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The Effects of Cold Water Immersion and Contrast Water Therapy for Recovery from Team Sport: A Systematic Review and Meta-Analysis

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To enhance recovery from sport, cold water immersion (CWI) and contrast water therapy (CWT) have become common practice within high level team sport. Initially, athletes relied solely upon anecdotal support. As there has been an increase in the volume of research into recovery including a number of general reviews, an opportunity existed to narrow the focus specifically examining the use of hydrotherapy for recovery in team sport. A Boolean logic [AND] keyword search of databases was conducted: SPORTDiscus; AMED; CINAHL; MEDLINE. Data was extracted and the standardised mean differences were calculated with 95% CI. The analysis of pooled data was conducted using a random-effect model, with Heterogeneity assessed using I2. Twenty three peer reviewed papers (n=606) met the criteria. Meta-analyses results indicated CWI was beneficial for recovery at 24h (CMJ: p= 0.05, CI -0.004 to 0.578; All-out sprint: p=0.02, -0.056 to 0.801) following team sport. CWI was beneficial for recovery at 72h (fatigue: p=0.03, CI 0.061 to 1.418) and CWT was beneficial for recovery at 48h (fatigue: p=0.04, CI 0.013 to 0.942) following team sport. CWI was beneficial for neuromuscular recovery 24h following team sport, whereas CWT was not beneficial for recovery following team sport. In addition, when evaluating accumulated sprinting, CWI was not beneficial for recovery following team sports. In evaluating subjective measures, both CWI (72h) and CWT (24h) were beneficial for recovery of perceptions of fatigue, following team sport. However neither CWI nor CWT was beneficial for recovery, of perceptions of muscle soreness, following team sport.
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... This is in contrast with previous research that has indicated some positive effects of COWI on DOMS and reduced muscle strength loss from 6 to 96 hours after exercise in comparison to passive recovery (Bieuzen et al., 2013). However, a previous systematic review found that only CWI 24 hours after exercise improved neuromuscular recovery and fatigue perception (Higgins et al., 2017). In the same study (Higgins et al., 2017), neither CWI nor COWI was found to enhance the recovery of perceived muscle soreness following team sports. ...
... However, a previous systematic review found that only CWI 24 hours after exercise improved neuromuscular recovery and fatigue perception (Higgins et al., 2017). In the same study (Higgins et al., 2017), neither CWI nor COWI was found to enhance the recovery of perceived muscle soreness following team sports. These differences between study findings can be explained by the often included participants with varying training statuses and physiological stressors, as reported by other systematic reviews on hydrotherapy and recovery (Bieuzen et al., 2013). ...
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Objective: This study assessed the effects of active recovery training, cold-water immersion, contrast-water immersion, and no intervention on pain pressure thresholds in the quadriceps, triceps, and full leg. Following these recovery strategies, it also examined the relationships between creatine kinase, myoglobin, and pain pressure thresholds. Methods: Twenty basketball players from the Śląsk Wrocław team, aged 18 to 35, participated in a randomized controlled trial. They were divided into four groups: active recovery training, cold-water immersion, contrast-water immersion, and control. The interventions were applied post-match, and pain pressure thresholds were measured in the quadriceps, triceps, and full leg using a Somedic Algometer type 2. Blood samples were collected for analysis of creatine kinase and myoglobin