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Post-exercise Recovery: Cooling and Heating, a Periodized Approach

September 2021
Frontiers in Sports and Active Living 3

DOI:10.3389/fspor.2021.707503

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Authors:

Robin Thorpe

Liverpool John Moores University

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OPINION

published: 01 September 2021

doi: 10.3389/fspor.2021.707503

Frontiers in Sports and Active Living | www.frontiersin.org 1September 2021 | Volume 3 | Article 707503

Edited by:

Robert Allan,

University of Central Lancashire,

United Kingdom

Reviewed by:

James Malone,

Liverpool Hope University,

United Kingdom

Chris Mawhinney,

Mahidol University, Thailand

Susan Y. Kwiecien,

Nicholas Institute of Sports Medicine

and Athletic Trauma (NISMAT),

United States

*Correspondence:

Robin T. Thorpe

robin.thorpe@live.co.uk

Specialty section:

This article was submitted to

Elite Sports and Performance

Enhancement,

a section of the journal

Frontiers in Sports and Active Living

Received: 10 May 2021

Accepted: 29 July 2021

Published: 01 September 2021

Citation:

Thorpe RT (2021) Post-exercise

Recovery: Cooling and Heating, a

Periodized Approach.

Front. Sports Act. Living 3:707503.

doi: 10.3389/fspor.2021.707503

Post-exercise Recovery: Cooling and

Heating, a Periodized Approach

Robin T. Thorpe 1,2

1Football Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool,

United Kingdom, 2College of Health Solutions, Arizona State University, Phoenix, AZ, United States

Keywords: recovery, fatigue, exercise, injury, cooling, heating, muscle damage (DOMS), periodization

RISING IMPORTANCE OF RECOVERY

Recovery is regarded as a multifaceted (e.g., physiological, psychological) restorative process

relative to time and modulated by external load, individual response to stress, and often dictated

by external athletic competition and demand (Kellmann et al., 2018). The increasing physical

demands of athletic competition, particularly, team sports (Barnes et al., 2014), involving high

ﬁxture frequency, has further exacerbated the physical and mental load placed on athletes (Ekstrand

et al., 2018). Athletes are now routinely exposed to longitudinal demands with, in some cases, only

48 h of recovery time between competitions. Fatigue may be deﬁned as “an inability to complete a

task that was once achievable within a recent time frame” (Pyne and Martin, 2011; Halson, 2014)

and derived from central and/or peripheral origins. Recovery time between successive competitions

may be insuﬃcient to allow athletes to fully regenerate leading to fatigue, which may increase the

risk of under-performance, non-functional overreaching, injury, and illness (Dupont et al., 2010;

Bengtsson et al., 2013). Demands are further increased in athletes competing in continental leagues,

play-oﬀ phases, international tournaments, and are further aggravated in circumstances such as the

English Premier League that does not include a winter break (Ekstrand et al., 2018) or in recent

times the eﬀect of the COVID-19 pandemic (Seshadri et al., 2021). Increased athlete training and

competition availability as a result of a reduction in injuries, substantially improves the likelihood

of success of an individual or team (Hägglund et al., 2013). Changes in injury occurrence also have a

signiﬁcant impact, particularly, ﬁnancial implications (team underachievement and player salaries)

of sporting organizations due to injury-related decrements in performance (Eliakim et al., 2020).

Growing demands and the rising importance of improving recovery have also prompted athletes to

inclusively invest in further bespoke personal support in an attempt to accelerate recovery.

EVIDENCE AND PRACTICE: A CONFUSING LANDSCAPE

A certain degree of fatigue, resulting in functional overreaching, is required to mediate adaptations

to training, which drive performance enhancement (Noakes, 2000). However, excessive fatigue

through insuﬃcient recovery may increase susceptibility to non-functional over-reaching, injury,

and illness of the players (Nimmo and Ekblom, 2007). Fatigue can be compensated with recovery

strategies which serve to restore homeostasis on a physiological and psychological level (Kellmann,

2002). Researchers and practitioners alike have investigated the eﬃcacy of commonly utilized

interventions to combat the deleterious eﬀects of athletic training and competition (Barnett, 2006;

Howatson and van Someren, 2008; Nédélec et al., 2012; Dupuy et al., 2018). A recent investigation

(Altarriba-Bartes et al., 2020) reviewing commonly used recovery strategies in professional soccer

found that all teams were utilizing at least one recovery strategy following games; however, the

range of interventions used was substantially diﬀerent between teams with water immersion (cold

Thorpe Recovery Periodization: Cooling and Heating

and hot), massage, and foam rolling representing 74, 70, and 57%

respectively (Altarriba-Bartes et al., 2020).

It is imperative that the origin of fatigue is understood in

order to most eﬀectively return the human body to homeostasis

following exercise. Furthermore, an understanding of the origin

of fatigue may help with tailoring an appropriate recovery

strategy to enhance the accelerated return to homeostasis.

Recovery time from training-induced stress may diﬀer within

and between the diﬀerent organismic systems of the human body

(Kellmann et al., 2018). The increased focus on athlete recovery

within professional sport has naturally been followed by many

scientiﬁc investigations attempting to understand the eﬃcacy of

a range of commonly performed strategies (Howatson and van

Someren, 2008; Leeder et al., 2012). However, few studies have

been able to demonstrate the eﬃcacy of strategies improving

recovery in athletes following training or competition (Bieuzen

et al., 2013; Hill et al., 2014; Dupuy et al., 2018; Davis et al.,

2020).

Much of the positive evidence for recovery strategies lies with

an enhanced perceptual outcome of recovery, often attributed

to an athlete’s belief in the modality or the placebo eﬀect

(Broatch et al., 2014; Wilson et al., 2018). Indeed, evidence

exists whereby recovery strategies have not improved fatigue

levels further than that of the placebo eﬀect (Cook and Beaven,

2013; Broatch et al., 2014; Malta et al., 2019). Research has

traditionally focused on administering one recovery intervention

at a time, whereas in the applied setting athletes are more likely to

administer multiple interventions in varying sequences due to the

many strategies available, of which many lack eﬃcacy (Costello

et al., 2016; Davis et al., 2020; Skorski et al., 2020). Although

extensive, the existing literature base investigating recovery

strategy eﬃcacy still lacks clarity and directional inﬂuence for

practitioners and athletes alike. Much of the data involves

study designs investigating changes in physical performance and

perceptual or muscle damage markers following an exhaustive

protocol or athletic competition (Leeder et al., 2012; Davis et al.,

2020). These methodological variances alongside less realistic

laboratory protocols detached from contextual performance and

investigation of only the acute recovery response (0–72 h),

including sub-elite subject cohorts may be some of the reasons

why inconclusive data exists (i.e., sole strategies performed

across entire recovery continuum), indirectly, creating confusion

for practical application. Movement toward a more periodized

research design approach has occurred where multiple strategies

have been assessed in an attempt to improve recovery (Martínez-

Guardado et al., 2020; Pooley et al., 2020). Reasons for applying

multiple modalities may arise from the fact that athletes are now

exposed to a variety of strategies and professional philosophy,

proposed to enhance recovery, rather than a physiology-based

rationale. Athletes performing multiple strategies rather than a

singular modality may be a step forward; however, a more critical,

evidence-based reasoning for the application of periodizing

varying strategies is required. A better understanding of the exact

physiological systems and mechanisms of fatigue may provide

a clearer landscape into unraveling recovery from exercise,

performance, and injury.

