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Alternating hot and cold water immersion for athlete recovery: A review



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.
Literary review
Alternating hot and cold water immersion
for athlete recovery: a review
Darryl J. Cochrane*
Department of Management, Sport Management and Coaching, Massey University, Private Bag 11 222, Palmerston North, New Zealand
Objectives. The aim of this review was to investigate whether alternating hotcold 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 hotcold 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 hotcold 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 hotcold water immersion improves
recuperation and influences the physiological changes that characterises post exercise recovery.
q2003 Published by Elsevier Ltd. All rights reserved.
Keywords: Recovery; Training; Post exercise; Hydrotherapy; Regeneration; Immersion
1. Introduction
Recovery is an important aspect of any physical
conditioning programme however, many athletes train
extremely hard without giving their body time to recover
which can lead to over reaching, burnout or poor
performances (Mackinnon and Hooper, 1991). Without the
necessary recovery interventions it is very difficult for an
athlete to maintain a high level of performance on a daily or
weekly basis. As athletes look for the leading edge, rest is
frequently overlooked for increases in overload, intensity
and volume.
Recently a lot of emphasis has been placed on speeding
up the recovery process so athletes can proceed to do
successive bouts of training or competition without the
associated fatigue or burn out effects. Numerous physical,
psychological and nutritional methods have been used to
accelerate the recovery process (Calder, 1996). There has
been an increase in the use of modalities such as massage,
floatation, hyperbaric oxygenation therapy and acupuncture
with little scientific evaluation of its use and effectiveness
for exercise recovery. Alternating hot cold water immer-
sion is one technique that is very popular and is practised
with increased frequency in aiding recovery after physical
training and competition (Calder, 2001a). Anecdotal reports
from coaches, medical personnel and athletes suggest that
this method of water immersion has positive effects on
subsequent performance.
The aim of this review was to source the literature and
provide the scientific rationale and mechanisms of using
alternating hotcold water immersion for post exercise
2. Therapeutic modalities
Ice packs, whirlpools, baths, heat packs, infra-red lamps,
paraffin wax and ice massage are various techniques of
Physical Therapy in Sport 5 (2004) 26–32
1466-853X/$ - see front matter
*Tel.: þ64-6-350-5799; fax: þ64-6-350-5661.
E-mail address: (D.J. Cochrane).
cryotherapy and thermotherapy that have been used in the
sports medicine and rehabilitation fields for the treatment of
acute injuries (Prentice, 1999). Additionally, contrast baths,
warm and cold packs have also played a major role in injury
management but increasingly these modalities are now used
for post exercise recovery. Warm spas with cold plunge
pools or contrast hotcold baths and showers are common
practises used by athletes after training or exercise.
According to Calder (1996) the contrast hot cold water
technique is thought to speed recovery by increasing the
peripheral circulation by removing metabolic wastes and
stimulating the central nervous system. Calder (2001b)
further claims that contrast hot cold increases lactate
clearance, reduces post exercise oedema and enhances
blood flow to the fatigued muscle. Additionally, it is thought
to slow down the metabolic rate and revitalise and energise
the psychological state.
3. Physiology of cooling and heating
There is a general consensus that the application of cold
ice or water immersion decreases skin, subcutaneous and
muscle temperature (Enwemeka et al., 2002; Myrer et al.,
1997; Hartvickson, 1962; Johnson et al., 1979; Lowden and
Moore, 1975). The decrease in tissue temperature is thought
to stimulate the cutaneous receptors causing the sympathetic
fibres to vasoconstrict which decreases the swelling and
inflammation by slowing the metabolism and production of
metabolites thereby limiting the degree of the injury
(Enwemeka et al., 2002).
Superficial tissues can remain cool up to four hours from
ice packs or cold water immersion (Beltisky et al., 1987;
Hocutt et al., 1982; McMaster et al., 1979). The mechanism
of this process still remains unclear. Enwemeka et al. (2002)
found that cold pack treatment up to 20 min significantly
decreased superficial tissue temperature by dulling and
reducing the sensation of pain. They concluded that cold
pack treatment limits the amount of swelling in acute
injuries by slowing the metabolic rate by shunting less blood
to the cold superficial area. Earlier research has shown that
metabolites are cleared by the blood exchange from
superficial to deep tissue. Incoming warm blood is diverted
to the deeper tissues thereby slowing down the cooling
effect of the deep tissues (Pugh et al., 1960). A cooling
effect also decreases nerve conduction velocity in super-
ficial tissues by slowing the rate of firing of muscle spindle
afferents and reflex responses thus decreasing muscle spasm
and pain (Prentice, 1999; de Jesus et al., 1973).
Thermotherapy has shown to increase tissue temperature,
increase local blood flow, increase muscle elasticity, cause
local vasodilation, increase metabolite production and
reduce muscle spasm (Prentice, 1999; Brukner and Khan,
2001; Zuluaga et al., 1995). Additionally, superficial
heating decreases sympathetic nerve drive which causes
vasodilation of local blood vessels and increases circulation.
