Cold Water Immersion Recovery after Simulated Collision Sport Exercise

Impact of different doses of cold water immersion (duration and temperature variations) on recovery from acute exercise-induced muscle damage: a network meta-analysis

Objective

This network meta-analysis and systematic review evaluated the recovery impacts of varying cold water immersion (CWI) protocols on acute exercise-induced muscle damage.

Methods

We searched CNKI, PubMed, Cochrane Library, Web of Science, and Embase from January 2000 to September 2024 for randomized controlled trials examining CWI's recovery effects on acute muscle damage. Data extraction, study screening, and risk of bias assessment were conducted independently by two reviewers. Analyses were performed using Stata 16.0.

Results

A total of 55 RCTs were included, with 42 reporting delayed onset muscle soreness (DOMS), 36 reporting jump performance (JUMP), and 30 reporting creatine kinase (CK) levels. Network meta-analysis showed that compared with the control group, MD-MT-CWI: Medium-duration medium-temperature cold water immersion (10-15 min, 11°C-15°C) [SMD = -1.45, 95%CI(-2.13, -0.77), P < 0.01] and MD-LT-CWI: Medium-duration low-temperature cold water immersion (10-15 min, 5°C-10°C) [SMD = -1.12, 95%CI(-1.78, -0.47), P = 0.01] significantly reduced DOMS; MD-LT-CWI (10-15 min, 5°C-10°C) [SMD = 0.48, 95%CI(0.20, 0.77), P = 0.01] and MD-MT-CWI (10-15 min, 11°C-15°C) [SMD = 0.42, 95%CI(0.15, 0.70), P = 0.02] significantly improved JUMP; MD-MT-CWI (10-15 min, 11°C-15°C) [SMD = -0.85, 95%CI(-1.36, -0.35), P = 0.01] and MD-LT-CWI (10-15 min, 5°C-10°C) [SMD = -0.90, 95%CI(-1.46, -0.34), P = 0.02] significantly reduced CK. Cumulative probability ranking showed that MD-LT-CWI (10-15 min, 5°C-10°C) was the most effective for improving JUMP and reducing CK, while MD-MT-CWI (10-15 min, 11°C-15°C) was the most effective for reducing DOMS.

Conclusion

Different dosages of cold water immersion (varying in duration and temperature) had different effects on recovery from acute exercise-induced muscle damage. We found that MD-LT-CWI (10-15 min, 5°C-10°C) was most effective for improving biochemical markers (CK) and neuromuscular recovery, while MD-MT-CWI (10-15 min, 11°C-15°C) was most effective for reducing muscle soreness. In practice, we recommend using MD-LT-CWI (10-15 min, 5°C-10°C) and MD-MT-CWI (10-15 min, 11°C-15°C) to reduce Exercise-induced muscle damage (EIMD). However, due to the limitations of the included studies, further high-quality studies are needed to verify these conclusions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024602359.

Mechanism involved of post-exercise cold water immersion: Blood redistribution and increase in energy expenditure during rewarming

Thermogenesis is well understood, but the relationships between cold water immersion (CWI), the post-CWI rewarming and the associated physiological changes are not. This study investigated muscle and systemic oxygenation, cardiorespiratory and hemodynamic responses, and gastrointestinal temperature during and after CWI. 21 healthy men completed randomly 2 protocols. Both protocols consisted of a 48 minutes heating cycling exercise followed by 3 recovery periods (R1-R3), but they differed in R2. R1 lasted 20 minutes in a passive semi-seated position on a physiotherapy table at ambient room temperature. Depending on the protocol, R2 lasted 15 minutes at either ambient condition (R2_AMB) or in a CWI condition at 10°C up to the iliac crest (R2_CWI). R3 lasted 40 minutes at AMB while favoring rewarming after R2_CWI. This was followed by 10 minutes of cycling. Compared to R2_AMB, R2_CWI ended at higherV ˙ O2 in the non-immersed body part due to thermogenesis (7.16(2.15) vs. 4.83(1.62) ml.min-1.kg-1) and lower femoral artery blood flow (475(165) vs. 704(257) ml.min-1) (p < 0.001). Only after CWI, R3 showed a progressive decrease in vastus and gastrocnemius medialis O2 saturation, significant after 34 minutes (p < 0.001). As blood flow did not differ from the AMB protocol, this indicated local thermogenesis in the immersed part of the body. After CWI, a lower gastrointestinal temperature on resumption of cycling compared to AMB (36.31(0.45) vs. 37.30(0.49) °C, p < 0.001) indicated incomplete muscle thermogenesis. In conclusion, the rewarming period after CWI was non-linear and metabolically costly. Immersion and rewarming should be considered as a continuum rather than separate events.

Effect of CO2 and H2 gas mixture in cold water immersion on recovery after eccentric loading

Background

The findings of previous studies support the efficacy of cold water immersion (CWI) with carbon dioxide (CO2) in enhancing muscle blood flow and maintaining aerobic performance efficiency. We hypothesize that the addition of hydrogen gas (H2), known for its antioxidant properties and role in inflammation regulation, to C-CWI can enhance recovery after eccentric exercise.

Subjects

and Methods: Thirty-four healthy subjects performed a knee-extensor eccentric exercise. They were randomly allocated into four groups: control, CWI, CO2-rich CWI (C-CWI), and CO2 + H2 gas mixture CWI (CH-CWI). In the three CWI groups, all subjects were immersed in the appropriate bath at 20 °C for 20 min immediately after 60 repetitions of eccentric exercise. Before exercise and after 48 h of recovery, the subjects' maximal voluntary isometric contraction torque (MVC-ISO), maximal voluntary concentric (MVC-CON) contraction torque, countermovement jump (CMJ) height, knee flexion range of motion (ROM), muscle soreness, and muscle thickness were measured.

Results

In the CH-CWI group only, the MVC-ISO, CMJ height, and ROM did not decrease significantly post-exercise, whereas all of these decreased in the other three groups. Muscle soreness at palpation, contraction, and stretching significantly increased post-exercise in all groups. Echo intensity and tissue hardness did not increase significantly in the CH-CWI group.

Conclusions

CH-CWI stimulated recovery from impairments in MVC-ISO torque, CMJ height, knee-flexion ROM, tissue hardness, and echo intensity. These findings indicate that CH-CWI can promote recovery after eccentric exercise.

