When people talk about Altitude training the image of Kenyan and Ethiopian athletes dominating distance events springs to mind. Some athletes and coaches know a little about altitude training and its effect on increasing red blood cell count subsequently delivering more oxygen to the working muscles, but pressed further, athletic eyes glaze over. There’s a bigger picture out there and Richard Pullan from The Altitude Centre in his first report explains how and why altitude training should be used with injured athletes.

Sustaining an injury is devastating for any athlete, it can be costly too. In football the FA estimate the true cost of injury to Premiership Clubs is in the region of £200 million per season, for a triathlete the cost is more personal, and recurring injuries often end careers.

The Altitude Centre works with a variety of top athletes from Premiership footballers to triathletes, helping with recovery and fitness.  When World Junior Triathlon Champion Alistair Brownlee suffered a recent stress fracture he turned to The Altitude Centre for advice, here we explain why.

When an athlete sustains an injured the rehabilitation process, started as soon as possible, involves:

• Early diagnosis
• Proper treatment
• Time for repair
• Limit de-training effect
• Keep morale high
• Preventing re-injury

Altitude training is being used throughout this rehabilitation process. This first report focuses on the initial stages of Alistair’s injury and how we can create a firm building block for recovery and limit any drop in his fitness.

Bone repair

At the initial stage of an injury, such as a broken bone or stress fracture in Alistair’s case, vascular disruption secondary to the fracture creates a hypoxic environment. Nature is quite clever, at the point where blood supply is cut off, the area becomes hypoxic. Not only do germs not breed, but the body responds to this hypoxia by rebuilding the connective tissue. This hypoxic microenvironment stimulates the expression of a variety of repair proteins, fibroblasts, endothelial cells, and osteoblasts. The tissue inhibitor of metalloproteinase-1, is also decreased in response to the local hypoxia.

Hypoxia can improve bone healing by altering the expression of cytokines, bone-specific extracellular matrix scaffolding molecules (collagens I and III), and their regulators according to Warren et al. 2001.

At the initial stage of a bone injury, hypoxia actually helps build the blocks for future recovery, in my later report we will see the role of hypoxia in increasing oxygen to the cell, which seems a paradox when you are actually breathing less oxygen at the time. Just like training, providing a stress stimulus, in this case reduced oxygen, actually makes you stronger and more efficient with it. Breathing supplementary oxygen under normal pressure does not increase oxygen delivery to the cell and in the long run will inhibit this process as your body starts to rely upon it. Less is more.

Sprains

With inflamed injuries such as an ankle sprain some swelling can be a good thing. Swelling can immobilise a joint to protect it from further damage and increase blood flow.

Too much swelling cuts blood supply to the injury site and traps toxins from broken blood capillaries. Most people put ice on an injury or use ultrasound to reduce swelling. Ice works by constricting the vascular system and stemming the flow of blood.  If no swelling is apparent heat is used to help speed up the repair process and mobilise the joints. Sometimes the use of cold and hot compresses are combined to flush through toxins.

Intermittent hypoxic training

A technique called Intermittent Hypoxic Training (IHT) is now being used by Physiotherapists to help injury recovery. Team GB Physiotherapist Ian Andrews has seen fantastic results on Grade 2 ankle injuries; the technique is now endorsed by the Australian Physiotherapy Association.

IHT utilises short bursts of very low oxygen air, followed by equal bursts of room air breathed via an oxygen mask. No exercise is required, which is great if you are not able to bear weight on the injury, such as in Alistair's condition. The five minute intervals are repeated for 60-90 minutes a day over a three week period. During the hypoxic intervals blood shifts from the arms and legs to the body core in a protective response, increasing blood flow to vital organs. This blood shift is similar to applying ice on an injury which produces the same peripheral vaso-restrictions. During the hypoxic phase the peripheral cells become more receptive to oxygen as they scavenge what’s available. When the period of breathing normal air commences vaso-dilation occurs and blood supply is restored. At this point greater oxygen is delivered to these cells whilst they are in their receptive state and for a brief moment more oxygen is delivered than at ambient room conditions. The intermittent nature of this technique acts like a hot cold compress, swelling is visibly reduced.

Maintaining fitness and morale

Whilst Alistair Brownlee is out of action with his stress fracture and forced to put his feet up, he is able to receive the recuperation benefits of IHT as well as maintaining a fitness boost, all via the little oxygen mask he wears watching TV.

IHT is used by many top athletes to improve power and endurance, several studies have shown performance improvements via this passive hypoxic technique. The most recent published study by Hamlin & Hellemans 2007 showed an average performance increase of 2.3% for a 3km run, with some of the tested athletes improving by as much as 6.1%, it is no wonder top athletes are utilising hypoxic training to improve performance. Anything that can help Alistair hold on to his World-beating fitness during this period has to be good for morale - having an injury is never part of the plan.

As Alistair breathes the five minute intervals of hypoxic air he is probably receiving the hardest cardiovascular workout he has ever had, but he simply does not notice it as most of the adaptations are happening at a cellular and sub cellular level. All Alistair can feel is a slight increase in his breathing rate and an associated rise in heart rate with a general sensation of relaxation and calm bough on by the stimulation of the pleasure hormones Dopamine and Serotonin. Alistair is training at 22,000ft from the comfort of his armchair.

In our next report we will show how hypoxic exercise sessions are helping to bring Alistair back to full fitness without overstressing his stress injury.

The Altitude Centre offer consultations on all elements of hypoxic training. They also have simulated altitude systems to rent or buy. For further information contact Richard Pullan on 0870 950 4479 or email richard@altitudecentre.com or visit www.altitudecentre.com