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Ice Bath / Cold Water Immersion Research

Below you will find a comprehensive range of research documents addressing the use of ice and ice baths for sports recovery. The results vary widely as do the protocols.

In addition, there is also a variation in the participants, some being competitive to elite sports people and others being drawn from a broader base, often a student population. One major issue for cold water immersion is the percentage of body fat. Those with higher body fat may need a lower temperature or longer immersion to have the same impact as those with low body fat.

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Soccer

The FIFA Science of Football Summit, Wembley Stadium April 2013

"How to prevent fatigue in football" session

Gregory Dupont of Université de Lille gave a very interesting presentation, which highlighted the strong correlation between fatigue and injury.

He reported an injury rate that was 6.2 times higher in players who played two matches per week, compared to those who only played one.

He, also, presented the findings of a review into post-match recovery strategies, which indicated the four major strategies proven to have a positive effect on fatigue and recovery are good sleep, proper nutrition, hydration and Cold Water Immersion.

Below you will find the references (and abstracts) of the publications of this research.

1. Dupont G., Nédélec, M., McCall A., McCormack, D., Berthoin, S. & Wisløff, U. 2010.
Effect of 2 Soccer Matches in a Week on Physical Performance and Injury Rate.
Am J of Sports Med 38 (9): 1752-1758.
Background: Recovery duration may be too short during the congested fixtures of professional soccer players with regard to maintaining physical performance and a low injury rate.

Purpose: To analyze the effects of 2 matches per week on physical performance and injury rate in male elite soccer players.

Study Design: Cohort study; Level of evidence, 3.

Methods: Match results, match-related physical performance, and injuries were monitored during 2 seasons (2007–2008 and 2008–2009) for 32 professional soccer players in a top-level team participating in the UEFA (Union of European Football Associations) Champions League. Total distance, high-intensity distance, sprint distance, and number of sprints were collected for 52 home matches. Injuries and player participation in matches and training were recorded throughout the full season.

Results: Physical performance, as characterized by total distance covered, high-intensity distance, sprint distance, and number of sprints, was not significantly affected by the number of matches per week (1 versus 2), whereas the injury rate was significantly higher when players played 2 matches per week versus 1 match per week (25.6 versus 4.1 injuries per 1000 hours of exposure; P\.001).

Conclusion: The recovery time between 2 matches, 72 to 96 hours, appears sufficient to maintain the level of physical performance tested but is not long enough to maintain a low injury rate. The present data highlight the need for player rotation and for improved recovery strategies to maintain a low injury rate among athletes during periods with congested match fixtures.
2. Nédélec, M., McCall, A., Carling, C., Legall, F., Berthoin, S. & Dupont, G. 2012
Recovery in soccer: part I – post-match fatigue and time course of recovery.
Sports Med. 42 (12): 997-1015.
In elite soccer, players are frequently required to play consecutive matches interspersed by 3 days and complete physical performance recovery may not be achieved. Incomplete recovery might result in underperformance and injury. During congested schedules, recovery strategies are therefore required to alleviate post-match fatigue, regain performance faster and reduce the risk of injury.

This article is Part I of a subsequent companion review and deals with post-match fatigue mechanisms and recovery kinetics of physical performance (sprints, jumps, maximal strength and technical skills), cognitive, subjective and biochemical markers. The companion review will analyse recovery strategies used in contemporary professional soccer.

Soccer involves many physically demanding activities including sprinting, changes in running speed, changes of direction, jumps and tackles, as well as technical actions such as dribbling, shooting and passing. These activities lead to a post-match fatigue that is linked to a combination of dehydration, glycogen depletion, muscle damage and mental fatigue. The magnitude of soccer match-induced fatigue, extrinsic factors (i.e. match result, quality of the opponent, match location, playing surface) and/or intrinsic factors (i.e. training status, age, gender, muscle fibre typology), potentially influence the time course of recovery.

Recovery in soccer is a complex issue, reinforcing the need for future research to estimate the quantitative importance of fatigue mechanisms and identify influencing factors. Efficient and individualized recovery strategies may consequently be proposed.
3. Nédélec, M., McCall, A., Carling, C., Legall, F., Berthoin, S. & Dupont, G. 2014.
Recovery in soccer: part II – recovery strategies
Sports Med. 42 (12): 997-1015.
In the formerly published part I of this two-part review, we examined fatigue after soccer matchplay and recovery kinetics of physical performance, and cognitive, subjective and biological markers.

To reduce the magnitude of fatigue and to accelerate the time to fully recover after completion, several recovery strategies are now used in professional soccer teams. During congested fixture schedules, recovery strategies are highly required to alleviate post-match fatigue, and then to regain performance faster and reduce the risk of injury. Fatigue following competition is multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue. Recovery strategies should consequently be targeted against the major causes of fatigue.

Strategies reviewed in part II of this article were nutritional intake, cold water immersion, sleeping, active recovery, stretching, compression garments, massage and electrical stimulation. Some strategies such as hydration, diet and sleep are effective in their ability to counteract the fatigue mechanisms. Providing milk drinks to players at the end of competition and a meal containing high-glycaemic index carbohydrate and protein within the hour following the match are effective in replenishing substrate stores and optimizing muscle-damage repair. Sleep is an essential part of recovery management. Sleep disturbance after a match is common and can negatively impact on the recovery process. Cold water immersion is effective during acute periods of match congestion in order to regain performance levels faster and repress the acute inflammatory process.

Scientific evidence for other strategies reviewed in their ability to accelerate the return to the initial level of performance is still lacking. These include active recovery, stretching, compression garments, massage and electrical stimulation. While this does not mean that these strategies do not aid the recovery process, the protocols implemented up until now do not significantly accelerate the return to initial levels of performance in comparison with a control condition.

In conclusion, scientific evidence to support the use of strategies commonly used during recovery is lacking. Additional research is required in this area in order to help practitioners establish an efficient recovery protocol immediately after matchplay, but also for the following days. Future studies could focus on the chronic effects of recovery strategies, on combinations of recovery protocols and on the effects of recovery strategies inducing an anti-inflammatory or a pro-inflammatory response.

Workshops

Clive Brewer (Assistant Director of High Performance, Toronto Blue Jays – previously Head of Performance at Widnes Vikings) held a workshop entitled:

Ice Baths in Elite Sports – Theory and Practice

In his workshop, Clive reported that the strength & conditioning coach's main objectives are to maximise fitness while minimising fatigue.

His presentation included a graph showing the impact of CWI on the performance and fatigue of his players post match. Performance was tested objectively, using a jump mat, enabling comparison of performance pre- and post match.



Impact of CWI on the performance and fatigue of  players post match


Reviews

1. Bleakley, C., Mcdonough, S., Gardner, E., Baxter, G.D., Hopkins, J.T. & Davison, G.W., 2012.
Cold-water immersion (Cryotherapy) for preventing and treating muscle soreness after exercise (Review).
Cochrane Database of Systematic Reviews (Online), Issue 2. Art. No. : CD008262. DOI: 10.1002/14651858.CD008262.pub2.
Background: Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise.

Objectives: To determine the effects of cold-water immersion in the management of muscle soreness after exercise.

Search Methods: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, hand searched journals and conference proceedings and contacted experts. In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications.

Selection Criteria: Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms).

Data Collection and Analysis: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model.

Main Results: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events. Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardised mean difference (SMD) -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD -1.70; 95% CI -2.49 to -0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery (MD 0.97; 95% CI -0.10 to 2.05; 10 units scale, worst to best) immediately after the end of cold-water immersion. Five studies compared cold-water with contrast immersion. Pooled data for pain showed no evidence of differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). Similar findings for pooled analyses at 24, 48 and 72 hour follow-ups applied to the four studies comparing cold-water with warm-water immersion. Single trials only compared cold-water immersion with respectively active recovery, compression and a second dose of cold-water immersion at 24 hours.

Authors’ Conclusions: There was some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention. There was insufficient evidence to conclude on other outcomes or for other comparisons. The majority of trials did not undertake active surveillance of pre-defined adverse events. High quality, well reported research in this area is required.
2. Cochrane, D.J., 2004.
Alternating hot and cold water immersion for athlete recovery: A review.
Physical Therapy in Sport, 5, pp.26-32.
Objectives: The aim of this review was to investigate whether alternating hot-cold water treatment is a legitimate training tool for enhancing athlete recovery. A number of mechanisms are discussed to justify its merits and future research directions are reported. Alternating hot-cold water treatment has been used in the clinical setting to assist in acute sporting injuries and rehabilitation purposes. However, there is overwhelming anecdotal evidence for it's inclusion as a method for post-exercise recovery. Many coaches, athletes and trainers are using alternating hot-cold water treatment as a means for post-exercise recovery

Design: A literature search was performed using SportDiscus, Medline and Web of Science using the key words recovery, muscle fatigue, cryotherapy, thermotherapy, hydrotherapy, contrast water immersion and training.