MATCHING THE STRESS AND

INTERVENTION: MONITORING-BASED

PRACTICE

Physical demands of both individual and team sports involve

varying contributions of metabolic and mechanical stress to

tissue. Mechanical stress deriving primarily from eccentric

contractions results in a temporary reduction in muscle function,

an increase in intracellular proteins in the blood, an increase in

perceptual muscle soreness, and evidence of swelling (Howatson

and van Someren, 2008). Thereafter, secondary damage is linked

to the subsequent inﬂammatory response and macrophage and

neutrophil inﬁltration which, further, in isolation compromise

the mechanically stressed area (Merrick, 2002). Metabolic

factors such as reductions in adenosine triphosphate (ATP),

creatine phosphate, glycogen (Krustrup et al., 2006), and pH

(Brophy et al., 2009) may also induce fatigue following exercise.

Biochemical changes in electrolytes and calcium may also

have negative eﬀects alongside hypoxia at the muscle cell level

contributing to metabolic fatigue. Mechanical stress and/or

metabolic fatigue may also contribute to neuromuscular cost

via altered muscle potassium and pH levels (Tee et al., 2007)

and excitation contraction coupling, respectively (Jones, 1996).

Environmental factors and exercise-induced heat generation

(Arbogast and Reid, 2004), which increases the concentration

of nicotinamide adenine dinucleotide phosphate oxidase within

the muscle ﬁber resulting in an increase in the production

of reactive oxygen species from the mitochondria and from

the inﬁltrating inﬂammatory cells (Powers and Jackson, 2008)

further exacerbating potential mechanical damage. The variance

in physiological origin associated with exercise and competition

infers that it is illogical that a single recovery strategy and/or a

generic “one size ﬁts all” approach would accelerate each of the

systems discussed (Minett and Costello, 2015). Evidence exists

where a singular temperature-based strategy applied locally to the

quadriceps over the entire recovery continuum failed to further

accelerate recovery beyond the acute period (0-72 h), albeit,

following severe marathon running–derived mechanical and

metabolic stress (Kwiecien et al., 2020a,b). Moreover, Petersen

and Fyfe (2021) suggested, from a chronic perspective, long-term

application of a singular intervention may have disadvantages

relating to adaptation (Petersen and Fyfe, 2021). It appears

that a binary perspective to recovery has arisen within the

literature, which in turn may have inﬂuenced the applied setting.

Alternatively, a framework where strategies are periodized to

match the individual symptoms, organismic fatigued system,

external load or the response to stress may be a more preferred

approach (Thorpe et al., 2017; Kellmann et al., 2018). Indeed,

monitoring of recovery or the response to load may provide

insights into the exact physiological stress an athlete is currently

experiencing. A recent review stated that the quantiﬁcation

of physiological stress via athlete response outcome measures,

athlete self-report, heart rate-derived autonomic nervous system,

neuromuscular functional jump/eccentric/concentric/isometric

protocols, biochemical/immunological/endocrine, and joint

range of motion could improve practical prescription of

Frontiers in Sports and Active Living | www.frontiersin.org 2September 2021 | Volume 3 | Article 707503

Thorpe Recovery Periodization: Cooling and Heating

modalities in enhancing recovery (Thorpe et al., 2017). For

example, assessing changes in perceived muscle soreness or

the autonomic nervous system via heart rate-derived metrics

(heart rate variability and/or heart rate recovery) may establish

whether or not an athlete is experiencing symptoms associated

with mechanical damage (Dupuy et al., 2018), thus a gateway

to understanding and quantifying which strategies may be

most appropriate for improving this fatigued system. Attention

ought to be prioritized to framework strategies that match the

associated physiological stress along the recovery continuum in

a systematic manner.

TEMPERATURE-DERIVED APPROACH:

PERIODIZING COOLING AND HEATING

Beyond sleep, nutrition, and hydration, recent work has focused

on the application of various temperature-based modalities

in an attempt to accelerate recovery (McGorm et al., 2018;

Kwiecien and McHugh, 2021). Indeed, among the vast array

of recovery strategies commonly used by athletes, temperature-

based modalities have shown the most promise, although, still

the data are inconclusive (Jakeman et al., 2009; Stanley et al.,

2012; Broatch et al., 2014). One of the most common recovery

strategies used is cryotherapy, or the application of cooling

(Altarriba-Bartes et al., 2020). Cooling has been performed for

decades in relation to injury, and intuitively, transferred to

recovery from exercise in more recent times. Topical cooling,

cold water immersion, whole body cryotherapy, and more

recently phase change material are most commonly used in

both the clinical and professional sports settings (Kwiecien

and McHugh, 2021). The mechanistic response between these

modalities has been shown to diﬀer and in some circumstances

provides a completely diﬀerent physiological eﬀect (Mawhinney

et al., 2017; Kwiecien and McHugh, 2021). The ultimate

objective for cooling is to reduce deep muscle temperature,

in an attempt to favorably reduce blood ﬂow and metabolism

at the aﬀected muscle site, in an eﬀort to diminish the

secondary damage phase (Merrick, 2002). A recent review

suggested that repeat application or elongating cooling time

would lead to the most advantageous results in reducing deep

muscle temperature, in turn, the proliferation of the secondary

damage phase (Kwiecien and McHugh, 2021). Importantly,

local changes in muscle temperature (cooling or heating) may

inﬂuence enzymatic activity and eﬀect rates of intramuscular

glycogen resynthesis (Cheng et al., 2017). Indeed, research has

also investigated the eﬀects of heating regarding performance,

adaptation, and to a lesser extent recovery (McGorm et al.,

2018). Heat therapy including hot water immersion has not

been widely investigated in terms of athletic recovery, although,

anecdotally performed frequently in athletes across many sports

(Altarriba-Bartes et al., 2020). Data exists supporting heating

for stimulating local blood supply and metabolism in tissues,

and emerging evidence indicate that heat activates more speciﬁc

molecular events, including changes in gene expression, anti-

inﬂammatory and antioxidant eﬀects, glycogen resynthesis,

mitochondrial biogenesis, heat shock protein expression, and

cellular healing (Hoekstra et al., 2008; McGorm et al., 2018;

Nadarajah et al., 2018). Data from animal and human studies

have shown metabolic-based recovery to be accelerated following

heat application which in turn modiﬁed the release of tetanic

[Ca2+] and glycogen resynthesis rates compared to cooling

(Cheng et al., 2017). Considering the existing evidence of

the possible recovery kinetics to both cooling and heating, it

appears that increasing or decreasing tissue temperature may

provide advantageous responses at varying points on the recovery

continuum, which are associated to mechanical damage and

metabolic fatigue.

A PRACTICAL GUIDE

An array of diﬀerent strategies are used by athletes in an

attempt to alleviate the deleterious symptoms associated with

exercise and competition (Nédélec et al., 2013; Altarriba-

Bartes et al., 2020). However, there is a lack of consensus

in how to design and prescribe strategies in improving the

multifactorial systems of recovery. It appears that the ﬁrst

and most critical physiological event to attempt to mediate

is the secondary damage phase shortly following mechanical

damage. The latest evidence suggests that prolonged cooling

is the most suitable intervention (Kwiecien and McHugh,

2021). Cooling via water immersion (in some cases multiple

exposures) or local phase change material has been shown to

have the most eﬀective results in reducing tissue temperature

(Mawhinney et al., 2017; Kwiecien et al., 2020b). Hereafter,

and to promote removal and enhanced transportation of

metabolic byproducts, and possible modulation of cellular

healing, hemodynamics and substrate resynthesis (McGorm

et al., 2018) heating is preferred via sauna microwave diathermy,

water-perfused garments, hot water immersion, or steam/heat

sheets (Hyldahl and Peake, 2020). This proposed framework

(Figure 1) may be individualized based on the proportionate

expense of mechanical and metabolic fatigue and whereby

increasing or decreasing tissue temperature beyond purely an

individualized approach, and when response to load/fatigue

monitoring is limited (Thorpe et al., 2017), periodizing strategies

to not only consolidate recovery across a training period but

also in an attempt to enhance adaptation is proposed. Indeed,

sequencing cooling strategies following endurance dominant

stress or heating strategies following strength-derived stress may

induce advantageous gene expression-related adaptations (Allan

et al., 2017; Cheng et al., 2017; Hyldahl and Peake, 2020). The

role of cooling and heating modalities should be chosen in

reﬂection of external physical demand and matched accordingly

to negate any contraindicative eﬀect to adaptation interactions

(Peake et al., 2020).