The increased blood flow allows an increased supply of
oxygen, antibodies and the ability to clear metabolites
(Zuluaga et al., 1995).
Myrer et al. (1994) proposed that if contrast therapy is
reported to produce physiologic effects (vasodilation and
constriction of local blood vessels, changes in blood flow,
reduction in swelling, inflammation and muscle spasm)
significant fluctuations of muscle temperature must be
produced by the alternating hot cold contrast treatments.
Participants immersed their right leg into a hot (40.6 8C)
whirlpool for 4 min followed by a cold (15.6 8C) whirlpool
for 1 min, and this was repeated four times (Myrer et al.,
1994). This protocol did not produce any significant
differences in intramuscular temperature 1 cm below the
skin in the gastrocnemius muscle. In a subsequent study,
Myrer et al. (1997) changed the modality of the contrast
therapy to cold and hot packs. The exposure duration was
extended to 5 min for both the hotcold treatment. The
rationale for using the packs was to give deeper penetration,
greater heat transfer and elicit superior temperature
fluctuations. The results verified their previous study that
hotcold contrast treatment does not produce the required
physiologic effects required to induce intramuscular tem-
perature changes. Wertz (1998) and Higgins and Kaminski
(1998) have also reported similar results. Lehmann et al.
(1974) suggested that for the physiologic effects to take
place the muscle temperature must reach at least 40 8C,
however, the above studies reported muscle temperatures
below 40 8C. More research is required to investigate the
required physiologic effects associated with using deep heat
treatments in hotcold contrast therapy.
4. Recovery
Recovery is defined as ‘the return of the muscle to its pre
exercise state following exercise’ (Tomlin and Wenger,
2001). Aerobic metabolism remains elevated in the recovery
phase after exercise. Known as excess post-exercise oxygen
consumption (EPOC) it assists in replenishing the body
stores (Bahr and Maehlum, 1986). EPOC consists of a fast
and slow component (Gaesser and Brooks, 1984). The fast
component restores 70% of ATP and PCr energy stores
within 30 s (Hultman et al., 1967) and reloads plasma
haemoglobin and muscle myoglobin (Bahr, 1992). The slow
component is observed after strenuous exercise and has
been associated with increased cardiac and respiratory
functions, elevated core temperature and removal of
metabolic waste products (Gaesser and Brooks, 1984;
Sahlin, 1992). Dependent on the exercise intensity it may
take up to 24 h for the slow component to return to its
resting levels (Gaesser and Brooks, 1984). Phosphagen
stores take 3 5 min to fully recover (Hultman et al., 1967)
compared to an hour or more for the resting return of lactate
and pH. The rise in lactate production and H
can disrupt the muscle contractile processes and the existing
D.J. Cochrane / Physical Therapy in Sport 5 (2004) 26–32 27
transport and metabolic pathways can become less efficient
(Tomlin and Wenger, 2001).The use of passive (no exercise,
massage, contrast hydrotherapy) or active recovery (light
exercise) for replenishing fuel stores and removal of
metabolic wastes has implications for accelerating post
exercise recovery rates.
4.1. Metabolic removal in active and passive recovery
Lactate production is evident when training or compet-
ing, however, the amount produced is dependent on the
duration and intensity of the exercise and the length of the
recovery interval. The ability to clear lactate in the recovery
phase relies on the working muscle to quickly remove,
tolerate and/or buffer H
(Sahlin and Henriksson, 1984).
hotcold immersion may have some merit in aiding
recovery if waste products are cleared faster. However,
the mechanism by which active recovery promotes lactate
removal is not clearly understood. This process is complex
as it depends on a range of factors for example, local blood
flow, chemical buffering, movement of lactate from muscle
to blood, lactate conversion to pyruvate in liver, muscle and
heart (McArdle et al., 2001).
Research has shown that lactate removal is increased
when active recovery periods are implemented compared to
passive rest for continuous or repeated bouts of exercise
(Hermansen and Stensvold, 1972; Weltman et al., 1979;
Cortes et al., 1989). Dodd et al. (1984) found that a recovery
period of moderate continuous intensity facilitated lactate
removal faster than passive recovery. Additionally, a
combination of high intensity (65% VO
max) and low
intensity (35% VO
max) was no more beneficial than a
recovery of low intensity (35% VO
max) for 40 min.
There is conflicting evidence on the effect that active and
passive recovery has on muscle glycogen synthesis. Choi
et al. (1994) have shown active recovery delays glucose
synthesis after high intensity (130% VO
max) intermittent
cycling in untrained males. However, Futre et al. (1987)
found no statistical differences between passive and active
recovery for muscle glycogen synthesis. Whatever the
outcome there are implications to the type of recovery
implemented in post training.
It appears that no further gains are elicited when
performing the intensity of the recovery period above
lactate threshold, as it may prolong the clearance of lactate
by accumulating more (Dodd et al., 1984; Gladden, 1989).
From isotope tracer studies, Brooks (2000) suggested that
lactate produced in fast twitch muscle fires can be
transported to other fast twitch or slow muscle fibres for
pyruvate conversion, which undergoes chemical reactions
for aerobic energy metabolism. This shuttling allows for
both production and removal of lactate. Signorile et al.