levels. Results: Active recovery training significantly improved pain pressure thresholds across all muscle groups compared to cold-water immersion, contrast-water immersion, and control (p=0.001, d = 0.87 to 6.12). Cold-water immersion showed significant benefits in the triceps and full leg muscles compared to contrast-water immersion and control (p=0.001, d =-2.90 to 5.56). Contrast-water immersion did not differ significantly from the control in any muscle group. No significant correlations were found between pain pressure thresholds and creatine kinase and myoglobin levels. Conclusion: Active recovery training was the most effective strategy for improving pain pressure thresholds in basketball players, with cold-water immersion offering additional benefits for specific muscle groups. The lack of correlation between pain pressure thresholds and muscle damage biomarkers suggests that pain pressure thresholds alone may not be a reliable indicator of muscle damage. Resumen Objetivo: Este estudio evaluó los efectos del entrenamiento de recuperación activa, la inmersión en agua fría, la inmersión en agua contrastada y la no intervención sobre los umbrales de dolor en los cuádriceps, tríceps y pierna completa. También se examinaron las relaciones entre la creatina quinasa, la mioglobina y los umbrales de dolor tras estas estrategias de recuperación. Métodos: Veinte jugadores de baloncesto del equipo Śląsk Wrocław, de entre 18 y 35 años, participaron en un ensayo controlado aleatorio. Los participantes fueron divididos en cuatro grupos: entrenamiento de recuperación activa, inmersión en agua fría, inmersión en agua contrastada y control. Las intervenciones se aplicaron después del partido, y los umbrales de dolor se midieron en los cuádriceps, tríceps y pierna completa utilizando un algómetro Somedic tipo 2. Se recogieron muestras de sangre para el análisis de los niveles de creatina quinasa y mioglobina. Resultados: El entrenamiento de recuperación activa mejoró significativamente los umbrales de dolor en todos los grupos musculares en comparación con la inmersión en agua fría, la inmersión en agua contrastada y el control (p=0.001, d = 0.87 a 6.12). La inmersión en agua fría mostró beneficios significativos en los músculos tríceps y pierna completa en comparación con la inmersión en agua contrastada y el control (p=0.001, d =-2.90 a 5.56). La inmersión en agua contrastada no mostró diferencias significativas respecto al control en ningún grupo muscular. No se encontraron correlaciones significativas entre los umbrales de dolor y los niveles de creatina quinasa y mioglobina. Conclusión: El entrenamiento de recuperación activa fue la estrategia más efectiva para mejorar los umbrales de dolor en los jugadores de baloncesto, con la inmersión en agua fría ofreciendo beneficios adicionales para grupos musculares específicos. La falta de correlación entre los umbrales de dolor y los biomarcadores de daño muscular sugiere que los umbrales de dolor por sí solos pueden no ser un indicador fiable del daño muscular. Palabras clave Deportes de equipo; entrenamiento deportivo; recuperación deportiva; sensibilidad al dolor Eficacia de estrategias de recuperación en umbrales de presión del dolor en jugadores de baloncesto Efficacy of recovery strategies on pain pressure thresholds in basketball players
... A key strength of our review is its novelty; to our knowledge, it is the first systematic review of general and wide-ranging health impacts of CWI in general populations. It considerably extends previous systematic reviews, which have considered the impacts of CWI in the context of exercise performance [2,6,[44][45][46], muscle soreness [46][47][48], and athlete populations [49,50]. We adhered to the highest quality systematic review methodology, including a comprehensive search strategy across multiple databases, ensuring a broad capture of relevant studies. ...