There is a clear physical and mental stress induced by

exercise, competition, and acute injury. A unique physiological

and immunological cascade then ensues. Identifying the diﬀerent

and proportionate mechanistic alterations is paramount in order

to mitigate against further reduced performance, injury, and

illness risk. Prioritizing sleep, rest, nutrition, hydration, and joint

range of motion during this phase is fundamental, thereafter,

Frontiers in Sports and Active Living | www.frontiersin.org 3September 2021 | Volume 3 | Article 707503

Thorpe Recovery Periodization: Cooling and Heating

FIGURE 1 | Practical framework to enhance recovery in athletes. Following external and internal load–stress response outcome measures, including, self-report

[soreness (DOMS), perceived fatigue, sleep quality]; heart rate-derived autonomic nervous system [heart rate variability (HRV), heart rate recovery (HRR), submaximal

heart rate (HRex)]; performance/neuromuscular functional assessment (force–time jump, eccentric, concentric, isometric protocols); and

biochemical/immunological/endocrine (creatine kinase, IL-6, C-reactive protein) may be used to distinguish limiting components of physiological fatigue systems

{structural damage [mechanical stress, direct insult, increases in temperature and nicotinamide adenine dinucleotide phosphate oxidase (NOX), and mitochondrial

reactive oxygen species (ROS)] and metabolic fatigue [ﬂuctuations in adenosine triphosphate (ATP), creatine phosphate, glycogen, pH, electrolytes, calcium, and

muscle potassium]} following exercise and injury. Following an initial fundamental strategy (optimal sleep, nutrition, hydration, and joint range of movement) the use of

cooling (topical icing/phase change material, cold water immersion, whole body cryotherapy) and heating (sauna, microwave diathermy water-perfused garments, hot

water immersion or steam/heat sheets) strategies may be used systematically and independently to match the stress to assist in alleviating structural damage

(secondary damage, soreness, swelling, and parasympathetic reactivation) and/or metabolic fatigue (muscle protein, IGF-1, satellite cells, soreness, swelling, ﬁbrosis,

and gene expression), respectively.

recovery interventions should be considered that alleviate the

particular physiological stress incurred at any given time point

on the recovery continuum (Kellmann et al., 2018). Reducing

tissue temperature via cooling has shown to mediate secondary

damage derived from mechanical stress (Merrick, 2002), whereas

heating has been shown to enhance tissue temperature, blood

ﬂow, and metabolism alleviating metabolic-associated fatigue

(McGorm et al., 2018). Identifying origins of fatigue via

the use of practical monitoring processes is recommended

for individualization of recovery strategy prescription (Thorpe

et al., 2017). In the absence of fatigue monitoring, a generic

approach in which reducing secondary damage via cooling as

the initial strategy followed by heating once the inﬂammatory

cascade diminishes is recommended because of the timeline and

functional detrimental properties of this process. The utilization

of cooling and heating to navigate and facilitate the associated

perturbations may be considered appropriate to accelerate

recovery via the diﬀerent physiological demands in athletes. A

periodized, systematic recovery process matching appropriate

thermoregulatory strategies to associated physiological systems

should be considered as a framework to enhance recovery

in athletes.

AUTHOR CONTRIBUTIONS

The author conﬁrms being the sole contributor of this work and

has approved it for publication.

REFERENCES

Allan, R., Sharples, A. P., Close, G. L., Drust, B., Shepherd, S. O., Dutton, J., et al.

(2017). Postexercise cold water immersion modulates skeletal muscle PGC-1α

mRNA expression in immersed and nonimmersed limbs: evidence of systemic

regulation. J. Appl. Physiol. 123, 451–459. doi: 10.1152/japplphysiol.00096.2017

Altarriba-Bartes, A., Peña, J., Vicens-Bordas, J., Casals, M., Peirau, X., and

Calleja-González, J. (2020). The use of recovery strategies by Spanish ﬁrst

division soccer teams: a cross-sectional survey. Phys. Sportsmed. 18:19150.

doi: 10.1080/00913847.2020.1819150

Arbogast, S., and Reid, M. B. (2004). Oxidative Stress Oxidant activity in skeletal

muscle ﬁbers is inﬂuenced by temperature, CO2level, and muscle-derived

Frontiers in Sports and Active Living | www.frontiersin.org 4September 2021 | Volume 3 | Article 707503

Thorpe Recovery Periodization: Cooling and Heating

nitric oxide. Am. J. Physiol. Regulat. Integrat. Comparat. Physiol. 298, 698–705.

doi: 10.1152/ajpregu.00072.2004

Barnes, C., Archer, D. T., Hogg, B., Bush, M., and Bradley, P. S. (2014). The

evolution of physical and technical performance parameters in the English

Premier League. Int. J. Sports Med. 35, 1095–1100. doi: 10.1055/s-0034-1375695

Barnett, A. (2006). Using recovery modalities between training

sessions in elite athletes: does it help? Sports Med. 36, 781–96.

doi: 10.2165/00007256-200636090-00005

Bengtsson, H., Ekstrand, J., and Hägglund, M. (2013). Muscle injury rates in

professional football increase with ﬁxture congestion: an 11-year follow-up

of the UEFA champions league injury study. Br. J. Sports Med. 47, 743–747.

doi: 10.1136/bjsports-2013-092383

Bieuzen, F., Bleakley, C. M., and Costello, J. T. (2013). Contrast water therapy and

exercise induced muscle damage: a systematic review and meta-analysis. PLoS

ONE 8:e62356. doi: 10.1371/journal.pone.0062356

Broatch, J. R., Petersen, A., and Bishop, D. J. (2014). Postexercise cold water

immersion beneﬁts are not greater than the placebo eﬀect. Med. Sci. Sports

Exerc. 46, 2139–2147. doi: 10.1249/MSS.0000000000000348

Brophy, R. H., Chiaia, T. A., Maschi, R., Dodson, C. C., Oh, L. S., Lyman, S., et al.

(2009). The core and hip in soccer athletes compared by gender. Int. J. Sports

Med. 30, 663–667. doi: 10.1055/s-0029-1225328

Cheng, A. J., Willis, S. J., Zinner, C., Chaillou, T., and Ivarsson, N., Ørtenblad,

N., et al. (2017). Post-exercise recovery of contractile function and endurance

in humans and mice is accelerated by heating and slowed by cooling skeletal

muscle. J. Physiol. 595, 7413–7426. doi: 10.1113/JP274870

Cook, C. J., and Beaven, C. M. (2013). Individual perception of recovery is

related to subsequent sprint performance. Br. J. Sports Med. 47, 705–709.

doi: 10.1136/bjsports-2012-091647

Costello, J. T., Baker, P. R., Minett, G. M., Bieuzen, F., Stewart, I. B., and Bleakley, C.

(2016). Cochrane review: whole-body cryotherapy (extreme cold air exposure)

for preventing and treating muscle soreness after exercise in adults. J. Evid.

