ArticlePDF Available

Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness

Authors:

Abstract and Figures

This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced (P < 0.05) at 24, 48 and 72 h post-exercise following CWT and at 48 and 72 h post-exercise following CWI when compared to PAS. Isometric force recovery was also greater (P < 0.05) at 24, 48, and 72 h post-exercise following HWI when compared to PAS. Perceived pain improved (P < 0.01) following CWT at 24, 48 and 72 h post-exercise. Overall, CWI and CWT were found to be effective in reducing the physiological and functional deficits associated with DOMS, including improved recovery of isometric force and dynamic power and a reduction in localised oedema. While HWI was effective in the recovery of isometric force, it was ineffective for recovery of all other markers compared to PAS.
Content may be subject to copyright.
Eur J Appl Physiol (2008) 102:447–455
DOI 10.1007/s00421-007-0605-6
123
ORIGINAL ARTICLE
EVect of hydrotherapy on the signs and symptoms of delayed
onset muscle soreness
Joanna Vaile · Shona Halson · Nicholas Gill ·
Brian Dawson
Accepted: 19 October 2007 / Published online: 3 November 2007
© Springer-Verlag 2007
Abstract This study independently examined the eVects
of three hydrotherapy interventions on the physiological
and functional symptoms of delayed onset muscle soreness
(DOMS). Strength trained males (n = 38) completed two
experimental trials separated by 8 months in a randomised
crossover design; one trial involved passive recovery (PAS,
control), the other a speciWc hydrotherapy protocol for 72 h
post-exercise; either: (1) cold water immersion (CWI:
n = 12), (2) hot water immersion (HWI: n = 11) or (3) con-
trast water therapy (CWT: n = 15). For each trial, subjects
performed a DOMS-inducing leg press protocol followed
by PAS or one of the hydrotherapy interventions for
14 min. Weighted squat jump, isometric squat, perceived
pain, thigh girths and blood variables were measured prior
to, immediately after, and at 24, 48 and 72 h post-exercise.
Squat jump performance and isometric force recovery were
signiWcantly enhanced (P < 0.05) at 24, 48 and 72 h post-
exercise following CWT and at 48 and 72 h post-exercise
following CWI when compared to PAS. Isometric force
recovery was also greater (P < 0.05) at 24, 48, and 72 h
post-exercise following HWI when compared to PAS. Per-
ceived pain improved (P < 0.01) following CWT at 24, 48
and 72 h post-exercise. Overall, CWI and CWT were found
to be eVective in reducing the physiological and functional
deWcits associated with DOMS, including improved recov-
ery of isometric force and dynamic power and a reduction
in localised oedema. While HWI was eVective in the recov-
ery of isometric force, it was ineVective for recovery of all
other markers compared to PAS.
Keywords Recovery · Eccentric exercise ·
Water immersion · Performance
Introduction
Delayed onset muscle soreness (DOMS) is a well-docu-
mented phenomenon, often occurring as the result of unac-
customed or high intensity eccentric exercise (Connolly
et al. 2003; MacIntyre et al. 1995). Associated symptoms
include muscle shortening, increased passive stiVness,
swelling, decreases in strength and power, localised sore-
ness, and disturbed proprioception (Proske and Morgan
2001). Symptoms will often present within 24 h post-exer-
cise and typically subside after 3–4 days (Clarkson and
Sayers 1999). Elite athletes are often susceptible to muscle
damage due to muscles being regularly subjected to repeti-
tive, high intensity contractions (Allen et al. 2004).
Recently, the use of various forms of hydrotherapy such
as cold water immersion (CWI), hot water immersion
(HWI), and contrast water therapy (CWT) as post-exercise
recovery interventions have gained popularity and are now
a common practice within the elite sporting environments
(Cochrane 2004; Vaile et al. 2007). However, such recovery
interventions are being employed despite lack of scientiWc
J. Vaile (&) · S. Halson
Department of Physiology, Australian Institute of Sport,
PO Box 176, Belconnen, ACT, Australia
e-mail: jo.vaile@ausport.gov.au
N. Gill
School of Sport and Exercise Science,
Waikato Institute of Technology, Hamilton, New Zealand
N. Gill
Division of Sport and Recreation,
Auckland University of Technology, Auckland, New Zealand
B. Dawson
School of Human Movement and Exercise Science,
University of Western Australia, Perth, Australia
448 Eur J Appl Physiol (2008) 102:447–455
123
investigation and evidence regarding their potential beneWts
and/or mechanisms by which they may work.
Various forms of cryotherapy have been shown to pro-
duce multiple physiological responses, including decreased
swelling (Yanagisawa et al. 2004), tissue temperatures
(Enwemeka et al. 2002), heart rate (HR) and cardiac output
(Sramek et al. 2000), enhanced creatine kinase clearance
(Eston and Peters 1999) and analgesic eVects, resulting in
altered perceptions of pain and discomfort (Bailey et al.
2007). However, there appear to be conXicting conclusions
regarding the eVect of CWI on performance, with some
studies suggesting beneWcial eVects (Bailey et al. 2007;
Burke et al. 2000; Lane and Wenger 2004) and others indi-
cating negligible changes (Isabell et al. 1992; Paddon-Jones
and Quigley 1997; Sellwood et al. 2007; Yamane et al.
2006). In contrast, despite limited research in the area, HWI
aVects the body diVerently resulting in increased HR, car-
diac output and tissue temperatures and may enhance the
inXammatory response (Wilcock et al. 2006). Contrast
water therapy (CWT) incorporates the combined eVect of
both CWI and HWI with athletes alternating between them
for a set period of time. While there is a limited research
investigating the physiological eVects of CWT and its role
on return/ maintenance of performance following damage
or exercise-induced fatigue, current knowledge suggests
CWT to be a promising recovery intervention (CoVey et al.
2004; Gill et al. 2006; Vaile et al. 2007). However, the use
of CWT has previously been criticised due to the unknown
eVects of exposure to both hot and cold water as well as the
eVect of CWT on tissue oedema accumulation.
Consequently, the present studies set out to examine the
eVect of the three hydrotherapy interventions (CWI, HWI,
and CWT) in comparison to a passive rest recovery follow-
ing a controlled exercise task, ensuring identical durations
of recovery, water exposure and temperatures were main-
tained. Functional and physical symptoms of DOMS and
the recovery of performance were assessed.
Methods
Subjects
A total of 38 strength trained males completed two experi-
mental trials separated by 8 months in a randomised cross-
over design; one trial involved passive recovery (PAS,
control), the other a speciWc hydrotherapy protocol. Sub-
jects were randomly assigned to one of the three groups
diV
ering only in recovery hydrotherapy intervention: (1)
cold water immersion (CWI, 15°C, n = 12), (2) hot water
immersion (HWI, 38°C, n = 11) or (3) contrast water ther-
apy (CWT, 15°C/38°C, n = 15). These interventions were
selected using water temperatures and durations similar to
those used in common practice and to ensure identical dura-
tions of water exposure. The physical and functional symp-
toms of DOMS were monitored throughout a 72 h follow-
up period and compared to pre-exercise values. After an
8 month washout period, the subjects completed the exer-
cise task with the alternate (hydrotherapy or PAS) recovery
protocol.
Experimental design
On two separate occasions (8 months apart; hydrotherapy
vs. PAS), subjects completed a muscle-damaging protocol
(MDP) consisting of seven sets of ten eccentric repetitions
on a leg press machine. Previously it has been demon-
strated that a single bout of eccentric exercise can have a
prophylactic eVect not only on muscle soreness, but also on
blood responses and performance capabilities after a sec-
ond bout of eccentric exercise performed within a few
weeks (Brown et al. 1997; Byrnes and Clarkson 1986; Mair
et al. 1995; Nosaka et al. 2001). Therefore, it was important
to consider this eVect and control it by utilising a crossover
design and selecting athletes who were both familiar and
accustomed to resistance training (Viitasalo et al. 1995). A
substantial washout period of 8 months was chosen to min-
imise the eVect of the Wrst session of eccentric exercise.
