Truth or Myth: Elevating Your Legs Improves Post-Workout Recovery

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Chris Carmichael,
CEO/Head Coach of CTS

A recent article on the top 3 myths about post-workout protein and recovery started a lot of discussions between our athletes and their coaches. Those conversations revealed even more myths that people still believe about post-workout recovery. This week let’s look at the age-old idea of elevating your legs after workouts.

Truth or Myth: You need to keep your feet elevated

This used to be post-workout dogma, and even standard practice during downtime at any cycling or running practice or workout session. Goodness knows how many hours I spent lying on my back with my feet up on a wall in pursuit of post-workout recovery.

The concept was that lactic acid would drain from your legs, or that blood polluted with metabolic waste would otherwise pool in your legs, so elevating them facilitated the circulation of that bad stuff out of the legs and allowed fresh, oxygenated, nutrient-rich blood to take its place.

There may be some benefit to lying around with your legs elevated after a hard workout, but it’s not draining lactate or lactic acid from your leg muscles or preventing blood from pooling in your legs. Lactate produced during exercise is circulated throughout the body in your blood, and can be used by any muscle – including your heart – for energy.

In other words, the lactate you produced during your workout only accumulated in your legs because your leg muscles were the ones doing the hard work. It was immediately circulated throughout the body, and both during and after exercise it was broken down to usable energy in muscle cells. You don’t need to drain lactate from your leg muscles because it already happened, and because if it’s around your muscles will reintegrate it into normal aerobic metabolism and break it down for energy.

How about facilitating circulation?

Well, as one vascular surgeon pointed out to me a long time ago, when you need to proactively assist the circulation of blood out of your extremities, that’s a medical problem. For a healthy person, your body is more than capable of circulating blood against gravity.

The flow of lymph and extracellular fluid, however, is more responsive to gravity. This is why ultradistance runners, some ultradistance cyclists, and people on long plane flights sometimes develop puffy ankles. It’s not blood that’s pooling, it’s extracellular fluid and maybe lymph.

What Elevating Your Legs Can Do For You

Elevating your legs can help to reduce swelling. Compression garments may be helpful for prevention of such swelling, and pneumatic compression (Normatec boots) may also be helpful for reducing it once it is present. If notable swelling (cankles) isn’t present, elevating your legs won’t hurt but it may not be necessary. If you do elevate your legs, sit up or get up and walk around for a few minutes about every 15 minutes.

Athletes who have been around a while will recognize the old adage: “Why stand when you can sit, why sit when you can lie down?” When it comes to post-workout recovery, getting athletes to simply do less and rest more is a win. Sitting or lying down, whether your feet are elevated or not, still means you’re resting. If you have the opportunity, taking a nap would be even better!

Related Articles

Top 3 Myths about Post-Workout Protein and Recovery

Here Is How You’re Sabotaging Your Own Training

The 6 Keys to Great Training and Big Improvements


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Comments 24

  1. I do it almost every morning for 10 minutes, gives me a nice passive stretch of my lower back and calves and hamys to start the day. Also nice relaxing few minutes I can’t be trying to do something.

  2. No scientific basis/evidence needed; just common sense and every day experience. Rest, naps, relaxing helps recovery. As usual there may be exceptions:)

  3. Obviously naps are good for you, and for recovery. There’s plenty of science on that.

    However your dismissal of this Leg drain seems to fly in the face of some scientific evidence. I was curious did you just consult a few Dr.’s? Did you read this peer reviewed study that indicates seems to indicate that there is benefit to leg drain (but falls short of “definitive proof” but to scientists, that is also usually a very high burden) [link below] It’s kinda pedantic, but then again most Peer reviewed studies are, but does provide food for thought.

    Efficacy in Sports Medicine and Rehabilitation
    Unfortunately, the literature regarding the influence of MLDTs for specific conditions encountered in conventional athletic injury rehabilitation is limited. To date, the most pertinent current research studies on the efficacy of MLDTs in sports medicine and rehabilitation are the work of Schillinger et al11, Eisenhart et al2, and Härén et al12. Several pilot13 and case studies4,14 have been published that suggest clinical effectiveness of MLDTs for several musculoskeletal conditions but they have failed to bolster the CEBM level of evidence and grade of recommendation supporting efficacy of such interventions in sports medicine and rehabilitation.