The effect of cold water immersion on the recovery of physical performance revisited: A systematic review with meta-analysis

This review evaluated the effect of CWI on the temporal recovery profile of physical performance, accounting for environmental conditions and prior exercise modality. Sixty-eight studies met the inclusion criteria. Standardised mean differences were calculated for parameters assessed at <1, 1-6, 24, 48, 72 and ≥96 h post-immersion. CWI improved short-term recovery of endurance performance (p = 0.01, 1 h), but impaired sprint (p = 0.03, 1 h) and jump performance (p = 0.04, 6h). CWI improved longer-term recovery of jump performance (p < 0.01-0.02, 24 h and 96 h) and strength (p < 0.01, 24 h), which coincided with decreased creatine kinase (p < 0.01-0.04, 24-72 h), improved muscle soreness (p < 0.01-0.02, 1-72 h) and perceived recovery (p < 0.01, 72 h). CWI improved the recovery of endurance performance following exercise in warm (p < 0.01) and but not in temperate conditions (p = 0.06). CWI improved strength recovery following endurance exercise performed at cool-to-temperate conditions (p = 0.04) and enhanced recovery of sprint performance following resistance exercise (p = 0.04). CWI seems to benefit the acute recovery of endurance performance, and longer-term recovery of muscle strength and power, coinciding with changes in muscle damage markers. This, however, depends on the nature of the preceding exercise.

Scheduling Concurrent Training 48 versus 72 h after Simulated Match Play: Effects on Neuromuscular Function and Fatigue

INTRODUCTION

Scheduling concurrent training (CT) during the in-season microcycle in field-based team sport is driven by prematch and postmatch recovery. This study examined the neuromuscular function, fatigue, and soreness responses to CT administered 48 h (match day (MD) + 2) versus 72 h (MD + 3) after match.

METHODS

Ten male recreational-level team sport athletes were monitored daily during two 5-d microcycles, which began with a simulated match (Soccer-specific Aerobic Field Test (SAFT90)) and CT performed either 48 or 72 h after match. Maximal voluntary force, quadriceps maximum EMG, voluntary activation, muscle contractile function (evoked twitch responses), muscle soreness, and fatigue were assessed immediately before and after the SAFT90, and every 24 up to 96 h after match. Outcome measures were also assessed immediately after CT. The CT consisted of an intermittent sprint protocol and a lower limb resistance training session separated by 1 h.

RESULTS

Immediately after the SAFT90 in both conditions, maximal voluntary force was below baseline (mean change (Δ), -14.6% ± 10.0%; P = 0.03), recovering 48 h post. Quadriceps contractile function (Δ, -31.5% ± 11.4%; P = 0.003) and voluntary activation (Δ, -8.9 ± 6.2%; P = 0.003) were also hampered after the SAFT90, recovering 24 h post in both conditions. In addition, the SAFT90 elicited elevated levels of fatigue and muscle soreness that recovered 24 h after the SAFT90 before increasing at 72 and 96 h post in the MD + 2 and MD + 3 conditions, respectively.

CONCLUSIONS

Recovery of fatigue was only observed at the end of the microcycle when CT was prescribed on MD + 2. Therefore, CT scheduled early (MD + 2) in the microcycle might avoid compromising forthcoming match preparation.

Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis

Cold water immersion (CWI) is very popular as a method reducing post-exercise muscle stiffness, eliminating fatigue, decreasing exercise-induced muscle damage (EIMD), and recovering sports performance. However, there are conflicting opinions as to whether CWI functions positively or negatively. The mechanisms of CWI are still not clear. In this systematic review, we used meta-analysis aims to examine the effect of CWI on fatigue recovery after high-intensity exercise and exercise performance. A total of 20 studies were retrieved and included from PubMed, PEDro and Elsevier databases in this review. Publication years of articles ranged from 2002 to 2022. In selected studies including randomized controlled trials (RCTs) and Crossover design (COD). Analyses of subjective indicators such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE), and objective indicators such as countermovement jump (CMJ) and blood plasma markers including creatine kinase(CK), lactate/lactate dehydrogenase(LDH), C-reactive protein(CRP), and IL-6 were performed. Pooled data showed as follows: CWI resulted in a significant decline in subjective characteristics (delayed-onset muscle soreness and perceived exertion at 0 h); CWI reduced countermovement jump(CMJ) significantly at 0 h, creatine kinase(CK) was lowered at 24 h, and lactate at 24 and 48 h. There was no evidence that CWI affects C-reactive protein(CRP) and IL-6 during a 48-h recovery period. Subgroup analysis revealed that different CWI sites and water temperatures have no effect on post-exercise fatigue recovery. Recommended athletes immersed in cold water immediately after exercise, which can effectively reduce muscle soreness and accelerate fatigue recovery.

Analysis of Recovery Methods' Efficacy Applied up to 72 Hours Postmatch in Professional Football: A Systematic Review With Graded Recommendations

BACKGROUND

Sleep, nutrition, active recovery, cold-water immersion, and massage were recently reported as the most used postmatch recovery methods in professional football. However, the recommendations concerning the effect of these methods remain unclear.

PURPOSE

To systematically review the literature regarding the effectiveness of the most common recovery methods applied to male and female football players (or other team sports) 72 hours postmatches and to provide graded recommendations for their use.

METHODS

A systematic search of the literature was performed, and the level of evidence of randomized and nonrandomized studies was classified as 1 or 2, respectively, with additional ++, +, and - classification according to the quality of the study and risk of bias. Graded recommendations were provided regarding the effectiveness of recovery methods for physical, physiological, and perceptive variables.

RESULTS

From the 3472 articles identified, 39 met the inclusion criteria for analysis. The studies' levels of evidence varied among methods (sleep: 2+ to 1++; nutrition: 2- to 1+; cold-water immersion: 2- to 1++; active recovery: 2- to 1+; and massage: 1- to 1+). Different graded recommendations were attributed, and none of them favored the effective use of recovery methods for physiological and physical parameters, whereas massage and cold-water immersion were recommended as beneficial for perceptive variables.

CONCLUSIONS

Cold-water immersion and massage can be recommended to recover up to 72 hours postmatch at a perceptive level. However, there is a current need for high-quality research that identifies effective recovery strategies that enhance recovery at the physical and physiological levels.

Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Performance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression

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.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01644-9.