Results: The physiologic effects of hot-cold water contrast baths for injury treatment have been well documented, but its physiological rationale for enhancing recovery is less known. Most experimental evidence suggests that hot-cold water immersion helps to reduce injury in the acute stages of injury, through vasodilation and vasoconstriction thereby stimulating blood flow thus reducing swelling. This shunting action of the blood caused by vasodilation and vasoconstriction may be one of the mechanisms to removing metabolites, repairing the exercised muscle and slowing the metabolic process down.

Conclusion: To date there are very few studies that have focussed on the effectiveness of hot-cold water immersion for post-exercise treatment. More research is needed before conclusions can be drawn on whether alternating hot-cold water immersion improves recuperation and influences the physiological changes that characterises post-exercise recovery.
3. Lateef, F., 2010.
Post Exercise ice water immersion: Is it a form of active recovery?
Journal of Emergencies, Trauma and Shock, 3(3), pp.302.
Ice water immersion and contrast temperature water immersion therapy post-exercise is fast becoming a common practice among athletes involved in a variety of sports. Several mechanisms have been put forth to explain the rationale for its use. However, there is still a lack of evidence from a sufficiently large-scale trial to support the routine practice and formal incorporation into certain sporting guidelines. We describe here two athletes who applied the therapy post-exercise and presented to the Emergency Department with delayed onset muscle pain.


Original Research

1. Al Haddad, H., Laursen, P.B., Chollet, D., Lemaitre, F., Ahmaidi, S. & Buchheit, M., 2010.
Effect of cold or thermoneutral water immersion on post-exercise heart rate recovery and heart rate variability indices.
Autonomic Neuroscience: Basic and Clinical, 156(1-2), pp.111-116.
This study aimed to investigate the effect of cold and thermoneutral water immersion on post-exercise parasympathetic reactivation, inferred from heart rate (HR) recovery (HRR) and HR variability (HRV) indices. Twelve men performed, on three separate occasions, an intermittent exercise bout (all-out 30-s Wingate test, 5 min seated recovery, followed by 5 min of submaximal running exercise), randomly followed by 5 min of passive (seated) recovery under either cold (CWI), thermoneutral water immersion (TWI) or control (CON) conditions. HRR indices (e.g., heart beats recovered in the first minute after exercise cessation, HRR60s) and vagal related HRV indices (i.e., natural logarithm of the square root of the mean of the sum of the squares of differences between adjacent normal R-R intervals (Ln rMSSD)) were calculated for the three recovery conditions. HRR60s was faster in water immersion compared with CON conditions [30± 9beatsmin-1 for CON vs. 43± 10beatsmin-1 for TWI (P=0.003) and 40± 13beatsmin-1 for CWI (P=0.017)], while no difference was found between CWI and TWI (P=0.763). Ln rMSSD was higher in CWI (2.32± 0.67 ms) compared with CON (1.98± 0.74 ms, P=0.05) and TWI (2.01± 0.61 ms, P=0.08; aES=1.07) conditions, with no difference between CON and TWI (P=0.964). Water immersion is a simple and efficient means of immediately triggering post-exercise parasympathetic activity, with colder immersion temperatures likely to be more effective at increasing parasympathetic activity.
2. Ascensão, A., Leite, M., Rebelo, A.N., Magalhäes, S. & Magalhäes, J., 2011.
Effects of cold water immersion on the recovery of physcal performance and muscle damage following a one-off soccer match.
Journal of Sports Sciences, 29(3), pp.217-225.
The aim of this study was to assess the effects of a single session of cold or thermoneutral water immersion after a one-off match on muscular dysfunction and damage in soccer players. Twenty-male soccer players completed one match and were randomly divided into cryotherapy (10 min cold water immersion, 10°C, n=10) and thermoneutral (10 min thermoneutral water immersion, 35°C, n=10) groups. Muscle damage (creatine kinase, myoglobin), inflammation (C-reactive protein), neuromuscular function (jump and sprint abilities and maximal isometric quadriceps strength), and delayed-onset muscle soreness were evaluated before, within 30 min of the end, and 24 and 48 h after the match. After the match, the players in both groups showed increased plasma creatine kinase activity (30 min, 24 h, 48 h), myoglobin (30 min) and C-reactive protein (30 min, 24 h) concentrations. Peak jump ability and maximal strength were decreased and delayed-onset muscle soreness increased in both groups. However, differential alterations were observed between thermoneutral water and cold water immersion groups in creatine kinase (30 min, 24 h, 48 h), myoglobin (30 min), C-reactive protein (30 min, 24 h, 48 h), quadriceps strength (24 h), and quadriceps (24 h), calf (24 h) and adductor (30 min) delayed-onset muscle soreness. The results suggest that cold water immersion immediately after a one-off soccer match reduces muscle damage and discomfort, possibly contributing to a faster recovery of neuromuscular function.
3. Bailey, D.M., Erith, S.J., Griffin, P.J., Dowson, A., Brewer, D.S., Gant, N. & Williams, C., 2007.
Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running.
Journal of Sport Sciences, 25(11), pp.1163-1170.
The aim of this study was to assess the effects of cold-water immersion (cryotherapy) on indices of muscle damage following a bout of prolonged intermittent exercise. Twenty males (mean age 22.3 years, s = 3.3; height 1.80 m, s = 0.05; body mass 83.7 kg, s = 11.9) completed a 90-min intermittent shuttle run previously shown to result in marked muscle damage and soreness. After exercise, participants were randomly assigned to either 10 min cold-water immersion (mean 10°C, s = 0.5) or a non-immersion control group. Ratings of perceived soreness, changes in muscular function and efflux of intracellular proteins were monitored before exercise, during treatment, and at regular intervals up to 7 days post-exercise. Exercise resulted in severe muscle soreness, temporary muscular dysfunction, and elevated serum markers of muscle damage, all peaking within 48 h after exercise. Cryotherapy administered immediately after exercise reduced muscle soreness at 1, 24, and 48 h (P < 0.05). Decrements in isometric maximal voluntary contraction of the knee flexors were reduced after cryotherapy treatment at 24 (mean 12%, sx=4) and 48 h (mean 3%, sx=3) compared with the control group (mean 21%, sx=5 and mean 14%, sx=5 respectively; P < 0.05). Exercise-induced increases in serum myoglobin concentration and creatine kinase activity peaked at 1 and 24 h, respectively (P < 0.05). Cryotherapy had no effect on the creatine kinase response, but reduced myoglobin 1 h after exercise (P < 0.05). The results suggest that cold-water immersion immediately after prolonged intermittent shuttle running reduces some indices of exercise-induced muscle damage.
4. Brohpy-Williams, N., Landers, G. & Wallman, K., 2011.
Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance.
Journal of Sport Science and Medicine, 10(4), pp.665-667.
The purpose of the study was to determine the effects of cold water immersion (CWI) performed immediately or 3 h after a high intensity interval exercise session (HIIS) on next-day exercise performance. Eight male athletes performed three HIIS at 90%VO2max velocity followed by either a passive recovery (CON), CWI performed immediately post-exercise (CWI(0)) or CWI performed 3 h post-exercise (CWI(3)). Recovery trials were performed in a counter balanced manner. Participants then returned 24 h later and completed a muscle soreness and a totally quality recovery perception (TQRP) questionnaire, which was then followed by the Yoyo Intermittent Recovery Test [level 1] (YRT). Venous blood samples were collected pre-HIIS and pre-YRT to determine C-Reactive Protein (CRP) levels. Significantly more shuttles were performed during the YRT following CWI(0) compared to the CON trial (p=0.017, ES = 0. 8), while differences between the CWI(3) and the CON trials approached significance (p = 0.058, ES = 0.5). Performance on the YRT between the CWI(0) and CWI(3) trials were similar (p = 0.147, ES = 0. 3). Qualitative analyses demonstrated a 98% and 92% likely beneficial effect of CWI(0) and CWI(3) on next day performance, compared to CON, respectively, while CWI(0) resulted in a 79% likely benefit when compared to CWI(3). CRP values were significantly lower pre-YRT, compared to baseline, following CWI(0) (p = 0.0.36) and CWI(3) (p = 0.045), but were similar for CON (p = 0.157). Muscle soreness scores were similar between trials (p = 1.10), while TQRP scores were significantly lower for CON compared to CWI(0) (p = 0.002 ) and CWI(3) (p = 0.024). Immediate CWI resulted in superior next-day YRT performance compared to CON, while delayed (3 h) CWI was also likely to be beneficial. Qualitative analyses suggested that CWI(0) resulted in better performance than CWI(3). These results are important for athletes who do not have immediate access to CWI following exercise.
5. Buchheit, M., Peiffer, J.J., Abbiss, C.R. & Laursen, P.B., 2009.
Effect of cold water immersion on postexercise parasympathetic reactivation.
American Journal of Physiology. Heart and Circulatory Physiology, 296(20): pp.H421-427.
The aim of the present study was to assess the effect of cold water immersion (CWI) on postexercise parasympathetic reactivation. Ten male cyclists (age, 29 ± 6 yr) performed two repeated supramaximal cycling exercises (SE(1) and SE(2)) interspersed with a 20-min passive recovery period, during which they were randomly assigned to either 5 min of CWI in 14°C or a control (N) condition where they sat in an environmental chamber (35.0 ± 0.3°C and 40.0 ± 3.0% relative humidity). Rectal temperature (T(re)) and beat-to-beat heart rate (HR) were recorded continuously. The time constant of HR recovery (HRRtau) and a time (30-s) varying vagal-related HR variability (HRV) index (rMSSD(30s)) were assessed during the 6-min period immediately following exercise. Resting vagal-related HRV indexes were calculated during 3-min periods 2 min before and 3 min after SE(1) and SE(2). Results showed no effect of CWI on T(re) (P = 0.29), SE performance (P = 0.76), and HRRtau (P = 0.61). In contrast, all vagal-related HRV indexes were decreased after SE(1) (P < 0.001) and tended to decrease even further after SE(2) under N condition but not with CWI. When compared with the N condition, CWI increased HRV indexes before (P < 0.05) and rMSSD(30s) after (P < 0.05) SE(2). Our study shows that CWI can significantly restore the impaired vagal-related HRV indexes observed after supramaximal exercise. CWI may serve as a simple and effective means to accelerate parasympathetic reactivation during the immediate period following supramaximal exercise.
6. Burke, D.G., Holt, L.E., Rasmussen, R., MacKinnon, N.C., Vossen, J.F. & Pelham, T.W., 2001.
Effects of hot or cold water immersion and modified porprioceptive neuromuscular facilitation flexibility exercise on hamstring length.
Journal of Athletic Training, 36(1), pp16-19.
Objective: To compare the changes in hamstring length resulting from modified proprioceptive neuromuscular facilitation flexibility training in combination with cold-water immersion, hot water immersion, and stretching alone.