Based. Med. 9, 43–44. doi: 10.1111/jebm.12187

Davis, H. L., Alabed, S., and Chico, T. J. A. (2020). Eﬀect of sports massage on

performance and recovery: a systematic review and meta-analysis. BMJ Open

Sport Exerc. Med. 6:e000614. doi: 10.1136/bmjsem-2019-000614

Dupont, G., Nedelec, M., McCall, A., McCormack, D., Berthoin, S., and Wisløﬀ, U.

(2010). Eﬀect of 2 soccer matches in a week on physical performance and injury

rate. Am. J. Sports Med. 38, 1752–1758. doi: 10.1177/0363546510361236

Dupuy, O., Douzi, W., Theurot, D., Bosquet, L., and Dugu,é, B. (2018).

An evidence-based approach for choosing post-exercise recovery

techniques to reduce markers of muscle damage, Soreness, fatigue, and

inﬂammation: a systematic review with meta-analysis. Front. Physiol. 9:403.

doi: 10.3389/fphys.2018.00403

Ekstrand, J., Spreco, A., and Davison, M. (2018). Elite football teams that do not

have a winter break lose on average 303 player-days more per season to injuries

than those teams that do: a comparison among 35 professional European teams.

Br. J. Sports Med. 53:9506. doi: 10.1136/bjsports-2018-099506

Eliakim, E., Morgulev, E., Lidor, R., and Meckel, Y. (2020). Estimation

of injury costs: ﬁnancial damage of English Premier League teams’

underachievement due to injuries. BMJ Open Sport Exercise Med.

6:e000675.doi: 10.1136/bmjsem-2019-000675

Hägglund, M., Waldén, M., Magnusson, H., Kristenson, K., Bengtsson, H., and

Ekstrand, J. (2013). Injuries aﬀect team performance negatively in professional

football: an 11-year follow-up of the UEFA champions league injury study. Br.

J. Sports Med. 47, 738–742. doi: 10.1136/bjsports-2013-092215

Halson, S. L. (2014). Monitoring training load to understand fatigue in athletes.

Sports Med. 44(Suppl 2), S139–S147. doi: 10.1007/s40279-014-0253-z

Hill, J., Howatson, G., van Someren, K., Leeder, J., and Pedlar, C.

(2014). Compression garments and recovery from exercise-induced

muscle damage: a meta-analysis. Br. J. Sports Med. 48, 1340–1346.

doi: 10.1136/bjsports-2013-092456

Hoekstra, S. P., Bishop, N. C., Faulkner, S. H., Bailey, S. J., and Leicht, C. A.

(2008). Acute and chronic eﬀects of hot water immersion on inﬂammation

and metabolism in sedentary, overweight adults. J. Appl. Physiol. 125.

doi: 10.1152/japplphysiol.00407.2018.-Regular

Howatson, G., and van Someren, K. A. (2008). The prevention and

treatment of exercise-induced muscle damage. Sports Med. 38, 483–503.

doi: 10.2165/00007256-200838060-00004

Hyldahl, R. D., and Peake, J. M. (2020). Combining cooling or heating

applications with exercise training to enhance performance and muscle

adaptations. J. Appl. Physiol. 129, 353–365. doi: 10.1152/japplphysiol.00322.

2020

Jakeman, J. R., Macrae, R., and Eston, R. (2009). A single 10-min bout of cold-

water immersion therapy after strenuous plyometric exercise has no beneﬁcial

eﬀect on recovery from the symptoms of exercise-induced muscle damage.

Ergonomics 52, 456–460. doi: 10.1080/00140130802707733

Jones, D. A. (1996). High-and low-frequency fatigue revisited. Acta Physiol. Scand.

156, 265–270. doi: 10.1046/j.1365-201X.1996.192000.x

Kellmann, M. (2002). Enhancing Recovery: Preventing Underperformance in

Athletes. Available online at: https://books.google.com/books?hl=enandlr=

andid=Qp-WkTxvlvICandoi=fndandpg=PP9anddq=Kellmann$+$M$+

$ed.$+$Enhancing$+$Recovery:$+$Preventing$+$Underperformance$+

$in$+$Athletes.$+$Champaign,$+$IL:$+$Human$+$Kinetics%3B$+

$2002andots$=$qK_yAWdi9Oandsig$=$h9SurdzrK0BYpOyJ9i7yQuEwUr4

(accessed May 20, 2021).

Kellmann, M., Bertollo, M., Bosquet, L., Brink, M., Coutts, A. J., Duﬃeld, R., et al.

(2018). Recovery and performance in sport: consensus statement. Int. J. Sports

Physiol. Perform. 13, 240–245. doi: 10.1123/ijspp.2017-0759

Krustrup, P., Mohr, M., Steensberg, A., Bencke, J., Kjaer, M., and Bangsbo,

J. (2006). Muscle and blood metabolites during a soccer game:

implications for sprint performance. Med. Sci. Sports Exerc. 38, 1165–1174.

doi: 10.1249/01.mss.0000222845.89262.cd

Kwiecien, S. Y., and McHugh, M. P. (2021). The cold truth: the role of cryotherapy

in the treatment of injury and recovery from exercise. Eur. J. Appl. Physiol. 1–18.

doi: 10.1007/s00421-021-04683-8

Kwiecien, S. Y., McHugh, M. P., Hicks, K. M., Keane, K. M., and Howatson,

G. (2020a). Prolonging the duration of cooling does not enhance

recovery following a marathon. Scand. J. Med. Sci. Sport. 31:13822.

doi: 10.1111/sms.13822

Kwiecien, S. Y., McHugh, M. P., and Howatson, G. (2020b). Don’t lose your

cool with cryotherapy: the application of phase change material for prolonged

cooling in athletic recovery and beyond. Front. Sport. Act. living 2:118.

doi: 10.3389/fspor.2020.00118

Leeder, J., Gissane, C., van Someren, K., Gregson, W., and Howatson, G.

(2012). Cold water immersion and recovery from strenuous exercise: a

meta-analysis. Br. J. Sports Med. 46, 233–240. doi: 10.1136/bjsports-2011-

090061

Malta, E. D. S., De Lira, F. S., Machado, F. A., Zago, A. S., Do Amaral, S. L.,

and Zagatto, A. M. (2019). Photobiomodulation by led does not alter muscle

recovery indicators and presents similar outcomes to cold-water immersion

and active recovery. Front. Physiol. 10:1948. doi: 10.3389/fphys.2018.

01948

Martínez-Guardado, I., Rojas-Valverde, D., Gutiérrez-Vargas, R., Ugalde Ramírez,

A., Carlos Gutiérrez-Vargas, J., and Sánchez-Ureña, B. (2020). Intermittent

pneumatic compression and cold water immersion eﬀects on physiological and

perceptual recovery during multi-sports international championship. J. Funct.

Morphol. Kinesiol. Artic. 5:45. doi: 10.3390/jfmk5030045

Mawhinney, C., Low, D. A., Jones, H., Green, D. J., Costello, J. T., and

Gregson, W. (2017). Cold water mediates greater reductions in limb blood

ﬂow than whole body cryotherapy. Med. Sci. Sports Exerc. 49, 1252–1260.

doi: 10.1249/MSS.0000000000001223

McGorm, H., Roberts, L. A., Coombes, J. S., and Peake, J. M. (2018). Turning

up the heat: an evaluation of the evidence for heating to promote exercise

recovery, muscle rehabilitation and adaptation. Sport. Med. 48, 1311–1328.

doi: 10.1007/s40279-018-0876-6

Merrick, M. (2002). Secondary injury after musculoskeletal trauma: a review and

update. J. Athl. Train. 37:209.

