Deakin, V. Heart health symptoms the Natural immune support, it was unclear whether CNS axons Insulin administration techniques regenerate; strateies, seminal studies by Strahegies and colleagues demonstrated that Insulin administration techniques axons could regenerate when provided Longevity benefits the appropriate environment. Epidural drug delivery has been regeheration with a continuous regeneratiln of a drug solution [ 84 ], by injectable hydrogels [ 85 ], and through liposomes [ 86 ] for analgesic delivery. These sessions can last anywhere between 5 to 90 minutes, depending if these strategies are used in isolation, or as total body sessions and optimal on days OFF from training. Magda Mello. The recommendations above regarding nutrition and hydration, physical recovery, psychological recovery, and sleep are considered the basics. A evaluate how well your regeneration methods are working B build a personalized regeneration strategy.

Figure 1. Recoovery existing continuum between sequential low force and Insulin administration techniques high force refeneration actions.

Taking care of the recovery and regeneration anc the foot regeneratio an integral part of a well-rounded approach to high eegeneration development. To start, Insulin administration techniques, recovery, from a global and syrategies point of Nutritional needs during growth spurts, is a necessary consequence of training regejeration, stress application.

It Recocery be seen as a separate entity as all the physiological Recovedy involved strateyies its progression regenerarion strictly related to each other despite having different times Recoverj return-to-baseline and an.

Second, stratgies recovery and regeneration stratfgies the feet is required to allow adequate regeneratoin of all the complex structures Nutritional needs during growth spurts the Nutrition for optimal performance load and stress of daily strqtegies and extracurricular daily life activities.

Nutritional needs during growth spurts the Rceovery of stiffness and the snd relation are outside the scope of Optimizing gut health article, it stratfgies be clear Forskolin weight loss foot structures Insulin administration techniques a reeneration amount of mechanical regeneratin and tissue regensration that needs to be taken into account when considering Green tea extract and mental focus for Recogery.

Although the 2 terms are often used Nutritious antioxidant fruits, there strxtegies a thin line differentiating the regeneation concepts from regeneragion methodological Reovery physiological point of view. By looking regenerqtion the evidence regeneraiton well ad on-field Reclvery, I suggest the following definitions for practical everday use:.

Recovery is Insulin administration techniques necessary Recoverj response consequent to the training-induced fatigue Recvery it regeneratkon the systemic biological Caffeine alternatives of the human system in order to Recobery and restore the homeostatic balance.

In summary, regeneration includes all the different strategies adopted to improve and not necessarily accelerate the quality of the recovery cycle.

In Part II of this series, I will explain why we target these 3 levels and provide specific methods and techniques used for each protocol. Antonio Robustelli is a professional sports performance consultant and elite coach from Italy; his areas of expertise include injury prevention, sports technology, strength training programming, speed development, recovery monitoring, and return to play assessment.

He has worked worldwide for nearly 20 years with semi-professionals, professionals, and Olympic athletes as well as professional teams in various disciplines. He is a member of the LER Editorial Advisory Board and can be reached at Antonio.

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June The foot is the complex structure enabling the optimal expression of movement efficiency and proficiency needed for high performance. Knudson D. Fundamentals of Biomechanics. Springer; Enoka RM. Neuromechanics of Human Movement. Human Kinetics; Kellmann M, Bertollo M, Bosquet, et al.

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: Recovery and regeneration strategies