Design and Setting: Training-only subjects stood motionless for 10 minutes, while subjects in the cold group stood in a coldwater bath (8° ± 1°C) immersed up to the gluteal fold for 10 minutes, and subjects in the hot group stood in a hot-water bath (44° ± 1°C) immersed up to the gluteal fold for 10 minutes. All subjects exercised only the right lower limb using a modified proprioceptive neuromuscular facilitation flexibility protocol, consisting of 1 set of 4 repetitions. This procedure was followed for 5 consecutive days

Subjects: Forty-five uninjured subjects (21 women, 24 men; age range, 18-25 years) were randomly assigned to the cold, hot, or stretching-alone group.

Measurements: Subjects were measured for maximum active hip flexion on the first and fifth days.

Results: Group results were assessed using a 2 × 3 analysis of variance, comparing changes in hamstring length from pretest to posttest. All 3 groups had significant improvements in hamstring length (pretest to posttest) (P < .05). However, no significant differences occurred among groups.

Conclusions: No advantage was apparent in using complete hot or cold immersion to increase hamstring length in healthy subjects.
7. Goodall, S. & Howatson, G., 2008.
The effects of multiple cold water immersion on indices of muscle damage.
Journal of Sports Science and Medicine, 7(2), pp.235-241.
The aim of this investigation was to elucidate the efficacy of repeated cold water immersions (CWI) in the recovery of exercise induced muscle damage. A randomised group consisting of eighteen males, mean ± s age, height and body mass were 24 ± 5 years, 1.82 ± 0.06 m and 85.7 ± 16.6 kg respectively, completed a bout of 100 drop jumps. Following the bout of damaging exercise, participants were randomly but equally assigned to either a 12 min CWI (15 ± 1°C; n = 9) group who experienced immersions immediately post-exercise and every 24 h thereafter for the following 3 days, or a control group (no treatment; n = 9). Maximal voluntary contraction (MVC) of the knee extensors, creatine kinase activity (CK), muscle soreness (DOMS), range of motion (ROM) and limb girth were measured pre-exercise and then for the following 96 h at 24 h increments. In addition MVC was also recorded immediately post-exercise. Significant time effects were seen for MVC, CK, DOMS and limb girth (p < 0.05) indicating muscle damage was evident, however there was no group effect or interaction observed showing that CWI did not attenuate any of the dependent variables (p > 0.05). These results suggest that repeated CWI do not enhance recovery from a bout of damaging eccentric contractions.
8. Hamlin, J.M., 2007.
The Effect of contrast temperature water therapy on repeated sprint performance.
Journal of Science and Medicine in Sport, 10(6), pp.398-402.
The aim of this study was to compare the effectiveness of two recovery techniques on blood lactate and repeated sprint performance. In a randomised cross-over design 20 junior representative rugby players (aged 19± 1 years) were given either contrast temperature water therapy or active recovery after performing a repeated sprint test. The test was then repeated 1h later to gauge the effects of the two recovery methods on subsequent repetitive sprinting performance. One week later, the two groups were reversed and the testing repeated. The test consisted of ten 40-m sprints with a 30-s turn-around between sprints. Recovery consisted of 6 min slow jogging (6.8 km h-1) for the active recovery group or 6 min of contrast temperature water therapy consisting of three 1-min hip-height immersions in cold water (8-10°C) alternated with three 1-min hot water (38°C) showers. Blood lactate concentration and heart rates were measured throughout the testing. Relative to the active recovery group the contrast temperature water therapy group showed a substantial decrease in blood lactate concentration 3 min after the procedure (-2.1 mmol L-1, 95% confidence limits, ±1.8 mmol L-1), and substantially lower heart rates both during the procedure (-9.1±8.7 min-1) as well as 1h later during the second set of sprints (-11.7±8.6 min-1). Effects of recovery group on repeated sprint performance were small to trivial and unclear. Compared to active recovery, contrast temperature water therapy decreases blood lactate concentration and heart rate but has little effect on subsequent repetitive sprinting performance.
9. Higgins, T., Cameron, M. & Climstein, M., 2012.
Evaluation of passive recovery, cold water immersion, and contrast baths for recovery, as measured by game performances markers, between two simulated games of rugby union.
Journal of Strength and Conditioning Research, Post Acceptance, 11 June 2012. DOI: 10.1519/JSC.0b013e31825c32b9.
In team sports, during the competitive season, peak performance in each game is of utmost importance to coaching staff and players. To enhance recovery from training and games a number of recovery modalities have been adopted across professional sporting teams. To date there is little evidence in the sport science literature identifying the benefit of modalities in promoting recovery between sporting competition games. This research evaluated hydrotherapy as a recovery strategy following a simulated game of rugby union and a week of recovery and training, with dependent variables between two simulated games of rugby union evaluated. Twenty-four male players were randomly divided into three groups: one group (n=8) received cold water immersion therapy (2 × 5min at 10°C, whilst one group (n=8) received contrast bath therapy (5 cycles of 10°C / 38°C) and the control group (n=8) underwent passive recovery (15mins, thermo neutral environment). The two forms of hydrotherapy were administered following a simulated rugby union game (8 circuits × 11 stations) and after three training sessions. Dependent variables where generated from five physical stations replicating movement characteristics of rugby union and one skilled based station, as well as sessional RPE values between two simulated games of rugby union. No significant differences were identified between groups across simulated games, across dependent variables. Effect size analysis via Cohen's d and ηp2 did identify medium trends between groups. Overall trends indicated that both treatment groups had performance results in the second simulated game above those of the control group of between 2% and 6% across the physical work stations replicating movement characteristics of rugby union. In conclusion, trends in this study may indicate that ice baths and contrasts baths may be more advantageous to athlete's recovery from team sport than passive rest between successive games of rugby union.
10. Higgins, T., Climstein, M. & Cameron, M., 2012.
Evaluation of Hydrotherapy, using passive tests and power tests, for recovery across a cyclic week of competitive rugby union.
Journal of Strength and Conditioning Research, Post Acceptance, 12 July 2012, DOI: 10.1519/JSC.0b013e318260ed9b.
In team sports, a cycle of training, competition, and recovery occurs weekly during the competitive season. This research evaluated hydrotherapy for recovery from a simulated game of rugby union and a week of recovery and training. Twenty-four experienced male rugby union players (mean age 19.46 SD ± 0.82, weight 82.38kg SD ± 11.12, height in centimetres 178.54 SD ± 5.75) were randomly divided into three groups: cold water immersion (n = 8), contrast bath therapy (n = 8) and a control group (n = 8) which received neither therapy. The two forms of hydrotherapy were administered immediately following a simulated rugby game. Testing was conducted one hour prior to the game and at five intervals post-game: one hour, 48 hours, 72 hours, 96 hours, and 144 hours. Dependent variables included countermovement jump, 10 and 40 meter sprints, sessional rating of perceived exertion (RPE), flexibility, thigh circumference, and delayed onset muscle soreness (DOMS). A significant difference in DOMS was found at 72 hours post (p = 0.03) and 96 hours post (p = 0.04) between the control and contrast bath groups, and at 48 hours post (p = 0.02) between cold water immersion and contrast bath groups. Cold water immersion and contrast baths scores for sessional RPE showed a significant difference at time points 72 hours post and 96 hours post (p = 0.05) between the two groups. Athletes' perceptions of muscle soreness and sessional RPE scores for training were greater in the contrast bath group (20%) after the simulated game and throughout the training week. Although results from passive and power tests were inconclusive in determining whether cold water immersion or passive recovery was more effective in attenuating fatigue, results indicated contrast baths had little benefit in enhancing recovery during a cyclic week of rugby union.