Nosaka et al. (2001) investigated the duration of the protec-
tive eVect of eccentric exercise-induced muscle damage,
concluding that the repeated bout eVect for most measures
appeared to last at least 6 months.
Two weeks prior to both the trials (separated by
8 months), subjects completed a comprehensive familiari-
sation session to determine maximal strength in the form of
one repetition maximum (1RM) on the leg press machine
and isometric squat 1RM to establish squat jump load (30%
isometric squat) (Nosaka and Newton 2002). Additionally,
subjects were familiarised with squat jump and isometric
squat protocols until no further learning/ improvement was
apparent (this was achieved by a maximum of three inde-
pendent familiarisation sessions). Following each testing
session, and once a day for 72 h post-exercise, subjects per-
formed one of the two recovery interventions (hydrotherapy
or PAS). Prior to participation, all subjects were informed
of the requirement and risks associated with the study and
provided informed written consent. The study was
approved by the Australian Institute of Sport Research
Ethics Committee.
Procedures
The DOMS-inducing exercise protocol consisted of 5 £ 10
eccentric bi-lateral leg press contractions with a load of
120% of one repetition maximum [1-RM (concentric)] fol-
lowed by 2 £10 at a load of 100% 1-RM. The aforementioned
Eur J Appl Physiol (2008) 102:447–455 449
123
protocol was chosen as eccentric strength has been shown
to be approximately 20–60% greater than concentric
strength and similar protocols have been successfully
employed to induce DOMS (Hortobagyi and Katch 1990).
During each eccentric contraction, the load was resisted
with both legs from full knee extension to a 90° knee angle
(Vaile et al. 2007) with contractions lasting for 3–5 s dura-
tion. After the completion of each eccentric repetition, the
load was raised by an electrical winch. Subjects completed
one contraction every 15 s and had a 3 min rest period
between sets (Nosaka and Newton 2002; Vaile et al. 2007).
Recovery interventions
Following each testing session, and once a day for 72 h
post-exercise, subjects performed one of two recovery
interventions (hydrotherapy or PAS). All subjects com-
pleted PAS recovery and one of the other three hydrotherapy
interventions (subjects wore shorts during the hydrotherapy
intervention and shorts/t-shirt during PAS). These were: (1)
passive recovery/control (PAS) whereby subjects were
seated with minimal movement for 14 min. (2) Cold water
immersion (CWI) where subjects immersed their entire
body (excluding head and neck) in 15°C water for 14 min.
(3) Hot water immersion (HWI) where subjects immersed
their entire body (excluding head and neck) in 38°C water
for 14 min. (4) Contrast water therapy (CWT) where sub-
jects immersed their entire body (excluding head and neck)
and alternated between cold water exposure (15°C 1 min)
and hot water exposure (38°C 1 min) water for a total of
14 min (seven cycles). Subjects were required to transfer
between the hot and cold baths in less than 5 s to ensure
maximal duration of water exposure. Recovery was per-
formed immediately following the post-exercise testing
session, and at 24, 48, and 72 h post-exercise.
Outcome measures
The eVects of the exercise task and subsequent recovery
were assessed through the measurement of isometric squat
force, squat jump performance, blood markers [creatine
kinase (CK), myoglobin (Mb), interleukin-6 (IL-6), lactate
dehydrogenase (LDH)], thigh circumference and perceived
muscle soreness. Measures were recorded pre-exercise, and
immediately post-exercise, as well as at 24, 48 and 72 h
post-exercise.
Recovery assessment
Isometric squat (peak force)
The production of vertical ground reaction forces were
measured via force platform (Kistler Instrumenté, Switzerland)
and assessed though an isometric squat performed against
an immovable bar on a Smith Machine. On each occasion,
subjects performed thee trials, each separated by 3 min,
with the best eVort (indicated by peak vertical force) used
to represent the subject’s isometric squat force. The squat
was performed in an identical position each time, with foot
placement recorded for each individual and maintained
throughout all testing sessions to ensure a straight line from
the temporo-mandibular joint to the lateral malleolus with
the subject in a standing position (Blazevich et al. 2002;
Vaile et al. 2007). The protocol used to assess the isometric
force was found to have ICC = 0.97 and TEM = 2.9%.
Squat jump (peak power)
Subjects were required to perform squat jumps (separated by
2 min) on a Smith machine, which was loaded, to a com-
bined weight equivalent of 30% of their isometric squat
force. The best of the three attempts was recorded for analysis.
Subjects were instructed to lower the weighted bar to a 90°
knee angle, pause for 2 s, and then jump upward for maxi-
mum height (Vaile et al. 2007). Peak power was measured
using a GymAware system (Kinetic Performance, Australia).
When assessed on ten subjects, this peak power protocol was
acceptably reliable (ICC = 0.94, TEM = 6.1%).
Blood markers
Venous blood samples were collected pre-exercise and at
each of the four post-exercise time-points. Each blood sam-
ple (8 mL) was collected from a superWcial forearm vein
using standard venipuncture techniques. All samples were
collected directly into serum separator collection tubes
(Greiner Bio-one; Frickenhausen, Germany) and serum
separated by centrifugation at 4,000 rpm for 5 min. Serum
samples were stored frozen at ¡80°C until analysis. Crea-
tine kinase (CV 0.6%) and LDH (CV 0.8%) concentrations
were determined using a Hitachi 911 automated clinical
chemistry analyser (Roche Diagnostics Corporation; India-
napolis, IN, USA) and commercially available reagents
(Roche Diagnostics Corporation; IN, USA). Myoglobin
(CV 2.6%) and IL-6 (CV 3.5%) concentrations were deter-
mined using an Immulite 1000 (Diagnostics Products Cor-
poration, CA, USA) solid-phase chemiluminescent enzyme
immunoassay system and commercially available assay kits
(Diagnostics Products Corporation, CA, USA).
Thigh circumference
A non-stretch anthropometric measuring tape (Lufkin,
USA) was used to measure circumference at three sites on
the upper leg: above-knee, mid-thigh and sub-gluteal. Mea-
surement sites were marked with a permanent marker to
450 Eur J Appl Physiol (2008) 102:447–455
123
ensure re-test reliability (0, 24, 48 and 72 h). Circumfer-
ence measurements were taken as an indicator of acute
changes in thigh volume (Brown et al. 1997; Chen and
Hsieh 2000; Chleboun et al. 1998; Eston and Peters 1999),
likely to occur from osmotic Xuid shifts or inXammation,
which has often been associated with muscle-damage and
eccentric exercise (Fielding et al. 2000). For the purposes
of presentation, mid-thigh girth was selected for representa-
tion of all upper leg measurements (above-knee, mid-thigh,
and sub-gluteal) as it closely resembled changes throughout
all the measured sites. When ten subjects were tested and
re-tested using identical methodology as used in the present
study the reliability of these measurements was ICC = 1.00
and TEM = 0.1%.
Perceived soreness
A visual analogue scale (VAS; 1–10) was used to assess the
subjects perceived soreness whereby they were required to
rank their perception of soreness on a scale of 0 to 10, with
0 being “normal” and 10 being “extremely sore”. This
method has been used previously as a non-invasive way to
monitor changes in perceived pain following muscle-
damaging protocols (Cleak and Eston 1992; Harrison et al.
2001; Vaile et al. 2007). Prior to reporting their VAS rank-
ing, subjects were required to perform a standardised half
squat to ensure all subjects were experiencing the same
movement/sensation.
Statistical analysis
Each part of the present study (CWI vs. PAS; HWI vs.
