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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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... The use of cooling such as cold-water immersion (CWI) has become a popular post-exercise recovery intervention based on the assumption that it can enhance the restoration of physical performance and augment chronic adaptations to training. Cooling has generally been thought to improve recovery by reducing the feelings of muscle soreness, alleviating exercise-induced muscle damage, and decreasing inflammation and edema, as has been discussed in previous reviews [2][3][4][5][6]. Application of local heating is more commonly used in the rehabilitation setting to treat musculoskeletal injuries or to protect muscle from potential damage [7,8]. ...
... Numerous reviews have analyzed the potential effects of cooling [2][3][4][5][6][9][10][11] or heating (combined or not with cooling) [2,3,5,7,10] on post-exercise recovery and training adaptations. In the current review, we postulate that cooling or heating could improve or worsen postexercise recovery and training adaptations depending on the form of exercise (endurance, resistance or sprint exercise) given that the mechanism of exercise-induced fatigue, and thus the potential recovery mechanisms involved, are known to be task-dependent [12,13]. ...
... Numerous reviews have analyzed the potential effects of cooling [2][3][4][5][6][9][10][11] or heating (combined or not with cooling) [2,3,5,7,10] on post-exercise recovery and training adaptations. In the current review, we postulate that cooling or heating could improve or worsen postexercise recovery and training adaptations depending on the form of exercise (endurance, resistance or sprint exercise) given that the mechanism of exercise-induced fatigue, and thus the potential recovery mechanisms involved, are known to be task-dependent [12,13]. ...
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The application of post-exercise cooling (e.g., cold water immersion) and post-exercise heating has become a popular intervention which is assumed to increase functional recovery and may improve chronic training adaptations. However, the effectiveness of such post-exercise temperature manipulations remains uncertain. The aim of this comprehensive review was to analyze the effects of post-exercise cooling and post-exercise heating on neuromuscular function (maximal strength and power), fatigue resistance, exercise performance, and training adaptations. We focused on three exercise types (resistance, endurance and sprint exercises) and included studies investigating (1) the early recovery phase, (2) the late recovery phase, and (3) repeated application of the treatment. We identified that the primary benefit of cooling was in the early recovery phase (< 1 h post-exercise) in improving fatigue resistance in hot ambient conditions following endurance exercise and possibly enhancing the recovery of maximal strength following resistance exercise. The primary negative impact of cooling was with chronic exposure which impaired strength adaptations and decreased fatigue resistance following resistance training intervention (12 weeks and 4–12 weeks, respectively). In the early recovery phase, cooling could also impair sprint performance following sprint exercise and could possibly reduce neuromuscular function immediately after endurance exercise. Generally, no benefits of acute cooling were observed during the 24–72-h recovery period following resistance and endurance exercises, while it could have some benefits on the recovery of neuromuscular function during the 24–48-h recovery period following sprint exercise. Most studies indicated that chronic cooling does not affect endurance training adaptations following 4–6 week training intervention. We identified limited data employing heating as a recovery intervention, but some indications suggest promise in its application to endurance and sprint exercise.
... The application of this method has been reported as highly recommended (ie grade A; high), 8 improving perceptive markers of well-being and fatigue. 2,5,30,31 However, the effect of cold strategies in performance and/or physiological outcomes up to 72 hours after exerciseinduced muscle damage is still unclear 2,5,30,31 and its long term usage may attenuate the development of muscle mass and strength. 2,32 Due to these unwanted effects, and according to Rey et al, 10 the use of cold water immersion should be preferred in the period immediately after a match (which seems to optimize recovery, than performing at latter postmatch periods) 8,10,25-27 and 2 days before the matchday (to attenuate fatigue effects on the matchday). ...
... The application of this method has been reported as highly recommended (ie grade A; high), 8 improving perceptive markers of well-being and fatigue. 2,5,30,31 However, the effect of cold strategies in performance and/or physiological outcomes up to 72 hours after exerciseinduced muscle damage is still unclear 2,5,30,31 and its long term usage may attenuate the development of muscle mass and strength. 2,32 Due to these unwanted effects, and according to Rey et al, 10 the use of cold water immersion should be preferred in the period immediately after a match (which seems to optimize recovery, than performing at latter postmatch periods) 8,10,25-27 and 2 days before the matchday (to attenuate fatigue effects on the matchday). ...