Minett, G. M., and Costello, J. T. (2015). Speciﬁcity and context in post-

exercise recovery: it is not a one-size-ﬁts-all approach. Front. Physiol. 6:130.

doi: 10.3389/fphys.2015.00130

Nadarajah, S., Ariyagunarajah, R., and Jong, E. D. (2018). Cryotherapy: not as cool

as it seems. J. Physiol. 596, 561–562. doi: 10.1113/JP275665

Nédélec, M., McCall, A., Carling, C., Legall, F., Berthoin, S., and Dupont,

G. (2012). Recovery in soccer: part I—post-match fatigue and time course

of recovery. Sports Med. 42, 997–1015. doi: 10.2165/11635270-000000000-

00000

Frontiers in Sports and Active Living | www.frontiersin.org 5September 2021 | Volume 3 | Article 707503

Thorpe Recovery Periodization: Cooling and Heating

Nédélec, M., McCall, A., Carling, C., Legall, F., Berthoin, S., and Dupont, G.

(2013). Recovery in soccer : part ii-recovery strategies. Sports Med. 43, 9–22.

doi: 10.1007/s40279-012-0002-0

Nimmo, M. A., and Ekblom, B. (2007). Fatigue and illness in athletes. J. Sports Sci.

25 Suppl 1, S93–102. doi: 10.1080/02640410701607379

Noakes, T. D. (2000). Physiological models to understand exercise fatigue and the

adaptations that predict or enhance athletic performance. Scand. J. Med. Sci.

Sport. 10, 123–145. doi: 10.1034/j.1600-0838.2000.010003123.x

Peake, J. M., Markworth, J. F., Cumming, K. T., Aas, S. N., Roberts, L. A.,

Raastad, T., et al. (2020). The eﬀects of cold water immersion and active

recovery on molecular factors that regulate growth and remodeling of skeletal

muscle after resistance exercise. Front. Physiol. 11:737. doi: 10.3389/fphys.2020.

00737

Petersen, A. C., and Fyfe, J. J. (2021). Post-exercise cold water immersion

eﬀects on physiological adaptations to resistance training and the underlying

mechanisms in skeletal muscle: a narrative review. Front. Sport. Act. Living

3:291. doi: 10.3389/fspor.2021.660291

Pooley, S., Spendiﬀ, O., Allen, M., and Moir, H. J. (2020). Comparative

eﬃcacy of active recovery and cold water immersion as post-match

recovery interventions in elite youth soccer. J. Sports Sci. 38, 1423–1431.

doi: 10.1080/02640414.2019.1660448

Powers, S. K., and Jackson, M. J. (2008). Exercise-induced oxidative stress:

cellular mechanisms and impact on muscle force production. Physiol. Rev. 88,

1243–1276. doi: 10.1152/physrev.00031.2007

Pyne, D. B., and Martin, D. T. (2011). “Fatigue Insights from individual and team

sports,” in Regulation of Fatigue in Exercise, ed F. E. Marino (New York, NY:

Nova Science).

Seshadri, D. R., Thom, M. L., Harlow, E. R., Drummond, C. K., and Voos, J. E.

(2021). Case report: return to sport following the COVID-19 lockdown and its

impact on injury rates in the german soccer league. Front. Sport. Act. Living

3:604226. doi: 10.3389/fspor.2021.604226

Skorski, S., Schimpchen, J., Pfeiﬀer, M., Ferrauti, A., Kellmann, M., and Meyer, T.

(2020). Eﬀects of postexercise sauna bathing on recovery of swim performance.

Int. J. Sports Physiol. Perform. 15, 934–940. doi: 10.1123/ijspp.2019-

0333

Stanley, J., Buchheit, M., Peake, J. M., and Kondo, N. (2012). The eﬀect of post-

exercise hydrotherapy on subsequent exercise performance and heart rate

variability. Eur. J. Appl. Physiol. 112, 951–961. doi: 10.1007/s00421-011-2052-7

Tee, J. C., Bosch, A. N., and Lambert, M. I. (2007). Metabolic

consequences of exercise-induced muscle damage. Sport. Med. 37,

827–836. doi: 10.2165/00007256-200737100-00001

Thorpe, R. T., Atkinson, G., Drust, B., and Gregson, W. (2017). Monitoring fatigue

status in elite team sport athletes: implications for practice. Int. J. Sports Physiol.

Perform. 12, 1–25. doi: 10.1123/ijspp.2016-0434

Wilson, L. J., Cockburn, E., Paice, K., Sinclair, S., Faki, T., Hills, F. A., et al. (2018).

Recovery following a marathon: a comparison of cold water immersion, whole

body cryotherapy and a placebo control. Eur. J. Appl. Physiol. 118, 153–163.

doi: 10.1007/s00421-017-3757-z

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Frontiers in Sports and Active Living | www.frontiersin.org 6September 2021 | Volume 3 | Article 707503

Normalization of rapid force to peak force in an isometric hamstring assessment using force plates

Article

Full-text available

Jun 2024

Purpose: The aim of this investigation was to determine the reliability of normalizing rapid force (RF) production to peak force assessed during an isometric knee flexor assessment, and to present a novel method of classifying athletes' potential training needs within the 90À90 isometric hamstring assessment. Procedures: Twenty elite female soccer players (age: 20.7 § 4.7 years; height: 168.2 § 5.5 cm; body mass: 62.8 § 7.0 kg), with no recent (>6 months) history of hamstring strain injury, volunteered to participate in the study. Following a standardized warm-up, each participant performed three maximal isometric hamstring contractions, with their heel resting on a force plate, elevated on a box, to ensure that their hips and knees were at 90°Data was analyzed to determine peak for (PF), RF was established as force expressed at 100 ms (F100) and force expressed at 200 ms (F200), with force at each time-point subsequently normalized to a percentage of PF. Findings: F100 and F200 normalized to PF demonstrated good absolute reliability (%CV = 6.12À7.62) and moderate relative reliability (ICC = 0.689À0.703). Concurrently observing PF and normalized F100 and F200 could provide clear training and monitoring goals. Conclusions: Normalizing measures of RF production, including F100 and F200, to PF can be performed reliability. Therefore, could be tracked overtime to identify changes as an effect of training or for fatigue monitoring purposes. However, further research is required to determine how knee flexor force-time characteristics change in relation to focused training and how these characteristics change in response to fatiguing activities.

Recovery management in sport: Overview and outcomes of a nine-year multicenter research program

Article

Jan 2024

The nine-year multicenter research project, titled REGman—Optimization of Training and Competition: Management of Regeneration in Elite Sports—aimed to advance the understanding of recovery management in sports and generate practical recommendations. In this article, we outline the overarching research program that links the specific research strands and outputs during the two federal funding cycles (2012–2021) and summarize the main project findings. The two-stage conceptual framework involved investigating monitoring measures for short-term fatigue and recovery, as well as assessing the efficacy of various recovery interventions. These interventions encompassed psychological relaxation and recovery strategies, sleep, cooling techniques like precooling, percooling, cold water immersion, or whole-body cryotherapy, compression garments, active recovery, stretching, heating interventions such as sauna or contrast water therapy, massage, and foam rolling. The findings revealed inconclusive or marginal effects of recovery interventions at the group level, while indicating possible interindividual differences in responses. Additionally, the findings highlighted the effectiveness of diverse monitoring measures, showing satisfactory sensitivity in tracking performance changes related to fatigue and recovery. The use of individualized reference ranges significantly improved classification accuracy compared to group-based reference ranges. Athletes and coaches are encouraged to prioritize fundamental aspects of training and recovery: meticulous training planning and execution, effective sleep management, and proper nutrition. Furthermore, monitoring and analyzing individual responses, even though it demands suitable methodologies and presents challenges in high-performance sports environments, can yield valuable insights for personalized recovery management. If these aspects are comprehensively addressed, and resources allow, additional recovery strategies might be explored.