PAS; CWT vs. PAS) was independently analysed. Mean
eVects were calculated using a spreadsheet via the unequal-
variances t statistic computed for change scores between
pre- and post-tests of the two groups (Batterham and Hop-
kins 2005). Each subject’s change score was expressed as a
percentage of baseline score via analysis of log-trans-
formed values, in order to reduce bias arising from non-uni-
formity of error. Baseline values (for all variables) from the
two trials, 8 months apart were also compared, with no sig-
niWcant diVerence observed over time.
Results
Isometric squat
No diVerences were observed between any interventions at
baseline or immediately post-exercise (P > 1.3) (Table 1).
However, change in isometric squat performance (%
change from baseline) was signiWcantly less at 24, 48, and
72 h post exercise following both HWI (¡12.8, ¡10.1,
¡3.2%; P < 0.05; Fig. 1b) compared to PAS (¡17.0,
¡16.0, ¡9.8%) and CWT (¡10.3, ¡7.4, ¡2.8%; P <0.01;
Fig. 1c) compared to PAS (¡17.3, ¡14.0, ¡11.5). Addi-
tionally at 48 and 72 h post-exercise, change in isometric
squat performance from baseline was signiWcantly less fol-
lowing CWI (¡7.3, ¡4.3%; P < 0.05; Fig. 1a) when com-
pared to PAS (¡15.7, ¡11.7%).
Weighted squat jump
Compared to PAS, change in peak power performance (%
change from baseline) was signiWcantly less at 48
(P = 0.01) and 72 (P = 0.03) h post-exercise following CWI
(Fig. 2a) and at 24, 48, and 72 h post-exercise following
CWT (P < 0.01; Fig. 2c). However, HWI did not positively
inXuence the recovery of squat jump performance com-
pared to PAS (Table 1). Production of peak power, 72 h
post-exercise was signiWcantly reduced below baseline by
8.2 § 4.1% following HWI and 7.7 § 3.2% following
PAS; no diVerences were observed between HWI and PAS
(P > 0.05; Fig. 2b) at any time point.
Mid-thigh girth
Mid-thigh girth was signiWcantly reduced at 24, 48 and 72 h
post-exercise following CWI (P < 0.03; Fig. 3a) and CWT
interventions (P < 0.01; Fig. 3c) compared to PAS
(Table 1). However, HWI was not eVective (P >0.05;
Fig. 3b) in reducing post-exercise thigh volume compared
to PAS.
Blood variables
SigniWcant reductions in [CK] were observed 24 h
(P = 0.03) and 72 h (P = 0.04) post-exercise following
CWI, and 48 h (P = 0.04) post-exercise following HWI
when compared to PAS. However, none of the three hydro-
therapy interventions inXuenced post-exercise changes of
Mb, IL-6, or LDH.
Perceived pain (VAS)
Perception of pain was reduced only at 24, 48, and 72 h
post-exercise following CWT (P < 0.01) compared to PAS
(Fig. 4c). Both CWI and HWI (P >0.05) were ineVective in
reducing perceptions of pain following intense eccentric
exercise (Fig. 4a/b).
Discussion
The main Wndings of the present studies were that follow-
ing DOMS-inducing exercise; all the three hydrotherapy
Eur J Appl Physiol (2008) 102:447–455 451
123
interventions (CWI, HWI, and CWT) improved the recov-
ery of isometric force compared to PAS througout the 72 h
post-exercise data collection period. However, compared to
PAS, only CWI and CWT signiWcantly enhanced the
recovery of dynamic power (squat jump), while HWI
appeared to have no eVect on the return of power, following
a similar trend to PAS. In addition to enhancing the recovery
of athletic performance, CWI and CWT (but not HWI)
signiWcantly reduced the degree of post-exercise swelling
when compared to PAS.
To the authors knowledge, the present studies are the
Wrst to independently investigate three commonly pre-
scribed post-exercise hydrotherapy interventions ensuring
identical exercise mode and intensity, duration of water
Table 1 Descriptive statistics (mean § SD) for dependent variables for each intervention and its independent control (CWT vs. PAS, CWI vs.
PAS, and HWI vs. PAS)
Appropriate statistics were completed using log transformed values
* P <0.05
Variable CWT vs. PAS CWT vs. PAS CWT vs. PAS
Jump squat (peak power W)
Baseline 3,938 § 871 3,969 § 879 4,158 § 945 4,170 § 947 3,902 § 303 3,900 § 277
0 h post ex 3,328 § 806 3,479 § 792 3,547 § 1033 3,564 § 878 3,446 § 351 3,382 § 278
24 h post ex 3,675 § 741 * 3,389 § 750 3,735 § 872 3,577 § 878 3,459 § 389 3,401 § 416
48 h post ex 3,805 § 821 * 3,473 § 755 3,939 § 877 * 3,507 § 795 3,487 § 455 3,460 § 370
72 h post ex 3,937 § 808 * 3,659 § 795 4,080 § 914 * 3,857 § 846 4,593 § 409 3,606 § 356
Isometric squat (peak force N)
Baseline 2,068 § 446 2,066 § 469 2,110 § 472 2,089 § 443 1,929 § 295 1,916 § 350
0 h post ex 1,733 § 320 1,750 § 389 1,748 § 424 1,734 § 420 1,592 § 262 1,597
§ 271
24 h post ex 1,857 § 405 * 1,711 § 396 1,877 § 418 1,792 § 401 1,685 § 286 * 1,598 § 342
48 h post ex 1,923 § 457 * 1,783 § 424 2,077 § 465 * 1,769 § 412 1,735 § 272 * 1,617 § 329
72 h post ex 2,018 § 477 * 1,833 § 436 2,074 § 487 * 1,859 § 463 1,868 § 291 * 1,724 § 290
Mid-thigh circumference (cm)
Baseline 56.2 § 4.5 56.1 § 4.5 56.7 § 3.7 56.6 § 3.4 57.3 § 3.8 57.4 § 3.7
0 h post ex 56.8 § 4.6 56.7 § 4.6 57.4 § 3.8 57.1 § 3.3 57.8 § 3.8 57.9 § 3.7
24 h post ex 56.4 § 4.5 * 56.9 § 4.7 57.1 § 3.8 * 57.6 § 3.2 58.1 §3.9 58.1 § 3.8
48 h post ex 56.3 § 4.6 * 56.9 § 4.7 56.9 § 3.8 * 57.4 § 3.3 57.9 §3.9 58.0 § 3.7
72 h post ex 56.3 § 4.5 * 56.7 § 4.7 56.9 § 3.8 * 57.1
§ 3.3 57.6 §3.8 57.8 § 3.8
Creatine kinase (U/L)
Baseline 176 § 76 218 § 168 223 § 222 189 § 45 199 § 241 143 § 105
0 h post ex 229 § 147 245 § 220 203 § 175 193 § 156 269 § 411 165 § 105
24 h post ex 736 § 1115 737 § 361 231 § 182 * 570 § 263 312 § 242 402 § 255
48 h post ex 416 § 589 361 § 318 211 § 259 263 § 174 225 § 221 * 748 § 1694
72 h post ex 359 § 433 271 § 234 204 § 343 * 296 § 290 151 § 57 169 § 86
Lactate dehydrogenase (U/L)
Baseline 271 § 72 218 § 107 236 § 82 207 § 61 261 § 87 256 § 93
0 h post ex 280 § 87 246 § 98 227 § 95 208 § 52 278 § 85 272 § 103
24 h post ex 291 §
132 270 § 123 194 § 65 194 § 69 271 § 90 269 § 97
48 h post ex 264 § 117 230 § 92 177 § 71 204 § 89 260 § 69 280 § 68
72 h post ex 254 § 109 247 § 112 183 § 68 219 § 75 254 § 83 267 § 77
Myoglobin (ng/mL)
Baseline 44.1 § 22.3 47.8 § 38.4 36.4 § 17.8 27.2 § 7.71 35.6 § 22.8 27.3 § 7.7
0 h post ex 95.4 § 76.6 116.2 § 101.1 60.7 § 30.1 67.5 § 24.9 65.1 § 44.3 74.8 § 68.1
24 h post ex 67.2 § 51.1 69.5 § 54.9 44.9 § 25.4 38.5 § 13.3 39.8 § 23.2 47.3 § 22.7
Interleukin-6 (pg/mL)
Baseline 1.5 § 0.6 1.7 § 0.7 3.6 § 3.9 2.6 § 2.3 1.7 § 1.1 2.6 § 2.7
0 h post ex 2.2 § 0.7 2.6 § 1.1 4.5 § 6.8 3.4 § 3.2 2.3 §
1.3 2.7 § 2.8
24 h post ex 1.5 § 0.9 1.9 § 1.0 3.7 § 6.3 2.8 § 2.5 1.7 § 0.9 2.4 § 2.1
452 Eur J Appl Physiol (2008) 102:447–455
123
exposure and water temperature (CWI 15°C, HWI 38°C,
CWT 38°C/15°C). The mechanism by which such interven-
tions may be eVective remains largely unknown. However,
there are multiple theories surrounding the eVectiveness of
water immersion.