11. Howatson, G., Goodall, S. & van Someren, K.A., 2009.
The influence of cold water immersion on adaptation following a single bout of damaging exercise.
European Journal of Applied Physiology, 105(4), pp. 615-621.
The aim of this investigation was to elucidate the effects of cold water immersions (CWIs) following damaging exercise on the repeated bout effect (RBE). Sixteen males performed two bouts of drop jump exercise separated by 14-21 days. Participants were equally, but randomly assigned to either a CWI (12-min CWI at 15°C) or control group (12-min seated rest). Treatments were given immediately after the first exercise bout, 24, 48 and 72 h post-exercise. No interventions were given following the second bout. Maximum voluntary contraction (MIVC), soreness (DOMS), creatine kinase (CK), thigh girth and range of motion (ROM) were recorded before and for 96 h following the initial and repeated bouts of damaging exercise. All variables, except ROM, showed a significant time effect (P < 0.01) indicating the presence of muscle damage following the initial bout; there were no differences between the CWI and control groups after the initial bout. Following the repeated bout of exercise there was a significant attenuation in the reduction of MIVC (P = 0.002) and a reduction in DOMS (P < 0.001), which is indicative of the RBE. There were no significant differences between groups following the repeated bout of damaging exercise. These data show that CWI had no effect following damaging exercise and did not inhibit the RBE. Despite CWI being used routinely, its efficacy remains unclear and there is a need to elucidate the benefits of this intervention on recovery and adaptation to provide practitioners with evidence based practice.
12. Ingram, J., Dawson, B., Goodman, C., Wallman, K. & Beilby, J., 2009.
Effect of water immersion methods on post-exercise recovery from simulated team sport exercise
Journal of Science and Medicine in Sports, 12(3), pp.417-421.
This study aimed to compare the efficacy of hot/cold contrast water immersion (CWI), cold-water immersion (COLD) and no recovery treatment (control) as post-exercise recovery methods following exhaustive simulated team sports exercise. Repeated sprint ability, strength, muscle soreness and inflammatory markers were measured across the 48-h post-exercise period. Eleven male team-sport athletes completed three 3-day testing trials, each separated by 2 weeks. On day 1, baseline measures of performance (10 m × 20 m sprints and isometric strength of quadriceps, hamstrings and hip flexors) were recorded. Participants then performed 80 min of simulated team sports exercise followed by a 20-m shuttle run test to exhaustion. Upon completion of the exercise, and 24h later, participants performed one of the post-exercise recovery procedures for 15 min. At 48 h post-exercise, the performance tests were repeated. Blood samples and muscle soreness ratings were taken before and immediately after post-exercise, and at 24h and 48 h post-exercise. In comparison to the control and CWI treatments, COLD resulted in significantly lower (p < 0.05) muscle soreness ratings, as well as in reduced decrements to isometric leg extension and flexion strength in the 48-h post-exercise period. COLD also facilitated a more rapid return to baseline repeated sprint performances. The only benefit of CWI over control was a significant reduction in muscle soreness 24h post-exercise. This study demonstrated that COLD following exhaustive simulated team sports exercise offers greater recovery benefits than CWI or control treatments.
13. Jakeman, J.R., Macrae, R. & Eston, R., 2009.
A single bout of cold water immersion therapy has no beneficial effect on recovery from the symptoms of exercise-induced muscle damage.
In: T. Reilly & G. Atkinson, eds. 2009. Contemporary Sport, Leisure and Ergonomics. Abingdon: Routledge. pp39-48.
The purpose of this study was to examine the effectiveness of a single bout of cold-water immersion on recovery from exercise-induced muscle damage. Eighteen physically active female volunteers (age 19.9 (±0.97 years), height 1.66 (±0.05 m), mass 63.7 (±10 kg)), completed 10 sets of 10 counter-movement jumps to induce muscle damage and were randomly allocated to a control or treatment group. The treatment group was given a single 10-min bout of lower limb cold-water immersion therapy at 10°C immediately following damage-inducing exercise. Indicators of muscle damage (plasma creatine kinase activity, perceived soreness and maximal voluntary contraction of the quadriceps) were assessed immediately prior to counter-movement jumps, and at 1, 24, 48, 72 and 96 h, following the damaging exercise. Significant (p = 0.05) time effects were recorded on all indicators of muscle damage, but there were no significant group or group x time interaction effects found on any of the measured variables. The results indicate that a single bout of cold-water immersion after a damaging bout of exercise has no beneficial effects on the recovery from exercise-induced muscle damage.
14. Juliff, L.E., 2011.
Influence of Recovery Modalities on Team Sports Performance, Perceptions and Physiological Variables
B.Sc. Thesis, Murdoch University.
Purpose: In order to cope with the demands and stress of training and competition many team sports have begun to utilise contrast water therapy as their preferred recovery modality. Although popular, there may be an inability to access necessary facilities when at sporting venues or overseas therefore contrast showers may prove to be a convenient, accessible and effective alternative. Research examining the influence of contrast showers on sport performance and psychological and physiological variables is lacking. Therefore, this study sought to examine the effects of contrast showers and contrast water therapy on vertical jump and repeated agility performance, skin and core temperature and psychological measures following a netball specific circuit in elite female netball players.

Methods: Eleven elite netball players completed three experimental sessions (randomised crossover design) followed by one of three post-exercise recovery interventions; (1) contrast water therapy (CWT, 38°C and 15°C), (2) contrast showers (CS, 38°C and 18°C) and (3) passive recovery (PAS, seated rest 20°C). For each trial, participants performed a fatiguing netball specific circuit followed by one of the recovery interventions. Repeated agility, repeated vertical jump, skin and core temperature and muscle soreness were measured before, immediately after, 5 hours post and 24 hours post-exercise.

Results: No significant differences (P > 0.05) were evident between conditions for exercise performance (vertical jump, repeated agility). Post-exercise CWT and CS provided similar cooling effects through decreased skin temperature (Tskin) results and a delayed drop in core temperature (Tcore) of (-1.0%) when compared to a passive condition. Perceived perceptions overall were greater in the CWT (18.95 ± 13.77) and CS (17.70 ± 12.98) conditions when compared with a passive recovery (72.80 ± 14.26). Furthermore, a significant (P < 0.001) change in perception of CS recovery conditions was observed pre and post condition indicating a significant favourable change in perception.