Post-Match Recovery in Soccer with Far-Infrared Emitting Ceramic Material or Cold-Water Immersion

We investigated the effects of two common recovery methods; far-infrared emitting ceramic materials (Bioceramic) or cold-water immersion on muscular function and damage after a soccer match. Twenty-five university-level soccer players were randomized into Bioceramic (BIO; n = 8), Cold-water immersion (CWI; n = 9), or Control (CON; n = 8) groups. Heart rate [HR], rating of perceived exertion [RPE], and activity profile through Global Positioning Satellite Systems were measured during the match. Biochemical (thiobarbituric acid reactive species [TBARS], superoxide dismutase [SOD], creatine kinase [CK], lactate dehydrogenase [LDH]), neuromuscular (countermovement [CMJ] and squat jump [SJ], sprints [20-m]), and perceptual markers (delayed-onset muscle soreness [DOMS], and the perceived recovery scale [PRS]) were assessed at pre, post, 24 h, and 48 h post-match. One-way ANOVA was used to compare anthropometric and match performance data. A two-way ANOVA with post-hoc tests compared the timeline of recovery measures. No significant differences existed between groups for anthropometric or match load measures (P > 0.05). Significant post-match increases were observed in SOD, and decreases in TBARS in all groups (p < 0.05), without differences between conditions (p > 0.05). Significant increases in CK, LDH, quadriceps and hamstring DOMS (p < 0.05), as well as decreases in 20-m, SJ, CMJ, and PRS were observed post-match in all groups (p < 0.05), without significant differences between conditions (p > 0.05). Despite the expected post-match muscle damage and impaired performance, neither Bioceramic nor CWI interventions improved post-match recovery.

Acute Neuromuscular Response to Team Sports-specific Running, Resistance, and Concurrent Training: A Cross-over Study

PURPOSE

To examine the changes in muscle contractile function, voluntary activation, and muscle damage following lower limb resistance training (RT), intermittent sprint exercise and concurrent training (CT).

METHODS

Ten male, recreational team sport athletes with a history of RT participated in a randomised cross-over study involving an intermittent sprint protocol (ISP), lower limb RT and CT (ISP and RT separated by 1 h). Prior to (PRE), immediately post (POST), 24 h and 48 h following each exercise condition, quadriceps muscle activation, voluntary activation, muscle contractile function (evoked twitch responses), creatine kinase (CK), muscle soreness and POMS-fatigue were recorded.

RESULTS

Quadriceps contractile function was hampered in all conditions, with a significantly greater decline observed POST RT (58.4 ± 18.0%) and CT (54.8 ± 8.6%) compared to ISP (35.9 ± 10.7%; p < 0.05), recovering at 48 h following all exercise conditions. POMS-fatigue ratings increased at POST in all conditions with CT and ISP eliciting the greatest increase, returning to baseline 48 h following all exercise conditions. Quadriceps muscle soreness remained elevated from PRE at 48 h following all exercise conditions. No changes across time were observed for voluntary activation and quadriceps surface EMG amplitude following any exercise condition. The volume and load lifted in the RT session was unaffected by prior intermittent exercise (ISP) in CT.

CONCLUSION

RT impairs contractile function which is not exacerbated when performed 1 h following the ISP. Contractile function following all exercise conditions displayed the same recovery profile (48 h) despite the post-exercise decrement being smaller following the ISP compared to RT and CT. Prior intermittent sprint exercise does not negatively impact the volume of exercise performed in a lower limb RT session.

Cold Water Immersion as a Strategy for Muscle Recovery in Professional Basketball Players During the Competitive Season

CONTEXT

Despite prior studies that have addressed the recovery effects of cold-water immersion (CWI) in different sports, there is a lack of knowledge about longitudinal studies across a full season of competition assessing these effects.

OBJECTIVE

To analyze the CWI effects, as a muscle recovery strategy, in professional basketball players throughout a competitive season.

DESIGN

A prospective cohort design.

SETTING

Elite basketball teams.

PARTICIPANTS

A total of 28 professional male basketball players divided into 2 groups: CWI (n = 12) and control (n = 16) groups.

MAIN OUTCOME MEASURES

Muscle metabolism serum markers were measured during the season in September-T1, November-T2, March-T3, and April-T4. Isokinetic peak torque strength and ratings of perceived exertion were measured at the beginning and at the end of the season. CWI was applied immediately after every match and after every training session before matches.

RESULTS

All serum muscular markers, except myoglobin, were higher in the CWI group than the control group (P < .05). The time course of changes in muscle markers over the season also differed between the groups (P < .05). In the CWI group, ratings of perceived exertion decreased significantly from the beginning (T1-T2) to the end (T3-T4). Isokinetic torque differed between groups at the end of the season (60°/s peak torque: P < .001 and ηp2=.884; and 180°/s peak torque: P < .001 and ηp2=.898) and had changed significantly over the season in the CWI group (P < .05).

CONCLUSIONS

CWI may improve recovery from muscle damage in professional basketball players during a regular season.

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

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.

Neuromuscular responses to fatiguing locomotor exercise

Over the last two decades, an abundance of research has explored the impact of fatiguing locomotor exercise on the neuromuscular system. Neurostimulation techniques have been implemented prior to and following locomotor exercise tasks of a wide variety of intensities, durations, and modes. These techniques have allowed for the assessment of alterations occurring within the central nervous system and the muscle, while techniques such as transcranial magnetic stimulation and spinal electrical stimulation have permitted further segmentalization of locomotor exercise-induced changes along the motor pathway. To this end, the present review provides a comprehensive synopsis of the literature pertaining to neuromuscular responses to locomotor exercise. Sections of the review were divided to discuss neuromuscular responses to maximal, severe, heavy and moderate intensity, high-intensity intermittent exercise, and differences in neuromuscular responses between exercise modalities. During maximal and severe intensity exercise, alterations in neuromuscular function reside primarily within the muscle. Although post-exercise reductions in voluntary activation following maximal and severe intensity exercise are generally modest, several studies have observed alterations occurring at the cortical and/or spinal level. During prolonged heavy and moderate intensity exercise, impairments in contractile function are attenuated with respect to severe intensity exercise, but are still widely observed. While reductions in voluntary activation are greater during heavy and moderate intensity exercise, the specific alterations occurring within the central nervous system remain unclear. Further work utilizing stimulation techniques during exercise and integrating new and emerging techniques such as high-density electromyography is warranted to provide further insight into neuromuscular responses to locomotor exercise.

Combined platelet-rich plasma and cold water immersion treatment minimize the damage following a skeletal muscle stretch injury in rats

The skeletal muscle stretch injuries are commonly observed in sports. In order to stimulate tissue healing, the platelet-rich plasma (PRP) and cold water immersion (CWI) are widely used in clinical practice. This study investigated the effects of isolated or combined PRP and/or CWI on the oxidative damage determined by a stretch injury induced in gastrocnemius muscle of rats. PRP and CWI are applied immediately after the injury, and the biochemical analysis was performed after 1, 3, 5, or 7 days. The levels of o thiobarbituric acid reactive substances and oxidized dichlorofluorescein were significantly increased, both in skeletal muscle tissue and erythrocytes preparations, and the combined PRP and CWI minimized these parameters. Moreover, combined PRP and CWI were more effective than the isolated treatments to increase catalase activity, also the ratio of reduced/oxidized glutathione, and the non-protein thiols (-SH) group levels. In conclusion, we could infer that the combination of these regular treatments used in an isolated form shows a great potential for treatments of muscular injuries.