The eVect of hydrostatic pressure exerted on the body
during water immersion is becoming more deWned. The
compressive eVect of immersion in water is thought to
create a displacement of Xuids from the periphery to the
central cavity. This results in multiple physiological
changes, including increases in substrate transport and car-
diac output as well as a reduction in peripheral resistance
(Hinghofer-Szalkay et al. 1987; Wilcock et al. 2006). Full
body (head out) water immersion, as prescribed in the pres-
ent studies, has been shown to increase central blood vol-
ume (Hinghofer-Szalkay et al. 1987; Johansen et al. 1997;
Wilcock et al. 2006) and extracellular Xuid volume via
Fig. 1 Percent change in isometric squat performance (peak force)
following CWI (a), HWI (b), and CWT (c). Performance was assessed
pre and post muscle-damaging exercise as well as at 24, 48, and 72 h
post-exercise. *SigniWcant diVerence between hydrotherapy interven-
tion and PAS
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWI
*
*
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
HWI
*
*
*
)ataddemrofsnatgol(
egna
hCtnecre
P
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWT
*
*
*
)ataddemr
o
fsnatgol(egnah
Ctn
ecreP
a
b
c
Fig. 2 Percent change in squat jump performance (peak power) fol-
lowing CWI (a), HWI (b), and CWT (c). Performance was assessed
pre and post muscle-damaging exercise as well as at 24, 48, and 72 h
post-exercise. *SigniWcant diVerence between hydrotherapy interven-
tion and PAS
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWI
*
*
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
HWI
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWT
*
*
*
)ataddemrofsnatgol(egnahCtnecreP
a
b
c
Eur J Appl Physiol (2008) 102:447–455 453
123
intracellular-intravascular osmotic gradients. Such changes
may increase the removal of waste products with the poten-
tial of enhancing recovery from exercise. Although the
present studies observed post-exercise increases in the
blood markers analysed, the only post-exercise reduction
observed between interventions was in CK response at 24
and 72 h post-exercise following CWI and 48 h post HWI
compared to PAS. In the present study, compared to PAS,
CWI and CWT were eVective in reducing swelling of the
thigh following muscle-damaging exercise. This result indi-
cates a possible increase in the re-absorption of interstitial
Xuid resulting in reduced oedema (Vaile et al. 2007). Simi-
lar to the eVects of compression garments (Bernhardt and
Anderson 2005; Doan et al. 2003; Kraemer et al. 2001),
hydrostatic pressure has been shown to increase the pres-
sure gradient between the interstitial compartment of the
legs and the intravascular space (Wilcock et al. 2006). In
addition, the reduction of post-exercise oedema may not
Fig. 3 Percent change in mid-thigh circumference following CWI (a),
HWI (b), and CWT (c). Circumference was assessed pre and post mus-
cle-damaging exercise as well as at 24, 48, and 72 h post-exercise.
*SigniWcant diVerence between hydrotherapy intervention and PAS
Baseline PostEx 24 h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
PAS
CWI
*
*
*
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
PAS
HWI
)ataddemrofsnatgol(egnahCtnecreP
Baseline Po stEx 24h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
PAS
CWT
**
*
)ataddemrofsna
tgol(egnahCtnecreP
a
b
c
Fig. 4 Perception of pain CWI (a), HWI (b), and CWT (c). The visual
analogue scale was completed immediately post muscle-damaging
exercise as well as at 24, 48, and 72 h post-exercise. *SigniWcant diVer-
ence between hydrotherapy intervention and PAS
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
CWI
)01-0SAV(elacSeugolanAlausiV
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
HWI
)01-0SAV(elacSeugolanAlausiV
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
CWT
*
*
*
)0
1-0SAV(elacS
e
u
g
o
l
anAlausiV
a
b
c
454 Eur J Appl Physiol (2008) 102:447–455
123
only improve the contractile functions within the muscle
but also decreases the chances of secondary damage to the
tissues that may result from cellular inWltration (Wilcock
et al. 2006). However, immersion in hot water did not have
the same eVect despite identical exposure time and water
depth. Therefore, in addition to hydrostatic pressure, water
temperature appears to play a role in overall recovery
following damaging exercise.
Main physiological eVects resulting from immersion in
cold water appear to be localised vasoconstriction and
decreased blood Xow that may reduce oedema (Meeusen
and Lievens 1986). The eVect of cold application through
various mediums has been shown to stimulate an analgesic
eVect, resulting in a decreased perception of pain (Cheung
et al. 2003; Meeusen and Lievens 1986). While the results
of the present study do not indicate an altered perception of
pain compared to PAS, it must be noted that pain ratings
were taken prior to immersion on each of the testing occa-
sions. Therefore, while subjects may have experienced an
acute analgesic eVect immediately post-CWI, any such
eVect had diminished 24 h post-recovery.
Not surprisingly, immersion in hot water has been shown
to demonstrate opposite physiological eVects on the body;
including an increase in blood Xow, HR, and cardiac output,
and a decrease in peripheral resistance (Wilcock et al.
2006). BeneWts such as decreased muscle spasm, stiVness
and increased range of motion have also been reported fol-
lowing the application of heat (Kaul and Herring 1994;
Prentice 1999). However, to the author’s knowledge, no
study has investigated the isolated eVects of hot water
immersion on the recovery of muscle damage in a controlled
environment. The present study found HWI to be beneWcial
only through enhanced recovery of isometric force in com-
parison to PAS. When a speciWc movement (squat jump)
was performed requiring dynamic power HWI did not
appear to provide any improvement in return of performance
to baseline levels. However, in comparison to PAS, CWT
enhanced the recovery of both isometric force production
and squat jump performance. The combined eVects of alter-
nating between hot and CWI appears to be more beneWcial
than when the interventions are prescribed as an isolated
exposure. However, despite a growing body of knowledge,
the physiological eVects arising from CWT remain largely
unknown. Contrast water therapy has been suggested to be
an eVective post-exercise intervention due to increased lac-
tate clearance (Cochrane 2004), decreased oedema (Vaile
et al. 2007), increased blood Xow (Cochrane 2004),
increased stimulation of the central nervous system and
reduced metabolic rate (CoVey et al. 2004; Hamlin
2007;
Vaile et al. 2007). Myrer et al. (1994) and Higgins and
Kaminski (1998) proposed one of the main eVects of CWT
to be a pumping action stimulated by vasodilation and vaso-
constriction of the blood vessels. No study has observed any
form of vasodilation or vasoconstriction during or following
CWT (Higgins and Kaminski 1998; Myrer et al. 1994),
however, this has only been assessed via intramuscular tem-
perature measures, with results indicating no signiWcant
changes following various applications of CWT. Measures
of blood Xow using Doppler ultrasound (or similar) proce-
dures may help to improve knowledge regarding the poten-
tial eVects of CWT on muscle blood Xow.