(1993) claimed that during recovery from low intensity
cycling, lactate clearance may be enhanced by active
muscles causing a pumping action and adjacent muscles
providing oxidative metabolism to removing metabolites.
Active recovery often requires additional energy that
further depletes precious energy stores therefore, if passive
recovery is proven to increase glycogen resynthesis contrast
hydrotherapy may be justified as a post training tool.
However, most athletes have the tendency to spend more
time in the warm water immersion thus off setting the
purported benefits as dehydration and neural fatigue are
Additionally, if competition is conducted at night
recovery could be compromised if other engagements
such as team debriefing, after match functions or press
conferences take priority. Conducting hotcold contrast
training may not be any more beneficial than complete rest.
Sanders (1996) used a contrast-temperature protocol
involving hotcold plunge pools to measure the recovery
of lactate levels in elite women hockey players after a
series of Wingate tests. A comparison of lactate clearances
following passive rest, light exercising (active recovery)
and the contrast immersion protocol was undertaken.
Results indicated that lactate levels were recovered equally
fast by using either the contrast water immersion or the
active recovery protocol. However, the lactate recovery
following passive rest was significantly slower. In sports
medicine contrast baths have been used to treat subacute
soft tissue and joint injuries by alternating hot cold, thus
promoting vasodilation/vasoconstriction causing a ‘pump-
ing’ action to reduce swelling of the injured site
(Rivenburgh, 1992; Prentice, 1999). This ‘pumping’ action
may explain the possible anecdotal reports of reduced post
exercise stiffness and the accelerated return to basal and
metabolic resting levels. However, the removal of
metabolites and reduced swelling from the mechanical
force of alternating hot cold immersion is unproven and
contentious. Myrer et al. (1997) suggested that
the significant skin temperature fluctuations from the
hotcold contrast packs caused vasoconstriction and
vasodilation thereby initiating subcutaneous response
and mechanical shunting. Conversely, they argue that the
increase in local blood flow would not reduce oedema, as
swelling reduction requires the removal of debris and fluid
performed by the lymphatic system. Since the lymphatic
system requires muscle contraction or gravity to move fluid
contents, it is unlikely this mechanism can be substan-
tiated, as lymph flow is independent of circulatory
changes.Tomasik (1983) studied the effect of blood
electrolytes and lactic acid levels in participants that
underwent 30 min of hydromassage or control (no hydro-
massage) after 15 min of sub-maximal cycling. The
investigation found that the hydromassage intervention
was able to return haematocrit, plasma potassium and lactic
acid levels to resting levels faster than those who received
no hydromassage. However, the acquired effects of
hypergravity and proprioception from the underwater jets
to assist the clearance of waste products were not
discussed. Unfortunately the studies of Tomasik (1983)
and Sanders (1996) have relied on measurements of blood
D.J. Cochrane / Physical Therapy in Sport 5 (2004) 26–3228
lactate to reflect muscle lactate clearance, which may
compromise conclusions on lactate removal (Tomlin and
Wenger, 2001). Further research is needed to establish
whether mechanical shunting from the hot cold immersion
elicits a possible mechanism for metabolite removal to
accelerate post exercise recovery.
4.2. Neural recovery
It is well established that during exercise there is a
decrease in parasympathetic and increase in sympathetic
activity. The sympathetic excitation causes a release of
noradrenaline and adrenaline that increases myocardial
contractility and accelerates heart rate (McArdle et al.,
2001). Additionally, vasodilation occurs in skeletal and
heart muscle, blood flow increases from vasoconstriction
of other organs and the airways become dilated. Post
exercise sympathetic activity remains high but with
adequate recovery it returns to resting levels. However,
if a high training load, volume or intensity is repeatedly
performed without the necessary rest, sympathetic activity
will become unceasingly high. This often leads to
overtraining/overreaching when the signs and symptoms
are not detected (Hahn, 1994).
Neurological recovery of the peripheral nervous system
may be augmented by contrast hydrotherapy, massage and
floatation by reducing the load of the sympathetic activity
(Hahn, 1994; Calder, 1996). Athletes who perform hot
cold hydrotherapy after training or competition have
reported lighter and less tight muscles with a feeling of
mental freshness (Calder, 2001a). This may be associated
to central nervous system relief. However, little is known
on the effects that hot– cold water immersion has on the
nervous system. Research conducted by Gieremek (1990)
examined reaction time of simple reflex tasks, the tendon
reflex (T reflex) of the Achilles tendon, Hoffman reflex (H
reflex) of the soleus and conduction of the tibialis nerve
before and after 30 min of jet pressured spa water
immersion (34 36 8C) in judo fighters and healthy
untrained males. He found that for both groups, the
underwater jet spa improved the efficiency of both the
central and peripheral nervous system. He supported his
claim from the significant changes of simple reaction
time, T and H reflexes. Gieremek stated that the
underwater jets and lukewarm water activated the
proprioreceptors to increase the excitability to the brain,
which stimulated the neuromuscular system. Additionally,
he justified the periphery efficiency component from the
significant increases in neural transmission and the
induced M-response of the H reflex.