An Evidence-Based Approach to Utilizing Cold Therapies for Post-Exercise Recovery

Article

Full-text available

Oct 2024

Whilst cold therapies such as cold-water immersion are regularly used in practice, the practical application does not always align with best practices. In this commentary, we highlight the key components of the British Association of Sport and Exercise Sciences (BASES) Expert Statement on the use of cooling therapies for post-exercise recovery and provide additional discussion on the empirical evidence and rationale that informed our perspective. We developed a series of specific questions to ensure that cold therapy recovery protocols are context-specific and tailored to the needs of the individual athletes. These questions, which cover the WHEN, WHAT, and HOW of cold therapy, were central to the development of the Expert Statement. This was presented as a decision tree to ensure that key messages could be concisely disseminated across a range of sporting environments and populations (e.g., gyms, locker rooms, and treatment rooms), supporting and informing decision-making for those wanting to use cold therapy to assist their recovery in line with previously published peer-reviewed work. Discussion points included the suitability of cooling therapies in some contexts, how athletes' choice of cooling mode should be largely driven by practicalities (e.g., budget and availability), and, lastly, future research directions.

The model of the brain as a complex system: Interactions of physical, neural and mental states with neurocognitive functions

Article

Full-text available

May 2024
CONSCIOUS COGN

The isolated approaching of physical, neural and mental states and the binary classification into stable traits and fluctuating states previously lead to a limited understanding concerning underlying processes and possibilities to explain, measure and regulate neural and mental performance along with the interaction of mental states and neurocognitive traits. In this article these states are integrated by i) differentiating the model of the brain as a complex, self-organizing system, ii) showing possibilities to measure this model, iii) offering a classification of mental states and iv) presenting a holistic operationalization of state regulations and trait trainings to enhance neural and mental high-performance on a macro-and micro scale. This model integrates current findings from the theory of constructed emotions, the theory of thousand brains and complex systems theory and yields several testable hypotheses to provide an integrated reference frame for future research and applied target points to regulate and enhance performance.

Relationship Between Thermography Assessment and Hamstring Isometric Test in Amateur Soccer Players

Chapter

Sep 2023
Lect Notes Comput Sci

Infrared thermography allows for the measurement of skin temperature (Tsk) to identify regions at risk of injury or pathology through thermal asymmetries. Isometric strength test has been shown to be a valid analysis to assess muscle strength and detect asymmetries. The objective was to analyze whether there is a relationship between the thermal asymmetries provided by thermography and the asymmetries observed in an isometric test. 31 amateur soccer players (Age: 20.51 ± 3.4; Weight: 71.72 ± 6.7; Height: 173.42 ± 4.7cm) were analyzed with thermography to extract the Tsk from the posterior thigh region of interest (ROI). On the other hand, subjects performed 90:90 hamstring isometric test. A Pearson correlation test was implemented with a significance level set at (p < 0.005). Results: The analysis of the Pearson correlation test did not show a significant correlation between any of the ROIs of the hamstring and the strength measurement parameters of the isometric test (Hams Cent. ROI (r = −0,10; p = 0,58); Hams Int. ROI (r = 0,00; p = 0,99); Hams Ext. ROI (r = −0,32; p = 0,07)). Furthermore, other ROIs of the legs also did not show a relationship with the newtons exerted in the isometric test (Popliteus ROI (r = −0,15; p = 0,39); Calf Int. ROI (r = −0,17; p = 0,34). Conclusions: There is no direct relationship between the isometric isolated manifestation of force and the temperature asymmetry of the posterior thigh computed by ThermoHuman. These results could suggest that both tests need to be performed in isolation because they provide complementary and unrelated information.

Acute Recovery after a Fatigue Protocol Using a Recovery Sports Legging: An Experimental Study

Article

Full-text available

Sep 2023
SENSORS-BASEL

Citation: Silva, G.; Goethel, M.; Machado, L.; Sousa, F.; Costa, M.J.; Magalhães, P.; Silva, C.; Midão, M.; Leite, A.; Couto, S.; et al. Acute Recovery after a Fatigue Protocol Using a Recovery Sports Legging: An Experimental Study. Sensors 2023, 23, 7634. https://doi.org/10.3390/ s23177634 Academic Editors: Abstract: Enhancing recovery is a fundamental component of high-performance sports training since it enables practitioners to potentiate physical performance and minimise the risk of injuries. Using a new sports legging embedded with an intelligent system for electrostimulation, localised heating and compression (completely embodied into the textile structures), we aimed to analyse acute recovery following a fatigue protocol. Surface electromyography-and torque-related variables were recorded on eight recreational athletes. A fatigue protocol conducted in an isokinetic dynamometer allowed us to examine isometric torque and consequent post-exercise acute recovery after using the sports legging. Regarding peak torque, no differences were found between post-fatigue and post-recovery assessments in any variable; however, pre-fatigue registered a 16% greater peak torque when compared with post-fatigue for localised heating and compression recovery methods. Our data are supported by recent meta-analyses indicating that individual recovery methods, such as localised heating, electrostimulation and compression, are not effective to recover from a fatiguing exercise. In fact, none of the recovery methods available through the sports legging tested was effective in acutely recovering the torque values produced isometrically.

Early Versus Late Rapid Force Production During Single-Joint Isometric Hamstring Assessment Using Force Plates

Article

Aug 2024
J STRENGTH COND RES

Ripley, NJ, Barber, R, Fahey, JT, and Comfort, P. Early versus late rapid force production during single-joint isometric hamstring assessment using force plates. J Strength Cond Res XX(X): 000–000, 2024—The aim of this study was to assess differences in time-matched early versus late rapid force (RF) development in female soccer players in the 90-90 isometric hamstring assessment. Twenty-one elite female soccer players (age: 20.7 ± 4.7 years; height: 168.2 ± 5.5 cm; body mass: 62.8 ± 7.0 kg), with no recent (>6 months) history of hamstring strain injury, volunteered to participate in the study. Following a standardized warm-up, each subject performed 3 maximal isometric unilateral hamstring contractions, with their heel resting on a force plate, elevated on a box, to ensure that their hips and knees were at 90°. Data were analyzed to determine peak force, early RF (ERF) 0–100 milliseconds and late RF (LRF) 100–200 milliseconds. Significant and large differences were observed in the percentage of peak force achieved between ERF (52.85 ± 11.53%; 54.99 ± 9.80%) and LRF (15.82 ± 5.58%; 15.25 ± 3.91%) for the left and right limbs, respectively ( p < 0.001, g = 2.13–3.06). The large differences between ERF and LRF can be used by practitioners to streamline performance assessment, which in turn will allow practitioners to act upon data collected more effectively. Additionally, regular monitoring ERF production could inform practitioners of any interventions that maybe required, such as reduction of load or introduction of specific recovery modalities and during return to play protocols.