Conclusion: Although no improvements in performance were noted after CWT or CS, neither modality negatively influenced performance. Furthermore, both CWT and CS resulted in faster cooling responses and greater perceptions of recovery when compared with passive sitting. For this reason, it is suggested that CWT and CS are viable recovery modalities that can be used to help increase recovery in netballers after intense training or competition scenarios.
15. Leal Junior, E.D., de Godoi, V., Mancalossi, J.L., Rossi, R.P., De Marchi, T., Parente, M., Grosselli, D., Generois, R.A., Basso, M., Frigo, L., Tomazino, S.S., Bjordal, J.M. & Lopes-Martins, R.A. 2011.
Comparison between cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) in short-term skeletal muscle recovery after high-intensity exercise in athletes - Preliminary results.
Lasers in Medical Science, 26(4), pp.493-501.
In the last years, phototherapy has becoming a promising tool to improve skeletal muscle recovery after exercise, however, it was not compared with other modalities commonly used with this aim. In the present study we compared the short-term effects of cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) with placebo LEDT on biochemical markers related to skeletal muscle recovery after high-intensity exercise. A randomized double-blind placebo-controlled crossover trial was performed with six male young futsal athletes. They were treated with CWIT (5°C of temperature [SD ± 1°]), active LEDT (69 LEDs with wavelengths 660/850 nm, 10/30 mW of output power, 30 s of irradiation time per point, and 41.7 J of total energy irradiated per point, total of ten points irradiated) or an identical placebo LEDT 5 min after each of three Wingate cycle tests. Pre-exercise, post-exercise, and post-treatment measurements were taken of blood lactate levels, creatine kinase (CK) activity, and C-reactive protein (CRP) levels. There were no significant differences in the work performed during the three Wingate tests (p > 0.05). All biochemical parameters increased from baseline values (p < 0.05) after the three exercise tests, but only active LEDT decreased blood lactate levels (p = 0.0065) and CK activity (p = 0.0044) significantly after treatment. There were no significant differences in CRP values after treatments. We concluded that treating the leg muscles with LEDT 5 min after the Wingate cycle test seemed to inhibit the expected post-exercise increase in blood lactate levels and CK activity. This suggests that LEDT has better potential than 5 min of CWIT for improving short-term post-exercise recovery.
16. Morton, H., 2007.
Contrast water immersion hastens plasma lactate decrease after intense anaerobic exercise.
Journal of Science and Medicine in Sport, 10(6), pp.467-470.
The benefits of rapid recovery after intense exercise are widely recognised, and lactate elimination is one indicator of recovery rate. This study examined the effect of contrast (alternating hot and cold) water immersion (CWI) on the rate of plasma lactate decrease during recovery after intense anaerobic exercise. Eleven subjects on each of two occasions undertook four successive 30-s Wingate tests separated by 30-s rest periods. On each occasion, plasma lactate concentration during recovery was measured 5 min post-exercise and thereafter at 5 min intervals for 30 min. On one occasion (determined randomly), the subjects recovered passively (PR) on a recovery bed and, on the other, they alternated partial body immersion in hot (36°C) and cold (12°C) water baths. Plasma lactate concentrations were analysed by repeated measures analysis of variance and by fitting a linear regression model, allowing for both gender and recovery mode differences. The rate of decrease in plasma lactate concentration over the 30-min recovery period was significantly higher (p < 0.001) in CWI; 0.28 (±0.02) mmol L-1 min-1 (CWI) compared to 0.22 (±0.02) mmol L-1 min-1 (PR). These values do not differ significantly between males and females. Contrast water immersion is a valid method of hastening plasma lactate decrease during recovery after intense anaerobic exercise for both males and females. An approximately 1.8 mmol L-1 difference between the two conditions may be expected after 30 min. With differences among elite competitors as little as 1-2%, this reduction may be of practical significance.
17. Peiffer, J.J., Abbiss, C.R., Nosaka, K., Peake, J.M. & Laursen, P.B., 2009.
Effect of cold water immersion after exercise in the heat on muscle function, body temperatures, and vessel diameter.
Journal of Science and Medicine in Sport, 12(1), pp.91-96.
Cold water immersion (CWI) is a popular recovery modality, but actual physiological responses to CWI after exercise in the heat have not been well documented. The purpose of this study was to examine effects of 20-min CWI (14°C) on neuromuscular function, rectal (Tre) and skin temperature (Tsk), and femoral venous diameter after exercise in the heat. Ten well-trained male cyclists completed two bouts of exercise consisting of 90-min cycling at a constant power output (216 ± 12 W) followed by a 16.1km time trial (TT) in the heat (32°C). Twenty-five minutes post-TT, participants were assigned to either CWI or control (CON) recovery conditions in a counterbalanced order. Tre and Tsk were recorded continuously, and maximal voluntary isometric contraction torque of the knee extensors (MVIC), MVIC with superimposed electrical stimulation (SMVIC), and femoral venous diameters were measured prior to exercise, 0, 45, and 90 min post-TT. Tre was significantly lower in CWI beginning 50 min post-TT compared with CON, and Tsk was significantly lower in CWI beginning 25 min post-TT compared with CON. Decreases in MVIC, and SMVIC torque after the TT were significantly greater for CWI compared with CON; differences persisted 90 min post-TT. Femoral vein diameter was approximately 9% smaller for CWI compared with CON at 45 min post-TT. These results suggest that CWI decreases Tre, but has a negative effect on neuromuscular function.
18. Peiffer, J.J., Abbiss, C.R., Watson, G., Nosaka, K. & Laursen, P.B., 2010
Effect of cold water immersion on repeated 1-km cycling performance in the heat.
Journal of Science and Medicine in Sport, 13(1), pp.112-116.
This study examined the effect of a short cold water immersion (CWI) intervention on rectal and muscle temperature, isokinetic strength and 1-km cycling time trial performance in the heat. Ten male cyclists performed a 1-km time trial at 35.0 ± 0.3°C and 40.0 ± 3.0% relative humidity, followed by 20 min recovery sitting in either cold water (14°C) for 5 min or in 35°C air (control); a second 1-km time trial immediately followed. Peak and mean cycling power output were recorded for both time trials. Rectal and muscle temperature, and maximal isokinetic concentric torque of the knee extensors were measured before and immediately after the first and second time trials. Rectal temperature was not different between cold water immersion and control conditions at any time points. After the second time trial, however, muscle temperature was significantly lower (-1.3 ± 0.7°C) in cold water immersion compared with the control trial. While peak and mean power decreased from the first to second time trial in both conditions (-86 ± 54 W and -24 ± 16 W, respectively), maximal isokinetic concentric torque was similar between conditions at all time points. The 5 min cold water immersion intervention lowered muscle temperature but did not affect isokinetic strength or 1-km cycling performance.
19. Pointon, M. & Duffield, R., 2012.
Cold water immersion recovery after simulated collision sport exercise.
Medicine and Science in Sports and Exercise, 44(2), pp.206-216.
Purpose: This investigation examined the effects of cold water immersion (CWI) recovery after simulated collision sport exercise.

Methods: Ten male rugby athletes performed three sessions consisting of a 2×30-min intermittent sprint exercise (ISE) protocol with either tackling (T) or no tackling (CONT), followed by a 20-min CWI intervention (TCWI) or passive recovery (TPASS and CONT) in a randomized order. The ISE consisted of a 15-m sprint every minute separated by self-paced bouts of hard running, jogging, and walking for the remainder of the minute. Every sixth rotation, participants performed 5×10-m runs, receiving a shoulder-led tackle to the lower body on each effort. Sprint time and distance covered during ISE were recorded, with voluntary (maximal voluntary contraction; MVC) and evoked neuromuscular function (voluntary activation; VA), electromyogram (root mean square (RMS)), ratings of perceived muscle soreness (MS), capillary and venous blood markers for metabolites and muscle damage, respectively measured before and after exercise, immediately after recovery, and 2 and 24 h after recovery.

Results: Total distance covered during exercise was significantly greater in CONT (P = 0.01), without differences between TPASS and TCWI (P > 0.05). TCWI resulted in increased MVC, VA, and RMS immediately after recovery (P < 0.05). M-wave amplitude and peak twitch were significantly increased after recovery and 2 h after recovery, respectively, in TCWI (P < 0.05). Although TCWI had no effect on the elevation in blood markers for muscle damage (P > 0.05), lactate was significantly reduced after recovery compared with TPASS (P = 0.04). CWI also resulted in reduced MS 2 h after recovery compared with TPASS (P < 0.05).

