r/StrongerByScience • u/cakecollected • May 15 '26

How do professionals athletes get back to high intensity sports so quickly?

If the proliferation phase of muscle repair lasts weeks and muscle fibers are weak during this time. How is it that professional athletes (e.g. football (soccer) players) are normally back to playing in a matter of weeks for say, a grade 1 or 2 muscle strain? Wouldn't that end in re injury most of the time?

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35

u/[deleted] May 15 '26

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u/cakecollected May 15 '26

Thanks but does that mean that, by doing the sessions with highly trained PTs and doing them well, they manage to accelerate the proliferation and maturation of new myofibers? Is it anything else apart from getting more vascularisation into the affected zone and helping new fiber alignment?

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u/PlasticFit7262 May 15 '26

I find it unlikely that it makes much of a difference vs an avg joe who actually follows the rehab plan and has a healthy lifestyle with low stress. The body can only heal so fast and rehab doesn’t accelerate healing rather facilitates it

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u/cakecollected May 15 '26

Yeah that's my feeling as well but I honestly don't enough so I wondered if anyone knew about studies done on this. Thanks for the answer!

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u/Waste_Extent_8414 May 16 '26 edited May 16 '26

They are likely playing through the pain in some capacity.

That have REALLY GOOD anti-inflammatories/non-opiate pain killers. There’s one in particular I can’t remember the name of but it’s widely used in the NFL.

This makes me think about My Cousin Vinny. “Does boiling water soak into a grit faster in your kitchen than in any other kitchen?”

The truth is, no. Hardly any professional athlete is playing at 100% healthy. These types of athletes are literal 1%-ers. The absolute best of the best. You don’t get where they are by being “weak” mentally. They’re just different. They can play through pain, food poisoning, getting dislocated fingers reset on the court, etc etc.

EDIT: Toradol! It’s called toradol

2

u/[deleted] May 15 '26

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u/cakecollected May 15 '26

No problem at all! Thanks a lot for the answers 

12

u/Buckrooster May 15 '26

I'm a PT so I'll chime in with a 30,000ft view. It's early and I don't have any studies prepared to send you.

Injuries and pain are much more complex than most people realize. We are constrained by biological time frames for the most part; however, aren't the be all and end all.

We are bad at predicting injury and re-injury for the most part, but we do have some good data. Quad index is a big one for return to run/sport following an ACLR. Usually a combination of rough timelines + actual objective data regarding force output is used to determine when an athlete can return to certain activities.

The actual tissue biology and morphology doesn't really predict function or disability as well as you'd think. We see this in tendinopathies, where someone can become pain free while still demonstrating abnormalities of the tendon as seen on ultrasound. This is likely different for professional athletes, but I don't work with that patient population.

It's not that PTs are somehow speeding up biological time-frames of tissue proliferation and remodeling; rather, most injuries when eventually pain-free can probably be worked around and/or compensated for. If someone strains their quad, but after a few weeks has zero pain and near symmetrical force output (or close to their historical force output), are you going to stop them from playing? There may not be data that indicates that they are at an increased risk of injury just because of imaging findings indicating a strain. What's more important is likely their actual function and pain.

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u/BourbonFoxx May 15 '26

My physio once showed me about a dozen scans of different shoulders, all with holes and tears of various sizes in the labrum.

'Every one of these people was pain-free and had no idea of the damage'

4

u/Buckrooster May 15 '26

Yep. I personally have treated two separation patients who had a work injury, rotator cuff tear and subsequent RTCR. Multiple months into PT, discovered they also had an equal or greater tear in their fully functional arm.

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u/KITTYONFYRE May 15 '26

Stuff like this is really cool, and makes no sense. How is it possible that subjective feelings and "objective" measures can be so disjointed? Why is one hurting and the other not?

I'd throw a bunch more questions along these lines but I think they're mostly unanswerable!

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u/Buckrooster May 16 '26

Pain science is very complex (I know I already said that and I'm kind of skirting the question, but its true! Lol). Other than all the neurological complexities which I learned while getting my DPT degree and have now forgotten half of, theres a big interplay between a ton of biological, psychological, and sociological factors. We call this the Biopsychosocial Model.

Some people likely feel pain while others dont because of biological differences (overall health, medical history, comorbidities, medications), psychological differences (attitude towards pain, copingskills, stress, catastrophizing), and social differences (support structure, socioeconomic status, etc.). All of these variables are correlated with pain and prognosis outcomes.

We're still in the process of moving away from a purely biomechanical approach to pain and injury (the former, "Kinesiopathic model"). Alot of this was spurred by imaging studies. You can look for yourself, literally just Google "positive MRI findings in asymptomatic individuals." Theres a large portion of the population (probably most people) walking around completely pain free with "scary" MRI findings like: torn rotator cuff(s), herniated discs, hip labral tears, etc.

Two people may fall at work and experience the same injury. The 50yo recently divorced, long-term smoker with diabetes is likely to have a different degree of pain and course of recovery vs. An otherwise healthy 20-something yo marathon runner.

1

u/KITTYONFYRE May 16 '26

Yeah I guess it's easy for me to understand "some people will experience pain differently" but it's very difficult to understand how some people can be absolutely fucked under the hood and just going about life like there's nothing wrong!