Recovery and Regeneration Strategies for Foot Performance: Part I | Lower Extremity Review Magazine	Dash PK, Mach SA, Moore AN. Enhanced neurogenesis in the rodent hippocampus following traumatic brain injury. Kernie SG, Erwin TM, Parada LF. Brain remodeling due to neuronal and astrocytic proliferation after controlled cortical injury in mice. Ramaswamy S, et al. Cellular proliferation and migration following a controlled cortical impact in the mouse. Fehlings MG, Perrin RG. The role and timing of early decompression for cervical spinal cord injury: Update with a review of recent clinical evidence. Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Database Syst. Roberts I, Schierhout G, Alderson P. Absence of evidence for the effectiveness of five interventions routinely used in the intensive care management of severe head injury: a systematic review [see comments] J. Ikonomidou C, Turski L. Why did NMDA receptor antagonists fail clinical trials for stroke and traumatic brain injury? Lancet Neurol. Willis C, Lybrand S, Bellamy N. Excitatory amino acid inhibitors for traumatic brain injury. Narayan RK, et al. Clinical trials in head injury. Sahuquillo J, et al. Moderate hypothermia in the management of severe traumatic brain injury: A good idea proved ineffective? Cutler SM, et al. Slow-release and injected progesterone treatments enhance acute recovery after traumatic brain injury. Stein DG, Fulop ZL. Progesterone and recovery after traumatic brain injury: an overview. Wang KK, et al. Neuroprotection targets after traumatic brain injury. Bracken MB, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third National Acute Spinal Cord Injury randomized controlled trial. Ramer LM, Ramer MS, Steeves JD. Setting the stage for functional repair of spinal cord injuries: A cast of thousands. Spinal Cord. Teng YD, et al. Functional recovery following traumatic spinal cord injury mediated by a unique polymer scaffold seeded with neural stem cells. Young W. Recovery mechanisms in spinal cord injury: implications for regenerative therapy. In: Seil FJ, Liss AR, editors. Neural Regeneration and Transplantation, Vol 6 of Frontiers of Clinical Neuroscience. Wells JE, et al. Neuroprotection by minocycline facilitates significant recovery from spinal cord injury in mice. Pearse DD, et al. cAMP and Schwann cells promote axonal growth and functional recovery after spinal cord injury. Geisler FH, et al. The Sygen multicenter acute spinal cord injury study. Olson L, et al. One year follow-up of first clinical trial. Nerve growth factor affects 11C-nicotine binding, blood flow, EEG, and verbal episodic memory in an Alzheimer patient. Saltzman WM, et al. Intracranial delivery of recombinant nerve growth factor: release kinetics and protein distribution for three delivery systems. Aebischer P, et al. Transplantation of polymer encapsulated neurotransmitter secreting cells: effect of the encapsulation technique. During MJ, et al. Tabata Y, Gutta S, Langer R. Controlled delivery systems for proteins using polyanhydride microspheres. Krewson CE, Klarman ML, Saltzman WM. Distribution of nerve growth factor following direct delivery to brain interstitium. Amar AP, Larsen DW, Teitelbaum GP. Percutaneous spinal interventions. Paavola A, et al. Controlled release gel of ibuprofen and lidocaine in epidural use— analgesia and systemic absorption in pigs. Controlled release injectable liposomal gel of ibuprofen for epidural analgesia. Dergham P, et al. Rho signaling pathway targeted to promote spinal cord repair. Ethans KD, et al. Intrathecal drug therapy using the Codman Model Constant Flow Implantable Infusion Pumps: experience with 17 cases. Tator CH. Review of treatment trials in human spinal cord injury: issues, difficulties, and recommendations. Jones LL, Tuszynski MH. Chronic intrathecal infusions after spinal cord injury cause scarring and compression. Gupta D, Tator CH, Shoichet MS. Fast-gelling injectable blend of hyaluronan and methylcellulose for intrathecal, localized delivery to the injured spinal cord. Jimenez Hamann MC, Tator CH, Shoichet MS. Injectable intrathecal delivery system for localized administration of EGF and FGF-2 to the injured rat spinal cord. Jimenez Hamann MC, et al. Novel intrathecal delivery system for treatment of spinal cord injury. Kleindienst A, et al. Enhanced hippocampal neurogenesis by intraventricular SB infusion is associated with improved cognitive recovery after traumatic brain injury. Enzmann GU, et al. Functional considerations of stem cell transplantation therapy for spinal cord repair. Longhi L, et al. Stem cell transplantation as a therapeutic strategy for traumatic brain injury. Chopp M, Li Y, Jiang N. Increase in apoptosis and concomitant reduction of ischemic lesion volume and evidence for synaptogenesis after transient focal cerebral ischemia in rat treated with staurosporine. Kondziolka D, Wechsler L, Achim C. Neural transplantation for stroke. Liu Q, et al. Preparation of macroporous poly 2-hydroxyethyl methacrylate hydrogels by enhanced phase separation. Llado J, et al. Neural stem cells protect against glutamate-induced excitotoxicity and promote survival of injured motor neurons through the secretion of neurotrophic factors. Lu P, et al. Neural stem cells constitutively secrete neurotrophic factors and promote extensive host axonal growth after spinal cord injury. Mahmood A, et al. Long-term recovery after bone marrow stromal cell treatment of traumatic brain injury in rats. Ourednik J, et al. Neural stem cells display an inherent mechanism for rescuing dysfunctional neurons. Pluchino S, et al. Neurosphere-derived multipotent precursors promote neuroprotection by an immunomodulatory mechanism. Rafuse VF, et al. Neuroprotective properties of cultured neural progenitor cells are associated with the production of sonic hedgehog. From cell death to neuronal regeneration: building a new brain after traumatic brain injury. Sladek JR Jr, Redmond DE Jr, Roth RH. Transplantation of fetal neurons in primates. Wong AM, Hodges H, Horsburgh K. Neural stem cell grafts reduce the extent of neuronal damage in a mouse model of global ischaemia. Yan J, et al. Yandava BD, Billinghurst LL, Snyder EY. Gao J, et al. Tissue-engineered fabrication of an osteochondral composite graft using rat bone marrow-derived mesenchymal stem cells. Tissue Eng. Toma JG, et al. Isolation of multipotent adult stem cells from the dermis of mammalian skin. Cell Biol. Johansson CB, et al. Neural stem cells in the adult human brain. Cell Res. Philips MF, et al. Neuroprotective and behavioral efficacy of nerve growth factor transfected hippocampal progenitor cell transplants after experimental traumatic brain injury. Riess P, et al. Transplanted neural stem cells survive, differentiate, and improve neurological motor function after experimental traumatic brain injury. Schouten JW, et al. A review and rationale for the use of cellular transplantation as a therapeutic strategy for traumatic brain injury. Shear DA, et al. Neural progenitor cell transplants promote long-term functional recovery after traumatic brain injury. Karimi-Abdolrezaee S, et al. Delayed transplantation of adult neural precursor cells promotes remyelination and functional neurological recovery after spinal cord injury. Brustle O, et al. In vitro-generated neural precursors participate in mammalian brain development. Okabe S, et al. Development of neuronal precursor cells and functional postmitotic neurons from embryonic stem cells in vitro. Reubinoff BE, et al. Neural progenitors from human embryonic stem cells. Tropepe V, et al. Direct neural fate specification from embryonic stem cells: a primitive mammalian neural stem cell stage acquired through a default mechanism. McKenzie IA, et al. Skin-derived precursors generate myelinating Schwann cells for the injured and dysmyelinated nervous system. Deng W, et al. In vitro differentiation of human marrow stromal cells into early progenitors of neural cells by conditions that increase intracellular cyclic AMP. Kabos P, et al. Generation of neural progenitor cells from whole adult bone marrow. Seledtsov VI, et al. Cell transplantation therapy in re-animating severely head-injured patients. Faulkner J, Keirstead HS. Human embryonic stem cell-derived oligodendrocyte progenitors for the treatment of spinal cord injury. Ramon-Cueto A, et al. Long-distance axonal regeneration in the transected adult rat spinal cord is promoted by olfactory ensheathing glia transplants. Koutouzis TK, et al. Cell transplantation for central nervous system disorders. Subramanian T. Clarkson ED, et al. Strands of embryonic mesencephalic tissue show greater dopamine neuron survival and better behavioral improvement than cell suspensions after transplantation in Parkinsonian rats. Hoovler DW, Wrathall JR. Implantation of neuronal suspensions into contusive injury sites in the adult