Scientific Assessment of Contrast Therapy in Exercise Recovery: A Meta-Analytical Approach

Article

May 2024

Contrast therapy’s effects have varied across studies, necessitating an examination of its effect size. Therefore, this study aimed to validate the efficacy of contrast therapy on post-exercise recovery through a meta-analysis of exercise performance and physiological variables. Searches were conducted in electronic databases with the keywords "contrast therapy," "exercise performance," and "recovery”. Then articles were screened according to PRISMA guidelines. Fifteen articles were included in the meta-analysis. The results indicated significant differences in sprint (g=0.3811, p

Throwing cold water on muscle growth: A systematic review with meta‐analysis of the effects of postexercise cold water immersion on resistance training‐induced hypertrophy

Article

Full-text available

Feb 2024
EUR J SPORT SCI

The purpose of this paper was to systematically review the literature and perform a meta‐analysis of the existing data on the effects of postexercise cold water immersion (CWI) coupled with resistance training (RT) on gains in measures of muscle growth. To locate relevant studies, we comprehensively searched the PubMed/MEDLINE, Scopus, and Web of Science databases. A total of 8 studies met the inclusion criteria; all investigated CWI as the means of cold application. Preliminary analyses conducted on noncontrolled effect sizes provided strong evidence of hypertrophic adaptations with RT that were likely to be at least small in magnitude (SMD0.5 = 0.36 [95% CrI: 0.10–0.61]; p (>0) = 0.995, p (>0.1) = 0.977). In contrast, noncontrolled effect sizes provided some evidence of hypertrophic adaptations with CWI + RT that were likely to be small to negligible in magnitude (SMD0.5 = 0.14 [95% CrI: −0.08–0.36]; p (>0) = 0.906, p (>0.1) = 0.68). The primary analysis conducted on comparative effect sizes provided some evidence of greater relative hypertrophic adaptations with RT compared to CWI + RT (cSMD0.5 = −0.22 [95% CrI: −0.47 to 0.04]) with differences likely to be greater than zero (p (<0) = 0.957) and of at least a small magnitude of effect (p (<−0.1) = 0.834). Meta‐regression did not indicate a potential moderation effect of training status (βTrained:Untrained0.5

{\beta }_{\text{Trained}:{\text{Untrained}}_{0.5}}

= −0.10 [95% CrI: −0.65 to 0.43] p < 0) = 0.653). In conclusion, based on the current data, the application of CWI immediately following bouts of RT may attenuate hypertrophic changes. Given the overall relatively fair to poor quality of the studies examined, the results of the current study should be interpreted with some caution.

Support Your Recovery Needs (SYRN) – a systemic approach to improve sport performance

Article

Full-text available

Nov 2023

Jakub Grzegorz Adamczyk

Study aim : The aim of this study was to present the Support Your Recovery Needs (SYRN) recovery system based on scientifically confirmed methods, addressing the needs of athletes based on their subjective feelings of fatigue after training or competition. Material and methods : The literature on supporting post-exercise recovery was reviewed. This was followed by an analysis of the effectiveness of selected methods. A time factor was imposed on the selected methods for which efficacy was confirmed. Depending on the type of stimulus and the time of its application, regenerative effects were assigned point values. Results : Within the SYRN approach over a dozen treatments and actions promoting post-exercise recovery have been identified. Conclusions : A methodical and organized approach should allow for the selection of recovery support methods based on their effectiveness, appropriate timing, and the combination of various methods to enhance post-exercise recovery and performance.

The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise

Article

Full-text available

Apr 2021
EUR J APPL PHYSIOL

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.

Post-exercise Cold Water Immersion Effects on Physiological Adaptations to Resistance Training and the Underlying Mechanisms in Skeletal Muscle: A Narrative Review

Article

Full-text available

Apr 2021

Post-exercise cold-water immersion (CWI) is a popular recovery modality aimed at minimizing fatigue and hastening recovery following exercise. In this regard, CWI has been shown to be beneficial for accelerating post-exercise recovery of various parameters including muscle strength, muscle soreness, inflammation, muscle damage, and perceptions of fatigue. Improved recovery following an exercise session facilitated by CWI is thought to enhance the quality and training load of subsequent training sessions, thereby providing a greater training stimulus for long-term physiological adaptations. However, studies investigating the long-term effects of repeated post-exercise CWI instead suggest CWI may attenuate physiological adaptations to exercise training in a mode-specific manner. Specifically, there is evidence post-exercise CWI can attenuate improvements in physiological adaptations to resistance training, including aspects of maximal strength, power, and skeletal muscle hypertrophy, without negatively influencing endurance training adaptations. Several studies have investigated the effects of CWI on the molecular responses to resistance exercise in an attempt to identify the mechanisms by which CWI attenuates physiological adaptations to resistance training. Although evidence is limited, it appears that CWI attenuates the activation of anabolic signaling pathways and the increase in muscle protein synthesis following acute and chronic resistance exercise, which may mediate the negative effects of CWI on long-term resistance training adaptations. There are, however, a number of methodological factors that must be considered when interpreting evidence for the effects of post-exercise CWI on physiological adaptations to resistance training and the potential underlying mechanisms. This review outlines and critiques the available evidence on the effects of CWI on long-term resistance training adaptations and the underlying molecular mechanisms in skeletal muscle, and suggests potential directions for future research to further elucidate the effects of CWI on resistance training adaptations.

Case Report: Return to Sport Following the COVID-19 Lockdown and Its Impact on Injury Rates in the German Soccer League

Article

Full-text available

Feb 2021

The Bundesliga made headlines for becoming the first major sports league to return to sport worldwide following COVID-19 lockdown. To-date, there lacks retrospective studies on longitudinal injury rates to elucidate the effect isolation measures had on the health and safety of professional athletes. This study sought to compare injury rates experienced by Bundesliga athletes before and after the COVID-19 lockdown. Data was collected from public injury and player reports regarding the Bundesliga, with injury defined as trauma resulting in loss of game time. Descriptive statistics were used to present differences in injury incidence between all Bundesliga Match days pre- and post-lockdown. Between the league's resumption and completion on May 16 and June 27, 2020, injuries occurred in 21 forwards (FW), 11 central midfielders (CM), 12 wide midfielders (WM), 16 central defenders (CD), 6 fullbacks (FB), and 2 goalkeepers. Players had 1.13 (95% CI 0.78, 1.64) times the odds of being injured following the COVID-19 lockdown, with a 3.12 times higher rate of injury when controlling for games played compared to injury rates pre-lockdown (0.84 injuries per game vs. 0.27 injuries per game). The most frequent injury group was muscular injuries with 23 injuries total, with 17% of athletes experiencing injury during their first competitive match following lockdown. Injury rate increased over 3-fold following COVID-19 lockdown. Athletes did not experience an increased rate of injury with more cumulative competitive matches played. High injury incidence for players yet to complete their first competitive match may imply suboptimal sport readiness following home confinement.

The use of recovery strategies by Spanish first division soccer teams: a cross-sectional survey

Article

Full-text available

Aug 2021

Objectives: different active and passive post-exercise recovery techniques such as massage, foam rolling, stretching or ice baths among others, are used by elite athletes to promote effective physiological, physical, and mental restoration. However, limited research is available investigating the use of recovery strategies in professional soccer. As such, we aimed to explore and describe the use of strategies by professional teams throughout the season, describing competitive and preparatory phases. Methods: the present study collected data from all professional Spanish soccer teams who played in "LaLiga" (The Spanish first division), during the season 2018-2019 (n=20) and the ones promoted for the season 2019-2020 (n=3). A six-section online survey was responded once. Results: teams used different recovery protocols and combinations, although natural and physical strategies such as sleep/nap, food/fluid replacement, cold/ice bath/shower/immersion, and massage were always present. However, there is no agreement in the protocols and timings employed. Three physical strategies showed a higher presence in the recovery protocols after competition: cold/ice bath/shower/immersion, massage and foam rolling; always used by seventeen teams (74%), sixteen (70%) and thirteen (57%) respectively. The design and supervision of recovery are multidisciplinary tasks in 87% of the teams. Our findings also demonstrate that although there is a body of scientific evidence on recovery, a gap between theory and practice exists with 13% of the teams acknowledging that insufficient logistics and economic resources limit the use of some strategies, and two teams (9%) not periodizing or individualizing recovery. Conclusion: the investigation provided insight into the current use of recovery strategies by "LaLiga" teams, highlighting that all clubs used them to one extent or another, but also that significant variability responding to individualized perceptions exists. Moreover, this study provides relevant contextual information that may be useful for professional soccer staff concerning the use of recovery strategies.

