Recovery

Does Joe Marler have a Miracle Milkman?

The 2017 RBS 6 Nations is around the corner. England will go into the tournament as favourites but there can be no doubt about the big story during the build-up. Its Joe Marler’s miracle come back from a broken leg, and how? Milk apparently…….

With Mako Vunipola injured, Marler had been the obvious choice to start at Loosehead. However, after picking up what he thought was a calf strain against Worcester in a game at the start of the year and subsequently being unable to recover, he was diagnosed with a stress fracture.

It is worth noting that although still a fracture, a stress fracture is a reasonably common condition accounting for roughly 10% of sports injuries (Graham et al, 2015). General prognosis would see athletes making a return in four to six weeks, rather than the months associated with a full fracture.

If the fracture had been diagnosed following the Worcester game, he would have had 5 weeks until running out at Twickenham this weekend, putting his recovery in line with the general prognosis. But Marler has admitted he continued to train and once the problem was diagnosed, just over a week later, the medical team were not expecting him to return until the middle of February. His recovery is, therefore, well ahead of schedule and no doubt welcome to Eddie Jones and the rest of the England team.

But did his well-publicised milk consumption really assist this rapid comeback?

Bone development happens when we are young. The key is to build up as much bone mass as possible via a mixture of calcium ingestion and physical activity (other factors play a role but are beyond the scope of this article). Rapid bone mass development takes place during adolescence, it’s at this point that calcium intake requirements are at their maximum, between 1000 and 1500 mg per day (Soliman et al, 2016).  Following this ‘growth phase’ and into young adulthood the body moves to maintain bone density, this is obtained by ensuring adequate calcium, other vitamins and minerals and physical activity, particularly weight bearing. From this point on, calcium is used to inhibit any bone loss that is typically associated with aging.

Stress fractures can be treated in a number of ways, from rest through to Ultrasound therapy. Marler made reference to potentially using a hyperbaric chamber, made famous by David Beckham’s metatarsal. A small study by Stewart and his team in the USA back in 2005 even showed that treatment with Biophosphonates could return athletes to training within a week.

Certainly, during a stress fracture injury period, adequate calcium levels would be important to ensure the bone doesn’t suffer any density loss. Not only that, to limit any drop in lean body mass, it would be advisable to ensure a high level of protein intake (Wall et al, 2015). To that end milk would seem a sensible option. However we have not been able to find any evidence to suggest a high calcium intake via milk, full fat or otherwise, supports rapid bone recovery.

Depressingly for the headline writers I think this one comes down to quality injury management. In Phil Pask, England has one of the most experienced rugby physiotherapists in the world. He has worked within the England system for 20 years and also supported a number of Lion’s tours. Marler himself thanked Pask for the work he had put in when describing how he had “rehabbed the crap out of it”. Any physio or team doctor will tell you that player ‘buy in’ and compliance to the process is the most important part of rehabilitation. It seems rather than any mystery healing powers in a bottle of gold top, Joe Marler simply bought into the process and did everything his expert medical team asked of him.

Joe’s Mum told him when he was a boy that drinking milk was important and back then as his bones were developing she was exactly right. It seems she may also have told him to listen to people trying to help him. In this case that person was Phil Pask. He deserves plenty of credit for getting Marler fit and ready for Saturday.

I am sure Joe's Milkman is a nice guy, but he can't take the credit for this one.......

How does he still do it?

On Saturday I was called by a researcher from BBC Radio 5 Live. He was interested in how Roger Federer is still able to perform at the top of tennis despite his age.

Since that conversation, Federer has become the second oldest Grand Slam winner in the open era (Ken Rosewall won titles at 35, 36 and 37). However, since 2000, only Sampras (31), Agassi (32), and Federer himself have won grand slams while being on the plus side of 30.

At 35, Federer’s latest win at the Australian Open is exceptional.

So how is he still able to compete in such a competitive professional sport?

The ageing process begins to induce a decline in male physical ability around the early 30’s. Borgest and a team of researchers in Australia highlighted the naturally occurring declines in metabolic, cardiovascular and hormonal systems as the precursors for performance decrements in their review study of 2015. These genetic factors cannot be escaped. And while, in well trained populations, the performance effects often do not become significant until their early 40’s, In the tiny margins of elite sport any decline can become evident very quickly.

What makes Federer’s achievement even more impressive is the nature of tennis as a sport. Whilst endurance capacity has been shown to stand up well via training in athletes in their 30’s, the ability to produce power due to the speed of muscle contraction can begin to significantly decrease in your 30’s (Kostka 2005). As tennis moves towards the power end of the sporting spectrum (we have previously talked about its shift), any drop in this key component would surely impact performance.

There is also a psychological element to ageing. For many, accepting you are no longer capable of the same levels of athleticism is difficult. Others are able to adjust their performances to rely on greater experience and knowledge of the various facets of the game. In this case adjustments, rather than relying on experience or knowledge, are probably the key. I would argue experience and knowledge can have an impact in team sport or against lesser players, but in the upper reaches of tennis, against players with similar levels of mastery, it is difficult to argue that Federer’s ‘experience’ would somehow plug a physical performance gap.

A more plausible explanation is that at 35, Federer is just below the cusp at which focused training, nutrition and other adjustments are no longer sufficient to maintain and manage the inevitable age-related declines. This would fit with Borgest et al (2015) who said “performance has been shown to be maintained until approximately the age of 35 years after which it declines slowly”.

Remember Federer’s well-publicised change of racket size in 2014? The new racket gave him a bigger sweet spot, allowing more room for error. Equipment changes are often a response to physical changes. Was this the first sign that his movement was slowing (which could have been linked to the power insight we spoke of earlier). Did other changes occur in his training and lifestyle to maintain his place inside the world elite? 

In the 5 years prior to 2016, Federer had played an average of 76 matches across 19 tournaments. Due to injury and the need to recover properly, he played only 28 matches across 7 tournaments in 2016. The decision to recover and take the time to develop a fitness programme that could address the specific needs of an ageing body have to be key factors in his victory - that and the early departure of Andy Murray who he was due to play in the quarter-finals.

Federer is clearly exceptional. His Grand Slam win at the age of 35 helps cement his legendary status within the game. To maintain his performance levels takes dedication to a lifestyle many of us couldn’t cope with. To recognise the need to adapt his training and preparation displays a psychological maturity, often missing in others.

Add to this the luck of excellent genetics and you have a 35-year-old Grand Slam Champion.

Roger Federer………..The Greatest of all Time. 

No sex and no booze – The modern footballer

It has been an interesting week in the world of high performance sport. At the Association of National Olympic Committees awards in Doha, Team GB’s Hockey success was again recognised via winning the best female team of Rio 2016. The shortlist for the IAAF athlete of the year was cut to three with Britain’s Mo Farah still in the running. Not to be outshone, football weighed in with its own take on how to recover/prepare for the stresses of professional sport by putting sex and booze under the microscope.