Conclusions: The introduction of body contact reduces exercise performance, whereas the use of CWI results in a faster recovery of MVC, VA, and RMS and improves muscle contractile properties and perceptions of soreness after collision-based exercise.
20. Pointon, M., Duffield, R., Cannon, J. & Marino, F.E., 2012.
Cold water immersion recovery following intermittent-sprint exercise in the heat.
European Journal of Applied Physiology, 112(7), pp.2483-2494.
This study examined the effects of cold water immersion (CWI) on recovery of neuromuscular function following simulated team-sport exercise in the heat. Ten male team-sport athletes performed two sessions of a 2 × 30-min intermittent-sprint exercise (ISE) in 32°C and 52% humidity, followed by a 20-min CWI intervention or passive recovery (CONT) in a randomized, crossover design. The ISE involved a 15-m sprint every minute separated by bouts of hard running, jogging and walking. Voluntary and evoked neuromuscular function, ratings of perceived muscle soreness (MS) and blood markers for muscle damage were measured pre- and post-exercise, immediately post-recovery, 2-h and 24-h post-recovery. Measures of core temperature (Tcore), heart rate (HR), capillary blood and perceptions of exertion, thermal strain and thirst were also recorded at the aforementioned time points. Post-exercise maximal voluntary contraction (MVC) and activation (VA) were reduced in both conditions and remained below pre-exercise values for the 24-h recovery (P < 0.05). Increased blood markers of muscle damage were observed post-exercise in both conditions and remained elevated for the 24-h recovery period (P < 0.05). Comparative to CONT, the post-recovery rate of reduction in Tcore, HR and MS was enhanced with CWI whilst increasing MVC and VA (P < 0.05). In contrast, 24-h post-recovery MVC and activation were significantly higher in CONT compared to CWI (P = 0.05). Following exercise in the heat, CWI accelerated the reduction in thermal and cardiovascular load, and improved MVC alongside increased central activation immediately and 2-h post-recovery. However, despite improved acute recovery CWI resulted in an attenuated MVC 24-h post-recovery.
21. Pournot, H., Bieuzen, F., Duffield, R., Lepretre, P.M., Cozzolino, C. & Hausswirth, C., 2011.
Short term effects of various water immersions on recovery form exhaustive intermittent exercise.
European Journal of Applied Physiology, 111(7), pp.1287-1295.
In order to investigate the effectiveness of different techniques of water immersion recovery on maximal strength, power and the post-exercise inflammatory response in elite athletes, 41 highly trained (Football, Rugby, Volleyball) male subjects (age = 21.5 ± 4.6 years, mass = 73.1 ± 9.7 kg and height = 176.7 ± 9.7 cm) performed 20 min of exhaustive, intermittent exercise followed by a 15 min recovery intervention. The recovery intervention consisted of different water immersion techniques, including: temperate water immersion (36°C; TWI), cold water immersion (10°C; CWI), contrast water temperature (10-42°C; CWT) and a passive recovery (PAS). Performances during a maximal 30-s rowing test (P30 s), a maximal vertical counter-movement jump (CMJ) and a maximal isometric voluntary contraction (MVC) of the knee extensor muscles were measured at rest (Pre-exercise), immediately after the exercise (Post-exercise), 1 h after (Post 1 h) and 24 h later (Post 24 h). Leukocyte profile and venous blood markers of muscle damage (creatine kinase (CK) and lactate dehydrogenase (LDH)) were also measured Pre-exercise, Post 1 h and Post 24 h. A significant time effect was observed to indicate a reduction in performance (Pre-exercise vs. Post-exercise) following the exercise bout in all conditions (P < 0.05). Indeed, at 1 h post-exercise, a significant improvement in MVC and P30 s was respectively observed in the CWI and CWT groups compared to pre-exercise. Further, for the CWI group, this result was associated with a comparative blunting of the rise in total number of leucocytes at 1 h post and of plasma concentration of CK at 24 h post. The results indicate that the practice of cold water immersion and contrast water therapy are more effective immersion modalities to promote a faster acute recovery of maximal anaerobic performances (MVC and 30” all-out respectively) after an intermittent exhaustive exercise. These results may be explained by the suppression of plasma concentrations of markers of inflammation and damage, sugesting reduced passive leakage from disrupted skeletal muscle, which may result in the increase in force production during ensuing bouts of exercise.
22. Rezaee, Z., Esfarjani, F. & Marandi, S.M, 2012.
Which temperature during the water immersion recovery is the best after a sprint swimming?
World applied Sciences Journal, 16(10), pp.1403-1408.
The aim of this study was to investigate the effect of water immersion at different temperatures on fatigue and sprint swimming. Ten elite women swimmers, age (17.8 ± 2.2), three times a week in 48-h intervals completed two 100-m front crawls (S1 and S2) interspersed with a 15-m recovery period consisting of: contrast water therapy (CWT, alternating hot 40°C, 2 min /cold 23°C, 1min), cold water immersion (CWI, 23°C) and hot water immersion (HWI, 40°C). Before and after S1 and S2 and every three-min during the recovery, skin temperature, blood lactate and heart rate were recorded. After the recovery, level of fatigue evaluated via TQR questioner, then participants performed (S2 ) and ultimately recorded the rate of perceived exertion through RPE questioner. Results showed that heart rate significantly decreased after CWI toward other groups. After CWT and CWI, skin temperature decreased significantly. Lactate removal was largest in CWT compared to the HWI. Both CWI and CWT were associated with improvement in swimming performance and following these methods TQR and RPE evaluated better than HWI (p ≤ 0.05). It seems CWT and CWI can be used in repeated high intensity interval performance with short recovery.
23. Roswell, G.J., Coutts, A.J., Reaburn, P. & Hill-Haas, S., 2011.
Effect of post-match cold-water immersion on subsequent match running performance in junior soccer players during tournament play.
Journal of Sports Sciences, 29(1), pp.1-6.
In this study, we investigated the effects of two hydrotherapy interventions on match running performance and perceptual measures of fatigue and recovery during a 4-day soccer tournament. Twenty male junior soccer players were assigned to one of two treatment groups and undertook either cold-water immersion (5 × 1 min at 10°C) or thermoneutral water immersion (5 × 1 min at 34°C) after each match. High-intensity running distance (> 15 km · h-1) and total distance covered, time spent in low (< 80% maximum heart rate), moderate (80-90% maximum heart rate), and high (> 90% maximum heart rate) heart rate zones, and rating of perceived exertion (RPE) were recorded for each match. Perceptions of general fatigue and leg soreness were recorded approximately 22 h after each match. There were decreases in both groups across the 4-day tournament for high-intensity running distance (P = 0.006, Cohen's d = 0.63), total distance run (P < 0.001, d = 0.90), time in high heart rate zone (P = 0.003, d = 0.90), and match RPE (P = 0.012, d = 0.52). Cold-water immersion was more effective than thermoneutral immersion for reducing the perception of leg soreness (P = 0.004, d = -0.92) and general fatigue (P = 0.007, d = -0.91), ameliorating the decrement in total distance run (P = 0.001, d = 0.55), and maintaining time in the moderate heart rate zone (P = 0.01, d = 1.06). In conclusion, cold-water immersion mediates the perceptions of fatigue and recovery and enhances the restoration of some match-related performance measures during a 4-day tournament.
24. Rupp, K.A., Selkow, N.M., Parente, W.R., Ingersoll, C.D., Weltman, A.L. & Saliba, S.A., 2012.
The effect of cold water immersion on 48-hour performance testing in collegiate soccer players.
Journal of Strength and Conditioning Research, 26(8), pp.2043-2050.
This randomized, controlled, laboratory study was designed to examine the effect of cold water immersion (CWI) as a recovery modality on repeat performance on the yo-yo intermittent recovery test (YIRT), a widely accepted tool for the evaluation of physical performance in soccer, separated by 48 hours. Twenty-two healthy Division I collegiate soccer players (13 men and 9 women; age, 19.8 ± 1.1 years; height, 174.0 ± 9.0 cm; mass, 72.1 ± 9.1 kg) volunteered as participants during the non-competitive season. The YIRT was used to induce volitional fatigue and was administered at baseline and again 48 hours later. Athletes progressively increased sprint speed between markers set 20 m apart until pace was failed. Countermovement vertical jump (CMVJ) was used to assess anaerobic power and was measured before YIRT, immediately post-YIRT, and 24 and 48 hours post-YIRT. A 10-cm horizontal visual analog scale was administered immediately, 24 hours and 48 hours post-YIRT to assess perceived fatigue (PF) in the legs. Participants were randomly placed into the CWI or control group. The CWI condition consisted of immersion to the umbilicus in a 12°C pool for 15 minutes, whereas the control group sat quietly for 15 minutes. There were no significant differences between intervention conditions on YIRT performance (control, 4,900 ± 884 m; CWI, 5,288 ± 1,000 m; p = 0.35) or PF (control, 9.4 ± 0.5 cm; CWI, 9.3 ± 0.6 cm; p = 0.65) at 48 hours post-YIRT. There was a main time effect for CMVJ over 48 hours, but no group differences (pre-YIRT, 64.6 ± 11.0 cm; post-YIRT, 66.4 ± 10.9 cm; 24 hours post-YIRT, 63.4 ± 9.9 cm; 48 hours post-YIRT, 63.1 ± 9.4 cm; p = 0.02). This study demonstrated that in collegiate soccer players, CWI performed immediately and 24 hours after induced volitional fatigue did not affect subsequent physical performance estimates.
25. Sellwood, K.L., Brukner, P., Williams, D., Nicol, A. & Hinman, R., 2007.
Ice-water immersion and delayed-onset muscle soreness: A randomised controlled trial.
British Journal of Sports Medicine, 41(6), pp. 392-397.
Objective: To determine if ice-water immersion after eccentric quadriceps exercise minimises the symptoms of delayed-onset muscle soreness (DOMS).

