By Alissa Siemers, ATC

When dealing with athletes, sports medicine providers must take into account the need to recover from vigorous exercise quickly and efficiently to keep athletes at peak performance in time for competition. Research shows that athletes can experience elevated muscle soreness and reductions in muscle function of up to 20 percent for several days after exercise.¹ Due to this physiological impairment, there is a need to attempt to enhance the rate of recovery.² While ice immersion has long been the gold standard in treating heat stroke to rapidly cool the body, some coaches and athletes believe it can also be used to aid in tissue recovery after strenuous exercise and before events. However, is there any scientific proof that cold water immersion (CWI), or ice baths, have any effect on recovery time, delayed-onset muscle soreness, or increased performance?

Physiologically, intense exercise is associated with energy substrate depletion, hyperthermia, mechanical muscle damage, oxidative stress, inflammation, and nervous system fatigue.² The resulting symptoms can be felt as reduced performance, likely due to increased muscle soreness and decreased muscle function, as well as increased stiffness and swelling that can last for several days.^3,4 In a review of the literature in 2011, it was found that “the mechanisms of CWI are speculated to be related to temperature and pressure-induced changes in blood flow and reduced muscle temperature, subsequently reducing post-exercise inflammation.” It is this rationale that has athletes flocking to cold whirlpools after practices.

The results of a meta-analysis of the available literature looking at four outcome variables: muscle power, muscle strength, muscle soreness, and creatine kinase, reveals several factors that support the use of CWI post exercise. When analyzing the effect of CWI on alleviating delayed-onset muscle soreness, there was a moderate effect across all groups (gender, age, high intensity exercise, and eccentric exercise) and across all time points up to 96 hours post exercise (24 hours, 48 hours, 72 hours, and 96). It was then further broken down to reveal that CWI was most effective 24 hours and 48 hours post high-intensity exercise, though ineffective 24 hours post eccentric exercise.² In addition, the research found that this modality was effective at helping the rate of recovery of muscle power (defined by explosive movements such as vertical jumps and 5 meter sprints). There was also a small effect on the amount of creatine kinase in the blood after CWI, but it did not affect the rate of recovery of muscle strength.²

More research needs to be done still to conclude whether CWI is effective due to the reduction of blood flow, decreasing tissue temperature, or simply a placebo effect on the perception of delayed-onset muscle soreness.⁵ There is also little evidence to show qualitatively how much of an effect CWI had on this perception. However, practitioners should take into consideration that this treatment can be useful in having an analgesic effect for up to 96 hours post exercise. Still, it is important the practitioner “understand the physiological stress induced following different exercise types before prescribing recovery modalities. While it is apparent that CWI has no acute negative effect on recovery from strenuous exercise, research should investigate chronic application on adaptation to training.”²

References

1. Bailey DM, Erith SJ, Griffi n PJ, et al. Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running. J Sports Sci 2007;25:1163–70.
2. Leeder J, Gissane C, van Someren K, et al. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med Published Online First: 22 September 2011. doi: 10.1136/bjsports-2011-090061
3. McHugh MP, Connolly DA, Eston RG, et al. Exercise-induced muscle damage and potential mechanisms for the repeated bout effect. Sports Med 1999;27:157–70.
4. Armstrong RB. Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 1984;16:529–38.
5. Beedie CJ. Placebo effects in competitive sport: Qualitative data. J Sports Sci Med 2007;6:21–8.

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CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.