Gieremek claimed that the reflex and electrophysiologi-
cal responses elicited from the underwater jet immersion
may have improved the speed of the central spread of
electrical activation in the nerve, neuromuscular synapses
and the muscle thereby producing a positive post exercise
recovery effect.
Viitasalo et al. (1995) investigated the effect of exposure
and non-exposure of underwater jet massage (36 37 8C) on
junior track and field athletes. The experiment used a cross
over design where two groups of equal size under went a
week of non-exposure and exposure of underwater jet
massage. Three treatments of 20 min were performed over
five days after power, speed and strength conditioning
sessions. During the exposure week of underwater jet
massage vertical jumping power declined slightly, continu-
ous vertical jumping ground contact time increased, serum
creatine kinase and myoglobin levels were elevated
compared to no water jet treatment. The results indicated
that the combination of intense speed, power and strength
sessions with underwater jet massage increased blood
markers to release more protein from the muscle to the
blood thereby enhancing the neuromuscular system.
4.3. Muscle recovery
It has been confirmed that eccentric, intensive and
unfamiliar exercises are causes of muscle damage (Clarkson
and Sayers, 1999 McHugh et al., 1999; Armstrong, 1984).
Delayed onset of muscle soreness (DOMS) usually
transpires 24 48 h post exercise with symptoms consisting
of tender, stiff and sore muscles (Clarkson et al., 1992).
Several theories have been presented to explain the
physiological mechanism of DOMS but with little agree-
ment. They include muscle fibre damage, breakdown of
muscle proteins resulting in inflammation and cellular
degradation (Armstrong, 1984; Smith, 1991; Friden and
Lieber, 1992; Byrd, 1992; Clarkson and Sayers, 1999).
McHugh et al. (1999) has argued for a combined neural,
connective and cellular mechanism. Whatever the proposed
mechanism causing DOMS the recovery process is
important for regeneration. The symptoms of DOMS
normally develop within 24 h and peak between 2472 h
(Cleak and Eston, 1992; Armstrong 1990).
The symptom of exercise-induced muscle damage (pain,
spasm and inflammation) is similar to that of injured muscle
therefore cryotherapy has been the primary treatment
modality. Kuligowski et al. (1998) studied the effectiveness
of warm, cold whirl pool and contrast therapy for treating
delayed-onset muscle soreness 24, 48, and 72 h post
exercise. The elbow flexors were eccentrically trained to
elicit DOMS. Resting elbow flexion, active elbow flexion
and extension, perceived soreness and maximal isometric
contraction were the criteria used to assess what effect the
different treatments had on DOMS. They found that
perceived soreness and resting elbow flexion returned to
baseline levels when cold whirlpool and contrast therapy
were administered, propagating that these treatments were
more effective than warm whirlpool and passive resting.
Contrary, Miller (1992) found that a warm whirlpool was
sufficient enough to decrease the perceived pain of DOMS
in down hill treadmill running. However, the efficacy of
control and warm whirlpool produced no significant
D.J. Cochrane / Physical Therapy in Sport 5 (2004) 26–32 29
difference on quadriceps flexibility or strength. Likewise
Easton and Peters (1999) concluded that following exhaus-
tive eccentric exercise the cold-water immersion appeared
to reduce muscle damage and stiffness but had no effect on
the perception of muscle tenderness and strength loss.
It can be concluded that the research is contradictory to
alleviating the symptoms of DOMS due to variations in the
type, frequency and duration of treatments.
4.4. Water temperature and ratio of cold to hot
for hydrotherapy recovery
The common practised ratio of warm to cold bath
duration for injury treatment is normally 3:1 or 4:1, with hot
baths ranging from 37 to 43 8C alternating with cold baths
temperature ranging from 12 to15 8C(Bell and Horton,
1987; Myrer et al., 1994; Brukner and Khan, 2001;
Halvorson, 1990). The duration of the treatment is normally
2030 min repeated twice daily (Higgins and Kaminski,
1998). It is also well documented that the treatment should
finish on the cold treatment to encourage vasoconstriction
for the injured athlete (Bell and Horton, 1987; Prentice,
1999; Zuluaga et al., 1995; Brukner and Khan, 2001).
Calder (1996) has documented guidelines (water tempera-
ture, repetitions and durations) for post exercise contrast
water recovery that are similar to injury management.
However, the duration for hotcold shower (1 –2 min hot,
1030 s cold) differs to that of a spa/bath (34 min hot, 30 –
60 s cold) with little justification. Higgins and Kaminski
(1998) and Myrer et al. (1997) found cold exposure of
approximately 1 min was not sufficient enough to signifi-
cantly decrease muscle temperature following warm water
immersion, thus nullifying the required physiologic effects.
There is a lack of evidence to support the post exercise
recovery guidelines especially in the light of injury contrast
treatment. Further research is required to investigate the
different hot to cold time ratios. The appropriate mode of
contrast treatment, the duration and the optimum water
temperature need to be examined to verify its effectiveness
as a recovery modality.