The Acute and Longer-Term Effects of Cold Water Immersion in Highly-Trained Volleyball Athletes During an Intense Training Block

Background: The use of cold water immersion (CWI) as a recovery strategy following exercise has drawn mixed findings over the last few decades. The purpose of the current study was two-fold; (1) to determine the acute effects of CWI within the training week, and (2) to investigate the longer-term effects of CWI over a 16-day period. Methods: In a randomized, controlled trial, 13 national-level volleyball athletes were allocated to two groups, an experimental (CWI, n = 7) and a control group (n = 6) during a 3-week national training camp. The experimental group were exposed to a CWI protocol after the last training session of each day (12 CWI sessions). Measures of lower (countermovement jump and squat jump height) and upper-body (medicine ball throw distance) power were collected pre- and post-training camp. Perceptual and neuromuscular performance measures (countermovement jump) were obtained during the training camp. Results: No significant differences between groups were observed for any measure (p > 0.05), however, small effect sizes were observed between experimental and control groups on day two of weeks one and two. Three weeks of training resulted in a significant decrease in countermovement jump height in the control group. A moderate effect size (d = 0.65) was found for countermovement jump performance between the experimental and control groups. Conclusion: Cold water immersion seems to provide little benefit to recovery in the acute setting (within the training week), however, chronically, there was a trend toward a benefit when implementing cold water immersion in well-trained volleyball athletes over 16 days.

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

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 3-6 h 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.

Cold-Water Immersion Does Not Accelerate Performance Recovery After 10-km Street Run: Randomized Controlled Clinical Trial

The use of strategies to assure better post-effort recovery is frequent in sports settings. There are several interventions available for exercise induced muscle damage recovery, but cold-water immersion (CWI) stands out among them. The effects of CWI are unclear in the literature and, although the number of street runners has been growing, there is a gap in the scientific evidence regarding the use of CWI to recover runners' performance after a 10-km street run. Purpose: The goal of our study was to analyze the effects of CWI on the recovery of muscle damage markers after a 10-km street run. Method: We randomly assigned thirty male recreational street runners, immediately after a 10-km street run, into three recovery groups: control (rest for 10 minutes), immersion (10 min immersed in water without ice at room temperature) and CWI (10 min immersed in water with ice at 10ºC). We assessed pain, triple hop distance, extensor peak torque and blood creatine kinase levels pre- and post-run, post-intervention and 24 hours after the run. Results: The 10-km run was enough to decrease triple hop distance and extensor peak torque, and increase levels of creatine kinase (p < 0.05); however, we found no time/group interactions in any of the assessed variables after we applied the appropriate interventions (p > 0.05). Conclusion: 10-min CWI at 10°C was no more effective than water immersion and rest in recovering muscle damage markers after 10-km runs.

Lay of the land: narrative synthesis of tackle research in rugby union and rugby sevens

Objectives

The purpose of this review was to synthesise both injury prevention and performance tackle-related research to provide rugby stakeholders with information on tackle injury epidemiology, including tackle injury risk factors and performance determinants, and to discuss potential preventative measures.

Design

Systematic review and narrative synthesis.

Data sources

PubMed, Scopus and Web of Science.

Eligibility criteria

Limited to peer-reviewed English-only publications between January 1995 and October 2018.

Results

A total of 317 studies were identified, with 177 in rugby union and 13 were in rugby sevens. The tackle accounted for more than 50% of all injuries in rugby union and rugby sevens, both at the professional level and at the lower levels, with the rate of tackle injuries higher at the professional level (mean 32/1000 player-hours) compared with the lower levels (mean 17/1000 player-hours). A player’s tackle actions and technical ability were identified as major risk factors for injury and a key determinant of performance.

Summary/conclusion

Evidence-based education, progressive tackle technique training with a high potential to transfer and law changes have been proposed as key modifiers of player tackle actions and technical ability. Conceivably, all three modifiers working in unison (as opposed to separately) will have a higher potential at reducing tackle injury risk while enhancing performance. With the guidance of tackle injury and performance studies, as well as stakeholder engagement, experiential and explorative tackle research has the potential to inspire innovative injury prevention and performance strategies.

The effects of cryotherapy on athletes' muscle strength, flexibility, and neuromuscular control: A systematic review of the literature

PURPOSE

This review aimed to investigate the effects of cryotherapy on the functional capacity parameters of athletes, such as muscular strength, flexibility, neuromuscular control, and balance.

METHODS

A computerized search of EBSCO Host databases, Proquest, Medline, SportDiscus, CinahlPlus, Health Source Nursing/Academic Edition, Academic Search Complete, and GoogleScholar databases was performed to identify clinical trials with a focus on cryotherapy applications in sport. Thekeywords used were "cryotherapy," "sports,""strength,""flexibility," and "proprioception."

STUDY SELECTION

Randomized control trials and randomized crossover studies of healthy athletes were included in this review. The methodological quality of the studies was assessed by the validation criteria given by Furlan et al (2009).

RESULTS

A total of 50 randomized controlled trials (RCTs) and randomized crossover studies met the above criteria and were included in the final analysis. The studies available indicate that there is no strong research evidence to suggest that cryotherapy can definitely influence joint strength and neuromuscular control. The only positive effect of cryotherapy appears to be an improvement in joint flexibility.

CONCLUSIONS

Limited and equivocal evidence is available to address the effect of cryotherapy on muscular function. The only evidence-based positive impact after the applications of cryotherapy is improved joint flexibility. Despite the extensive use of cryotherapy in sports, further research is needed to document the actual effects of cryotherapy applications on athletes' functional performance and rehabilitation parameters.

No Effect of Partial-Body Cryotherapy on Restoration of Countermovement Jump or Well-Being Performance in Elite Rugby Union Players During the Competitive Phase of the Season

PURPOSE

Partial body cryotherapy (PBC) has been shown to be beneficial for postexercise recovery; however, no study has demonstrated the effectiveness of PBC for recovery following elite rugby union training. Rugby union is a unique sport that involves high-velocity collisions and may induce greater performance decrements than other sports; thus, PBC could be beneficial. The application of PBC in "real world" has rarely been investigated during the competitive phase of a playing season and warranted investigation.

METHODS

In a counterbalanced sequential research design, professional rugby athletes (n = 18; age 25.4 [4.0] y; training age 7.2 [4.0] y; mass 99.8 [10.6] kg; height 188.3 [6.0] cm) were assigned to a 12-week PBC intervention, washout period (4 wk), and reassessed as their own controls. Self-reported well-being, muscle soreness, sleep quality, and countermovement jump height were assessed before and 40 hours after "real-world" training. Wilcoxon signed-rank tests and Cohen d were used for statistical analysis.

