Ice baths

Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise: Cochrane Review

The DOMS is commonly felt as pain, stiffness and fatigue in muscles 24-48hrs following intensive exercise. This is caused by (Creatine kinase and myoglobin) proteins released into the blood stream due to the break down of muscle fibers as a result of micro-trauma during significant stress. Cold water immersion therapy (ice baths) made famous by Paula Radcliffe and favored many other sports men and women, including the GB women’s volleyball team, is a common method of recovery. The aims are to reduce the physiological effects and symptoms of the DOMS to allow athletes to train and/or compete at a high intensity during multiple sessions in the same day or on consecutive days.

Mo Farah enjoying the ice bath!

Delayed onset muscle soreness commonly results after sports and exercise activity. Cold-water immersion (CWI), which involves people immersing themselves in water at temperatures of less than 15°C, is sometimes used to manage muscle soreness after exercise and to speed up recovery time.

Our review included 17 small trials, involving a total of 366 participants. Study quality was low. Fourteen trials compared cold-water immersion applied after exercise with ‘passive’ treatment involving rest or no treatment. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. There was some evidence that cold-water immersion reduces muscle soreness at 24, 48, 72 and even at 96 hours after exercise compared with ‘passive’ treatment. Limited evidence from four trials indicated that participants considered that cold-water immersion improved recovery/reduced fatigue immediately afterwards. Most of the trials did not consider complications relating to cold-water immersion and so we cannot say whether these are a problem. There were only limited data available for other comparisons of cold-water immersion versus warm or contrasting (alternative warm/cold) water immersion, light jogging, and compression stockings. None of these showed important differences between the interventions being compared.

Cold water immersion in thought to constrict blood vessels and flush waste products, like lactic acid, out of the affected tissues. Decrease metabolic activity and slow down physiological processes, reduce swelling and tissue breakdown

Then, with rewarming, the increased blood flow speeds circulation, and in turn, improves the healing process. Although there is no current protocol regarding the ideal time and temperature for cold immersion routines, most athletes or trainers who use them recommend a water temperature between 12 to 15 degrees Celsius and immersion times of 5 to 10 and sometimes up to 20 minutes.

While the evidence shows that cold-water immersion reduces delayed onset muscle soreness after exercise, the optimum method of cold-water immersion and its safety are not clear.

Further research is required to investigate the specific physiological effects at work here and improve clinical knowledge of the optimum prescription in terms of time scale and temperature.

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