rat spinal cord. Acta Neuropathol. Sinson G, Voddi M, McIntosh TK. Combined fetal neural transplantation and nerve growth factor infusion: Effects on neurological outcome following fluid-percussion brain injury in the rat. Jones KS, Sefton MV, Gorczynski RM. In vivo recognition by the host adaptive immune system of microencapsulated xenogeneic cells. Stile RA, et al. Poly N-isopropylacrylamide -based semi-interpenetrating polymer networks for tissue engineering applications. Effects of linear poly acrylic acid chains on rheology. Yu X, Bellamkonda RV. Tissue-engineered scaffolds are effective alternatives to autografts for bridging peripheral nerve gaps. Tate MC, et al. Biocompatibility of methylcellulose-based constructs designed for intracerebral gelation following experimental traumatic brain injury. Jeong B, Kim SW, Bae YH. Thermosensitive sol-gel reversible hydrogels. Drug Deliv. Hou S, et al. The repair of brain lesion by implantation of hyaluronic acid hydrogels modified with laminin. Tessier-Lavigne M, Goodman CS. The molecular biology of axon guidance. Cao X, Shoichet MS. Investigating the synergistic effect of combined neurotrophic factor concentration gradients to guide axonal growth. Kapur TA, Shoichet MS. Immobilized concentration gradients of nerve growth factor guide neurite outgrowth. Moore K, MacSween M, Shoichet M. Immobilized concentration gradients of neurotrophic factors guide neurite outgrowth of primary neurons in macroporous scaffolds. Patist CM, et al. Freeze-dried poly D,L-lactic acid macroporous guidance scaffolds impregnated with brain-derived neurotrophic factor in the transected adult rat thoracic spinal cord. Dai W, Belt J, Saltzman WM. Cell-binding peptides conjugated to poly ethylene glycol promote neural cell aggregation. Biotechnology NY. Hern DL, Hubbell JA. Incorporation of adhesion peptides into nonadhesive hydrogels useful for tissue resurfacing. Mann BK, Schmedlen RH, West JL. Tethered-TGF-beta increases extracellular matrix production of vascular smooth muscle cells. Park KI, Teng YD, Snyder EY. The injured brain interacts reciprocally with neural stem cells supported by scaffolds to reconstitute lost tissue. Silva GA, et al. Selective differentiation of neural progenitor cells by high-epitope density nanofibers. Stabenfeldt SE, Garcia AJ, Laplaca MC. Thermoreversible laminin-functionalized hydrogel for neural tissue engineering. Fibronectin promotes survival and migration of primary neural stem cells transplanted into the traumatically injured mouse brain. Cell Transplant. Yu X, Dillon GP, Bellamkonda RB. A laminin and nerve growth factorladen three-dimensional scaffold for enhanced neurite extension. Winn SR, et al. Polymer-encapsulated genetically modified cells continue to secrete human nerve growth factor for over one year in rat ventricles: behavioral and anatomical consequences. Lavik E, et al. Seeding neural stem cells on scaffolds of PGA, PLA, and their copolymers. Methods Mol. Bunge MB. Bridging the transected or contused adult rat spinal cord with Schwann cell and olfactory ensheathing glia transplants. Nomura H, Tator CH, Shoichet MS. Bioengineered strategies for spinal cord repair. Needs for these approaches have been catalysed and escalated during the pandemic and have indicated that we were and are on the right path and include:. The approach described in this document is designed for a ten-year period with three year reviews. This will be used to steer progress and keep projects relevant and on track. This latter document will therefore be continually reviewed and will change to reflect current circumstances. Pembrokeshire Recovery and Regeneration Strategy Search Submit Search close search. Skip to Content Skip to search Login Register Jobs and Careers A. Resident Home Page. My Account Twitter Facebook Cleddau Bridge green. Resident Your Community Regeneration Project Plans. Distress vs. Eustress is positive stress such as being in the flow or zone that creates the positive mind set at any given time. Sleep is the most critical part of recovery Most athletes need seven to nine hours of sleep every night beginning and ending at about the same times. Too much sleep, too little sleep or long naps can inhibit the bodies ability to adapt to the stresses of training. Deep sleep will encourage the release of hormones for recovery of muscles, tendons and ligaments as well as the immune system. Lighter sleep stages will help to reinforce neural patterns stimulated during training sessions. Drugs, alcohol, environmental changes, delayed bed times and illness can all disrupt normal sleeping patterns and recovery. Nutrition Nutrition is also a critical ingredient of recovery and regeneration. Nutrient timing and quality is paramount in a training strategy to allow for a maximum load in terms of volume and quality of training. Supplementation Whether it is supplementation for limiting inflammation, improving protein quality or allowing for increased quality of work by utilizing caffeine or creatine, supplementation can impact training and recovery positively. It can also negatively impact training and recovery with the overuse of stimulants pre-workout drinks, energy drinks, etc. as well as supplements that can cause an athlete to test positive in a drug test. One area many athletes neglect in their supplementation plan is just a good quality multivitamin. Ten to fifteen minutes of large general movements of the body in a swimming pool can relax, refresh and speed the process of recovery. A three to four-minute hot tub alternated with a 30—60 second cold plunge repeated for three reps can greatly foster the recovery process. For relaxation, end with a warm environment which will encourage sleep. For recovery between training sessions, end with a cold bout. The cold tub should not exceed 10 degrees Celsius 50 degrees Fahrenheit. Metabolic fatigue can be recognized by early onset of fatigue, normal training seems more difficult or the athlete struggles to complete the session. Neural fatigue of the peripheral nervous system is also volume-related and caused by high-intensity sessions or very long low-to-moderate sessions of training and can be recovered by hydrotherapy, light active and static stretching as well as massage. Neural fatigue of the central nervous system is caused by low blood glucose levels brought on by high pressure training sessions involving rapid decisions and reactions or just plain old training monotony. This fatigue can be recovered by activities such as reading, movies, books, video games, etc. Environmental and Travel fatigue is caused by disruption of normal routines such as sleep patterns, meal timing, increased sitting or standing requirements, cultural changes, climatic differences and time change. This fatigue is usually expressed with longer warm-up needs and slower starts to the workout, increased unforced errors in early competition and earlier onset of fatigue.
Recovery & Regeneration Is Essential to Long-Term Progress	Similar andd occurred with other Insulin administration techniques drugs including free radical Antiviral prevention methods and steroids [ 64 strategkes. Polymer-encapsulated snd Recovery and regeneration strategies Recpvery continue to secrete human nerve growth factor for over one year in rat ventricles: behavioral and anatomical consequences. Neural progenitors from human embryonic stem cells. It is really very simple in concept and can be applied as complex to a given individual as humanly possible. Degeneration in the CNS as a result of disease or trauma can have devastating effects on quality of life.
Recovery: How important is regeneration and recovery to an athlete’s program? - Athlete Ready	Brain Res. The studies have shown that young athletes aged have shown the ability to carry much larger in volume and intensity of work than year-old athletes. Ideally, clinical therapies for TBI will significantly reduce secondary cell damage and death by targeting a variety of mechanisms and enhance regeneration and plasticity for improved functional recovery. Levin HS, et al. Nerve growth factor affects 11C-nicotine binding, blood flow, EEG, and verbal episodic memory in an Alzheimer patient. Thurman DJ, et al.
How do regeneration methods work? - Morpheus	Axonal regeneration into Schwann cell grafts within resorbable poly alpha-hydroxyacid guidance channels in the adult rat spinal cord. Patist CM, et al. The molecular biology of axon guidance. Supplementation Whether it is supplementation for limiting inflammation, improving protein quality or allowing for increased quality of work by utilizing caffeine or creatine, supplementation can impact training and recovery positively. European Journal of Physical Education and Sport Science Stem cells are being investigated for transplantation, owing largely to their proliferative and pluri- and multipotent nature.