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Purpose: This study investigated the influence of components of fitness on measures of performance attenuation and recovery following Gaelic football match play. Methods: Measurements of players' anthropometric characteristics, body composition, running speed, lower-body strength and power, blood lactate concentrations, running economy, and maximal aerobic capacity (V˙O2max) were taken over 2 separate days 1 week prior to a competitive match. Creatine kinase, countermovement jump height, drop jump height, contact time, reactive strength index, and perceptual responses were tested prematch, at full time, 24 hours postmatch, and 48 hours postmatch. Results: Multiple components of fitness were associated with reduced performance attenuation and improved recovery responses (adjusted R2 = 9.8%-27.6%; P < .05). Players were divided into higher-standard and lower-standard V˙O2max (higher standard: 57.4 [4.2] mL·kg-1·min-1; lower standard: 45.3 [3.8] mL·kg-1·min-1) and relative squat (higher standard: 1.46 [0.11] 1-repetition-maximum kg·body mass-1; lower standard: 1.20 [0.08] 1-repetition-maximum kg·body mass-1) groups. After adjusting for prematch baseline differences, there were significant differences between V˙O2max groups in drop jump height at 24 hours postmatch (ηp2=.078-.154; P < .05) and countermovement jump height at 48 hours postmatch (ηp2=.134; P < .05), where the lower-standard group displayed larger decrements. In addition, there were significant differences between relative squat groups at all postmatch time points in contact time (ηp2=.156-.194; P < .05) and reactive strength index (ηp2=.127-.223; P < .05) and in perceptual responses at 24 hours postmatch (ηp2=.152; P < .05), where the lower-standard group expressed larger decrements. Conclusion: Coaches should prioritize the development of aerobic capacity and neuromuscular function as an effective method of reducing performance attenuation and enhancing recovery kinetics in Gaelic football.
... The application of this method has been reported as highly recommended (ie grade A; high), 8 improving perceptive markers of well-being and fatigue. 2,5,30,31 However, the effect of cold strategies in performance and/or physiological outcomes up to 72 hours after exerciseinduced muscle damage is still unclear 2,5,30,31 and its long term usage may attenuate the development of muscle mass and strength. 2,32 Due to these unwanted effects, and according to Rey et al, 10 the use of cold water immersion should be preferred in the period immediately after a match (which seems to optimize recovery, than performing at latter postmatch periods) 8,10,25-27 and 2 days before the matchday (to attenuate fatigue effects on the matchday). ...
... The application of this method has been reported as highly recommended (ie grade A; high), 8 improving perceptive markers of well-being and fatigue. 2,5,30,31 However, the effect of cold strategies in performance and/or physiological outcomes up to 72 hours after exerciseinduced muscle damage is still unclear 2,5,30,31 and its long term usage may attenuate the development of muscle mass and strength. 2,32 Due to these unwanted effects, and according to Rey et al, 10 the use of cold water immersion should be preferred in the period immediately after a match (which seems to optimize recovery, than performing at latter postmatch periods) 8,10,25-27 and 2 days before the matchday (to attenuate fatigue effects on the matchday). ...
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Background: In football (ie, soccer), the effectiveness of recovery practices is critical to maintain high levels of performance, prevent residual fatigue, and reduce injury risk. However, the recovery methods that professional football teams put in place up to 72 hours postmatch are widely unknown. Purpose: This study aimed to characterize the postmatch recovery practices in Portuguese football teams in different postmatch periods and match locations. Methods: Portuguese football teams (total, N = 56; male: first league [n = 17], second league [n = 16], under-23 league [n = 12]; female: first league, n = 11) participated in the study. The practitioners in charge of recovery strategies in each team filled out the online questionnaire in the middle of the 2019-20 season. The questions focused on the type of recovery methods to be used at different times after home and away matches. Results: After home matches, stretching, electrostimulation, active recovery, and massage were used with higher frequency (P < .017) in later postmatch periods (ie, 12-24, and 24-72 h) compared with immediately postmatch. After away matches, several differences were found (P < .017) for the stretching, electrostimulation, active recovery, cold-water immersion, massage, nutrition, and sleep between postmatch periods. Regarding match location, stretching (r = .19), active recovery (r = .39), cold-water immersion (r = .46), and massage (r = .29) showed a higher frequency of use immediately after home matches. Conversely, the use of compression garments (r = .27) was higher immediately after away matches. Conclusions: It was concluded that in professional football, recovery methods are not applied uniformly along postmatch periods and differ depending on the match location.
... In addition to appropriate nutrition and rest/sleep, a multitude of physical recovery interventions have gained the attention of researchers and athletes (1,2,5). While evidence on many such interventions is equivocal (2,6), the volume and quality of evidence to support the use of compression garments (CG) has increased in recent years (7)(8)(9)(10). Compression appears to be particularly beneficial for recovery from exercise-induced muscle damage (EIMD) (7,8). ...
... Recent analyses have reported that the use of CG is associated with clear and significant improvements to recovery following EIMD (8,24). Indeed, the evidence on CG appears to compare favorably with other recovery interventions (2,(6)(7)(8). The information presented in this review has consolidated recent evidence which suggest that the effects of CG for recovery from EIMD are mediated by compression pressures and display a dose-response relationship (9,23,24). ...
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The use of compression garments (CG) has been associated with improved recovery following exercise-induced muscle damage. The mechanisms responsible are not well established, and no consensus exists regarding the effects of compression pressure (i.e., the “dose”), which until recently was seldom reported. With the increasing prevalence of studies reporting directly measured pressures, the present review aims to consolidate current evidence on optimal pressures for recovery from exercise-induced muscle damage. In addition, recent findings suggesting that custom-fitted garments provide greater precision and experimental control are discussed. Finally, biochemical data from human trials are presented to support a theoretical mechanism by which CG enhance recovery, with recommendations for future research. The effects of compression on adaptation remain unexplored. More studies are required to investigate the relationship between compression pressure and the recovery of performance and physiological outcomes. Furthermore, improved mechanistic understanding may help elucidate the optimal conditions by which CG enhance recovery.
