recov-
and myoglobin, and support the small energy ery procedures improved perceptions of overall
cost to sustain an elevated circulation and ven- fatigue and leg soreness, with greater benefits of
tilation [30, 31] (Table  63.2). However, despite the combination on leg soreness [34].
being considered as essential for optimum per-
formance, there is no investigation that has identi- 63.4.2.3 Hydrotherapy
fied the optimum cooldown process in basketball. One method gaining popularity as a means to
enhance post-game or post-training recovery is
63.4.2.1 Active Recovery immersion in cold water. Much of the literature
Although the dearth of scientific research, active on water immersion as an intent to improve ath-
recovery may be beneficial for athletes through letic recovery appears to be based on anecdotal
enhanced blood flow in muscle tissue, which information, but it is suggested that this method
facilitates the removal of metabolic waste, and can improve recovery 24–72 h after exercise [35].
may contribute to a reduction in muscle lesions In this study, the cold-water immersion occurred
and pain [74]. Active recovery may have a larger within 5 min of the completion of the match and
effect on delayed onset muscle soreness (DOMS) consisted of five 2 min intermittent immersions of
than perceived fatigue in athletes [74]. However, the lower limb (up to the iliac crest) in a cold-water
the prescribed protocol seems play a role in the bath (11.8 °C), separated by 2 min rest in ambient
impact of active recovery. For instance, after air (sitting, room temperature of 20.8 °C). Ice was
a rugby contest, 1  h of low-intensity aquatic added to the bath at regular intervals to maintain
exercise did not alter creatine kinase (CK) con- water temperature at 11 ± 0.78 °C (Table 63.2). In
centrations [75], but 7 min of low-intensity exer- basketball, few articles have analyzed the effect of
cise enhanced CK clearance [13] (Table  63.2). water immersion on recovery. They demonstrated
Considering the practicality of active recovery that it is more useful than massage in the recov-
for athletes [32], future investigations should fur- ery from basketball matches [36]. It has been
ther analyze the physiological and psychological shown that a tournament elicited small to moder-
effect of this cooldown method, particularly in ate impairments in physical performance, and that
elite basketball players. cold-water immersion appears to promote better
restoration of physical measures, such as 20-m
63.4.2.2 Stretching acceleration, than CHO and stretching routines or
Post-event cooldown strategies relying on compression garments [8].
stretching techniques should not be done with the Contrast water therapy (CWT) or chang-
goal to drastically improve flexibility. Dynamic ing from cold to warm water immersion and/
stretching has gained popularity, due to a number or vice versa is another recovery method gain-
of studies showing an increase in high-intensity ing popularity in recent years. This method has
808 T. Huyghe et al.

demonstrated to significantly reduce the percep- ferent recovery period lengths, length of applied
tion of pain at 24, 48, and 72  h post-eccentric compression, amount of pressure applied, and
exercise [74] due to peripheral vasoconstriction place of applied compression (upper limbs, lower
and vasodilation as this reduces the formation of limbs, or whole body) in order to prescribe more
edema after exercise, alters acute inflammatory specific protocols to each player. Finally, indi-
responses, and reduces blood CK concentrations, vidual differences in sensitivity to blood flow
suggesting less muscle damage [74]. In particu- changes may also impact the rate of recovery
lar, altering warm water (40–42 °C; 3 min) and when wearing compression garments [74].
cold water (8 ± 1 °C; 1 min) for a 20-min period
has demonstrated to improve recovery (specifi- 63.4.2.5 Cryotherapy
cally hematological and physical components) Whole-body cryotherapy is an expensive recov-
compared to passive recovery in university-level ery method which typically includes short
rugby players [76] (Table 63.2). However, future exposure (2–4  min) to extreme cold (−110° to
studies are needed to identify the reliability of −140  °C) induced by air (Table  63.2). Due to
this recovery protocol at various times through- the numerous cryostimulation methods used by
out the season in elite basketball players. researchers and practitioners, the impact of cryo-
therapy on DOMS and fatigue remain inconsis-
63.4.2.4 Compression Garments tent. However, whole-body cryotherapy (WBC)
Compression garments are articles of clothing could reduce DOMS after an exposure of 3 min
such as socks or leggings that provide support. at −140 and −195 °C in recreational participants
For instance, small-to-moderate benefits of in- [79]. This cooldown method may also improve
flight compression socks have been reported on muscle fatigue, pain, and well-being (DOMS and
systolic blood pressure, right calf girth, CMJ self-perceived fatigue) [74] although the effects
height, mean velocity, and relative power in elite on DOMS seem to occur shortly after exercise
volleyball players after long-haul travel, com- (<6 h after exercise), while not after 24 h or later
pared with a passive control group [86]. The uti- [74], and multiple cryostimulation treatments are
lization of compression garments has also been required to experience positive benefits on recov-
adopted for athletes due to their potential ben- ery. Furthermore, in elite basketball players com-
efits for physical performance and recovery [37]. peting at the European Championship, 3  min of
Compression garments apply mechanical pres- cold exposure (at −130 °C) significantly improved
sure to the body, and they compress and support their mean thermal sensation score during partial-
underlying tissues [38]. The garments can come body cryostimulation (PBC) exposure in athletes
in varying degrees of compression and therefore [80]. However, large inter-individual differences
enhance recovery. In a recent systematic review were reported mainly due to differences in body
(with meta-analysis) conducted by Marqués- mass index (BMI) [80]. Although future studies
Jiménez et al., evidence concluded the benefits of are needed on the effects of WBC and PBC on
compression garments on exercise-induced mus- recovery and sensation in elite basketball players,
cle damage, specifically in reducing perceived a 3-min exposure seems to be well tolerated by
muscle soreness and swelling while improv- athletes in general, and may be most effective dur-
ing neuromuscular power and strength [77]. ing the heaviest training or competition periods of
Although controversy in optimal pressure, time the year. In physically active men, 3-min WBC
of treatment and type of garment to maximize in the evening after training has recently demon-
these benefits, Brown et  al. suggested the larg- strated to improve both objective and subjective
est benefits resulted from compression garments sleep quality, thus WBC may be considered for
applied 2–8  h and >24  h after strength training that particular reason as well [81]. However, spe-
sessions [78] (Table  63.2). Nevertheless, future cial attention should be given to female athletes
studies are warranted in basketball players par- with a low BMI as they seem to be significantly
ticipating in a variety of exercise modalities, dif- more sensitive to cold air exposure [80].
63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 809