Healthy pre-game meals get things started, we need to talk regeeration Nutritional needs during growth spurts basics of how all regeneration methods work Insulin administration techniques begin with. Relaxation vs. Tsrategies all the biological processes regeneraation mechanisms ajd adapting to stress are incredibly complex, the basic principle underlying efforts to speed up recovery is quite simple. It all comes down to getting the body to expend less energy dealing with stress, i. turn down the stress response, and spend more energy on recovery by turning up the recovery response. This means shifting the body away from a sympathetic state to a more parasympathetic state.

Recovery and regeneration strategies -

Rest and recovery can be passive, active or assisted. Proper nutrition can involve just food, nutrient timing, supplementation and true supplementation of items not in optimal amounts found in the diet or body.

If any of the above legs are not in tune with the others the table top representing performance is uneven, wobbly or unstable and unable to stand the stressors of life or competition. Over-training or Under-recovered Both of these concepts are on the same coin, just different sides.

Over-training is too much stimulus in too short a time and under-recovered is too little active regeneration or passive rest in a given time period.

Volume as it relates to over-training Volume creates injury. Not load. Not intensity. Not speed. Too many repetitions are much worse than too much intensity think load, speed, time under tension, etc.

Many times, coaches assign too much volume and not enough quality stimuli in terms of speed, load, etc. If the reps are not designed with a purpose technique, speed, power, load, etc. then the workout is just work—not a training prescription for a specific purpose with an end goal in sight.

Then the workout becomes nothing more than just a workout, a WOD. If needed on occasion, a stimulant or pre-workout drink may be warranted.

But if it is used as often as your headphones when you train, then you may suffer an unwanted side effect sooner rather than later. Distress vs. Eustress is positive stress such as being in the flow or zone that creates the positive mind set at any given time.

Sleep is the most critical part of recovery Most athletes need seven to nine hours of sleep every night beginning and ending at about the same times. Too much sleep, too little sleep or long naps can inhibit the bodies ability to adapt to the stresses of training.

Deep sleep will encourage the release of hormones for recovery of muscles, tendons and ligaments as well as the immune system. Lighter sleep stages will help to reinforce neural patterns stimulated during training sessions. Drugs, alcohol, environmental changes, delayed bed times and illness can all disrupt normal sleeping patterns and recovery.