5. Holistic approach
Training and competition creates an overload to stress
the body, which in turn produces fatigue followed by
improved performance (Calder, 1996). Depending on the
nature of the training or activities; nutritional, physiologi-
cal, neurological and psychological components are
stressed in different ways that result in fatigue. Calder
(1995) devised a ranking system to help coaches identify
which of the four fatigue components are the most
stressed. For endurance training the ranking from the
most to the least fatigued was nutritional, physiological,
neurological, and psychological. However, for speed
training the order was neurological, physiological,
nutritional and psychological fatigue. According to Calder
(1995) the site of fatigue for the neurological component is
the peripheral nervous system; physiological (muscle cell);
nutritional (fluid and fuel stores); and psychological
(central nervous system). From the ranking system the
athlete and coach can then identify the appropriate
recovery techniques needed to accelerate the recovery,
which are rehydration and carbohydrate intake for fluid
and fuel stores; hydrotherapy, ‘warm down’ and massage
for increasing blood flow to fatigued muscles; visualisa-
tion, progressive muscular relaxation, meditation, flotation
and massage for psychological fatigue; passive rest,
massage, hydrotherapy, and ‘warm down’ for neurological
fatigue. The holistic approach for recovery training may
give better responses rather than using isolated recovery
techniques. Flanagan et al. (1998) simulated a soccer
tournament to examine the effects of recovery strategies
on young male soccer players. They found those in the
recovery group did not show any significant decline in 10
and 20 m speed times until the sixth day of competition
compared to the control group. However, there was no
change in vertical jump for both groups during the
tournament. The recovery techniques that were employed
included; massage, active pool sessions, hot cold
showers, stretching, hydration and nutritional plans. The
consequences of the combined recovery techniques pre-
vented physical drop off, lowered the occurrence of
influenza symptoms and produced a higher rating
of overall wellness.
6. Conclusion
Despite the popularity of hot cold water immersion as a
recovery modality, little research has been conducted. hot
cold contrast therapy for acute injuries has been used to
explain the purported physiologic effects for post exercise
recovery. However, the conflict of literature makes it
difficult to give a conclusive mechanism. Additionally, the
guidelines of the duration spent in each water condition,
the repetitions, temperature, the use of underwater jets, the
learning and training effect of the body adapting to the hot
cold contrast therapy all need to be vigorously investigated
before it can be claimed as an accelerant for aiding
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... If you do experience DOMS, there are several ways to manage the symptoms and improve recovery (Barata, Cervaens, Resende, Camacho, & Marques, 2011;Ciccone, Leggin, & Callamaro, 1991;Cochrane, 2004;Connolly, Sayers, & McHugh, 2003;Harahap & Siregar, 2021;Hotfiel et al., 2018;K.-J. Kim, Lee, Jung, & Bang, 2009): ...
... The use of ice or heat to treat DOMS is a matter of debate among healthcare providers and fitness experts. Some researchers indicate that using ice on the muscles after a workout can help reduce inflammation and soreness, while others believe that heat is more effective at relaxing the muscles and increasing blood flow to the area (Cochrane, 2004). Cryotherapy can reduce swelling and decrease the rate of metabolism, which in turn reduces the response, vascular permeability, and the formation of edema. ...
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Delayed onset muscle soreness (DOMS) is a type of muscle pain that typically occurs a day or two after engaging in physical activity that in- volves unaccustomed or strenuous muscle contractions. The exact cause of DOMS is not fully understood, but it is thought to be related to mi- croscopic damage to the muscle fibers and surrounding tissue, as well as inflammation in the muscle. There are several strategies that can be used to manage DOMS, including rest, streching, cold and heat modalities, medications, massage and exercise. It is important to note that DOMS is a normal response to physical activity and usually resolves on its own within a few days. However, if the pain persists or is severe, it is important to seek medical attention. In this review, we aimed to compile the most recent studies related to DOMS.
... e: 5 Contrast bathing is suggested to cause vasoconstriction and vasodilation of blood vessels, increasing peripheral circulation and therefore accelerating the removal of lactic acid and oedema. 5,9 This is supported by Vaile et al. 60 who found thigh volume measured immediately after contrast bathing, was significantly less than the thigh volumes of a passive rest group. However, it has been documented that the removal of oedema via drainage into the lymphatic system, requires muscular contraction or gravity and is independent of vascular activity. ...
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... Therefore, the physiological effects of cold therapy may be partially mediated through a decrease in microvascular blood flow around the injured site, which in turn can reduce edema and inflammation induction. Finally, the alternating use of cold and heat therapy can result in drastic changes in muscle perfusion owing to a combination of cold / heat effects, which is called the pumping effect [30]. It has been reported that the pumping effect might cause changes in muscle perfusion through vasodilation and vasoconstriction, thereby weakening the immune response and reducing muscle cell damage. ...
