Dr Ula: Why I prescribe recovery, and why your body can’t heal in the same mode that’s hurting it

I see a version of this most weeks in clinic.

A woman who is doing the right things; she exercises, she eats well, she’s getting what looks like reasonable sleep and yet her inflammatory markers are edging up, her cortisol pattern isn’t quite right, and her HRV suggests she’s not recovering particularly well between stressors.

Nothing about it is dramatic. It’s just… off.

She’s not lazy, and she’s not “stressed” in the way people usually mean it. But her system isn’t getting the conditions it needs to repair properly. And more often than not, no one has explained it to her in those terms.

That’s usually the point where we start talking about recovery, not as a vague idea, but as something that can be approached more deliberately.

The nervous system piece

When you look at this properly, it comes back to how the nervous system is functioning.

The autonomic nervous system has two broad roles, one that supports action and response, and one that supports recovery and regulation. Both need to be there, and both need to be accessible.

What I tend to see, particularly in women through midlife, is not that one system is “on” and the other is “off,” but that the balance between the two has shifted. The system becomes biased toward being switched on, and less able to move out of that state efficiently.

It’s rarely caused by a single event. It’s usually the accumulation of things that don’t feel dramatic on their own, work, family, decision fatigue, disrupted sleep, constant low-level stimulation.

Over time, the system just loses some of its flexibility.

We get a sense of that through patterns like reduced HRV, flatter cortisol curves, and slower recovery after stressors. None of these are diagnostic in isolation, but together they start to tell a story.

What recovery actually is

One of the reasons this gets missed is that recovery is often framed as 'doing less'.

Clinically, it’s not that simple.

Recovery is when the body is doing a different kind of work, regulating inflammatory activity, repairing tissue, adjusting hormonal signalling, restoring energy systems. It’s active, just not in a way that feels effortful.

And it doesn’t always happen just because you stop.

For a lot of people, especially if things have been running in the same pattern for a while, the system needs a clearer signal to shift.

That’s where structured recovery strategies can be useful.

The tools — in context

I tend to use a small number of modalities, but always in the context of the person in front of me.

Sauna is one of them. It produces a clear cardiovascular and thermal response — heart rate rises, circulation changes, and a number of cellular stress-response pathways are engaged. There’s a growing body of research looking at what that means for vascular and metabolic health over time.

Contrast therapy — alternating heat and cold — is another. It introduces a controlled cycle of stress and recovery, which can be helpful for people whose systems don’t shift easily on their own.

Red light therapy is something I use more selectively. There’s emerging evidence around mitochondrial function and cellular energy production, but it’s not something I apply broadly without a reason.

Massage is probably the simplest of the group. It can support relaxation and recovery, and for some people it’s one of the easiest ways to introduce regular parasympathetic input.

None of these are cures, and none of them are interchangeable. They’re inputs. The question is always whether that input makes sense for the system it’s being applied to.

The consistency piece

The other thing that becomes obvious once you’ve looked at enough data is that consistency matters far more than intensity.

It’s not the occasional high-effort session that changes anything. It’s what happens when something is repeated, at a level the body can actually adapt to, over time.

That’s when you start to see shifts — not always dramatic, but directional.

Which is why I tend to structure recovery rather than leave it open-ended. Frequency matters. So does follow-up.

The part that tends to get overlooked

When I ask what someone’s doing for recovery, the answer is usually that there isn’t anything consistent.

Exercise is planned. Work is planned. Everything else is scheduled.

Recovery tends to sit in the space that’s left over, which often means it doesn’t really happen.

The impact of that isn’t immediate. It builds gradually. The system becomes a bit less adaptable, a bit slower to recover, a bit more reactive over time.

And then eventually something shows up — in symptoms, or in blood work — that looks new, but actually isn’t.

What this means in practice

For most people, this isn’t about adding more. It’s about being more deliberate with what’s already there.

If you’re doing things like sauna, or cold exposure, or anything that’s meant to support recovery, the question isn’t whether they’re “good.”

It’s whether they’re doing what you think they are, in your physiology, right now.

That’s where measurement helps. Not to overcomplicate things, but to understand direction.

What becomes possible

If you’ve been doing the right things but not getting the response you expect, or you’ve never really looked at how well your system is recovering, that’s usually where we start.

A Discovery Consultation is simply a way of stepping back and looking at the whole picture, and deciding what, if anything, is worth investigating further.

Dr. Ula

Co-Founder and Lead Physician, Autonomy

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