RESULTS

No differences were observed between PBC and control conditions (P > .05; d = 0.00-0.14) for well-being (-0.02% [0.08%] vs 0.01% [0.06%]), muscle soreness (-0.01% [0.11%] vs 0.01% [0.16%]), sleep quality (-0.03% [0.14%] vs 0.10% [0.29%]), or countermovement jump height (36.48-36.59 vs 38.13-37.52 cm; P = .54).

CONCLUSIONS

These results suggest PBC is ineffective for the restoration of selected performance parameters during the performance maintenance phase of the competitive season. To ascertain the appropriation of its use, future investigations should seek to assess the use of cryotherapies at various phases of the elite rugby union competitive season.

The influence of playing position in soccer on the recovery kinetics of cognitive and physical performance

BACKGROUND

The physical activity and playing actions performed during a soccer match vary according to player position. The aim of the present study was to analyze the recovery kinetics of cognitive performance, physical performance and subjective ratings after a competitive soccer match.

METHODS

Eight goalkeepers and eight outfield players played in the match with data collected before, 45 min, 24 h and 48 h after the match. Subjective ratings, Vienna Reaction Test (reaction time, motor time), Vienna Determination Test (number of stimuli, number of correct responses), squat jump, countermovement jump and 6-s sprint were analyzed.

RESULTS

No significant interaction between position and time was found for Vienna Reaction Test and Vienna Determination Test performance. No significant interaction between position and time was found for squat jump and countermovement jump but squat jump and countermovement jump significantly decreased (P<0.01) at 24 h. Countermovement jump performance was still significantly affected at 48h (P<0.05). A significant interaction between position and time (P<0.05) was found for 6-s sprint. Sprint performance was significantly reduced for outfield players only immediately after the match (P<0.01). There was no interaction effect of position and time on subjective ratings. A significant correlation was found between number of jumps and ball kicks performed during the match by goalkeepers and the change score in squat jump (r =-0.90; P<0.01) and countermovement jump (r =-0.90; P<0.01) observed at 48 h.

CONCLUSIONS

Outfield players require a longer time than goalkeepers to recover sprint performance whilst cognitive function tested in the present study is not affected by the match whatever the position.

Effects of Various Recovery Strategies on Repeated Bouts of Simulated Intermittent Activity

Crowther, FA, Sealey, RM, Crowe, MJ, Edwards, AM, and Halson, SL. Effects of various recovery strategies on repeated bouts of simulated intermittent activity. J Strength Cond Res 33(7): 1781-1794, 2019-A large variety of recovery strategies are used between and after bouts of exercise to maximize performance and perceptual recovery, with limited conclusive evidence regarding the effectiveness of these strategies. The aim of this study was to compare 5 postexercise recovery strategies (cold water immersion, contrast water therapy, active recovery, a combined cold water immersion and active recovery, and a control condition) to determine which is most effective for the recovery of performance, perceptual, and flexibility measures during and after repeated bouts of simulated small-sided team sport demands. Fourteen recreationally active males (mean ± SD; age: 26 ± 6 years; height: 180 ± 5 cm; mass: 81 ± 9 kg) undertook repeated bouts of exercise, simulating a rugby sevens tournament day followed by the above listed recovery strategies (randomized, 1 per week). Perceptual, performance, and flexibility variables were measured immediately before, 5 minutes after all 3 exercise bouts, and at 75 minutes after the first 2 exercise bouts. Contrast water therapy was found to be superior to active at 75 minutes after bout 2 and 5 minutes after bout 3 for repeated-sprint ability and relative average power. The combined recovery strategy was superior to active for repeated-sprint ability at 5 minutes after bout 3; relative best power at 5 minutes after bout 2; total quality recovery before bout 2, 75 minutes after bout 2, and before bout 3; was superior to active for muscle soreness from 75 minutes after bout 1 and for the remainder of the day; and was superior to the control at 75 minutes after bout 1, 75 minutes after bout 2, and before bout 3. The active recovery was detrimental to total sprint time and relative average power at 75 minutes after bout 2 and 5 minutes after bout 3 in comparison with contrast water therapy and the control (not relative average power). Relative average power was decreased after active at 5 minutes after bout 2 in comparison with the combined recovery strategy and the control. Relative average power after cold water immersion was decreased at 75 minutes after bout 2 in comparison with the control and contrast water therapy. Total quality recovery was significantly reduced after active in comparison with the combined recovery strategy before bout 2, 75 minutes after bout 2, and before bout 3. Muscle soreness was also significantly increased after active recovery at 75 minutes after bout 1 and for the remainder of the day in comparison with the combined recovery strategy and was increased at 5 minutes after bout 3 in comparison with the control. Active recovery is not recommended because of the detrimental performance and perceptual results noted. As no recovery strategies were significantly better than the control condition for performance recovery and the combined recovery strategy is the only superior recovery strategy in comparison with the control for perceptual recovery (muscle soreness only), it is difficult to recommend a recovery strategy that should be used for both performance and perceptual recovery. Thus, based on the methodology and findings of this study unless already in use by athletes, no water immersion recovery strategies are recommended in preference to a control because of the resource-intensive (time and equipment) nature of water immersion recovery strategies.

Stochastic ordering of simulated rugby match activity produces reliable movements and associated measures of subjective task load, cognitive and neuromuscular function

The study assesses the test-retest reliability of movement and physiological measures during a simulated rugby match that employed activities performed in a stochastic order. Twenty male rugby players (21.4 ± 2.1 y) completed two trials of a 2 × 23 min rugby movement simulation protocol during which the order of events was performed in a stochastic order, with 7-10 days between trials. Movement characteristics, heart rate (HR), RPE, maximum voluntary contraction (MVC), voluntary activation (VA%) of the quadriceps, Stroop test and subjective task load rating (NASA-TLX) were measured. The most reliable measures of external load was relative distance (typical error [TE] and CV% = 1.5-1.6 m min^-1 and 1.4-1.5%, respectively), with all other movement characteristics possessing a CV% <5%. The most reliable measure of internal load, neuromuscular function and perceptual measures were for %HRmax (TE and CV% = 1.4-1.7% and 1.4-2.1%, respectively), MVC before (TE and CV% = 10.8-14.8 N·m and 3.8-4.6%, respectively), and average RPE (TE and CV% = 0.5-0.8 AU and 3.6-5.5%, respectively). The Stroop test, NASA-TLX and blood lactate produced the least reliable measures (CV% >5%). Future studies can confidently examine changes in several perceptual, neuromuscular, physiological and movement measures related to rugby activity using stochastic movements.