    Schillinger et al11 conducted a randomized controlled trial that analyzed biochemical indices of structural skeletal muscle cell integrity upon the implementation of MLDTs following a bout of endurance treadmill running to anaerobic threshold. Compared to control participants who received no manual therapy interventions, the MLDT group displayed a statistically significant decrease in concentrations of blood lactate dehydrogenase and aspartate aminotransferase immediately following a treatment session and at a 48-hour follow-up. The observed decrease in serum levels of specific skeletal muscle enzymes following an MLDT intervention demonstrates the potential for expedited regenerative and repair mechanisms to skeletal muscle cell integrity following structural damage as the result of taxing loads associated with physical activity11. Eisenhart et al2 investigated the effects of osteopathic manipulative treatment (OMT) on acute ankle sprains managed in an emergency department. Participants randomly assigned to the OMT group received lymphatic drainage techniques in conjunction with the current standard of care compared to a control group prescribed only the standard of care. Results of one OMT session produced statistically significant decreases in pain and edema. At the follow-up evaluation one week post-intervention, the OMT group displayed improvement in outcome measures for range of motion compared to the control group. Though the results of Eisenhart et al2 demonstrate potential MLDT efficacy for this orthopaedic injury commonly treated by physical rehabilitation specialists, the definitive contribution of lymphatic drainage techniques in a multimodal OMT paradigm is difficult to ascertain. However, this research study may serve as a springboard for subsequent investigations on the effect of MLDTs in treating commonly encountered orthopaedic conditions.

    Härén et al12 conducted a prospective cohort research study that evaluated the efficacy of MLDTs following wrist bone fracture and subsequent treatment of the distal radius. In this experimental design, all enrolled patients received the standard of care for this condition with participants then randomized into MLDT and control groups. In addition to the standard of care, the MLDT group received 10 MLDT treatments. Härén et al12 reported that the MLDT group displayed statistically significantly decreased measures of hand volume suggesting less edema present in the injured extremity. This preliminary evidence supports efficacy of MLDTs in sports medicine and rehabilitation specific to managing wrist bone fractures. However, continued investigations with larger sample sizes are required to confirm and validate the results of the three aforementioned human research studies.

    Applicable case and pilot studies have produced results that support the clinical effectiveness of incorporating MLDTs into multimodal treatment interventions for musculoskeletal4,13 and neuromuscular14 ailments. These positive outcomes include statistically significant decreases in pain13 as well as clinically significant reductions in edema4, improvements in wound healing4, and restorations of anatomical structure and physiological functions4,14. These pragmatic reports suggest that MLDTs are effective in a treatment paradigm when used in conjunction with other interventions. Although these results support the potential effectiveness of MLDTs for musculoskeletal conditions in a context that mirrors real-world clinical practice, unfortunately the specific contribution of MLDTs to these positive outcomes remains unknown. This is generally due to the research methods employed, i.e., predominately quasi-experimental designs, which rank low according to CEBM standards for ranking the levels of evidence and validity scores scrutinized by the PEDro scale9,10. Hence, these pragmatic studies fail to support efficacy, in the strictest terms, of MLDTs in sports medicine and rehabilitation19.

    The strongest evidence from RCTs suggests that MLDTs may be efficacious in the resolution of enzyme serum levels associated with acute structural skeletal muscle cell damage11 as well as in the reduction of edema following wrist bone fracture of the distal radius12 and acute ankle sprain2. However, based on CEBM standards for ranking the levels of evidence, there is currently an insufficient and inconsistent ensemble of evidence to support a grade of recommendation on which to establish clinical practice guidelines for the use of MLDTs in rehabilitating athletic injuries.