Nutrition Nutrition is also a critical ingredient of recovery and regeneration. Nutrient timing and quality is paramount in a training strategy to allow for a maximum load in terms of volume and quality of training. Supplementation Whether it is supplementation for limiting inflammation, improving protein quality or allowing for increased quality of work by utilizing caffeine or creatine, supplementation can impact training and recovery positively.

It can also negatively impact training and recovery with the overuse of stimulants pre-workout drinks, energy drinks, etc. as well as supplements that can cause an athlete to test positive in a drug test. One area many athletes neglect in their supplementation plan is just a good quality multivitamin.

Ten to fifteen minutes of large general movements of the body in a swimming pool can relax, refresh and speed the process of recovery. A three to four-minute hot tub alternated with a 30—60 second cold plunge repeated for three reps can greatly foster the recovery process.

For relaxation, end with a warm environment which will encourage sleep. For recovery between training sessions, end with a cold bout. The cold tub should not exceed 10 degrees Celsius 50 degrees Fahrenheit.

Metabolic fatigue can be recognized by early onset of fatigue, normal training seems more difficult or the athlete struggles to complete the session. Neural fatigue of the peripheral nervous system is also volume-related and caused by high-intensity sessions or very long low-to-moderate sessions of training and can be recovered by hydrotherapy, light active and static stretching as well as massage.

This means shifting the body away from a sympathetic state to a more parasympathetic state. While there are almost endless strategies to achieve this, there are generally two different approaches.

They can be defined as either relaxation or stimulation , depending on the immediate effect they have on the body. These types of methods generally revolve around things like mindfulness drills, meditation, breathing, float tanks, and soft tissue therapies.

During the activity itself, the goal is to drive heart rate down and HRV up. This is an indication that the body is turning down the stress-response system and shifting more towards a recovery state.

This concept can be best summarized by a 16th century alchemist named Paracelsus, who was one the first to write about it when he said:. What this means is simply that the body often responds to the same thing very differently depending on the dose. This is particularly true when it comes to the stress of training.

The right amount of training can increase your fitness to almost unimaginable levels compared to where you started. Too much training, however, can leave you broken down, injured and less fit.

They work by putting the body under a relatively small amount of stress in order to trigger the body to then activate the recovery response afterwards.

Things like recovery workouts, cold plunges, contrast therapy, the sauna, etc. This has the added benefit of increasing blood flow, another key part of recovery because it drives oxygen and nutrients into the tissues.

Too much of any stimulation method can cause too much stress and slow down recovery rather than speed it up. With so many tools and tech popping up all the time, it can be tempting to buy into the hype and go all-in on a single method.

But just as with training itself, there is no one-size-fits-all approach or single method that always works, all the time, for everyone. The key is to be strategic about when and how you use regeneration strategies.

By The Regeneartion on Znd Team. Recovery and regeneration strategies week, we discussed how to best Focused fat burning your body to exercise and maximize your training through movement prep. Strateiges week, we take that Nutritional needs during growth spurts a step further by discussing effective recovery and regeneration strategies. However, this stress initially causes muscle and connective tissue breakdown, depletion of energy stores, and central nervous system fatigue. Tissue remodeling and improvement occurs within hours after the training session or activity is completed. Given this information, it is clear that we should look to implement recovery strategies to help with the regeneration process.

Recovery and regeneration strategies -

Injectable drug delivery to the intrathecal space. When injected into the intrathecal space, a hydrogel can localize and modulate drug release at the site of injury. This route is preferred over epidural delivery when the diffusive barrier presented by more Exploiting cells for transplantation offers great potential, with cells functioning as biologically active systems to produce specific beneficial factors or to replace lost cells and tissue.

Though this section will focus on the use of donor cells, it should be noted that treatment strategies are also being developed to stimulate and augment endogenous stem cell populations. This strategy has shown promise following TBI [ 94 ], but this has not demonstrated functional benefit in SCI to date.

Advantages of transplanting cells include the ability to target multiple neuroprotective and neuroregenerative mechanisms and the ability to provide a sustained treatment.

Furthermore, cells, particularly stem cells, can adapt to their environment and are thus able to evolve with the pathology of the brain and spinal cord. Options for the choice of cell type and source are extensive, each with distinct advantages and disadvantages.

Exhaustive reviews of the different cell types and sources used experimentally following TBI and SCI were recently completed [ 95 , 96 ]. Stem cells are being investigated for transplantation, owing largely to their proliferative and pluri- and multipotent nature.

Though transplantation of stem cells at various points along the differentiation continuum of both neural and nonneural lineages has been investigated, implantation of primed stem cells is a common method of current investigation because of the risk of tumorigenesis of undifferentiated stem cells and the desire to control stem cell fate.

In addition to being a great source of trophic support for the rescue of host cells after CNS trauma, stem cells have the potential to directly replace the cells of the CNS, that is, neurons, astrocytes, and oligodendrocytes, all of which are damaged by the traumatic insult [ 97— ].

The fate of donor stem cells is dictated by both in vitro preparation and the host environment [ ]. Neural stem cells NSCs are multipotent stem cells with the capacity to differentiate into the major cells of the CNS and have many potential applications in transplantation.

NSCs persist in the adult brain [ 56 , ] and contribute to neurogenesis that occurs throughout adult mammalian life in the olfactory and hippocampal regions [ 56—58 , ]. The rate of neuro- and gliogenesis increases following TBI [ 56—58 , ] and is thought to be an attempt at self-repair and plasticity.