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Background Cold-water immersion (CWI) has gained popularity as a health and wellbeing intervention among the general population. Objective This systematic review and meta-analysis aimed to evaluate the psychological, cognitive, and physiological effects of CWI in healthy adults. Methods Electronic databases were searched for randomized trials involving healthy adults aged ≥ 18 years undergoing acute or long-term CWI exposure via cold shower, ice bath, or plunge with water temperature ≤15°C for at least 30 seconds. Outcomes of interest were sleep, stress, fatigue, energy, skin health, immunity, inflammation, mental wellbeing, depression, anxiety, mood, concentration, and alertness or focus. Meta-analyses were conducted using RevMan software (version 5.4), applying random effects models to calculate standardized mean differences (SMD) between pre- and post-CWI exposure outcomes. Risk of bias was assessed using the PEDro scale. Results Eleven studies were included, comprising 3177 total participants and a mean PEDro score of 6.4 (n = 7 moderate quality, n = 4 high quality). CWI interventions were performed in baths (n = 10) or showers (n = 1) at temperatures ranging from 7°C to 15°C and durations ranging from 30 seconds to 2 hours. The meta-analysis revealed significant increases in inflammation immediately (SMD: 1.03, [95% CI: 0.37, 1.68], p < 0.01) and 1 hour post CWI (SMD: 1.26, [95% CI: 0.59, 1.94], p < 0.01), indicating an acute inflammatory response. A significant reduction in stress was observed 12 hours post-CWI (SMD: –1.00, [95% CI: –1.40, –0.61], p < 0.01), however, no significant effects on stress were detected immediately (SMD: –0.09 [95% CI: –0.45, 0.63], p > 0.05), 1 hour (SMD: –0.29 [95% CI: –0.66, 0.08], p > 0.05), 24 hours (SMD: –0.06 [95% CI: –0.50, 0.38], p > 0.05), or 48 hours (SMD: 0.09 [95% CI: –0.28, 0.46], p > 0.05) post-exposure. While meta-analysis showed no significant effects on immune function immediately (SMD: –0.16 [95% CI: –0.82, 0.51], p > 0.05) or 1 hour (SMD: –0.18 [95% CI: –1.09, 0.74], p > 0.05) post-CWI, narrative synthesis suggested longer-term benefits, including a 29% reduction in sickness absence among participants who took cold showers. Improvements were also observed in sleep quality and quality of life, but not mood. Conclusions This systematic review suggests that CWI delivers time-dependent effects on inflammation, stress, immunity, sleep quality, and quality of life, offering potential practical applications for health practitioners considering CWI for stress management and wellbeing support. However, the current evidence base is constrained by few RCTs, small sample sizes, and a lack of diversity in study populations. Future high-quality RCTs are needed to examine the long-term effects of CWI, its impact on diverse health outcomes, and optimal CWI protocols. PROSPERO (ID: CRD42024500591)
... 80% of junior racquet sports players use methods such as foam rolling, cold water immersion (CWI), hot baths, and protein intake . However, the effectiveness of CWI in limiting fatigue shows contradictory results, and its applicability in real-life conditions is questionable (Abaïdia et al., 2017;Ascensão et al., 2011;Bahnert et al., 2013;Fyfe et al., 2019;Hausswirth et al., 2011;Higgins et al., 2017;Kellmann & Beckmann, 2003;Leeder et al., 2012;Pooley et al., 2020;Tavares et al., 2019). ...
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Objective: This study examined the effects of two recovery techniques, combined techniques and passive recovery, on physiological, neuromuscular, and psychophysiological performance in competitive squash players during three days of simulated matches. Methodology: Eleven elite squash players (age: 15 ± 5 years; height: 172.80 ± 8 cm; body mass: 65.05 ± 11.46 kg) participated in a crossover-designed study. Blood lactate levels, countermovement jump, perceived exertion, and recovery were assessed before, after, and 48 hours post-match. Statistical analyses included Student's t-test or Wilcoxon test, as well as repeated measures ANOVA or Friedman + Wilcoxon tests for intra-week analyses. Results: Significant differences were observed in pre-match lactate levels between the first and third weeks (t = -5.81; p < .01) and in post-match lactate levels (t = -2.42; p < .03). No significant differences were found for countermovement jump pre-match (p < .50) or post-match (p <.15). Perceptual parameters such as sleep, stress, fatigue, muscle soreness, and perceived exertion showed no significant differences in pre-match measurements (p < .14, p <.09, p < .74, p < .51, p < .27) or in post-match muscle soreness and perceived exertion (p <.39, p < .41). Discussion: A simulated 45-minute squash match resulted in moderate fatigue, with full recovery within 24 hours. Repeated combined techniques provided no cumulative benefits over time and were equally effective as passive recovery in reversing physiological and neuromuscular changes. Conclusions: Combined techniques neither enhanced nor impaired the recovery process and were as effective as passive recovery.