Evidence-based post-exercise recovery strategies in rugby: a narrative review

In the sport of rugby, athletes need a multitude of sport-specific skills along with endurance, power, and speed to optimize performance. Further, it is not unusual for athletes to play several competitive matches with insufficient recovery time. Rugby requires repeated bouts of high-intensity actions intermixed with brief periods of low-to-moderate active recovery or passive rest. Specifically, a match is characterized by repeated explosive activities, such as jumps, shuffles, and rapid changes of direction. To facilitate adequate recovery, it is necessary to understand the type of fatigue induced and, if possible, its underlying mechanisms. Common approaches to recovery may include nutritional strategies as well as active (active recovery) and passive recovery (water immersions, stretching, and massage) methods. However, limited research exists to support the effectiveness of each strategy as it related to recovery from the sport of rugby. Therefore, the main aim of the current brief review is to present the relevant literature that pertains to recovery strategies in rugby.

Recovery following Rugby Union matches: effects of cold water immersion on markers of fatigue and damage

We investigated the effect of postmatch cold-water immersion (CWI) on markers of muscle damage, neuromuscular fatigue, and perceptual responses within 72 h after a rugby match. Twenty-two professional male rugby players were randomized into CWI (10 °C/10 min; n = 11) or control (CON: 30 min seated; n = 11) groups. Activity profile from Global Positioning Satellite systems and postmatch rating of perceived exertion were measured to determined match load. Biochemical (tumor necrosis factor alpha (TNF-α), interleukin-6), neuromuscular performance (squat (SJ) and countermovement jumps (CMJ), peak power output (PPO), rate of force development (RFD), stiffness, 10- and 30-m sprint time, and perceptual markers (soreness, perceived recovery) were obtained before and immediately after the match, and then at 30 min, 24 h, 48 h, and 72 h after the match. Magnitude-based inference and Cohen’s effect size (ES) were used to analyze change over time and between groups. Thus, the higher/beneficial, similar/trivial, or lower/harmful differences were evaluated as follows: <1%, almost certainly not; 1% to 5%, very unlikely; 5% to 25%, unlikely; 25% to 75%, possible; 75% to 95%, likely; 95% to 99%, very likely; >99%, almost certainly. Changes were unclear for the match loads, sprint times, and perceptual markers between groups. Higher %ΔSJ at 24 h (very likely (ES = 0.75)) and in %ΔPPO_SJ at 48 h (likely (ES = 0.51)) were observed in CWI than in CON. Values in %ΔRDF_CMJ were higher immediately after (likely (ES = 0.83)), 30 min after (very likely (ES = 0.97)), and 24 h after the match (likely (ES = 0.93)) in CWI than in CON. Furthermore, %Δlog TNF-α were lower in the CWI group than in the CON group immediately after (almost certainly (ES = −0.76)), 24 h after (very likely (ES = −1.09)), and 72 h after the match (likely (ES = −0.51)), and in Δstiffness_SJ at 30 min after (likely (ES = −0.67)) and 48 h after the match (very likely (ES = −0.97)). Also, different within-groups effects throughout postmatch were reported. Implementing postmatch CWI-based strategies improved the recovery of markers of inflammation and fatigue in rugby players, despite no change in markers of speed or perceptual recovery.

Impact-Induced Muscle Damage and Contact Sports: Etiology, Effects on Neuromuscular Function and Recovery, and the Modulating Effects of Adaptation and Recovery Strategies

Athletes involved in contact sports are habitually exposed to skeletal-muscle damage in their training and performance environments. This often leads to exercise-induced muscle damage (EIMD) resulting from repeated eccentric and/or high-intensity exercise and to impact-induced muscle damage (IIMD) resulting from collisions with opponents and the playing surface. While EIMD has been an area of extensive investigation, IIMD has received comparatively little research, with the magnitude and time frame of alterations following IIMD not presently well understood. It is currently thought that EIMD results from an overload of mechanical stress that causes ultrastructural damage to the cellular membrane constituents. Damage leads to compromised ability to produce force, which manifests immediately and persists for up to 14 d following exercise exposure. IIMD has been implicated in attenuated neuromuscular performance and recovery and in inflammatory processes, although the underlying course over time remains unclear. Exposure to EIMD leads to an adaptation to subsequent exposures, a phenomenon known as the repeated-bout effect. An analogous adaptation has been suggested to occur following IIMD; however, to date, this contention remains equivocal. While a considerable body of research has explored the efficacy of recovery strategies following EIMD, strategies promoting recovery from IIMD are limited to investigations using animal contusion models. Strategies such as cryotherapy and antioxidant supplementation that focus on attenuating the secondary inflammatory response may provide additional benefit in IIMD and are explored herein. Further research is required to first establish a model of generating IIMD and then explore broader areas around IIMD in athletic populations.

Dietetic-nutritional, physical and physiological recovery methods post-competition in team sports

To a proper recovery, is absolutely necessary to know that athletes with enhanced recovery after maximal exercise are likely to perform better in sports. Recovery strategies are commonly used in team sports despite limited scientific evidence to support their effectiveness in facilitating optimal recovery and the players spend a much greater proportion of their time recovering than they do in training. According to authors, some studies investigated the effect of recovery strategies on physical performance in team sports, lack of experimental studies about the real origin of the fatigue, certify the need for further study this phenomenon. Thus, developing effective methods for helping athletes to recover is deemed essential. Therefore, the aim of this review is provide information for his practical application, based on scientific evidence about recovery in team sports.

Influence of recovery strategies upon performance and perceptions following fatiguing exercise: a randomized controlled trial

Background

Despite debate regarding their effectiveness, many different post-exercise recovery strategies are used by athletes. This study compared five post-exercise recovery strategies (cold water immersion, contrast water immersion, active recovery, a combined cold water immersion and active recovery and a control condition) to determine which is most effective for subsequent short-term performance and perceived recovery.

Methods

Thirty-four recreationally active males undertook a simulated team-game fatiguing circuit followed by the above recovery strategies (randomized, 1 per week). Prior to the fatiguing exercise, and at 1, 24 and 48 h post-exercise, perceptual, flexibility and performance measures were assessed.

Results

Contrast water immersion significantly enhanced perceptual recovery 1 h after fatiguing exercise in comparison to active and control recovery strategies. Cold water immersion and the combined recovery produced detrimental jump power performance at 1 h compared to the control and active recovery strategies. No recovery strategy was different to the control at 24 and 48 h for either perceptual or performance variables.