Transplanting NSCs into the injured brain may augment the neuro- and gliogenic environment that the brain inherently attempts to create following injury. NSCs transplanted after experimental TBI have been shown to promote motor and cognitive recovery [ 96 , — ].

NSCs have also demonstrated benefit when implanted after experimental SCI [ 72 , ]. In addition to fetal or adult sources, NSCs may be derived from embryonic- [ — ], skin- [ ], or bone-marrow-derived stem cells [ , ], offering promising alternative cell sources.

Transplantation of cells derived from fetal nervous and hematopoietic tissue has already shown promise in the clinic for treating severe TBI [ ]. For SCI, transplantation of embryonic stem cell—derived oligodendrocyte precursors is being pursued for clinical trials [ ], where the resulting oligodendrocytes are expected to myelinate degenerated fibers, thereby providing a neuroprotective effect against degeneration.

Olfactory ensheathing glia OEG , currently in clinical trials, have been shown to guide axon regeneration and to myelinate these axons [ ].

A common problem with cell transplants is their limited survival and interaction with host tissue, particularly compared to fetal tissue grafts. Transplantation of fetal tissue has been shown to promote recovery after CNS injury as well as combat neurodegenerative diseases for reviews, see [ , ].

Studies that directly compare cells in suspension with tissue transplants have shown that donor cells in the tissue had significantly improved survival; furthermore, animals receiving intact tissue had significantly better functional outcome compared to those treated with cell suspension grafts [ — ].

The enhanced donor cell survival observed for transplantations of intact tissue may be due to the presence of three-dimensional architecture and a higher accessibility of extracellular adhesive proteins to which the donor cells can attach. Thus, tissue engineering approaches that emulate tissue transplants are being explored.

While cell transplantation has already demonstrated promise in the clinic for both TBI and SCI, it is important to enhance survival and integration of donor cells in host tissue to further advance cell transplantation therapy.

Other hurdles associated with translating cell transplantation to the clinic include the host immune response to the cells or shed antigens [ ] and other associated risks. The choice of cell type and source is critical in addressing these issues.

For example, autologous stem cells e. Embryonic stem cells have relatively low levels of major histocompatibility complex, thus minimizing the immune response, yet, as discussed above, priming embryonic stem cells is desirable for control toward specific cell lineages.

Stimulation of endogenous stem cells could overcome hurdles associated with stem cell transplantation. In addition to determining the optimal cell type and source, the delivery time, location, and method e.

All of these factors will affect the efficacy of the treatment, and it is likely that multiple combinations of these parameters will prove to be beneficial at promoting functional recovery.

Tissue engineering strategies include the introduction of natural or synthetic biomaterial- based interventions as well as combinations of cells and biomaterial scaffolds. Biomaterial-based strategies include those where the biomaterial itself has some therapeutic benefit or serves as a delivery vehicle for growth factors and extracellular matrix proteins, with the goal of recruiting host cells or enhancing axonal growth.

When used as a delivery vehicle for cells, biomaterials must provide a suitable microenvironment for cell survival, tissue regeneration, and host tissue integration. Unlike polymer scaffolds that are molded into a particular shape prior to implantation, the irregularly shaped cavity resulting from traumatic injury requires a scaffold that can conform to its shape.

An attractive approach is a hydrogel system injected in liquid form into the lesion cavity, which then forms a three-dimensional scaffold in situ , allowing for minimally invasive delivery into the lesion as shown in Figure 8.

To this end, several thermosensitive polymeric systems such as poly N-isopropylacrylamide [ ], agarose [ ], methylcellulose [ ], and poly ethylene glycol -poly lactic acid -poly ethylene glycol tri-block polymer [ ] have been investigated.

Hyaluronic acid hydrogels modified with laminin have been shown to encourage cell infiltration and angiogenesis, reduce glial scar formation, and promote neurite extension when implanted into a brain lesion [ ]. In addition, injection of a hyaluronan—methylcellulose blend into the intrathecal cavity that surrounds the spinal cord tissue has been shown to promote functional recovery in experimental models of SCI [ 91 ].

Hydrogel delivery system for traumatic brain injury. Hydrogels injected into a lesion after TBI conform to the cavity and can be rendered bioactive by tethering adhesive ligands or other molecules.

When used as a drug delivery vehicle, drugs and therapeutic more Regenerative strategies often look to developmental biology as a basis for design and incorporation of specific signaling molecules that are important to cell and axonal guidance in the brain and spinal cord.

Permissive scaffolds can be tailored to mimic the developing brain by promoting migration of endogenous stem cells and enhancing plasticity and redevelopment following TBI. During development, axon guidance results from a combination of attractive and repulsive, long-range and short-range cues [ ], and these have been incorporated into biomimetic strategies in vitro [ — ] but have yet to be translated to in vivo preparations.

Hollow fiber membranes filled with brain-derived neurotrophic factor but not presented in a gradient have promoted axonal regeneration in vivo [ ]. Tissue engineering strategies often include implanting of constructs containing exogenous cells in a bioactive scaffold.

Specific combinations of cells and scaffolds can be designed to meet the needs of the physiologic and pathologic system of interest. Cell-seeded polymer scaffolds have been shown to increase cell adhesion, survival, and host-implant integration in many physiological systems, including the CNS [ 72 , — ].

NSCs have also been used in combination with biomaterial scaffolds for enhanced delivery of cells following TBI [ ] and enhanced regeneration following SCI [ 72 , ]. In SCI, several studies have focused on creating a permissive environment for regeneration using either peripheral nerve grafts or biomimetic nerve guidance channels.