63.4.3 Mental Recovery Strategies basketball-­specific research on mental recovery

strategies and their impact on player mental sta-
To ensure that athletes maximize the benefits tus is lacking.
from demanding training sessions and remain
robust enough to cope with multiple perfor-
mances, it is vital that individual athletes have 63.4.4 Therapeutic Interventions
the ability to recognize when and how they need
to recover. Burnout is defined as a state of mental, 63.4.4.1 Acupuncture
emotional, and physical exhaustion brought on by Acupuncture is a recovery method used in tradi-
persistent devotion to a goal in which its achieve- tional Chinese medicine for many years in which
ment is dramatically opposed to reality [40]. thin needles are inserted into the body. Although
Recently, it was demonstrated that an increase in the scarcity of scientific research on this method
self-control could reduce negative anxiety effects in elite basketball players, one interesting study
and improve player’s performance under pres- indicated the positive effects of acupuncture
sure [41]. Furthermore, mental fatigue may play stimulation (beginning 15  min prior to exercise
a significant role in technical performance of and ending after player exhaustion) on the recov-
elite basketball players [82], suggesting the need ery abilities of university basketball players [47].
for a holistic approach to recovery encompassing In particular, 30 university basketball players
both physical and mental strategies. were randomly assigned to three groups: experi-
Results from recent studies indicated that ment group (acupuncture at the Neiguan (PC6)
session Ratings of Perceived Exertion (sRPE) and Zusanli (ST36) acupoints), sham group (acu-
seems to be a viable tool in monitoring internal puncture 1 cm away from the PC6 and ST36 acu-
load. These responses might help coaches to plan points), and control group (no acupuncture) while
appropriate loads, hence maximizing recovery heart rate (HRmax), oxygen consumption (VO2max),
and performance [42]. Recently, short rest peri- and blood lactate concentration were recorded
ods during the day (between subsequent training in each group during the rest period and at 5-,
sessions) have been suggested as vital opportu- 30- and 60-min after exercise [47]. Significantly
nities for mental recovery interventions and may lower levels of HRmax, VO2max and blood lactate
help in assisting players to return to baseline lev- concentration were reported in the experiment
els of mental abilities (e.g., concentration, vigi- group compared to both sham and normal groups
lance, attention) and restoration of mental energy at the 30  min post-exercise test period while
[83]. For instance, relaxation techniques (e.g. blood lactate concentration of the experiment
yoga, meditation, and autogenic training), breath- group was the lowest at the 60-min post-exercise
ing techniques (e.g., pranayama), mental imagery test period compared to all other groups [47]
(e.g., focusing on the upcoming performance, (Table  63.2). Hence, these findings suggest that
imagination of positive and confidence-boosting acupuncture schemes may enhance the recovery
atmospheres, positive self-talk, and goal-setting), ability in elite basketball athletes [47]. Tandya
powernaps, debriefing (e.g., in-person post- et  al. also demonstrated the positive effects of
training and post-game evaluations, distancing acupuncture on lactate clearance following high-
and reorientation from previous experiences and intensity exercise in elite basketball players [84].
feelings), mental detachment (e.g., disengaging However, it should be noted that external fac-
from work-related topics), restorative environ- tors (e.g., lifestyle, exercise preferences) were
ments (e.g., immersion into natural settings such not taken into account and may have influenced
as fascinating landscapes), post-exercise music these findings. Hence, future studies should aim
(e.g., slow and sedative music), and controlled to include these factors when possible. Moreover,
consumption of caffeine have all demonstrated to many variations have accumulated over the years,
serve as beneficial psychological recovery strate- and techniques vary depending on the coun-
gies in elite athletes [83] (Table 63.2). However, try in which the acupuncture is performed, thus
810 T. Huyghe et al.