... Además, (Trégouët, 2013) mencionan que el vendaje funcional no elástico influye en la biomecánica del tobillo reduciendo el rango de inversión y previniendo un posible esguince de tobillo en deportistas. Otro aspecto importante es la recuperación con inmersión en frio y calor utilizada por los fisioterapeutas, según la revisión sistemática del autor (JCochrane, 2004) publicada en Cochrane, este menciona que por la evidencia más experimental sugiere que la inmersión en agua caliente-frío ayuda a reducir las lesiones en las etapas agudas, a través de la vasodilatación y vasoconstricción estimulando así el flujo de sangre por lo tanto la reducción la inflamación, es decir que los fisioterapeutas si están basando sus técnicas y procedimientos en la evidencia científica. ...
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Introducción: El rol del fisioterapeuta deportivo está definido respecto a las competencias que debería ejercer, pero no hay claridad en que si se está cumpliendo con dichas competencias debido a las escasas investigaciones. Objetivo: Describir el perfil profesional y el rol del fisioterapeuta deportivo en el Cauca y Nariño. Método: Tipo de estudio descriptivo – trasversal, la muestra del estudio fueron 21 profesionales de Fisioterapia vinculados al área de deporte, en los departamentos de Cauca y Nariño en el 2019. Resultados: el género masculino prevalece, en donde más laboran los fisioterapeutas es en institutos o secretarías de deporte, en nivel de formación académica 52,4% tenía posgrado en deporte y actividad física, en el tipo de contratación tiene mayor prevalencia la prestación de servicios. De las competencias de mayor actuación prevalece la prevención, el retorno al deporte, promoción de la salud, el entrenamiento. En las funciones del Ft, se reporta en mayor medida él siempre está presente en los entrenos, él nunca está presente en las competencias y a veces viaja con el equipo, el 85,7% reporto que si realizan prevención de lesiones, en cuanto a la indicación de Fisioterapia el 42,9% reporto que se realiza por médico y fisioterapeuta. Conclusiones: La mitad de los fisioterapeutas deportivos realizan estudios de postgrado. El rol del fisioterapeuta es principalmente para la rehabilitación de lesiones. La mayoría de fisioterapeutas no basan su abordaje en modelos teóricos o en evidencia científica; La indicación de FT deportiva en su mayoría es realizada en conjunto Fisioterapeuta- Medico.
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Background Physical exercise is essential to improve quality of life, with muscle recovery after exercise being crucial since it reduces the delayed sensation of muscle discomfort and fatigue. The present study aims to identify the methods used by physiotherapists to recover sports practitioners after physical exercise and presents a non-experimental, quantitative and descriptive nature. Methods Fifty-two physiotherapists (52% women), with 9.8 ± 7.3 years of experience and different sports backgrounds, were asked to complete an anonymous questionnaire that consisted of (1) participant demographics, (2) recovery wearable sports garment, and (3) development of a new product for muscle recovery. Results Physiotherapists reported that sports practitioners use legging-like garments during training (n=22), after training (n=19), while some physiotherapists were not aware if their athletes use any legging-like garment (n=17). The common characteristics of the garments are the compression (56%), heating (34%) and, in some cases, massage (6%) and printed electronic devices (4%). Physiotherapists mention that sports practitioners usually report lower limbs localized muscle fatigue after training or competition (90%), and the most affected areas are the entire lower limb (n=12), quadriceps (n=9) and hamstring and glutes (n=7 each). The most common therapy used is massage (n=12), followed by electrostimulation (n=8) and compression (n=5). Conclusion Physiotherapists believe that electrostimulation should be used to recover quadriceps, hamstrings and the whole lower limb, and localized heating should be centered in the entire lower limb, hamstrings and quadriceps (in number of answers). Alternatively, massage is better to recover the whole lower limb, gastrocnemius, and hamstrings. When asked what characteristics the garment should have, physiotherapists reported that comfort (n=44), breathability (n=37) and ease of care and cleaning are vital.
In our minimized follow-up trial with 137 participants with chronic low back pain, one group of participants received regular outpatient care, and the other group received balneotherapy by immersion in 42℃ thermal-mineral water in addition to regular outpatient care on 15 occasions for 3 weeks. Pain on movement and at rest on the 0–100 mm visual analogue scale (VAS), Oswestry index, the number of participants evaluating the symptoms clinically acceptable (Patient Acceptable Symptom State, PASS) and the EuroQol-5D-5L (EQ-5D-5L) quality of life questionnaire were assessed at basal time (at week 0) and after balneotherapy (at weeks 3 and 12). The VAS pain scores, the Oswestry index, the EQ-5D-5L index and the EQ-VAS significantly improved in the balneotherapy group after treatment at week 3 (p < 0.001) and week 12 (p < 0.001) compared to baseline, with a significant between group difference at week 3 (p < 0.001) and week 12 (p < 0.001). The pain VAS score on movement was 66.82 ± 11.48, 26.69 ± 21.49, and 20.09 ± 23.29 in the balneotherapy group, and 63.67 ± 14.77, 67.35 ± 15.44, and 70.23 ± 18.26 in the control group at the consecutive visits. The PASS increased in both groups at week 3 and week 12 compared to the baseline, with a significant between-group difference at week 3 and week 12 for the balneotherapy group. Our results suggest the therapeutic efficacy of immersion in 42℃ thermal mineral water on chronic low back Identifier: NCT05342051.