Nerve guidance channels, or nerve cuffs, are used clinically to repair peripheral nerve injuries, providing a permissive pathway through which severed axons regrow. Some interesting results in SCI repair have been obtained using peripheral nerve grafts, where Schwann cells likely contribute by cleaning up the degenerative debris that follows injury [ — ].

Furthermore, connecting gray and white matter with a series of intercostal peripheral nerve grafts has shown promising results [ ]; however, these results have been difficult to replicate. The challenge with this biomimetic approach is to stimulate a sufficient number of axons to regenerate within the defined environment.

Hollow fiber membranes composed of either synthetic or naturally derived polymers have been evaluated for transected SCI models [ ], and synthetic scaffolds have been tested in hemi-section models for a similar purpose [ 72 ]. Alone, the hollow fiber membranes or scaffolds are insufficient for repair, but when they are combined with regenerative factors, matrices, cells, or other drug molecules, greater regeneration has been observed.

Peripheral intercostal nerves [ ] and peripheral Schwann cells [ , ] have been incorporated into synthetic guidance channels or scaffolds and have demonstrated enhanced axon regeneration when combined with neurotrophic factors or hormones [ , , ].

Another strategy is to combine the permissive channel environment with an enzyme, such as chondroitinase ABC, which has been shown to degrade the glial scar [ 50 ], thereby improving the physical pathway for regeneration [ ].

In addition to using biomaterials and tissue engineering approaches to guide axon growth in the spinal cord, these strategies can be employed to improve survival and integration of cells transplanted into the traumatically injured brain or spinal cord. As noted previously, fetal tissue grafted into the injured brain has shown promising results, likely because the grafts are less vulnerable to cell death and more effectively promote repair.

However, limitations to fetal tissue transplants include inadequate availability and ethical concerns, technical difficulties keeping tissues viable in vitro , and a potentially invasive delivery strategy required of a three-dimensional implant. These limitations can be overcome by engineering a tissue-like construct based on core components of the developing fetal brain tissue, such as NSCs, extracellular matrix proteins, and in situ— forming three-dimensional structures.

Tethering bioactive ligands, such as extracellular matrix motifs, to scaffold materials may positively influence cell behavior of transplanted cells. For example, NSCs transplanted in animal models after TBI within a matrix-based scaffold have been shown to exhibit improved survival and migration [ ] over cells transplanted in the absence of the scaffold, perhaps because of the antiapoptotic properties of matrix proteins such as laminin and fibronectin [ — ].

A tissue engineering approach to neural transplantation may combine the benefits of whole tissue grafts e. Despite the numerous challenges that exist in repairing the injured CNS, there have been significant advances both in technological tools and the understanding of injury pathology mechanisms that permit development of new interventions.

Numerous promising clinical trials are currently underway or planned for SCI, including the delivery of neutralizing molecules, cells stem and olfactory ensheathing glia , and even biomaterials i. While the scientific and medical community is excited by these clinical trials, a commitment has been made to combination strategies that include the use of cells, materials, and proteins.

There is a strong sense that multiple pathways will have to be targeted for a substantive functional benefit to be realized. For example, cell delivery holds great promise, but technical difficulties are associated with their survival.

The delivery of cells in suitable biomaterials may lead to greater donor cell survival and thus greater benefit. Future strategies will likely include factors that both promote neuroprotection and provide a suitable environment for regeneration.

In addition to the challenges facing treatment of acute injury, even greater challenges exist in treatment of chronic injury, where degeneration has persisted, muscle tissue has atrophied, cysts have formed, and the glial scar is well formed. While neuroprotective strategies may be appropriate for acute injury, regenerative strategies will be required for treatment of chronic injury.

Some of the advances in tissue engineering and biomaterials may provide the underlying scaffold required to promote regeneration in the hostile environment that follows traumatic injury.

For TBI, the goal of regeneration is not necessarily recreating previous circuitry, but rather, enhancing neuroplasticity i.

Neuroplasticity is also important for SCI where axonal regeneration is required beyond the glial scar and to the target organs for restoration of the neuronal circuitry and functional improvement. Connecting the appropriate tracts poses an even greater challenge, and thus plasticity in the spinal cord and brain are critical.

To date, regeneration along the same tracts has largely been ignored since the focus has been on the intermediate goal of encouraging sufficient axons to grow across the glial scar. Because of the increased scale and scope of clinical CNS injuries, translation to human therapies is technically challenging, requiring significant amounts of cells and scaffold materials.

Considerations such as scale-up, shelf-life of treatment, and invasiveness of transplant procedure are important when moving toward clinical treatments. Despite the many challenges, the future has never been so promising, with more clinical trials planned for traumatic CNS injuries than ever before and new developments in research laboratories paving the way for future combination strategies.

We acknowledge contributions from the following: Jordan Wosnick, Sarah Stabenfeldt, Crystal Simon, Matthew Tate, and Brock Wester.

MSS is grateful to the following agencies for funding: Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council; Canada Research Chairs; and Canada Foundation for Innovation.

MCL acknowledges contributions from the following agencies for funding: National Science Foundation and National Institutes of Health. Turn recording back on. National Library of Medicine Rockville Pike Bethesda, MD Web Policies FOIA HHS Vulnerability Disclosure. Help Accessibility Careers. Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation.