The present series of studies has contributed to the
limited knowledge base investigating the eVects and mech-
anisms underlying the three popular hydrotherapy interven-
tions. The Wndings indicate CWI and CWT to be eVective
in minimising the physiological and functional deWcits
associated with DOMS, when compared to PAS. While
HWI was eVective in the recovery of isometric force, it was
ineVective for recovery of all other markers compared to
PAS.
Acknowledgments The authors would like to acknowledge the
Australian Institute of Sport and Waikato Institute of Technology for
funding the aforementioned studies. In addition, Professor Will
Hopkins is acknowledged for his assistance with the statistical analysis.
References
Allen TJ, Dumont TL, MacIntyre DL (2004) Exercise-induced muscle
damage: mechanisms, prevention, and treatment. Physiother Can
56:67–79
Bailey DM, Erith SJ, GriYn PJ, Dowson A, Brewer DS, Gant N et al
(2007) InXuence of cold-water immersion on indices of muscle
damage following prolonged intermittent shuttle running. J Sports
Sci 25(11):1163–1170
Batterham A, Hopkins W (2005) A decision tree for controlled trials.
Sportscience 9:33–39
Bernhardt T, Anderson GS (2005) InXuence of moderate prophylactic
compression on sport performance. J Strength Cond Res
19(2):292–297
Blazevich AJ, Gill N, Newton RU (2002) Reliability and validity
of two isometric squat tests. J Strength Cond Res 16(2):298–
304
Brown S, Child SH, Donnelly AE (1997) Exercise-induced skeletal
muscle damage and adaptation following repeated bouts of eccen-
tric muscle contractions. J Sports Sci 15:215–222
Burke DG, MacNeil SA, Holt LE, MacKinnon NC, Rasmussen RL
(2000) The eVect of hot or cold water immersion on isometric
strength training. J Strength Cond Res 14(1):21–25
Byrnes WC, Clarkson PM (1986) Delayed onset muscle soreness and
training. Clin Sports Med 5(3):605–614
Chen T, Hsieh S (2000) The eVects of repeated maximal voluntary is-
okinetic eccentric exercise on recovery from muscle damage. Res
Q Exerc Sport 17(3):260–288
Cheung K, Hume P, Maxwell L (2003) Delayed onset muscle soreness:
treatment strategies and performance factors. Sports Med
33(2):145–164
Chleboun GS, Howell JN, Conatser RR, Giesey JJ (1998) Relationship
between muscle swelling and stiVness after eccentric exercise.
Med Sci Sports Exerc 30(4):529–535
Clarkson PM, Sayers SP (1999) Etiology of exercise-induced muscle
damage. Can J Appl Physiol 24(3):234–248
Eur J Appl Physiol (2008) 102:447–455 455
123
Cleak MJ, Eston RG (1992) Muscle soreness, swelling, stiVness and
strength loss after intense eccentric exercise. Br J Sports Med
26(4):267–272
Cochrane DJ (2004) Alternating hot and cold water immersion for ath-
lete recovery: a review. Phys Ther Sport 5:26–32
CoVey V, Leveritt M, Gill N (2004) EVect of recovery modality on
4-hour repeated treadmill running performance and changes in
physiological variables. J Sci Med Sport 7(1):1–10
Connolly DA, Sayers SP, McHugh MP (2003) Treatment and preven-
tion of delayed onset muscle soreness. J Strength Cond Res
17(1):197–208
Doan BK, Kwon YH, Newton RU, Shim J, Popper EM, Rogers RA
et al (2003) Evaluation of a lower-body compression garment.
J Sports Sci 21(8):601–610
Enwemeka CS, Allen C, Avila P, Bina J, Konrade J, Munns S (2002)
Soft tissue thermodynamics before, during, and after cold pack
therapy. Med Sci Sports Exerc 34(1):45–50
Eston R, Peters D (1999) EVects of cold water immersion on the
symptoms of exercise-induced muscle damage. J Sports Sci
17(3):231–238
Fielding RA, Violan MA, Svetkey L, Abad LW, Manfredi TJ, Cosmas
A et al (2000) EVects of prior exercise on eccentric exercise-in-
duced neutrophilia and enzyme release. Med Sci Sports Exerc
32(2):359–364
Gill ND, Beaven CM, Cook C (2006) EVectiveness of post-match
recovery strategies in rugby players. Br J Sports Med 40(3):260
263
Hamlin MJ (2007) The eVect of contrast temperature water therapy on
repeated sprint performance. J Sci Med Sport 10(6):398–402
Harrison BC, Robinson D, Davison BJ, Foley B, Seda E, Byrnes WC
(2001) Treatment of exercise-induced muscle injury via hyper-
baric oxygen therapy. Med Sci Sports Exerc 33(1):36–42
Higgins D, Kaminski TW (1998) Contrast therapy does not cause Xuc-
tuations in human gastrocnemius. J Athl Train 33:336–340
Hinghofer-Szalkay H, Harrison MH, Greenleaf JE (1987) Early Xuid
and protein shifts in men during water immersion. Eur J Appl
Physiol Occup Physiol 56(6):673–678
Hortobagyi T, Katch FI (1990) Eccentric and concentric torque-veloc-
ity relationships during arm Xexion and extension. InXuence of
strength level. Eur J Appl Physiol Occup Physiol 60(5):395–401
Isabell WK, Durrant E, Myrer W, Anderson S (1992) The eVects of ice
massage, ice massage with exercise, and exercise on the preven-
tion and treatment of delayed onset muscle soreness. J Athl Train
27(3):208–217
Johansen LB, Jensen TU, Pump B, Norsk P (1997) Contribution of
abdomen and legs to central blood volume expansion in humans
during immersion. J Appl Physiol 83(3):695–699
Kaul MP, Herring SA (1994) SuperWcial heat and cold: how to maxi-
mise the beneWts. Phys Sportsmed 22(12):65–74
Kraemer WJ, Bush JA, Wickham RB, Denegar CR, Gomez AL, Got-
shalk AL et al (2001) Continuous compression as an eVective
therapeutic intervention in treating eccentric-exercise-induced
muscle soreness. J Sport Rehabil 10:11–23
Lane KN, Wenger HA (2004) EVect of selected recovery conditions on
performance of repeated bouts of intermittent cycling separated
by 24 hours. J Strength Cond Res 18(4):855–860
MacIntyre DL, Reid WD, McKenzie DC (1995) Delayed muscle sore-
ness. The inXammatory response to muscle injury and its clinical
implications. Sports Med 20(1):24–40
Mair J, Mayr M, Muller E, Koller A, Haid C, Artner-Dworzak E et al
(1995) Rapid adaptation to eccentric exercise-induced muscle
damage. Int J Sports Med 16(6):352–356
Meeusen R, Lievens P (1986) The use of cryotherapy in sports injuries.
Sports Med 3(6):398–414
Myrer JW, Draper DO, Durrant E (1994) Contrast water therapy and
intramuscular temperature in the human leg. J Athl Train 29:318–
322
Nosaka K, Newton M (2002) DiV
erence in the magnitude of muscle
damage between maximal and submaximal eccentric loading.