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İÇİNDEKİLER Bölüm 1. Sorularla Kardio tenis / Doç. Dr. Hüseyin GÜMÜŞ Bölüm 2. Kardio Tenis ve Beslenme/ Doç. Dr. İrfan YILDIRIM Bölüm 3. Kardio Teniste Masaj Uygulamaları / Doç. Dr. Mustafa Can KOÇ Bölüm 4. Kardio Tenis ve Sağlık/ Dr. Öğretim Üyesi Yasin ERSÖZ
Cervical spondylosis (CS) is a degenerative age-related disorder affecting the cervical region of the spinal cord which manifests mainly with radiating pain in the neck, numbness in fingers, and headache. To control the symptoms and manage the disease progression, a combination of Complementary and Alternative Medicine with conventional management is necessary. Hence this study is aimed to evaluate the effect of Revulsive Compress (RC) along with the Integrated Naturopathy and Yoga (INY) approach in patients with CS. Out of 210 subjects screened, 60 subjects between the ages of 40 to 85 years were selected for the study. The subjects were randomly assigned into two groups, Group 1 (n = 30) Case group taking RC with INY and Group 2 (n = 30) control group taking only INY protocol for 10 days. Pain, Symptom score, Range of Motion (ROM), and Quality of life (QOL) were assessed before and after the intervention on the 11th day. The result of this study shows that with 10 days of RC and INY intervention, there was a significant reduction in the pain [Visual analog scale (VAS): p = 0.001] and symptom score [Neck disability index: p = 0.001] when compared to the control group. There was a significant improvement in QOL and ROM. The results of this study show that RC intervention with INY is having a substantial effect on patients with CS. Pain and Symptom score have been reduced significantly with marked improvement in QOL and ROM. Hence, this intervention can be used in the management of patients with CS, either as an individual or accompanied by management.
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Recovery is a training principle. It focuses on identifying strategies that athletes can use to minimise and manage residual fatigue from training and competition. The resulting performance benefits reported are threefold. By minimising the effects of residual training fatigue, appropriate recovery strategies will: 1. Accelerate adaptation to the training stimuli ie maximum gains from training, maintain quality in every session, eg movement efficiency etc 2. Improve performances ie through consistency and repeatability of quality training performances 3. Minimise and eliminate non-adaptive responses to training and performance ie prevent overtraining, fewer illnesses, injuries, or burnout problems. The challenge for coaches has been to identify what capacities are fatigued, and what strategies should be used to recover from this fatigue. Reliable scientific support for these strategies is difficult to find. Hydrotherapy Water therapies are much under utilised and undervalued in Australia. In Europe and Scandinavia a wide range of therapies have been in use for several thousand years. Recent research from Finland has demonstrated that underwater massaging following strength/power training reduces fatigue and helps to maintain neuro-muscular performances (Viitasalo et al. 1995). Similar results have been reported by Flanagan et al. 2000) with young soccer players during tournament conditions. These findings also support the use of a spa and plunge pool routine to aid recovery. This routine involves first having a shower, followed by a spa (39 - 40oC) for three minutes and then a cold shower or a plunge into a cold pool (10 - 15oC) for 30 to 60 seconds. Spas should be used only if the athlete is in a healthy state and has no new soft tissue injuries. Athletes should not stay in a spa for more than five minutes, as they are likely to experience a large drop in blood pressure. A contrast-temperature protocol involving a hot pool, with no underwater massaging, and cold plunge (same protocol as outlined above), was also used by Jo Sanders in 1996 to measure the recovery of lactate levels in high performance hockey players after a series of Wingate tests. A comparison of lactate clearances following passive rest, light exercising (active recovery) and the contrast immersion techniques was undertaken. Results indicated that lactate levels are recovered equally fast by using either the contrast water immersion protocol or the active recovery protocol. Lactate recovery following passive rest was significantly slower (Sanders, 1996). Even contrast-temperature showering within 5 to 10 minutes following a training session is a good way to reduce metabolic fatigue, enhance arousal, and relax muscles. If there is access to a pool then interspersing light active movements with a few static stretches in the pool environment appears to reduce post training/game stiffness and accelerate the return to a normal homeostatic state. Short periods (30-60 seconds x 1 minute dry rub with a towel: 3 reps) of cold water (10-15oC) immersion to reduce post exercise oedema have become popular in many
The purpose of this study was to determine the differences in lactate removal between untrained and trained subjects following an exhaustive bout of ergometric cycling. Five untrained and six trained subjects performed a maximal bicycle ergometer test followed by a 10-minute active recovery session performed at 40% of the subject's VO2max. Arterialized venous blood samples were drawn at maximal exercise and at 2-minute intervals throughout the AR phase and for a subsequent 10 minutes of seated passive recovery. Between-group variances were analyzed by ANOVA while lactate removal rates were analyzed by one-way ANOVA for repeated measures with Newman-Kuels post hoc analysis. Our results revealed no significant differences (p < .05) in maximal, active recovery, and passive recovery lactate values between the untrained and trained subjects. However, the trained subjects' lactate values were lower than the untrained subjects' response throughout both recovery phases. Lactate clearance rates were significantly different (p <.05) across trials in both the untrained and trained subjects. The untrained subjects showed significant differences in lactate values at minutes 6, 8, and 10 of active recovery and at minutes 6, 8, and 10 of passive recovery, while the trained subjects' lactate values were significantly different at minutes 8 and 10 of active recovery and at minutes 4, 6, 8, and 10 of passive recovery. Our results suggest that the trained subjects' arterialized venous lactate was removed sooner than the untrained subjects' following a period of light aerobic exercise, demonstrating an apparent increase in metabolic efficiency.