Design: A prospective randomised double-blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non-dominant leg.

Interventions: Participants were randomised to three 1-min immersions in either ice water (5 ± 1°C) or tepid water (24°C).

Main outcome measures: Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one-legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann-Whitney U tests.

Results,: No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop-for-distance or serum CK over time. There was a significant difference in pain on sit-to-stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 vs. 2.0 mm, respectively, p = 0.009).

Conclusions: The protocol of ice-water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes.
26. Stanley, J., Buchheit, M. & Peake, J.M., 2012.
The effect of post-exercise hydrotherapy on subsequent exercise performance and heart rate variability.
European Journal of Applied Physiology, 112(3), pp.951-961.
We investigated the effect of hydrotherapy on time-trial performance and cardiac parasympathetic reactivation during recovery from intense training. On three occasions, 18 well-trained cyclists completed 60 min high-intensity cycling, followed 20 min later by one of three 10-min recovery interventions: passive rest (PAS), cold water immersion (CWI), or contrast water immersion (CWT). The cyclists then rested quietly for 160 min with R-R intervals and perceptions of recovery recorded every 30 min. Cardiac parasympathetic activity was evaluated using the natural logarithm of the square root of mean squared differences of successive R-R intervals (ln rMSSD). Finally, the cyclists completed a work-based cycling time trial. Effects were examined using magnitude-based inferences. Differences in time-trial performance between the three trials were trivial. Compared with PAS, general fatigue was very likely lower for CWI (difference [90% confidence limits; -12% (-18; -5)]) and CWT [-11% (-19; -2)]. Leg soreness was almost certainly lower following CWI [-22% (-30; -14)] and CWT [-27% (-37; -15)]. The change in mean ln rMSSD following the recovery interventions (ln rMSSDPost-interv) was almost certainly higher following CWI [16.0% (10.4; 23.2)] and very likely higher following CWT [12.5% (5.5; 20.0)] compared with PAS, and possibly higher following CWI [3.7% (-0.9; 8.4)] compared with CWT. The correlations between performance, ln rMSSDPost-interv and perceptions of recovery were unclear. A moderate correlation was observed between ln rMSSDPost-interv and leg soreness [r = -0.50 (-0.66; -0.29)]. Although the effects of CWI and CWT on performance were trivial, the beneficial effects on perceptions of recovery support the use of these recovery strategies.
27. Vaile, J.M., Gill, D.N. & Blazevich, A.J. 2007.
The effect of contrast water therapy on symptoms of Delayed Onset Muscle Soreness.
Journal of Strength and Conditioning Research, 21(3), pp.697-702.
This study examined the effect of contrast water therapy (CWT) on the physiological and functional symptoms of delayed onset muscle soreness (DOMS) following DOMS-inducing leg press exercise. Thirteen recreational athletes performed 2 experimental trials separated by 6 weeks in a randomized crossover design. On each occasion, subjects performed a DOMS-inducing leg press protocol consisting of 5 × 10 eccentric contractions (180 seconds recovery between sets) at 140% of 1 repetition maximum (1RM). This was followed by a 15-minute recovery period incorporating either CWT or no intervention, passive recovery (PAS). Creatine kinase concentration (CK), perceived pain, thigh volume, isometric squat strength, and weighted jump squat performance were measured prior to the eccentric exercise, immediately post recovery, and 24, 48, and 72 hours post recovery. Isometric force production was not reduced below baseline measures throughout the 72-hour data collection period following CWT (approximately 4-10%). However, following PAS, isometric force production (mean ± SD) was 14.8 ± 11.4% below baseline immediately post recovery (p < 0.05), 20.8 ± 15.6% 24 hours post recovery (p < 0.05), and 22.5 ± 12.3% 48 hours post recovery (p < 0.05). Peak power produced during the jump squat was significantly reduced (p < 0.05) following both PAS (20.9 ± 13.4%) and CWT (12.8 ± 8.0%), with the mean reduction in power for PAS being marginally (not significantly) greater than for CWT (effect size = 0.76). Thigh volume measured immediately following CWT was significantly less than PAS. No significant differences in the changes in CK were found; in addition, there were no significant (p > 0.01) differences in perceived pain between treatments. Contrast water therapy was associated with a smaller reduction, and faster restoration, of strength and power measured by isometric force and jump squat production following DOMS-inducing leg press exercise when compared to PAS. Therefore, CWT seems to be effective in reducing and improving the recovery of functional deficiencies that result from DOMS, as opposed to passive recovery.
28. Vaile, J., Halson, S., Gill, N. & Dawson, B., 2008.
Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness.
European Journal of Applied Physiology, 102(4), pp.447-455.
This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced (P < 0.05) at 24, 48 and 72 h post-exercise following CWT and at 48 and 72 h post-exercise following CWI when compared to PAS. Isometric force recovery was also greater (P < 0.05) at 24, 48, and 72 h post-exercise following HWI when compared to PAS. Perceived pain improved (P < 0.01) following CWT at 24, 48 and 72 h post-exercise. Overall, CWI and CWT were found to be effective in reducing the physiological and functional deficits associated with DOMS, including improved recovery of isometric force and dynamic power and a reduction in localised oedema. While HWI was effective in the recovery of isometric force, it was ineffective for recovery of all other markers compared to PAS.
29. Van Wyk, D.V. & Lambert, M.I., 2009.
Recovery Strategies Implemented By Sport Support Staff of Elite rugby Players in South Africa.
M.Phil Thesis. University of Cape Town.
Objective: The main aim of this study was to determine strategies used to accelerate recovery of elite rugby players after training and matches, as used by medical support staff of rugby teams in South Africa. A secondary aim was to focus on specifics of implementing ice/cold water immersion as recovery strategy.

Design: A Questionnaire-based cross sectional descriptive survey was used.

Setting and Participants: Most (n = 58) of the medical support staff of rugby teams (doctors, physiotherapists, biokineticists and fitness trainers) who attended the inaugural Rugby Medical Association conference linked to the South African Sports Medicine Association Conference in Pretoria (14-16th November, 2007) participated in the study.

Results: Recovery strategies were utilized mostly after matches. Stretching and ice/cold water immersion were utilized the most (83%). More biokineticists and fitness trainers advocated the usage of stretching than their counterparts (medical doctors and physiotherapists). Ice/Cold water immersion and Active Recovery were the top two rated strategies. A summary of the details around implementation of ice/cold water therapy is shown (mean) as utilized by the subjects: (i) The time to immersion after matches was 12 ± 9 min ;(ii) The total duration of one immersion session was 6 ± 6 min; (iii) 3 immersion sessions per average training week was utilized by subjects; (iv) The average water temperature was 10 ± 3°C.; (v) Ice cubes were used most frequently to cool water for immersion sessions, and (vi) plastic drums were mostly used as the container for water.

