Cold-water Immersion (Cryotherapy) for Preventing and Treating Muscle Soreness After Exercise (Review).
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT and Davison GW. Cochrane Databases Syst Rev. 2012; 2.
Various strategies to attenuate muscle soreness following exercise exist. One popular intervention, cold water immersion (CWI), consists of immersion in water with a temperature less than 59°F (15°C). However, the clinical benefit of CWI to reduce exercise-induced muscle soreness remains unclear. Therefore, Bleakley et al. performed a systematic review to determine the effects of CWI on delayed onset muscle soreness. Following an electronic database search, two authors used a standardized form to select eligible trials by first screening titles and abstracts. After obtaining the full text, the same authors extracted data using a customized form. Whenever disagreements occurred between these two authors the issue was resolved by consensus or a third party. A total of 58 articles were initially identified and then narrowed down to 17 studies which were included in the review (366 participants, CWI: 5°C to 15°C, treatment time: 5 to 24 minutes). All of these studies were randomized controlled studies published between 1998 and 2009 Overall study quality was “low” (small sample size, high risk of bias [e.g., insufficient blinding, selection bias], etc.). Fourteen studies compared CWI with rest or “no treatment”, while three studies compared CWI to an alternative treatment (contrast baths and warm water immersion). Pooled analysis of these studies showed a statistically significant effect favoring CWI following activity at 24, 48, 72 and 96 hour follow-ups compared to no treatment or alternative treatments.
Overall, CWI attenuated muscle soreness after exercise better than doing nothing but the variability between trials (e.g., different exercise protocols used to induce muscle soreness, temperature and duration of CWI) made determining the best protocol difficult. This demonstrates a need for future research to begin to focus, not only on the effectiveness of the treatment, but on optimizing protocol guidelines. The authors also raised a question regarding the safety of this treatment because there was insufficient evidence to determine the risk of adverse events associated with CWI. Do you find this treatment of be effective and if so, how long after activity do you use it?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, & Davison GW (2012). Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane database of systematic reviews (Online), 2 PMID: 22336838
Another variable is submersion in tap water. Tap water temperature varies on pipe temperature and time of year but not adding ice makes this treatment more tolerable in order to sit in a bath. The differential temperature then from normal body temperature of 98.6 and perhaps tap water at 70 degrees would still result in 28.6 degrees differential of cooling effects.
Anonymous, your comment about using tap water is very interesting to me. I'd be interested to hear if you use this in your clinical practice, and what type of results you see in athletes and patients. Do they still feel like they are getting a treatment benefit from cool as opposed to cold water? I'm also interested in the physiological effects of cool versus cold water immersion. I believe the length of treatment required in cool water would be much longer than cold water; in order to decrease tissue temperature enough to have a physiological effect on pain or soreness, I would think the water should be colder.
You definitely bring up an important issue regarding cold water immersion. Because we don't have a gold standard immersion prescription to reduce muscle soreness, we are left to consider the wide range of parameters currently used. This leaves clinicians with a variety of options but only anecdotal evidence about what is best for athletes. The water becomes even muddier when you consider treatment goals – so far we've only talked about pain; but what about inflammation, blood flow, proprioception, etc.?
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Your article was extremely in-depth and shed light on many aspects to reduce muscle soreness. Thanks!
Manhattan Sports Medicine
This is a great site. It's the 2nd time in the last 3 days that I came across it looking for 2 different things and came to it 2 different ways…. Anyway, I'm going to get a water thermometer for my athletes and tell them to have it below 59 degrees when they're sore. This is good, usable information.
This was a great article review looking at cold water immersion and the effects it has on DOMS and post-exercise pain. The theory behind and ice bath post exercise has always interested me, mainly because there is so little amount of research on it.
I raise the question to whether or not cold water immersion post exercise is really doing anything. From my experience with an "ice bath" post exercise the athletes do not stay in the tub for longer than 8-10 minutes. This short treatment time makes me question if you can actually say you are receiving any physiological effects. We have seen from studies that it takes an average of 15-20 (or even longer) to actually decrease muscle temperature to the current accepted 7-8 degrees Celsius drop.
I agree with using an cold water immersion post exercise to help minimize pain, but when it comes to trying to achieve a desired philological effect, I question the theory. Like all cryotherapy treatments, as a clinican we should make clear what our goals are when applying a treatment. Currently, as a clinican my goal for post exercise treatment is to decrease pain, not muscular temperature.
More studies need to look into what whole body ice immersion has on the body post exercise.
Hi Kyle Kosik,
I absolutely agree with your comment on being clear with treatment goals when applying a treatment. From the data presented, it does not seem like a 8-10 minute treatment is sufficient for decreasing intramuscular temperature. I also agree on your idea for future research. Taking a step back and looking into what effects CWI has on the body may be a good step to start at. Perhaps starting with the effect that CWI has on the body post exercise and then tracing that back to a therapeutic response could be extremely effective. I also have to pose a question to you. As I have been discussing from one of my other posts (https://sportsmedresearch.blogspot.com/2012/07/taping-versus-semi-rigid-bracing-on.html) do you think there is a patient satisfaction component to this? For example, a 8-10 minute CWI bath give the athlete a feeling of combating the effects of their recent exercise bout therefore they respond by feeling less adverse effects?