Soft-tissue responses to injuries result in impaired neuromuscular function. Therapeutic heat and cold can minimize this injury response and maximize functional recovery. Before determining which type of treatment is most appropriate at a given stage, the team physician must understand not only the expected physiologic response to each modality but also the athlete's individual response to a given mode. For example, although cryotherapy has broad applicability to sports injuries, many athletes tolerate cold poorly. The author discusses both the art and the science of treating injuries with therapeutic heat and cold.
The purposes of this study were to evaluate and compare the ability of wet ice (WI), dry ice (DI), and cryogen packs (CGPs) to reduce and maintain the reduction of skin temperature directly under the cooling agent and to determine whether the cooling effect on skin extended beyond the surface area in contact with the cooling agent. Ten female volunteers participated in the study, and each of the three cold modalities was applied randomly to the skin overlying the right triceps surae muscle. After 15 minutes of cold application, mean skin temperatures recorded under WI, DI, and CGP decreased 12°, 9.9°, and 7.3°C, respectively. The only significant differences in cooling were between WI and DI and between WI and CGP. Fifteen minutes after removal of the cold modalities, no significant differences were found in mean skin temperature between WI, DI, and CGP. The residual mean decrease in skin temperature between the pretreatment rest interval (time 0) and 15 minutes after removal of the cold modality (time 30) was significant for WI only. No cooling was demonstrated 1 cm proximal or distal to any of the cooling agents after 15 minutes of cold application. These findings provide valuable information for the use of cryotherapy in the clinical setting.
This study investigated the effect of a 30-minute, 10 degrees C water bath on the intramuscular temperature of a lower leg and the contralateral lower leg. Intramuscular temperature was measured in 10 subjects using hypodermic thermistor probes inserted 25.3 mm into the lateral head of the gastrocnemius muscles of both legs. One lower leg was submersed in a 10 degrees C cold bath with the water level maintained 5 cm above the patella and with the subject in a nonweight-bearing position. Intramuscular temperature significantly decreased in both lower legs during treatment, although the intramuscular temperature of the treatment lower leg was significantly lower than that of the contralateral lower leg. A temperature difference continued for four hours after treatment; however, the temperature of both lower legs was significantly lower after four hours than it was before the cold bath treatment.
The effects of differing recovery patterns following maximal exercise on blood lactate disappearance and subsequent performance were examined. Nine subjects completed four randomly assigned experimental sessions. Each session consisted of a 5-min maximal effort performance test conducted on a Monark bicycle ergometer (T1) followed by 20 min of recovery and a second 5-min maximal effort performance test (T2). Blood lactate levels were measured during min 5, 10, 15, and 20 of recovery. Recovery patterns consisted of passive recovery (PR), active recovery below anaerobic threshold (AR less than AT), active recovery above anaerobic threshold (AR greater than AT), and active recovery above anaerobic threshold while breathing 100% oxygen (AR greater than AT + O2). Blood lactate levels prior to T2 were significantly different across treatments (P less than 0.05). Comparison among treatments and between T1 and T2 revealed no significant differences in work output. It was concluded that while lactate disappearance following severe exercise can be affected by varying the recovery pattern, elevated levels of blood lactate exert no demonstrable effect on maximal effort performance of 5-min duration.
An attempt to evaluate the potential of four modalities to cool soft tissue mass has been done under laboratory conditions using canines. The cooling of deep soft tissues within the thigh after application of various cooling devices was recorded over a 60-min exposure period. Under these circumstances, ice performed best, a frozen gel pack performed in a parallel but slightly less efficient manner. Two other modalities, an inflatable bladder filled with refrigerant gas and an endothermic chemical reaction, were least efficient in cooling.
The purpose of this study was to examine the intramuscular temperature response during an ice massage treatment. In addition, the effect of subcutaneous tissue thickness and limb circumference on temperature changes was investigated. Intramuscular temperature was measured by intramuscular thermocouples each minute during ice massage treatments of five, ten and fifteen minutes. It was shown that ice massage produces a significant drop in intramuscular temperature. However, there was no significant difference in temperature change after five minutes of treatment. In addition it was shown that there is a high multiple correlation between logarithmic time, subcutaneous tissue thickness, limb circumference, and intramuscular temperature change.