4.2. Warm-up
There are not many teachers out there who do not advocate warming up. What shape and purpose each warm-up has, can vary greatly and within the same class of students, they can look completely different. LeBron famously starts his warm-up routines long before each game begins (ESPN, 2017).
Warming up, especially starting the day when the body temperature is lower, should focus mostly on increasing the body temperature (Eichner, 2010) and slightly raising the pulse. In a meta-analysis from 2010 on warm-ups by Fradkin et al, they found that warm-ups improve performance on almost all physical levels. However, it was noted that warming up can be detrimental to one’s performance when the warm-up are too unrelated to the task such as doing long bouts of cardiovascular training before doing fine movements (Fradkin et al, 2010).
Since increased body core temperature increases flexibility of our joints (Gilette et al, 1991), we should first raise our body temperature and then do task specific warm-ups as supported by Abar et al. (Abar et al, 2011). For task specific warm-ups, we need to make sure that these are not too strenuous. A good recommendation for musicians was shared by Janet Horvath, author of Playing (Less) Hurt: An Injury Prevention Guide for Musicians: warm-up should be done in mezzopiano to mezzoforte dynamic and not too strenuous for a while before moving to anything more challenging (Bulletproof Musician, 2013 - 2020).
4.3. Fitness
When any stress is put on a muscle, it is important to let it recover. Muscle breakdown and muscle fatigue is the first stage in developing overuse injuries. Professional athletes like LeBron James do a mixture of weight training and cardio 5-7 times a week during the season, simply for recovery and maintenance of their physique (Business Insider, 2020).
According to a study done by Hood et al, short bouts of high intensity interval training in untrained individuals improved the body’s recovery functions by 35% (Hood et al, 2011). Furthermore, any form of resistance training has been shown to stimulate muscle mitochondrial biogenesis which plays important role in rebuilding and healing the muscle tissue (Groennebaek and Vissing, 2017).
Since it is known that the blood stream handles the delivery of oxygen and glucose which the muscles use for energy, using exercises for specific body parts can be useful. According to an article by Joyner and Casey, we can in fact stimulate blood flow into specific body with resistance training and therefore increase the natural recovery and maintenance of the muscle tissue (Joyner and Casey, 2015).
In my discussion with Katarina Porander, she talked extensively how important it is for musicians and especially percussionists, to train so we can feel recovered after each performance. She prescribes case specific resistance training programs to all her clients (Porander, 2020).
4.1. Sleep
First, let’s take a look at sleep. Professional athletes take their sleep habits very seriously and it has been reported that LeBron James makes sure to get up to 10 hours of sleep every day (CNBC, 2020).
According to P. Schwarz et al, sleep deprivation impairs muscular recovery on a cellular level (Schwarz et al, 2013) and Cheri D. Mah et al. showed that when student athletes extended their sleep, they could measure improvements in athletic performance, reaction time and mood. They furthermore deduced that athletes can only peak when sleep schedule is optimal (Mah et al, 2011). So, if we want our bodies to have a chance to recover properly, sleep is essential.
The literature also indicates that cognitive performance such as long-term memory is negatively impacted by a lack of sleep. Giving even more weight to the notion that we need to sleep properly and that our sleep is essential more than physical recovery (Alhola and Polo-Kantola, 2007).
This begs the question of how we can regulate our sleep optimally. Chin Moi Chow, associate professor of sleep and wellbeing in University of Sydney, has few tips for that. These include silencing the mind through meditation, reducing bad daytime and pre-sleep habits, staying asleep by optimising the darkness levels, noise levels and room temperature where you sleep, sticking to your sleeping routine and breaking bad sleep beliefs (The Conversation, 2010 - 2020).
4.5. Massage
Every locker room in the NBA has a massage therapist (Business Insider, 2020). Lebron James himself has been reported to get massages 2-3 times a week from his private massage therapist. I have had deep fascial massage several times and found it very effective as did some of my correspondents. But is there any evidence to support that?
The literature about massages is not very dense but there is some interesting evidence out there.
Many placebo studies have been conducted about massage and in a 2015 study compared patients' headaches and upper trap tightness to relieve from a deep tissue fascial massage and a fake ultrasound treatment. Both groups showed a drop in perceived headaches which gives the idea that mentality contributes to tightness validity (Moraska et al, 2015). In a 2005 study, Zainuddin et al found that massage after exercise reduced delayed onset muscle soreness, which is the soreness following exercise (Zainuddin et al, 2005) which was supported by a Dupuy et al meta-analysis in 2018 (Dupuy et al, 2018). A study compared a cortisol massage treatment, massage treatment, cortisol (steroids) and placebo and found no statistical significance in long term recovery from tennis elbow (Olaussen et al, 2015).