Conclusion: In this survey the representative group of support staff provided insight to which strategies are utilized in South African elite rugby teams to accelerate recovery of players after training and/or matches.
30. Versey, N., Halson, S. & Dawson, B., 2011.
Effect of contrast water therapy duration on recovery of cycling performance: a dose-response study.
European Journal of Applied Physiology, 111(1), pp.37-46.
This study investigated whether contrast water therapy (CWT) has a dose-response effect on recovery from high-intensity cycling. Eleven trained male cyclists completed four trials, each commencing with a 75-min cycling protocol containing six sets of five 15-s sprints and three 5-min time-trials in thermoneutral conditions. Ten minutes post-exercise, participants performed one of four recovery protocols: CWT for 6 min (CWT6), 12 min (CWT12), or 18 min (CWT18) duration, or a seated rest control trial. The CWT commenced in hot water (38.4 ± 0.6°C) and alternated between hot and cold water (14.6 ± 0.3°C) every minute with a 5-s changeover. The cycling protocol was repeated 2 h after completion of exercise bout one. Prior to exercise bout two, core temperature was lower in CWT12 (-0.19 ± 0.14°C, mean ± 90% CL) and CWT18 (-0.21 ± 0.10°C) than control. Compared with control, CWT6 substantially improved time-trial (1.5 ± 2.1%) and sprint performance (3.0 ± 3.1%), and CWT12 substantially improved sprint total work (4.3 ± 3.4%) and peak power (2.7 ± 3.8%) in exercise bout two. All CWT conditions generally improved thermal sensation, whole body fatigue and muscle soreness compared with control, but no differences existed between conditions in heart rate or rating of perceived exertion. In conclusion, CWT duration did not have a dose-response effect on recovery from high-intensity cycling; however, CWT for up to 12 min assisted recovery of cycling performance.
31. Webb, N., 2011.
The relative efficacy of three recovery modalities following professional rugby league competition matches.
M.Sc Thesis. Auckland University of Technology.
Achieving a balance between training and competition stresses and recovery is important in maximizing the performance of athletes. Specifically, following contact sport where the degree of muscular damage and trauma caused by numerous collisions is substantial, the rate and quality of recovery is crucial for each player to optimally recover prior to the first training session of the training week following a game. The physiological response of specific recovery modalities and their effect on performance have been commonly investigated following exercise. However the investigation of recovery modalities following contact sport and their effect on important recovery markers leading into the first training session following a game is limited. The use of active recovery and various hydrotherapy procedures are common modalities that are implemented into a recovery regime following a game and are thought to enhance the recovery process. The objective of this thesis was to analyze whether these recovery modalities provided beneficial recovery effects following professional rugby league matches. Literature surrounding all recovery strategies (excluding nutritional strategies) and its possible influence on physiological recovery following both delayed onset of muscle soreness (DOMS) inducing exercise protocols and team contact sport matches was then appraised and discussed. Following these reviews an experimental study was conducted to investigate the relative efficacy of post game recovery modalities on jump height performance, perceived ratings of muscle soreness, and muscle damage 1, 18, and 42 hours following professional rugby league competition games. Twenty-one professional rugby league players performed three different recovery modalities (cold water immersion (Bleakley & Dawson, 2010), contrast water therapy (Vaile, Halson, Gill, & Dawson, 2008) and active recovery (Abraham, 1977)) following three competition games at 1, 18, and 42 hours post game. The effects of the recovery treatments were analyzed with mixed modelling with a covariate included (fatigue score) to adjust for changes in the intensity of each match on the post-match values of dependent variables. Standardization of effects was used to make magnitude-based inferences, presented as mean; ± 90% confidence intervals. CWI and CWT clearly improved jump height performance (CWI 2.3; ± 3.7%, CWT 3.5%; ± 4.1%), reduced muscle soreness (CWI -0.95; ± 0.37, CWT -0.55; ± 0.37), and decreased creatine kinase (CWI -11.0; ± 15.1%, CWT 18.2; ± 20.1% ) by 42 hours post game compared to ACT. CWT was however clearly more effective compared to CWI on the recovery of muscle soreness and creatine kinase by 42 hours post game. Therefore CWT recovery following team contact sport is recommended.
32. Wilcock, I., 2005.
The effect of water immersion, active recovery and passive recovery on repeated bouts of explosive exercise and blood plasma fraction.
M.Sc. Thesis. Auckland University of Technology.
Optimising recovery post-game or post-training could provide a competitive advantage to an athlete, especially if more than one bout of exercise is performed in a day. Active recovery is one common method that is thought to enhance the recovery process. Another recovery method that is gaining popularity is water immersion. The objective of this thesis was to analyse whether these two recovery methods provided greater recovery from explosive exercise than passive recovery. A physiological rationale that may explain the possibility of enhanced recovery with water immersion was initially investigated. The literature surrounding active recovery, water immersion and passive recovery on strength, cycling, running and jumping was then examined. Following these reviews an experimental study was conducted investigating the effects of water immersion, active recovery and passive recovery conducted after repeated bouts of explosive exercise. The rationale for active recovery post-exercise is that during intense exercise, fluid from the blood is forced into the working muscles due to the increase in mean arterial pressure, which increases muscle volume and decreases blood plasma fraction. Active recovery reduces this exercise induced edema and, with an associated increase in blood flow throughout the body, may increase the metabolism of waste substrates produced during exercise. Researchers have observed this increased substrate metabolism with reductions in post-exercise blood lactate accumulation following active recovery. Water immersion would appear to cause a similar physiological response to active recovery without the need to expend extra energy. When a large portion of the body is immersed, hydrostatic pressure acts on the body's fluids within the immersed region. Fluids from the extravascular space move into the vascular system reducing exercise-induced increases in muscular volume and reducing soft tissue inflammation. Additionally, blood volume increases and is redistributed towards the central cavity, which in turn increases cardiac preload, stroke volume, cardiac output, and blood flow throughout the body. Cardiac output increases in relation to the depth of immersion and have been observed to increase by as much as 102% during head-out immersions. These cardiovascular responses occur without any increase in energy expenditure. If extra-intravascular fluid movement is enhanced, then the movement and metabolism of waste substrates could increase. Observations of increased post-exercise blood lactate clearance with water immersion would support this theory. Most methodologies studying the performance benefits of active recovery and water immersion suffer many limitations. These limitations often consist of the experimental time schedule not replicating what is likely to occur in a practical situation, no isolation of water temperature and hydrostatic pressure effects, and lack of a sport-like exercise consisting of repeated expressions of explosive power. Light-intensity active recovery and water immersion do not appear to be detrimental to performance, but neither does there appear to be enough evidence to claim they are beneficial. Effects of active recovery and water immersion would seem to be trivial to small, with any benefits more likely following multiple bouts of high-intensity exercise and recovery or following muscle damaging exercise. There may be a link between blood plasma fraction and performance, however, evidence is inconclusive. Given these issues and limitations the aim of this research was to investigate whether combinations of active recovery, water immersion and passive recovery could maintain peak power and work during subsequent bouts of explosive exercise. We also investigated whether there was any difference in subjects' blood plasma faction and perceived fatigue between the recovery modes. A cross-over experiment was conducted on seven subjects over four weeks. On the same day of each week subjects performed three sessions of maximal jumping, each two hours apart, followed by a different recovery method. Each jump session consisted of three sets of 20 maximal jumps repeated every three seconds, with a minute's rest in-between. Immediately following the jumping subjects performed 10 minutes of either (A) active recovery on a cycle ergometer followed by seated rest, (I) immersion to the gluteal fold in 19°C water followed by seated rest, (AI) active recovery followed by immersion, or (P) seated passive rest. Jumping was conducted on an instrumented supine squat machine that allowed the measurement of total peak power and total work. Pre-jump, post jump and post-recovery blood was taken and the percentage of blood plasma fraction calculated. Perceived leg fatigue was also measured at these times. Observed differences in total peak power and total work between the recovery modes were non-significant. No differences were observed in the change of blood plasma fraction between the recovery modes or perceived fatigue. One reason for any lack of difference between the recovery modes may have been the brevity of the recovery time. Research that has observed significant benefits of active recovery and water immersion compared to passive recovery have used recovery times greater of 15 minutes or more. Additionally, changes in blood plasma fraction between active recovery, water immersion and passive recovery have not been apparent until at least 10 minutes post-recovery in previous research. Alternatively, rather than brevity, it may be that active recovery or water immersion simply does not provide any benefit to performance recovery. Overall there is a meagre amount of research into active recovery, water immersion and passive recovery. Further research that incorporates a variety of exercise and recovery protocols is required.

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