    Manual lymphatic drainage techniques remain a clinical art founded upon hypotheses, theory, and preliminary evidence. Researchers must strive to clarify the biophysical effects that underpin its various proposed therapeutic applications in the human organism. Randomized controlled trials and longitudinal prospective cohort studies are required to establish the efficacy of MLDTs in producing positive outcomes for patients rehabilitating from sports-related injuries. Researchers employing such experimental designs should use diligence in selecting specific modes of MLDTs to be incorporated in respective intervention regimens so that diverse forms of the therapy are avoided with investigated treatment protocols. The applied and clinical sciences research studies of Schillinger et al11, Eisenhart et al2, and Härén et al12 along with advanced basic science experimental methods implemented by Knott et al16 and Hodge et al17 may serve as groundwork references for future hybrid investigations in this domain of manual therapy. Once this facet of a proposed research paradigm has been established, the focus might expand to include determination of optimal treatment durations as well as the most effective rate and frequency of administered MLDTs for the development of a defined intervention algorithm.

    1. Post
      Author

      The journal article you reference is interesting, but there are some important differences between manual lymph drainage techniques (MLDTs) and elevating your legs. MLDT is a massage technique, whereas putting your legs up is passive. The journal article also deals almost entirely with acute injuries or chronic illnesses. Only one of the studies in the review looked at recreational athletes without acute injuries (sprained ankle, broken wrist). A similar study in 2015 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681911/) also showed a faster reduction in specific muscular enzymes following post-exercise MLDT. If anything, the review adds to the case for post-exercise massage therapy, but not for healthy athletes – in the absence of injury – laying down with your legs passively up on the wall.

      Keep in mind, too, that we’re not against laying down with your legs up on the wall. It’s a valuable pause, instead of going directly on to the next activity. It’s rest, and rest is good. That time is not wasted, but the benefit may not be what we previously believed. – CTS

    2. Like most medical articles describe in their conclusions “More research is needed”. A lot of “research” doesn’t apply to specific individuals, only statistically to large cohorts (hence, bell curves). Bottom line, try it and if helps and makes you feel better, do it. If not, then it doesn’t work for you.

    1. Here’s a few of many studies that support napping as a beneficial recovery tool.

      http://blog.bridgeathletic.com/the-physiology-of-naps-and-their-benefits-for-athletes

      “There are many studies on this topic, one of which found that motor memories are enhanced through daytime naps. Motor memory is extremely important in sport when trying to learn a new skill or technique to better one’s performance. A simple nap can help facilitate the learning of this new skill. Other benefits include improved alertness and athletic performance immediately upon arising from short naps (20 min or less) and are seen after the body adjusts from waking after a longer nap. Naps can be extremely beneficial to a tired athlete at the right time and place.”

  4. Hi Jessica, when you feel faint it’s because your brain is not getting enough oxygen. By propping your legs up it means that blood can reach your brain more easily and deliver oxygen. You might want to speak to your doctor about why you are experiencing this. E.g it could be low blood pressure / iron deficiency etc

  5. I am a newbie runner who is slowly increasing my stamina and speed after being incredibly out of shape. I feel fine during my run and cool down, but sometimes I feel incredibly out of it, faint and dizzy afterwards. I prop my legs up solely to alleviate these symptoms. I noticed this wasn’t debunked in the article and was wondering if it’s a myth as well?

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  10. Finally, love for the nap. Unless one has problems with insomnia, naps are great. I find that short ones (~20 minutes) or one whole sleep cycle if really tired (~75 minutes) are more restorative than any other strategy. After rolling out though.

  11. As a former elite gymnast and now a fitness instructor and gymnastics coach. Elevating your legs 6 to 12 inches above your heart is beneficial for recovery. This gives your veins time to relax, as your lower legs are the furthest point away from your heart. This is a must, also spinal alignment napping!

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  13. Try Active recovery boots, such as Normatec, but shop around as the Recovery Pump brand is cheaper and the thigh ‘boot’ actually works where as the the Normatec version is rubbish, (i.e. doesn’t fit, not easily adjusted and just a poor design). Recovery pump boots are just as good as Normatec AND the thigh belt version is brilliant

  14. Great article!! I always heard that you had to elevate you legs after hard workouts but now I know that is not the case. Now II will cocentrate on taking a nap…..thanks !!!!

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