J Strength Cond Res 16(2):202–208
Nosaka K, Sakamoto K, Newton M, Sacco P (2001) How long does the
protective eVect on eccentric exercise-induced muscle damage
last? Med Sci Sports Exerc 33(9):1490–1495
Paddon-Jones DJ, Quigley BM (1997) EVect of cryotherapy on muscle
soreness and strength following eccentric exercise. Int J Sports
Med 18(8):588–593
Prentice WE (1999) Therapeutic modalities in sports medicine, 4th
edn. WCB/McGraw Hill, Boston
Proske U, Morgan DL (2001) Muscle damage from eccentric exercise:
mechanism, mechanical signs, adaptation and clinical applica-
tions. J Physiol 537(Pt 2):333–345
Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R (2007) Ice-
water immersion and delayed-onset muscle soreness: a random-
ised controlled trial. Br J Sports Med 41(6):392–397
Sramek P, Simeckova M, Jansky L, Savlikova J, Vybiral S (2000) Hu-
man physiological responses to immersion into water of diVerent
temperatures. Eur J Appl Physiol 81(5):436–442
Vaile J, Gill N, Blazevich AJ (2007) The eVect of contrast water therapy
on symptoms of delayed onset muscle soreness (DOMS) and explo-
sive athletic performance. J Strength Cond Res 21(3):697–702
Viitasalo JT, Niemela K, Kaappola R, Korjus T, Levola M, Mononen
HV et al (1995) Warm underwater water-jet massage improves
recovery from intense physical exercise. Eur J Appl Physiol
Occup Physiol 71(5):431–438
Wilcock IM, Cronin JB, Hing WA (2006) Physiological response to
water immersion: a method for sport recovery? Sports Med
36(9):747–765
Yamane M, Teruya H, Nakano M, Ogai R, Ohnishi N, Kosaka M
(2006) Post-exercise leg and forearm Xexor muscle cooling in
humans attenuates endurance and resistance training eVects on
muscle performance and on circulatory adaptation. Eur J Appl
Physiol 96(5):572–580
Yanagisawa O, Kudo H, Takahashi N, Yoshioka H (2004) Magnetic
resonance imaging evaluation of cooling on blood Xow and
oedema in skeletal muscles after exercise. Eur J Appl Physiol
91(5–6):737–740
... For example, whole-body passive heating may impair muscle glycogen resynthesis [24], whilst localised heating can accelerate muscle glycogen recovery [12,25]. Indeed, the effects of passive heating on recovery appear to be mixed with studies showing beneficial [26][27][28], detrimental [29,30], or no effect [31,32], re-emphasising the context specific nature of passive heating. Moreover, passive heating has been reported to induce negative consequences, such as dizziness or headaches [33], which are likely a manifestation of heat illness [7] or orthostatic intolerance [34,35]. ...
... This observation is consistent with previous research showing sauna-bathing is considered an important method of recovery in a variety of populations by both athletes and practitioners [46,47]. However, this demonstrates that practice is not always research led as studies have found conflicting outcomes when using passive heating as a recovery modality, with increased stress and impaired next day performance [29,30], and mixed outcomes for glycogen resynthesis [12,24,25,31] and the reduction of muscle soreness [27,48]. It is unclear from this study whether the current usage and belief in passive heating as a recovery modality comes from scientific research. ...
... A survey of sauna users reported the median duration of sauna sessions to be 16 min with relaxation being the primary motivation for sauna-bathing [33]. However, in sport, similar recovery outcomes to no heating have been found after 14 min of hot-water immersion following both muscle damaging exercise and high-intensity exercise [27,32], with beneficial effects of passive heating typically observed following a longer heating duration. For example, a duration of 20-40 min elicits improved sprint performance following a warm-up [11], promotes heat acclimation [18,45], and increases haematological, vascular, and muscular adaptation [19][20][21][22][23].Therefore, whilst these longer durations may be required for physiological effects, either acutely or when repeated to elicit chronic adaptation, passive heating of a shorter 5-15 min duration may be sufficient to elicit short term psychological benefits such as a relaxation or a placebo effect that may subsequently lead to positive outcomes. ...
Article
Full-text available
Recent research into passive heating has shown that it can enhance performance when used as; a stimulus for heat acclima-tion, part of regular training, or during a warm-up. However, this research is contradictory to established practices such as ice baths in the case of recovery. The current usage and understanding of passive heating within sport is unknown. This study aimed to establish the current prevalence, practices and perceptions of passive heating from athletes and sport science practitioners within sport using an online survey. Of the 343 respondents, 62% of athletes and 69% of practitioners reported using passive heating within their sport, with a greater prevalence amongst combat sport athletes or athletes competing at a higher standard (p < 0.05). The most commonly reported purpose of engaging in passive heating for athletes was recovery (66%), and for practitioners was heat acclimation (64%). Most athletes previously engaging in passive heating perceived it to be beneficial for its intended purpose (86%), providing anecdotal evidence to support its use where there currently is no scientific evidence. Moreover, transient negative consequences, such as dizziness or fatigue, were experienced by 55% of athletes highlighting the potential detrimental effects passive heating could have on training or performance that should be considered by athletes and practitioners. Therefore, this survey establishes key differences between scientific understanding and sporting practices whilst identifying areas of future development for the use of passive heating within sport.
... This indicates that TCWI intervention had a better effect on muscle damage than IM. This is in line with other studies that showed that TCWI reduces the concentration of serum CK after 24 H [1,26]. Moreover, Howatson et al. [8] compared the effect of IM to placebo on muscle damage. ...
Article
Full-text available
Purpose: The purpose of the study is to compare the effects of total cold-water immersion to ice massage on muscle damage, performance, and delayed onset of muscle soreness. Methods: Sixty participants were randomized into two groups where they completed a muscle damage protocol. Afterward, muscle damage, muscle performance, and delayed onset muscle soreness were respectively measured by serum Creatine Kinase (CK) test, one-repetition maximum (1-RM) test, countermovement jump (CMJ) test, and visual analog scale (VAS). The measurements were taken at five different timelines (Baseline, 2 H, 24 H, 48 H, and 72 H). Results: Data showed that values of all within-group measures of the dependent variables had extremely significant statistical differences (p < 0.001) for both intervention groups. Serum CK values peaked at 24 H for both groups. At 72 H, serum CK values dropped to baseline values in the total cold-water immersion group, while remaining high in the ice massage group. At 72 H, the values of the 1-RM test, CMJ test, and VAS approximated baseline values only in the total cold-water immersion group (p < 0.001). Conclusions: Total cold-water immersion (TCWI) was more effective when compared to ice massage (IM) on improving values of recovery from exercise-induced muscle damage (EIMD). Hence, this modality may be considered during athletic recovery to maximize athletic performance. Clinical trial registration: This trial was registered in ClinicalTrials.gov under the trial registration number ( NCT04183816 ).
... Our findings of increased perceived soreness following a muscle damaging protocol are similar to prior research which report peak soreness 24-48 h following a damaging exercise bout (Jakeman et al. 2010;Vaile et al. 2008;Nosaka and Kuramata 1991;Kanik et al. 2019). However, we observed no differences between treatment conditions for perceived soreness, though numerically the EPC condition had lower perceived soreness following treatment. ...
Article
Full-text available
Purpose To identify the effects of a single 30 min partial lower leg external pneumatic compression (EPC) treatment compared to a static compression (SC) garment or a no treatment control (CTL) on markers of recovery and performance following a muscle damaging protocol. Methods Thirty healthy, active males (23 ± 3 years; 180.2 ± 9.0 cm; 81.6 ± 11.3 kg) performed 100 drop jumps from a 0.6 m box followed by a randomized, single 30 min treatment of either a partial lower leg EPC device worn below the knee and above the ankle (110 mmHg), SC garment (20–30 mmHg) covering the foot and calf just below the knee, or no treatment CTL, and then returned 24 and 48 h later. Participants were assessed for measures of muscle soreness, fatigue, hemodynamics, blood lactate, muscle thickness, circumferences, and performance assessments. Results The drop jump protocol significantly increased muscle soreness (p < 0.001), fatigue (p < 0.001), blood flow (p < 0.001), hemoglobin (p < 0.001), and muscle oxygen saturation (SMO2; p < 0.001). Countermovement jump and squat jump testing completed after treatment with either EPC, SC, or CTL revealed no differences for jump height between any condition. However, EPC treatment maintained consistent braking force and propulsive power measures across all timepoints for countermovement jump testing. EPC and SC treatment also led to better maintenance of squat jump performance for average relative propulsive force and power variables at 24 and 48 h compared to CTL. Conclusions A single 30 min partial leg EPC treatment may lead to more consistent jump performance following a damaging bout of exercise.