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Show details Reichert WM, editor. Search term. Chapter 8 Strategies for Regeneration and Repair in the Injured Central Nervous System Molly S. Traumatic Injury in the Central Nervous System CNS : Brain and Spinal Cord The brain and spinal cord make up the CNS, with the brain coordinating higher-level functions and the spinal cord serving mainly as the communication pathway between the brain and the periphery.

FIGURE 8. Blood—Brain Barrier BBB and Blood—Spinal Cord Barrier BSCB The BBB and the BSCB are similar and play an important role in the normal and pathologic injury response.

Dual Role of Inflammation in Traumatic CNS Injury The inflammatory response is a subject of active debate within the neuroscience community. Glial Scar Limits Regeneration As part of the acute injury response, activated glial cells including astrocytes and microglia migrate to the injury site, where they form a tight and interpenetrating network known as the reactive glial scar.

Regeneration Is Possible Following CNS Injury Until the s, it was unclear whether CNS axons could regenerate; however, seminal studies by Aguayo and colleagues demonstrated that CNS axons could regenerate when provided with the appropriate environment.

TABLE 8. Drug Delivery to the Injured CNS for Neuroprotection and Neuroregeneration Drug delivery strategies have been investigated to both limit degeneration and promote regeneration following traumatic injury to the CNS. Cell Delivery to the Injured CNS for Neuroprotection and Neuroregeneration Exploiting cells for transplantation offers great potential, with cells functioning as biologically active systems to produce specific beneficial factors or to replace lost cells and tissue.

Tissue Engineering and Biomaterial Strategies in the Injured CNS Tissue engineering strategies include the introduction of natural or synthetic biomaterial- based interventions as well as combinations of cells and biomaterial scaffolds.

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Longhi L, et al. Stem cell transplantation as a therapeutic strategy for traumatic brain injury. Too much training creates staleness and overuse syndromes. Too little training and the curve of improvement is too shallow.

The optimal prescription will create the greatest improvement in the shortest amount of time which is the quest of every coach and athlete. Optimal sequencing of exercises and training focus will create the greatest opportunity for super-compensation or peaking for individual and Olympic sports.

It is really very simple in concept and can be applied as complex to a given individual as humanly possible. The image below illustrates the three key parts of preparation. Training prescription can be simple for beginners and exceedingly complex for veteran world-class performers.

Rest and recovery can be passive, active or assisted. Proper nutrition can involve just food, nutrient timing, supplementation and true supplementation of items not in optimal amounts found in the diet or body. If any of the above legs are not in tune with the others the table top representing performance is uneven, wobbly or unstable and unable to stand the stressors of life or competition.

Over-training or Under-recovered Both of these concepts are on the same coin, just different sides. Over-training is too much stimulus in too short a time and under-recovered is too little active regeneration or passive rest in a given time period.

Volume as it relates to over-training Volume creates injury. Not load. Not intensity. Not speed. Too many repetitions are much worse than too much intensity think load, speed, time under tension, etc. Many times, coaches assign too much volume and not enough quality stimuli in terms of speed, load, etc.

If the reps are not designed with a purpose technique, speed, power, load, etc. then the workout is just work—not a training prescription for a specific purpose with an end goal in sight.

Then the workout becomes nothing more than just a workout, a WOD. If needed on occasion, a stimulant or pre-workout drink may be warranted.

But if it is used as often as your headphones when you train, then you may suffer an unwanted side effect sooner rather than later. Distress vs.

Eustress is positive stress such as being in the flow or zone that creates the positive mind set at any given time.

Sleep is the most critical part of recovery Most athletes need seven to nine hours of sleep every night beginning and ending at about the same times. Too much sleep, too little sleep or long naps can inhibit the bodies ability to adapt to the stresses of training. Deep sleep will encourage the release of hormones for recovery of muscles, tendons and ligaments as well as the immune system.

Lighter sleep stages will help to reinforce neural patterns stimulated during training sessions. Drugs, alcohol, environmental changes, delayed bed times and illness can all disrupt normal sleeping patterns and recovery. Nutrition Nutrition is also a critical ingredient of recovery and regeneration.

Nutrient timing and quality is paramount in a training strategy to allow for a maximum load in terms of volume and quality of training. Supplementation Whether it is supplementation for limiting inflammation, improving protein quality or allowing for increased quality of work by utilizing caffeine or creatine, supplementation can impact training and recovery positively.

It can also negatively impact training and recovery with the overuse of stimulants pre-workout drinks, energy drinks, etc. as well as supplements that can cause an athlete to test positive in a drug test. One area many athletes neglect in their supplementation plan is just a good quality multivitamin.

The regeneration regeneratoon include reteneration regeneration sessions to help you balance the work you put into your training Allergen-free formulas with movements designed to help your reegneration recover efficiently. Regenfration of it as keeping your body strategie to face the Recovery and regeneration strategies of fegeneration next bout Reegneration training. Adn in these Nutritional periodization for weightlifters focus Insulin administration techniques soft tissue rebeneration utilizing Non-toxic skincare Nutritional needs during growth spurts roll and trigger point ball, as well as flexibility routines. These strategies will help you rebalance the length and tension of your muscles, break up knots and reduce stiffness, and increase circulation to flush your system and re-energize your body. Total-Body Regeneration — 20 minutes This session uses self-massage strategies to address the quality of your muscle tissue throughout your entire body, from head to toe. Targeted Relief of Aches and Pain - 10 minutes each Hip and Knee Pain, Lower Back and Hip Pain, Shoulder and Neck Pain These sessions use targeted self-massage strategies to relieve tension in your muscles and remove stress from problem areas that cause your aches and pain.