... This causes alternate vasoconstriction and vasodilation of the vessels by the modality and hence improves circulation and this, in turn, helps to reduce pain in case of varicosities. [6] To improve circulation, low-level cold LASER was used for 10 min. This LASER works effectively for reducing pain by improving circulation and releasing nitric oxide in the microcirculation that would in turn prevent pain and comfort the patient. ...
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... The use of COOL could favour the process of re-establishing performance due to 1) facilitating rapid reduction in body temperature and consequently CNS-mediated fatigue; 2) the induction of peripheral vasoconstriction, which in turn stimulates increased venous return and greater removal of muscle by-products accumulated during exercise and 3) combined events 1 and 2 may cause a decrease in cardiovascular tension, ratings of perceived exertion, swelling and muscle pain; COOL has an important analgesic effect (BLEAKLEY & DAVISON, 2010;IHSAN et al., 2016), being able to facilitate the execution of subsequent movements ). However, although asking players into COOL is a conduct capable of originating beneficial effects as above mentioned, mainly associated with wellbeing (ASCENSAO et al., 2011) and/or neuromuscular performance up to 24 h after sports events (HIGGINS et al., 2017), its effectiveness for acute recovery in athletic performance aspects is still controversial, specially relating to motor skills. ...
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Athletic performance is mutually dependent upon individual constraints and practical interventions. Regarding the former, it is recognised that brain activity and sleep indices can modulate movement planning and execution. Concerning the strategies used in practice, contemporary short-term prescriptions have been adopted by conditioning professionals and physiotherapists with the primary intention to acutely enhance musculoskeletal power output or accelerate post-exercise recovery processes. These includes postactivation performance enhancement (PAPE)-based plyometric warm-up and induced cooling (COOL) through ice packs, respectively. However, it remain unknown whether measures of brain dynamics and natural sleep patterns influence skill-related performance in soccer. To date, the literature does not show a consensus for PAPE effectiveness in young populations. Generally, COOL also negatively affects subsequent lower limb movements requiring high force-velocity levels. Based on these assumptions, the general aim of the current thesis was to investigate the influence of internal individual constraints (EEG and sleep-derived indices) and effects of short-term practical interventions (PAPE and COOL) on the movement kinematics and performance aspects of soccer kicking in youth academy players. A series of six studies is presented. These include a literature review, one technical note and four original experimental research articles (two observational and two interventions) in an attempt to answer the questions defined in the research programme. From the data gathered here, it was possible to provide evidence that a) kick testing in studies systematically lacked resemblance to competition environments; b) occipital brain waves during the preparatory phase determines ball placement while late frontal signalling control both ankle joint in impact phase and post-impact ball velocity; c) poor sleep quality and late chronotype preference are linked to subsequent impaired targeting ability; d) acute enhancements achieved via PAPE/plyometric conditioning are purely neuromuscular, being slightly converted into kicking mechanics or performance improvements; e) in a hot environment, repeated high-intensity running efforts impair both ball placement and velocity whilst a local 5-minutes COOL application assists recovery of overall kick parameters and f) a markerless deep learning-based kinematic system appear as reliable alternative in capturing on-field kicking motion patterns. To conclude, both internal individual constraints (EEG and sleep quality) and a short-term practical intervention (cooling quadriceps/hamstrings with ice packs) have an acute impact in kicking performance in youth soccer context. A model integrating evidence from all papers is presented alongside limitations and recommendations for future studies in this field. Keywords: Technical skill; 3-dimensional kinematics; Accuracy; EEG; Human movement; Motor Control; Biomechanics.
... Cold-water immersion (CWI) is one of the most common modalities for athletic muscle recovery . Post-exercise CWI is reported to exert a positive effect on neuromuscular performance and subjective recovery (Higgins et al., 2017). Exercising and assessment of leg muscles are commonly conducted in the area of post-exercise cooling studies, which clearly demonstrate a high relevance of optimal recovery strategies, especially for the knee extensor muscles . ...
... Cold-water immersion (CWI) is one of the most common modalities for athletic muscle recovery . Post-exercise CWI is reported to exert a positive effect on neuromuscular performance and subjective recovery (Higgins et al., 2017). Exercising and assessment of leg muscles are commonly conducted in the area of post-exercise cooling studies, which clearly demonstrate a high relevance of optimal recovery strategies, especially for the knee extensor muscles . ...
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Entender a duração da carreira de um jogador de basquete e os elementos envolvidos neste processo é um aspecto crucial para profissionais que lidam com a preparação física. Assim sendo, neste texto descrevemos algumas particularidades importantes que podem prolongar a longevidade de carreira dos atletas, baseado em dados de jogadores consagrados e o que a literatura científica demonstra sobre este fenômeno. Palavras-chave: basquete, preparação física, longevidade de carreira
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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 BLUF 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. BSTRACT 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.