... There is the potential that CWI may specifically impact powerful dynamic movements rather than static strength [8]. Most studies (6/8) included in the recovery of muscular strength analysis used isometric strength testing [43,46,50,55,56,58], and as isometric strength is slower to develop force than dynamic power activities because of the lack of a stretch-shortening cycle, so force production is more reliant on the stiffness of the musculo-tendinous system [92]. Research reports that increased musculo-tendinous stiffness increases isometric force, whereas reduced musculo-tendinous stiffness increases the performance of movements reliant on the stretch-shortening cycle [93]. ...
Article
Full-text available
Background Studies investigating the effects of cold-water immersion (CWI) on the recovery of athletic performance, perceptual measures and creatine kinase (CK) have reported mixed results in physically active populations. Objectives The purpose of this systematic review was to investigate the effects of CWI on recovery of athletic performance, perceptual measures and CK following an acute bout of exercise in physically active populations. Study Design Systematic review with meta-analysis and meta-regression. Methods A systematic search was conducted in September 2021 using Medline, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare and Embase databases. Studies were included if they were peer reviewed and published in English, included participants who were involved in sport or deemed physically active, compared CWI with passive recovery methods following an acute bout of strenuous exercise and included athletic performance, athlete perception and CK outcome measures. Studies were divided into two strenuous exercise subgroups: eccentric exercise and high-intensity exercise. Random effects meta-analyses were used to determine standardised mean differences (SMD) with 95% confidence intervals. Meta-regression analyses were completed with water temperature and exposure durations as continuous moderator variables. Results Fifty-two studies were included in the meta-analyses. CWI improved the recovery of muscular power 24 h after eccentric exercise (SMD 0.34 [95% CI 0.06–0.62]) and after high-intensity exercise (SMD 0.22 [95% CI 0.004–0.43]), and reduced serum CK (SMD − 0.85 [95% CI − 1.61 to − 0.08]) 24 h after high-intensity exercise. CWI also improved muscle soreness (SMD − 0.89 [95% CI − 1.48 to − 0.29]) and perceived feelings of recovery (SMD 0.66 [95% CI 0.29–1.03]) 24 h after high-intensity exercise. There was no significant influence on the recovery of strength performance following either eccentric or high-intensity exercise. Meta-regression indicated that shorter time and lower temperatures were related to the largest beneficial effects on serum CK (duration and temperature dose effects) and endurance performance (duration dose effects only) after high-intensity exercise. Conclusion CWI was an effective recovery tool after high-intensity exercise, with positive outcomes occurring for muscular power, muscle soreness, CK, and perceived recovery 24 h after exercise. However, after eccentric exercise, CWI was only effective for positively influencing muscular power 24 h after exercise. Dose–response relationships emerged for positively influencing endurance performance and reducing serum CK, indicating that shorter durations and lower temperatures may improve the efficacy of CWI if used after high-intensity exercise. Funding Emma Moore is supported by a Research Training Program (Domestic) Scholarship from the Australian Commonwealth Department of Education and Training. Protocol registration Open Science Framework: 10.17605/OSF.IO/SRB9D.
... Asian traditional medicine tends to emphasize warmer temperature in general, although the theory of yin and yang is based on the balance. Even in the modern medical practice, the optimal temperature for recovery is not fully consistent during recovery (Cochrane, 2004;Crowe et al., 2007;Vaile et al., 2008). Traditional temperature managements, or 'hot-cold' theory practices, are maintained in a new cultural environment with minimal conflict with the modern medical system. ...
Article
Full-text available
Objectives Traditional postpartum care practices in East Asia have been recognized as non-functional by some government public health agencies. This study examined the perception of traditional postpartum care practice among families of Korean descent in the United States. In addition to pragmatic health care issues, the research was designed to contribute to cross-cultural understanding of hot–cold theory of reproductive behavior. Methods A descriptive survey study and follow-up interviews were conducted among women of Korean descent living in the United States (n = 141). A questionnaire was used to explore the variation in women’s beliefs about traditional postpartum care and the extent to which they or their relatives practiced this care. In the follow-up interview, the participants freely described the different ways of postpartum care practice. Results Compared to women from other Asian and immigrant populations, women of Korean descent maintained similar or higher rates of believing the functionality of temperature maintenance care practice, and believed that the associated forms of traditional care will continue in the future. Conclusions for Practice Traditional postpartum care practices are broadly shared and practiced in Asian immigrant populations, even in highly industrialized and modernized settings. Furthermore, from their own experience of somatic pain and its functionality, women called for better implementation of traditional care as an alternative or supplement to modern medical care. Health-care systems need to improve understanding and accommodation of cultural beliefs about possible benefits of temperature maintenance after childbirth in Asian ethnic populations.
... The aim of HWI is to ease muscle tension and increase blood flow to assist in the removal of metabolic waste and increase nutrient delivery to and from the cells [54]. HWI has been shown to enhance the maintenance of neuromuscular performance after intense exercise [55] and enhance the recovery of isometric force compared to control after muscle-damaging exercise [56]. While these studies show positive impacts of HWI on athletic recovery, more research is required to fully understand the physiological and performance effects of HWI and how this might be applied in a basketball specific scenario. ...
Article
Full-text available
Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players’ recovery for training and competition throughout the season.
Article
Introduction: Alterations caused in the metabolism of those who practice physical exercise regularly generate health benefits, however, in athletes, these alterations can cause muscle damage, so post-recovery recovery methods are extremely important for their physiological maintenance. Objective: To analyze the effectiveness of the contrast therapy technique with post-exercise recovery according to professional athletes. Methods: A questionnaire was applied that addressed the technical scientific knowledge of professional athletes over 18 years of age, of both sexes, about post-exerciseffort recovery techniques (PERT), personal information, and ethical issues, on an online platform. Descriptive statistical analysis was performed, with values presented in percentages and an association through the Chi-Square test on the knowledge of PERT and other independent variables. Results: In total, 63 athletes, 15 women and 48 men, answered the online questionnaire, 71.4% were between 18 and 30 years old, including swimmers, footballers, and athletics practitioners, and 85.7% had more than three years' experience in the sport and 57.1% competed at an international level. Considering the main PERTs, 92.1% were aware, 58.7% knew more than four, 96.8% frequently used at least one PERT, and 65.1% had used it for more than three years. Knowledge of PERTs is associated with age (p = 0.001), education (p = 0.001), practice time (p = 0.001), hours of daily training (0.001), and competitive level (p = 0.03). With respect to the use of the contrast technique, 36.5% of the respondents had already used it, and 34.9% found it effective. Conclusion: The athletes who used the contrast technique reported a good perception of recovery.
Article
Full-text available
Eccentric exercise continues to receive attention as a productive means of exercise. Coupled with this has been the heightened study of the damage that occurs in early stages of exposure to eccentric exercise. This is commonly referred to as delayed onset muscle soreness (DOMS). To date, a sound and consistent treatment for DOMS has not been established. Although multiple practices exist for the treatment of DOMS, few have scientific support. Suggested treatments for DOMS are numerous and include pharmaceuticals, herbal remedies, stretching, massage, nutritional supplements, and many more. DOMS is particularly prevalent in resistance training; hence, this article may be of particular interest to the coach, trainer, or physical therapist to aid in selection of efficient treatments. First, we briefly review eccentric exercise and its characteristics and then proceed to a scientific and systematic overview and evaluation of treatments for DOMS. We have classified treatments into 3 sections, namely, pharmacological, conventional rehabilitation approaches, and a third section that collectively evaluates multiple additional practiced treatments. Literature that addresses most directly the question regarding the effectiveness of a particular treatment has been selected. The reader will note that selected treatments such as anti-inflammatory drugs and antioxidants appear to have a potential in the treatment of DOMS. Other conventional approaches, such as massage, ultrasound, and stretching appear less promising.
Article
Full-text available
Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1–2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.