... 80% of junior racquet sports players use methods such as foam rolling, cold water immersion (CWI), hot baths, and protein intake . However, the effectiveness of CWI in limiting fatigue shows contradictory results, and its applicability in real-life conditions is questionable (Abaïdia et al., 2017;Ascensão et al., 2011;Bahnert et al., 2013;Fyfe et al., 2019;Hausswirth et al., 2011;Higgins et al., 2017;Kellmann & Beckmann, 2003;Leeder et al., 2012;Pooley et al., 2020;Tavares et al., 2019). ...
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Objective: This study examined the effects of two recovery techniques, combined techniques and passive recovery, on physiological, neuromuscular, and psychophysiological performance in competitive squash players during three days of simulated matches. Methodology: Eleven elite squash players (age: 15 ± 5 years; height: 172.80 ± 8 cm; body mass: 65.05 ± 11.46 kg) participated in a crossover-designed study. Blood lactate levels, countermovement jump, perceived exertion, and recovery were assessed before, after, and 48 hours post-match. Statistical analyses included Student's t-test or Wilcoxon test, as well as repeated measures ANOVA or Friedman + Wilcoxon tests for intra-week analyses. Results: Significant differences were observed in pre-match lactate levels between the first and third weeks (t =-5. A simulated 45-minute squash match resulted in moderate fatigue, with full recovery within 24 hours. Repeated combined techniques provided no cumulative benefits over time and were equally effective as passive recovery in reversing physiological and neuromuscular changes. Conclusions: Combined techniques neither enhanced nor impaired the recovery process and were as effective as passive recovery.
... These findings are similar to those of Higgins et al. (2017, and Vanderlei et al. (2017), all of whom have suggested that CWI treatment is harmless to the human body and is effective in expediting recovery from EIMD in both generally healthy individuals and athletes who participate in team sports. ...
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This study investigated the effect of five consecutive days of cold‐water immersion (CWI) on recovery from exercise‐induced muscle damage (EIMD) in the hamstrings following maximal eccentric contraction (EC) exercise. Eighteen healthy adult women were randomly assigned to a CWI group and a control group (CG) (n = 9/group). Participants performed 10 sets of 10 repetitions of isokinetic EC at 30°/second and underwent maximum voluntary isometric contraction (MVC), delayed onset muscle soreness (DOMS) assessment, straight leg raise (SLR) test, and plasma myoglobin (Mb) measurement. The CWI group received one 14‐min session of CWI treatment (14°C) at 1, 25, 49, 73, and 97 h after the EC test, whereas the CG rested in a seated position at the same five time points without receiving treatment. (1) All the dependent variables in the CWI group and CG exhibited significant changes after the EC test (p < 0.05). (2) The recovery effect in the CWI group was significantly greater than in the CG in terms of the MVC, DOMS, SLR, and plasma Mb concentration results. MVC increased by 89.3 ± 2.0% on the fourth day (p < 0.013), DOMS decreased by 15.4 ± 1.5 mm on the second day (p < 0.000), SLR increased by 86.3 ± 1.1% on the second day (p < 0.014), and plasma Mb decreased by 436.3 ± 60.8% on the third day (p < 0.014). The study indicates that five consecutive days of CWI at 14°C significantly enhance recovery from exercise‐induced muscle damage in the hamstrings.
... In recent years, deliberate cold and heat exposure has gained recognition as a valuable recovery strategy for athletes navigating demanding training and competition schedules (Bezuglov et al., 2021;Higgins et al., 2017). These interventions offer numerous proposed benefits of accelerating recovery through a decrease in muscle soreness, inflammation, and fatigue (Bleakley et al., 2012), improving mental well-being, and providing relaxation and psychological recovery benefits (Laukkanen et al., 2019). ...