Prolonging the duration of cooling does not enhance recovery following a marathon

Article

Full-text available

Sep 2020
SCAND J MED SCI SPOR

Runners commonly utilise cryotherapy as part of their recovery strategy. Cryotherapy has been ineffective in mitigating signs and symptoms of muscle damage following marathon running and is limited by its duration of application. Phase change material (PCM) packs can prolong the duration of cooling. This study aimed to test the efficacy of prolonging the duration of cooling using PCM on perceptual recovery, neuromuscular function, and blood markers following a marathon run. Thirty participants completed a marathon run and were randomised to receive three hours of 15°C PCM treatment covering the quadriceps or recover without an intervention (control). Quadriceps soreness, strength, counter‐movement jump (CMJ) height, creatine kinase (CK), and high sensitivity c‐reactive protein (hsCRP) were recorded at baseline, 24, 48 and 72 hours after the marathon. Following the marathon strength decreased in both groups (P<0.0001), with no difference between groups. Compared to baseline, strength was reduced 24 (P=0.004) and 48 hours after the marathon (P=0.008) in the control group, but only 24 hours (P=0.028) in the PCM group. Soreness increased (P<0.0001) and CMJ height decreased (P<0.0001) in both groups, with no difference between groups. Compared to baseline, CMJ height was not reduced on any days in the PCM group but was reduced in the control group 24 (P<0.0001) and 48 hours (P=0.003) after the marathon. CK and hsCRP increased in both groups (P<0.0001). Although the marathon run induced significant muscle damage, prolonging the duration of cooling using PCM did not accelerate the resolution of any dependent variables.

Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond

Article

Full-text available

Aug 2020

Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of three to six hours with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.

The Effects of Cold Water Immersion and Active Recovery on Molecular Factors That Regulate Growth and Remodeling of Skeletal Muscle After Resistance Exercise

Article

Full-text available

Jun 2020

Regular postexercise cooling attenuates muscle hypertrophy, yet its effects on the key molecular factors that regulate muscle growth and remodeling are not well characterized. In the present study, nine men completed two sessions of single-leg resistance exercise on separate days. On 1 day, they sat in cold water (10°C) up to their waist for 10 min after exercise. On the other day, they exercised at a low intensity for 10 min after exercise. Muscle biopsies were collected from the exercised leg before, 2, 24, and 48 h after exercise in both trials. These muscle samples were analyzed to evaluate changes in genes and proteins involved in muscle growth and remodeling. Muscle-specific RING finger 1 mRNA increased at 2 h after both trials (P < 0.05), while insulin-like growth factor (IGF)-1 Ec, IGF-1 receptor, growth arrest and DNA damage-inducible protein 45, collagen type I alpha chain A, collagen type III alpha chain 1, laminin and tissue inhibitor of metallopeptidase 1 mRNA increased 24−48 h after both trials (P < 0.05). By contrast, atrogin-1 mRNA decreased at all time points after both trials (P < 0.05). Protein expression of tenascin C increased 2 h after the active recovery trial (P < 0.05), whereas FoxO3a protein expression decreased after both trials (P < 0.05). Myostatin mRNA and ubiquitin protein expression did not change after either trial. These responses were not significantly different between the trials. The present findings suggest that regular cold water immersion attenuates muscle hypertrophy independently of changes in factors that regulate myogenesis, proteolysis and extracellular matrix remodeling in muscle after exercise.

Intermittent Pneumatic Compression and Cold Water Immersion Effects on Physiological and Perceptual Recovery During Multi-Sports International Championship

Article

Full-text available

Jun 2020

Background: Congested-fixture championships are common during the selection of the athletes and teams participating in the Olympic Games. Throughout these tournaments, it is fundamental to perform optimally, rest well, and recover between competitions. This study aimed to a) explore the effectiveness of the use of intermittent pneumatic compression (IPC) and cold water immersion (CWI) to recover muscle mechanical function (MuscleMechFx), hydration status (HydS), pain perception (PainPercep), rate of perceived exertion (RPE), sleep hours, and sleep quality (SleepQual) during a regional multi-sports international championship and b) compare these results by sex. Methods: A total of 52 basketball and handball players were exposed to a recovery protocol after the competition as follows: IPC, sequential 20 min at 200 mmHg, and CWI, continuous 12 min at 12 °C. Results: MuscleMechFx presented differences by match and sex (p = 0.058) in time of contraction of biceps femoris; SleepQual and sleep hours were different between matches (<0.01). Conclusions: IPC + CWI seems to be effective to maintain some MuscleMechFx, HydS, and recovery and pain perception during a congested multi-sport tournament.

Estimation of injury costs: Financial damage of English Premier League teams' underachievement due to injuries

Article

Full-text available

May 2020

Background In individual sports, the effect that injuries have on an athlete’s performance, success and financial profit is implicit. In contrast, the effect of a single player’s injury or one player’s absence in team sports is much more difficult to quantify, both from the performance perspective and the financial perspective. Objectives In this study, we attempted to estimate the effect of injuries on the performance of football teams from the English Premier League (EPL), and the financial implications derived from this effect. Methods Our analysis is based on data regarding game results, injuries and estimations of the players’ financial value for the 2012–2013 through the 2016–2017 seasons. Results We found a statistically significant relationship (r=−0.46, 95% CI −0.6 to 0.28, p=0.001) between the number of days out due to injuries suffered by team members during a season and the place difference between their actual and expected finish in the EPL table (according to overall player value). Moreover, we can interpolate that approximately 136 days out due to injury causes a team the loss of one league point, and that approximately 271 days out due to injury costs a team one place in the table. This interpolation formula is used as a heuristic model, and given the relationship specified above accounts for a significant portion of the variance in league placement (21%), the remaining variance is related to other factors. Calculating the costs of wage bills and prize money, we estimate that an EPL team loses an average of £45 million sterling due to injury-related decrement in performance per season. Conclusion Professional football clubs have a strong economic incentive to invest in injury prevention and rehabilitation programmes.

Combining cooling or heating applications with exercise training to enhance performance and muscle adaptations

Article

Jul 2020

Athletes use cold water immersion, cryotherapy chambers or icing in the belief that these strategies improve postexercise recovery and promote greater adaptations to training. A number of studies have systematically investigated how regular cold water immersion influences long-term performance and muscle adaptations. The effects of regular cold water immersion after endurance or high-intensity interval training on aerobic capacity, lactate threshold, power output and time trial performance are equivocal. Evidence for changes in angiogenesis and mitochondrial biogenesis in muscle in response to regular cold water immersion is also mixed. More consistent evidence is available that regular cold water immersion after strength training attenuates gains in muscle mass and strength. These effects are attributable to reduced activation of satellite cells, ribosomal biogenesis, anabolic signaling and muscle protein synthesis. Athletes use passive heating to warm up before competition or improve postexercise recovery. Emerging evidence indicates that regular exposure to ambient heat, wearing garments perfused with hot water or microwave diathermy can mimic the effects of endurance training by stimulating angiogenesis and mitochondrial biogenesis in muscle. Some passive heating applications may also mitigate muscle atrophy through their effects on mitochondrial biogenesis and muscle fiber hypertrophy. More research is needed to consolidate these findings, however. Future research in this field should focus on (1) the optimal modality, temperature, duration and frequency of cooling and heating to enhance long-term performance and muscle adaptations and (2) whether molecular and morphological changes in muscle in response to cooling and heating applications translate to improvements in exercise performance.