Article
Full-text available
Objectives. The aim of this review was to investigate whether alternating hot – cold water treatment is a legitimate training tool for enhancing athlete recovery. A number of mechanisms are discussed to justify its merits and future research directions are reported. Alternating hot– cold water treatment has been used in the clinical setting to assist in acute sporting injuries and rehabilitation purposes. However, there is overwhelming anecdotal evidence for it's inclusion as a method for post exercise recovery. Many coaches, athletes and trainers are using alternating hot – cold water treatment as a means for post exercise recovery. Design. A literature search was performed using SportDiscus, Medline and Web of Science using the key words recovery, muscle fatigue, cryotherapy, thermotherapy, hydrotherapy, contrast water immersion and training. Results. The physiologic effects of hot – cold water contrast baths for injury treatment have been well documented, but its physiological rationale for enhancing recovery is less known. Most experimental evidence suggests that hot– cold water immersion helps to reduce injury in the acute stages of injury, through vasodilation and vasoconstriction thereby stimulating blood flow thus reducing swelling. This shunting action of the blood caused by vasodilation and vasoconstriction may be one of the mechanisms to removing metabolites, repairing the exercised muscle and slowing the metabolic process down. Conclusion. To date there are very few studies that have focussed on the effectiveness of hot– cold water immersion for post exercise treatment. More research is needed before conclusions can be drawn on whether alternating hot– cold water immersion improves recuperation and influences the physiological changes that characterises post exercise recovery.
Article
The wide array of superficial heat and cold modalities offers physicians many options for treating sports-related injuries. Appropriate application of heat and cold therapies can reduce the impact of an injury by relieving pain, reducing swelling, and encouraging rehabilitation.
Article
HARRISON, B. C., D. ROBINSON, B. J. DAVISON, B. FOLEY, E. SEDA, and W. C. BYRNES. Treatment of exercise-induced muscle injury via hyperbaric oxygen therapy. Med. Sci. Sports Exerc., Vol. 33, No. 1, 2001, pp. 36–42. Purpose: This study examined the role of hyperbaric oxygen therapy (HBO) in the treatment of exercise-induced muscle injury. Methods: 21 college-aged male volunteers were assigned to three groups: control, immediate HBO (iHBO), and delayed HBO (dHBO). All subjects performed 6 sets (10 repetitions per set) of eccentric repetitions with a load equivalent to 120% of their concentric maximum. HBO treatments consisted of 100-min exposure to 2.5 ATA and 100% oxygen with intermittent breathing of ambient air (30 min at 100% O2, 5 min at 20.93% O2). HBO treatments began either 2 (iHBO) or 24 h (dHBO) postexercise and were administered daily through day 4 postexercise. Forearm flexor cross-sectional area (CSA) and T2 relaxation time via magnetic resonance imaging (MRI) were assessed at baseline, 2, 7, and 15 d postinjury. Isometric strength and rating of perceived soreness of the forearm flexors were assessed at baseline, 1, 2, 3, 4, 7, and 15 d postinjury. Serum creatine kinase (CK) was assessed on day 0 and on days 1, 2, 7, and 15 postinjury. Results: Mean baseline CSA values were: 2016.3, 1888.5, and 1972.2 mm2 for control, iHBO, and dHBO, respectively. All groups showed significant increases in CSA in response to injury (21% at 2 d, 18% at 7 d) (P < 0.0001), but there were no significant differences between groups (P = 0.438). Mean baseline T2 relaxation times were: 26.18, 26.28, and 27.43 msec for control, iHBO, and dHBO, respectively. Significant increases in T2 relaxation time were observed for all groups (64% at 2 d, 66% at 7 d, and 28% at 15 d) (P < 0.0001), but there were no significant differences between groups (P = 0.692). Isometric strength (P < 0.0001), serum CK levels (P = 0.0007), and rating of perceived soreness (P < 0.0001) also indicated significant muscle injury for all groups, but there were no differences between groups (P = 0.459, P = 0.943, and P = 0.448, respectively). Conclusion: These results suggest that hyperbaric oxygen therapy was not effective in the treatment of exercise-induced muscle injury as indicated by the markers evaluated.
Article
Delayed onset muscle soreness (DOMS) is a sensation of discomfort that occurs 1 to 2 days after exercise. The soreness has been reported to be most evident at the muscle/tendon junction initially, and then spreading throughout the muscle. The muscle activity which causes the most soreness and injury to the muscle is eccentric activity. The injury to the muscle has been well described but the mechanism underlying the injury is not fully understood. Some recent studies have focused on the role of the cytoskeleton and its contribution to the sarcomere injury. Although little has been confirmed regarding the mechanisms involved in the production of delayed muscle soreness, it has been suggested that the soreness may occur as a result of mechanical factors or it may be biochemical in nature. To date, there appears to be no relationship between the development of soreness and the loss of muscle strength, in that the timing of the two events is different. Loss of muscle force has been observed immediately after the exercise. However, by collecting data at more frequent intervals a second loss of force has been reported in mice 1 to 3 days post-exercise. Future studies with humans may find this second loss of force to be related to DOMS. The role of inflammation during exercise-induced muscle injury has not been clearly defined. It is possible that the inflammatory response may be responsible for initiating, amplifying, and/or resolving skeletal muscle injury. Evidence from the literature of the involvement of cytokines, complement, neutrophils, monocytes and macrophages in the acute phase response are presented in this review. Clinically, DOMS is a common but self-limiting condition that usually requires no treatment. Most exercise enthusiasts are familiar with its symptoms. However, where a muscle has been immobilised or debilitated, it is not known how that muscle will respond to exercise, especially eccentric activity.
Article
The purpose of this study was to compare the changes in force production resulting from isometric strength training, in combination with 3 different treatment conditions: control, cold water immersion, and hot water immersion. Forty-five noninjured subjects between the ages of 18 and 25 were randomly assigned to 1 of 3 groups: control, cold, or hot. Subjects exercised only their right lower limb using static muscular contractions, consisting of 1 set of 4 repetitions, for 5 consecutive days. On the first day, after a few warm-up contractions, subjects were measured for maximum isometric force production (MIFP) of the hip extensor (HE) musculature at the end range of hip flexion. After this initial measure, subjects underwent their respective treatments. Control subjects rested for 10 minutes, subjects in the cold group stood in a cold water bath (8 +/- 1[degrees] C) immersed up to their gluteal fold for 10 minutes, and subjects in the hot group stood in a hot water bath (43 +/- 1[degrees] C) immersed up to their gluteal fold for 10 minutes. After the last training session, subjects were again measured for MIFP of the HE musculature at end range. Group results were assessed using a two-way analysis of variance procedure, comparing changes in isometric force production from pre-to posttest and between sexes. Multiple comparisons were performed to determine where significant (p < 0.05) differences occurred. All 3 groups had significant improvements in HE isometric force production (pre to post). The increase in MIFP for the cold group was significantly greater than that of the control and hot groups. Sex differences were evident in the cold group only, with men experiencing greater increases. (C) 2000 National Strength and Conditioning Association
Article
Context Prior investigations using ice, massage, or exercise have not shown efficacy in relieving delayed-onset muscle soreness. Objectives To determine whether a compression sleeve worn immediately after maximal eccentric exercise enhances recovery. Design Randomized, controlled clinical study. Setting University sports medicine laboratory. Participants Fifteen healthy, non-strength-trained men, matched for physical criteria, randomly placed in a control group or a continuous compression-sleeve group (CS). Methods and Measures Subjects performed 2 sets of 50 arm curls. 1RM elbow flexion at 60°/s, upper-arm circumference, resting-elbow angle, serum creatine kinase (CK), and perception-of-soreness data were collected before exercise and for 3 days. Results CK was significantly ( P < .05) elevated from the baseline value in both groups, although the elevation in the CS group was less. CS prevented loss of elbow extension, decreased subjects’ perception of soreness, reduced swelling, and promoted recovery of force production. Conclusions Compression is important in soft-tissue-injury management.