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Background: Youth athletes experience high-intensity physical and mental stress during a competitive season. In athlete populations, accumulated stress and strain have been associated with contributing to levels of fatigue that decrease athletic performance. While deliberate heat and cold exposure have been prevalent to aid recovery, there is a lack of conclusive literature regarding the specific implementation, periodisation, and monitoring for optimal recovery in youth athletes. Objective: This study aimed to investigate external physical (lower-body muscular power), internal physical (rating of perceived exertion) and psychological (profile of mood states) outcome measures during a 12-week competitive first XV rugby season to determine the effectiveness of a deliberate heat and cold exposure intervention. Methods: A single-group repeated measure within-subjects design was performed with 29 male first XV rugby athletes (mean age 17.6 ± 0.6 years; mean body weight 87.5 ± 9.7 kg; mean height 182.2 ± 6.2 cm) who volunteered for this study. Countermovement jump (CMJ), rating of perceived exertion (RPE) and profile of mood states (POMS) were recorded every fortnight over a 12-week competition. A total of two separate deliberate cold exposures (5°C for 5-minutes) and one deliberate heat exposure (100°C for 15-minutes) were administered weekly over the 12-week competitive season. Results: CMJ peak power (p = 0.759) and mean CMJ concentric power (p = 0.712) revealed no significant time effect. RPE presented a significant time effect (p 0.001). Among the ten POMS domains examined, eight domains did not show a significant time effect (p 0.05). However, the domains related to feeling sore or fatigued (p = 0.032) and excitement about competition (p 0.001) displayed significant time effects. Conclusion: The recovery intervention of two cold and one heat exposures did not directly improve changes in CMJ power or psychological states; however physical and psychological performance was maintained. Further research is necessary to understand the duration and frequency of using recovery strategies to improve the long-term effectiveness of young athletes.
... CWT studies yield mixed and inconclusive results on post-exercise recovery. One meta-analysis [56] reported benefits of CWT on DOMS and performance recovery, while other failed to see such effects [70,71]. Despite anecdotal endorsements, scientific evidence for CWT as an effective treatment for injuries or as a recovery aid is limited, largely due to methodological flaws and unaccounted placebo effects. ...
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Purpose This narrative umbrella review evaluates the efficacy of recovery strategies for elite winter sports athletes by comparing their scientific and clinical validity. It aims to provide evidence-based recommendations for coaches and athletes, preparing them for the Milano-Cortina 2026 Olympic Games through a critical evaluation of various post-training and competition recovery methods. Methods This narrative umbrella review involved a systematic literature search on PubMed, focusing on recent meta-analyses and review articles related to recovery strategies. Special emphasis was placed on their practical applications to ensure the findings are relevant to real-world settings. Results The study examined multiple recovery strategies, including sleep, nutrition, and physical methods, revealing a general scarcity of high-quality studies and insufficient control over placebo effects. A key finding emphasizes the crucial roles of nutrition and sleep in the recovery process, highlighting the need for personalized recovery plans tailored to the athlete's and sport's specific demands. The effectiveness of physical recovery methods varied, with some demonstrating significant benefits in specific contexts (e.g., massage and cold-water immersion to alleviate muscle pain and fatigue), whereas others (e.g., stretching and sauna) lacked robust evidence of their efficacy as recovery methods. Conclusion This paper presents recommendations for optimizing recovery strategies in elite winter sports, focusing on the specific demands of the Milano-Cortina 2026 Olympic Games. It provides a framework for athletes and coaches aiming to enhance performance recovery and achieve optimal athletic condition.