Conclusion

For short term perceptual recovery, contrast water therapy should be implemented and for short-term countermovement power performance an active or control recovery is desirable. At 24 and 48 h, no superior recovery strategy was detected.

Trial registration

Retrospectively registered; ISRCTN14415088; 5/11/2017.

Efficacy of Repeated Cold Water Immersion on Recovery After a Simulated Rugby Union Protocol

Barber, S, Pattison, J, Brown, F, and Hill, J. Efficacy of repeated cold water immersion on recovery after a simulated rugby union protocol. J Strength Cond Res 34(12): 3523-3529, 2020-Training and athletic competition frequently results in exercise-induced muscle damage (EIMD). The purpose of this study was to investigate the efficacy of repeated cold water immersion (CWI) on recovery after a simulated rugby union match. Sixteen male, club-level rugby players were matched for body mass and randomly assigned to either a CWI group or control (CON) group. After the simulated rugby match, the CWI group underwent 2 × 5-minute immersions at a temperature of 10° C separated by 2.5 minutes seated at room temperature, whereas the CON group remained seated for 15 minutes. Creatine kinase (CK), perceived muscle soreness, counter movement jump (CMJ), and maximal voluntary isometric contraction (MVIC) of the knee extensors were measured pre-exercise, postexercise, 24 and 48 hours after exercise. Large effect sizes were observed for muscle soreness at 24 and 48 hours after exercise with lower soreness values observed in the CWI group. Large effect sizes were observed for CMJ at all time points and at 24 and 48 hours post for MVIC with improved recovery of muscle function observed in the CWI group compared with the CON group. Last, a moderate effect size was observed for CK immediately after exercise, followed by large effect sizes at 24 and 48 hours after exercise, with CK concentration blunted in the CWI group. Overall, these findings provide some support for the use of CWI to enhance recovery from EIMD after a simulated rugby union match.

Effects of postexercise ice-water and room-temperature water immersion on the sensory organization of balance control and lower limb proprioception in amateur rugby players: A randomized controlled trial

BACKGROUND

This single-blinded, three-armed randomized controlled trial aimed to compare the effects of postexercise ice-water immersion (IWI), room-temperature water immersion (RWI), and no water immersion on the balance performance and knee joint proprioception of amateur rugby players.

METHODS

Fifty-three eligible amateur rugby players (mean age ± standard deviation: 21.6 ± 2.9 years) were randomly assigned to the IWI group (5.3 °C), RWI group (25.0 °C), or the no immersion control group. The participants in each group underwent the same fatigue protocol followed by their allocated recovery intervention, which lasted for 1 minute. Measurements were taken before and after the fatigue-recovery intervention. The primary outcomes were the sensory organization test (SOT) composite equilibrium score (ES) and the condition-specific ES, which were measured using a computerized dynamic posturography machine. The secondary outcome was the knee joint repositioning error. Two-way repeated measures analysis of variance was used to test the effect of water immersion on each outcome variable.

RESULTS

There were no significant within- and between-group differences in the SOT composite ESs or the condition-specific ESs. However, there was a group-by-time interaction effect on the knee joint repositioning error. It seems that participants in the RWI group had lower errors over time, but those in the IWI and control groups had increased errors over time. The RWI group had significantly lower error score than the IWI group at postintervention.

CONCLUSION

One minute of postexercise IWI or RWI did not impair rugby players' sensory organization of balance control. RWI had a less detrimental effect on knee joint proprioception to IWI at postintervention.

The physiological response to cold-water immersion following a mixed martial arts training session

Combative sport is one of the most physically intense forms of exercise, yet the effect of recovery interventions has been largely unexplored. We investigated the effect of cold-water immersion on structural, inflammatory, and physiological stress biomarkers following a mixed martial arts (MMA) contest preparation training session in comparison with passive recovery. Semiprofessional MMA competitors (n = 15) were randomly assigned to a cold-water immersion (15 min at 10 °C) or passive recovery protocol (ambient air) completed immediately following a contest preparation training session. Markers of muscle damage (urinary myoglobin), inflammation/oxidative stress (urinary neopterin + total neopterin (neopterin + 7,8-dihydroneopterin)), and hypothalamic-pituitary axis (HPA) activation (saliva cortisol) were determined before, immediately after, and 1, 2, and 24 h postsession. Ratings of perceived soreness and fatigue, counter movement jump, and gastrointestinal temperature were also measured. Concentrations of all biomarkers increased significantly (p < 0.05) postsession. Cold water immersion attenuated increases in urinary neopterin (p < 0.05, d = 0.58), total neopterin (p < 0.05, d = 0.89), and saliva cortisol after 2 h (p < 0.05, d = 0.68) and urinary neopterin again at 24 h (p < 0.01, d = 0.57) in comparison with passive recovery. Perceived soreness, fatigue, and gastrointestinal temperatures were also lower for the cold-water immersion group at several time points postsession whilst counter movement jump did not differ. Combative sport athletes who are subjected to impact-induced stress may benefit from immediate cold-water immersion as a simple recovery intervention that reduces delayed onset muscle soreness as well as macrophage and HPA activation whilst not impairing functional performance.

Use of Cold-Water Immersion to Reduce Muscle Damage and Delayed-Onset Muscle Soreness and Preserve Muscle Power in Jiu-Jitsu Athletes

CONTEXT

Cold-water immersion (CWI) has been applied widely as a recovery method, but little evidence is available to support its effectiveness.

OBJECTIVE

To investigate the effects of CWI on muscle damage, perceived muscle soreness, and muscle power recovery of the upper and lower limbs after jiu-jitsu training.

DESIGN

Crossover study.

SETTING

Laboratory and field.

PATIENTS OR OTHER PARTICIPANTS

A total of 8 highly trained male athletes (age = 24.0 ± 3.6 years, mass = 78.4 ± 2.4 kg, percentage of body fat = 13.1% ± 3.6%) completed all study phases.

INTERVENTION(S)

We randomly selected half of the sample for recovery using CWI (6.0°C ± 0.5°C) for 19 minutes; the other participants were allocated to the control condition (passive recovery). Treatments were reversed in the second session (after 1 week).

MAIN OUTCOME MEASURE(S)

We measured serum levels of creatine phosphokinase, lactate dehydrogenase (LDH), aspartate aminotransferase, and alanine aminotransferase enzymes; perceived muscle soreness; and recovery through visual analogue scales and muscle power of the upper and lower limbs at pretraining, postrecovery, 24 hours, and 48 hours.