4.6. Inflammation
Athletes fight continuously to keep down the inflammation in their bodies. Inflammation is the body’s response to many stimuli, including rebuilding muscle and healing tendons and other tissue. Athletes, such as LeBron, use compression sleeves, chryothreapy, massages and other methods to keep their inflammation down (Business Insider, 2020). Musicians seem to very keen on using ice.
Diet has been gaining traction as a tool to deal with inflammation and with a quick internet search it is possible to find a list of magic or superfoods to help to deal with inflammation. However, in a 2010 meta-analysis by Leo Galland MD, it is suggested that Mediterranean diet, which has an abundance of healthy fats and omega aids, has more anti-inflammatory effect than a “North American and Northern European” dietary pattern. He goes on to state that this may be a good choice for dealing with chronic inflammation (Galland, 2010).
LeBron’s chryotherapy chamber has been mentioned a few times but all it is, is an extreme version of a cold treatment meant to reduce inflammation.
In a 2018 study by Wilson et al, they looked at the cryothreapy, cold water immersion and a placebo treatment to try and learn about the effects of cold therapy. They found that cryothreapy did not outperform cold water immersion to reduce soreness and inflammation after intense exercise, and neither chryothreapy or cold water immersion were significantly better than a placebo treatment (Wilson et al, 2019 ). Furthermore, Broatch et al. found that a placebo was superior to cold water immersion in reading of readiness for exercise, pain and vigour 48 hours after intense training (Broatch et al, 2014).
In a 2014 review of the literature by A. Mooventhan and L. Nivethitha, it was found that cold water immersion and contrast treatment (hot-cold treatment) did show some benefits to muscle-skeletal recovery and perceived pain levels. They also concluded that any form of hydrotherapy is not harmful in any way (Mooventhan and Nivethitha, 2014).
In the world of sports, few people take better care of their body than basketball superstar LeBron James. LeBron is in the 17th year of his basketball career and at 35 years old he is producing on the basketball court in the same way is his 25 year-old-self. This is not an accident since LeBron reportedly spends around 1.5 million dollars annually on his body. He has a team of experts advising him on nutrition, sleep, training and recovery. LeBron James has his own cryochamber at his house. He travels with a hyperbaric chamber and uses compression sleeves before and after games. He also has a personal trainer, physical therapist and a nutritionist on call 24/7 (Business Insider, 2020).
Musicians generally do not have the same resources as superstar athletes. But what we do have in common is that our body is our livelihood and if a physical impairment makes us unable to perform, we will be left in a tight spot.
What can we as musicians learn from athletes in terms of preventing and recovering from injuries?
4.4. Stretching
Many teachers and therapists promote stretching as a way to stay both injury-free and as a recovery tool. While stretching can certainly feel good, it is not always the key. What does stretching do for us and what does it not do?
In December of 2015, Behm et al, did a meta-analysis on the different effects of static stretching (SS), proprioceptive neuromuscular facilitation (PNF) and dynamic stretching (DS) (Behm et al, 2016).
SS is the common stretch that we know as holding a stretch on a muscle for a specific time. PNF stretching has three stages: firstly, an outside party performs a stretch on you, secondly, you contract the muscle that is being stretched or resist and lastly, you relax while the outside party pushes you deeper into the stretch. DS is when a limb is moved repeatedly through its full range of motion.
According to Behm et al, static stretching has either no or negative affect on muscular performance performed after stretching, especially when stretches are held for longer times but also for stretches held for less than 60 seconds. When stretches are held for shorter time, they have less negative effects on muscular performance. Therefore, if stretching is necessary for some reason, it is advised not to hold the stretch longer than 30 seconds (Behm et al, 2016).
Stretching has been shown positive effect in range of motion, so stretching makes us more flexible. According to a study on the relationship of strength, flexibility and throwing speed by Schwesig et al, range of motion (flexibility) does not correlate with strength, and furthermore, flexibility of the shoulder joint does not play a significant role in throwing power. With this in mind, we can deduce that if flexibility is hindering our performance, stretching is beneficial but does not seem to correlate with increased muscular performance (Schwesig et al, 2016).
According to a article by Witvrouw et al, the current scientific literature does not support the hypothesis of stretching being injury preventative (Witrouw et al, 2004). When stretching has been researched as an injury preventative measure, it has been successful when prescribed as a part of a wholesome warm-up program prior to the exercise. “I make my clients stretch but it is just one part of a big program” (Porander 2020).
Stretching is a controversial topic in the sports science world. An article published in April 2020 on Pain Science's website says that stretching is mostly meaningless compared to the other physical activities (Pain Science, 2020), while articles like Harvard Health Letter say it is essential (Harvard Health Publishing, 2010 - 2020).
I tend to fall into the earlier group after having stretched intensively but carefully for the last five years with basically nothing to show for it.