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Knee osteoarthritis is a degenerative joint disease known for disability and health burden on society among the elderly. Primarily it causes knee pain during functional activity. To manage this efficiently author suggested to work on varicose vein / venous insufficiency to get optimal recovery. In this study female patient presented to the outpatient department with a chief complain of both knee and leg pain. She assessed and tailor-made a rehabilitation program was given for 1 month by addressing varicose veins for the management of knee osteoarthritis. This study helps us to understand the role of varicose vein management in the case of knee osteoarthritis. Keywords: knee osteoarthritis, pneumatic therapy, Varicose vein, venous feeling time
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An English championship league soccer team did not experience impaired physical match performance in a second match after 75 hours of recovery. J. Aust. Strength Cond. 22(4)16-23. 2014 Physical, technical and tactical performance can affect recovery responses, although English Championship soccer players did not experience impaired physical match performance in a second match after 75 hours of recovery, suggesting that players coped with short recovery between matches. ABSTRACT The purpose of this study was to examine the hormonal and neuromuscular responses and physical match performance in a second match after 75 hours of recovery in English Championship League (ECL) soccer players during a mid-season weekly period. Nine male professional outfield soccer players whose mean age, height, and mass were 25.7 (± 3.4) years, 180 (± 6.0) cm, 78.1 (± 3.4) kg respectively from an ECL team competed in two matches separated by 75 hours. Subjects completed an optional post-match recovery strategy that included: massage, cold-water immersion, or low intensity dynamic movement. Team possession was greater in match 2 compared to match 1 (48 to 62%) while average pass frequency by each player increased in match 2. High intensity running was significantly greater during the second half of match 2 in comparison to the first half. Salivary cortisol was significantly elevated immediately post-match 1 compared to baseline. Jump height was reduced post-match 1 for up to 40 hours. In conclusion, the ECL soccer players in this study did not experience impaired physical performance in the second match after 75 hours of recovery, indicating that players coped with this short recovery period between matches. In addition, support for the use of athlete monitoring to assess recovery status is evident since each match elicited different post-match hormonal and neuromuscular responses.
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During rugby game, or intensive rugby training there are many high intensity explosive exercises and eccentric muscle contractions, therefore adequate recovery is very important to rugby players. In the present study we have tested the effects of cold water immersion (CWI) after game-simulated (80 min.) rugby training on muscle power recovery and blood markers of muscle damage. Twenty well-trained collegiate male rugby players (age: 20.3 ± 0.6 years old, body height: 1.74 ± 0.05 m, body weight: 85.4 ± 2.0 kg, body fat: 18.2 ± 1.4 %) volunteered for this study. This study was conducted as a cross-over design; i.e., the subjects were randomly assigned either to CWI (n = 10) or passive rest condition (n = 10) for the 1(st) trial and 1 week later the subjects were switched conditions for the 2(nd) trial. After the simulated rugby training, including tackles and body contacts, muscle functional ability and blood markers of muscle damage were tested immediately, after CWI or passive rest, and again 24 hours later. Statistical analysis of all muscle functional tests (10 m dash, counter movement jump, reaction time, side steps) except for 10 seconds maximal pedaling power and blood makers of muscle damage (aspartate aminotransferase, lactate dehydrogenase, creatine kinase, and creatinine) revealed significant main effects for time (p < 0.05). However, no statistically significant interactions were found in any of the muscle functional tests and blood markers between groups and time courses. Our results suggest that a rugby game induces muscle damage and reduces muscle function. However, CWI has no significant restorative effect after an 80-minute rugby game in terms of muscle damage. Key PointsCold water immersion study for the recovery of rugby playersMuscle strength and muscle power were mainly evaluated as well as muscle enzymes of muscle break downSubjects were highly trained rugby players with control group.
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The Delphi technique is a widely used and accepted method for gathering data from respondents within their domain of expertise. The technique is designed as a group communication process which aims to achieve a convergence of opinion on a specific real-world issue. The Delphi process has been used in various fields of study such as program planning, needs assessment, policy determination, and resource utilization to develop a full range of alternatives, explore or expose underlying assumptions, as well as correlate judgments on a topic spanning a wide range of disciplines. The Delphi technique is well suited as a method for consensus-building by using a series of questionnaires delivered using multiple iterations to collect data from a panel of selected subjects. Subject selection, time frames for conducting and completing a study, the possibility of low response rates, and unintentionally guiding feedback from the respondent group are areas which should be considered when designing and implementing a Delphi study.