future studies are needed to identify best-practice was controlled at a temperature of 25–26  °C
protocols in order to optimize recovery in elite following basketball activity) or control group
basketball players. For instance, an alternative (10 min of rest following basketball activity) [87]
method described as “myofascial trigger point (Table 63.2). Each player was required to perform
puncturing” (dry needling) has gained popularity 20 min of basketball simulation after which they
in recent years. In a recent study on participants were monitored on HRV and physical fitness, and
with a history in lateral ankle sprains, the authors monitored again after the intervention (massage
concluded that dry needling the fibularis muscles or rest). The results indicated that traditional Thai
may induce short-term improvements in strength massage can increase HRV, reduce sympathetic
and unilateral balance [85], though follow-­ up activity, and increase parasympathetic activity
studies are needed with larger sample sizes and which contributes to the greater recovery rate in
in basketball players specifically to substanti- basketball players [87]. Nevertheless, more stud-
ate these findings. Considering the current evi- ies are needed to confirm the positive benefits of
dence on acupuncture, this recovery method can various massage techniques.
be safely applied as a complementary strategy to
optimize the recovery of elite basketball players
after strenuous exercise by enhancing the clear- Take-Home Message
ance of lactate levels in muscles. It is also a rela- Recovery from training is recognized as
tive simple and well-tolerated method with little one of the most important components of
side effects reported in the literature. training regimen. To maximize year-round
player recovery, primary recovery strate-
63.4.4.2 Massage gies (e.g., sleep, nutrition, and hydration)
Many athletes consider sports massage as an should be prioritized and encompassed
essential part of their training and recovery rou- by secondary recovery strategies (e.g.,
tine. These athletes report that a sports massage ergogenic aids, cooldown strategies, psy-
helps them train more effectively, improve per- chological strategies, manual therapy).
formance, prevent injury, and speed recovery. Furthermore, daily fatigue monitoring is
Massage is effective in alleviating DOMS by essential to understand and maximize the
approximately 30% and reducing swelling [39]. applicability, effectiveness, and efficiency
However, Delextrat and colleagues (2005) dem- of each of these recovery strategies at the
onstrated that massage did not have any effect on individual level.
repeated sprint ability (RSA) [36]. Although mas- Consistent high-quality sleep, food, and
sage alone may not impact RSA, another study fluid consumption play a fundamental role
found that stretching as an adjunct to massage in the recovery process following exercise
may improve recovery from official matches in in elite basketball players. Adequate sleep
basketball players [34]. This study by Delaxtrat can be promoted and maintained through
et  al. (2005) was the first study to analyze the a variety of strategies, such as nutritional
impact of massage on recovery in basketball interventions (e.g., high-carbohydrate and
[36]. Recently, Kaesaman et al. (2019) indicated melatonin-rich foods prior to bedtime),
that massage (specifically traditional Thai mas- optimal timing of light exposure (e.g., blue
sage) is a more effective strategy than passive light in the AM vs red light in the PM), and
rest on recovery [87]. In particular, 16 basketball lifestyle habits (alcohol, caffeine, social
players were randomly assigned to either experi- media usage, pre-bed routines). High
ment group (10 min of traditional Thai massage muscle glycogen restoration and status of
throughout the body including biceps and triceps, euhydration can be achieved through high-
deltoid, latissimus dorsi, thoracolumbar fascia, carbohydrate consumption plus leucine and
trapezius, and stretching muscles of hamstrings, adequate proactive drinking immediately
rectus femoris, arms, and back, while the room
63  Post-Exercise Recovery Strategies in Basketball: Practical Applications Based on Scientific Evidence 811

performances in national-level female basketball

after exercise. Ergogenic aids may support players. J Sports Med Phys Fitness. 2012;52:128–36.
6. Moraska A. Sports massage: a comprehensive review.
the recovery process through metabolic J Sports Med Phys Fitness. 2005;45:370–80.
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beta-alanine. Hydrotherapy (e.g., cold- cise glycogen synthesis during short-term recovery.
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cryotherapy, and compression clothes may effect of recovery strategies on physical performance
also aid in player recovery by reducing and cumulative fatigue in competitive basketball. J
DOMS and/or self-perceived fatigue 24  h Sports Sci. 2008;26:1135–45.
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Alaphilippe A, Mandigout S, Ratel S, et  al.
develop proactive mental recovery habits, Longitudinal follow-up of biochemical markers of
suggesting relaxation techniques, breathing fatigue throughout a sporting season in young elite
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