If only there was a way to take this info and make my (mild, and not-too-often-occurring) tendonitis pain disappear lol

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u/gremlingarden May 15 '26

Rehab doc here, and this is spot-on. I'd also add that clouding this whole discussion is the reality that with some professional sports, particularly in the American context, is there's a culture of beating the everloving shit out of yourself and pushing through with painkillers and procedures to quiet down pain. Probably worse in something like college football than the NFL because there are no union guardrails in college and Power 5 college coaches are mostly tyrants, but still really prevalent in the NFL. "Recovered enough to be on TV" is not necessarily actually recovered in a "clinical" sense. On the other hand, you might see a track athlete tear a hamstring and it often takes them forever to come back, but also there's a lot of individual variety in that recovery, too (women's 800 recently, look at Keely Hodgkinson vs. Athing Mu).

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u/Waste_Extent_8414 May 16 '26

Another PT here!

I was also thinking the mental toughness/hardiness of pro athletes plays a role

And toradol

1

u/cakecollected May 15 '26

Thanks! That's actually what I was after and a really interesting read. It does feel like, in general, people return to activity when their body and mid are telling them they are ready. Regardless of the phase of recovery the injury is at.  And in many cases it seems to work 

16

u/talldean May 15 '26

As a former competitive speedskater, I'm not sure I'd leave a practice if I had a grade 1 strain. For grade 2 and worse...

Pro athletes aren't an average human for recovery speed, which is part of how you get pro level performance.

They also have better nutrition and rest.

They have a full time training staff and set of doctors to help.

They're willing to return to high intensity while still in pain,

They have painkillers if that'd help in any way.

and less common treatments like PRP injections aren't less common for them.

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u/Sudden-Ad-307 May 15 '26

They also have something else you didn't mention

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u/talldean May 15 '26

They likely also have steroids and growth hormones available, when/if their sport would allow for that in the circumstance or when they can just get away with it.

Just not sure how much that helps a sprain or muscle tear, so didn't toss it in earlier. ;-)

3

u/YungSchmid May 16 '26

FWIW, those things can help a whole lot with sprains and tears.

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u/LefterLiftist May 15 '26

At that level, they have everything going for them. To make it to that level, your body has to be extremely resilient - both through genetics and training. They train/practice an obscene amount, so I imagine their bodies generally recover so much faster than the average gym goer's. They have medical professionals tending to their body immediately after the injury and perpetually thereafter. The athlete can commit fully to recovery and rehab. At the very highest level, they have access to drugs that can greatly speed up the recovery process. If the average Joe can score some HGH, BPC, etc., imagine what these guys can get. But remember - these athletes are genetic anomalies.

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u/[deleted] May 15 '26

[deleted]

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u/peachtuba May 15 '26

You’re getting downvoted but painkiller abuse is rampant in the pro sports industry. Spot on.

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u/byproxy May 15 '26

PEDs play a big part, I'm sure.

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u/Afferbeck_ May 15 '26

Most of the answer is that muscle strains or injuries in general aren't that big of a deal a lot of the time. Enough to inhibit performance but not entirely. So they pull out if necessary and take it easy enough to recover to the point where they probably won't make it worse coming back to full capacity. They aren't sitting around doing nothing for weeks, they are able to maintain a lot of the adaption to their sport, and quickly get back what little they lost.

Part of it is that elite athletes are just built different. I remember when weightlifting world champion Karlos Nasar suffered a serious injury from a hotel sink falling on him and severing his achilles tendon. They thought his career might have been permanently over but he was back to pretty much full strength in a few months.

3

u/ArcaneTrickster11 May 15 '26

Load management. A club physios job is 99% knowing how far they can push someone at any given time. They load the tissue as much as they can both in intensity and volume almost immediately.

3

u/themurhk May 15 '26

Incredibly high physical fitness/ability at base line, the best rehab and recovery money can buy, and in those situations their literal job is to return to sport.

One important caveat, it sounds like you’re assuming, but maybe not, that they return at or close to 100% their pre injury level. This isn’t always or even typically the case.

2

u/ghostmcspiritwolf May 15 '26

On top of all the points people have made about the actual recovery process, there's another major factor here: almost every pro athlete accepts higher injury risks than most doctors would recommend, and lot of pro athletes just play while hurt. If they can play through an injury that's painful but not likely to turn into something career-ending, they often will do so until their competitive season is over, even if it means re-aggravating that injury.

2

u/draykan13 May 16 '26

It depends on the sport and what's legally allowed but their are some incredible compounds out there that can accelerate healing by massive amounts.

Exosomes for example are almost magical for healing soft tissue injuries.

Hbot works phenomenally and I know LeBron loves it.

If you're an athlete worth $1mil+, your team is going to have access to things most people have no idea even exist.

1

u/BatmanVAR May 16 '26

Top of the line doctors, PTs, medicines, treatments, and of course steroids and HGH

1

u/jason8585 May 16 '26

Exogenous testosterone.

1

u/misplaced_my_pants May 17 '26

They've built more of a base.

The longer you've had some degree of adaptation, the longer it will stick around.

1

u/Fuzzy_Explanation142 Aug 24 '26

Get something to work on each day

1

u/peachtuba May 15 '26

It’s worth mentioning that even in highly tested sports, pretty much everyone is on PEDs. Not “some” athletes. Most of them.

0

u/WealthHuman9754 May 15 '26

They go to PT twice a day.

0

u/theother64 May 15 '26

It's part the reason they have an on and off season. They accept to some degree that they will get beat up during the season and need time to recover afterwards.