RESULTS

Athletes who underwent CWI showed better posttraining recovery measures because circulating LDH levels were lower at 24 hours postrecovery in the CWI condition (441.9 ± 81.4 IU/L) than in the control condition (493.6 ± 97.4 IU/L; P = .03). Estimated muscle power was higher in the CWI than in the control condition for both upper limbs (757.9 ± 125.1 W versus 695.9 ± 56.1 W) and lower limbs (53.7 ± 3.7 cm versus 35.5 ± 8.2 cm; both P values = .001). In addition, we observed less perceived muscle soreness (1.5 ± 1.1 arbitrary units [au] versus 3.1 ± 1.0 au; P = .004) and higher perceived recovery (8.8 ± 1.9 au versus 6.9 ± 1.7 au; P = .005) in the CWI than in the control condition at 24 hours postrecovery.

CONCLUSIONS

Use of CWI can be beneficial to jiu-jitsu athletes because it reduces circulating LDH levels, results in less perceived muscle soreness, and helps muscle power recovery at 24 hours postrecovery.

The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis

The aim of this review and meta-analysis was to critically determine the possible effects of different cooling applications, compared to non-cooling, passive post-exercise strategies, on recovery characteristics after various, exhaustive exercise protocols up to 96 hours (hrs). A total of n = 36 articles were processed in this study. To establish the research question, the PICO-model, according to the PRISMA guidelines was used. The Cochrane’s risk of bias tool, which was used for the quality assessment, demonstrated a high risk of performance bias and detection bias. Meta-analyses of subjective characteristics, such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE) and objective characteristics like blood plasma markers and blood plasma cytokines, were performed. Pooled data from 27 articles revealed, that cooling and especially cold water immersions affected the symptoms of DOMS significantly, compared to the control conditions after 24 hrs recovery, with a standardized mean difference (Hedges’ g) of -0.75 with a 95% confidence interval (CI) of -1.20 to -0.30. This effect remained significant after 48 hrs (Hedges’ g: -0.73, 95% CI: -1.20 to -0.26) and 96 hrs (Hedges’ g: -0.71, 95% CI: -1.10 to -0.33). A significant difference in lowering the symptoms of RPE could only be observed after 24 hrs of recovery, favouring cooling compared to the control conditions (Hedges’ g: -0.95, 95% CI: -1.89 to -0.00). There was no evidence, that cooling affects any objective recovery variable in a significant way during a 96 hrs recovery period.

Effect of run training and cold-water immersion on subsequent cycle training quality in high-performance triathletes

The purpose of the study was to investigate the effect of cold-water immersion (CWI) on physiological, psychological, and biochemical markers of recovery and subsequent cycling performance after intensive run training. Seven high-performance male triathletes (age: 28.6 ± 7.1 years; cycling VO2peak: 73.4 ± 10.2 ml · kg(-1) · min(-1)) completed 2 trials in a randomized crossover design consisting of 7 × 5-minute running intervals at 105% of individual anaerobic threshold followed by either CWI (10 ± 0.5° C) or thermoneutral water immersion (TNI; 34 ± 0.5° C). Subjects immersed their legs in water 5 times for 60 seconds with 60-second passive rest between each immersion. Nine hours after immersion, inflammatory and muscle damage markers, and perceived recovery measures were obtained before the subjects completed a 5-minute maximal cycling test followed by a high-quality cycling interval training set (6 × 5-minute intervals). Power output, heart rate, blood lactate (La), and rating of perceived exertion (RPE) were also recorded during the cycling time-trial and interval set. Performance was enhanced (change, ± 90% confidence limits) in the CWI condition during the cycling interval training set (power output [W · kg(-1)], 2.1 ± 1.7%, La [mmol · L(-1)], 18 ± 18.1%, La:RPE, 19.8 ± 17.5%). However, there was an unclear effect of CWI on 5-minute maximal cycling time-trial performance, and there was no significant influence on perceptual measures of fatigue/recovery, despite small to moderate effects. The effect of CWI on the biochemical markers was mostly unclear, however, there was a substantial effect for interleukin-10 (20 ± 13.4%). These results suggest that compared with TNI, CWI may be effective for enhancing cycling interval training performance after intensive interval-running training.

Is recovery driven by central or peripheral factors? A role for the brain in recovery following intermittent-sprint exercise

Prolonged intermittent-sprint exercise (i.e., team sports) induce disturbances in skeletal muscle structure and function that are associated with reduced contractile function, a cascade of inflammatory responses, perceptual soreness, and a delayed return to optimal physical performance. In this context, recovery from exercise-induced fatigue is traditionally treated from a peripheral viewpoint, with the regeneration of muscle physiology and other peripheral factors the target of recovery strategies. The direction of this research narrative on post-exercise recovery differs to the increasing emphasis on the complex interaction between both central and peripheral factors regulating exercise intensity during exercise performance. Given the role of the central nervous system (CNS) in motor-unit recruitment during exercise, it too may have an integral role in post-exercise recovery. Indeed, this hypothesis is indirectly supported by an apparent disconnect in time-course changes in physiological and biochemical markers resultant from exercise and the ensuing recovery of exercise performance. Equally, improvements in perceptual recovery, even withstanding the physiological state of recovery, may interact with both feed-forward/feed-back mechanisms to influence subsequent efforts. Considering the research interest afforded to recovery methodologies designed to hasten the return of homeostasis within the muscle, the limited focus on contributors to post-exercise recovery from CNS origins is somewhat surprising. Based on this context, the current review aims to outline the potential contributions of the brain to performance recovery after strenuous exercise.

The relationship between physical abilities, ball-carrying and tackling among elite youth rugby league players

This study investigated the relationship between the physical abilities of adolescent rugby league players and tackling and ball-carrying skills performed during matches, across three seasons (under-15 to under-17). The players were measured each season for acceleration (10-30 m), peak and mean speed (10-30 m), sprinting force (10-30 m), aerobic power, counter-movement jump (CMJ) height and jumping power. The matches were filmed and analysed for ball-carrying and tackling frequency per minute (successful and unsuccessful outcomes). There were strong relationships between successful carries∙min(-1) and 10 m force in the under-15 (R = 0.61, P < 0.001), under-16 (R = 0.69, P < 0.001) and under-17 groups (R = 0.64, P < 0.001). There were also strong and moderate relationships between predicted vertical power and successful carries∙min(-1) in the under-15 (R = 0.63, P = 0.011) and under-17 group (R = 0.40, P = 0.030), respectively. There were no relationships between carries or tackles and any other performance indicators. These findings suggest that acceleration, in accordance with gains in body mass, support ball-carrying but not tackling performance. Performance measurements, such as CMJ or aerobic power, do not support ball-carrying ability among youth rugby league players.

Recovery in soccer : part ii-recovery strategies

In the formerly published part I of this two-part review, we examined fatigue after soccer matchplay and recovery kinetics of physical performance, and cognitive, subjective and biological markers. To reduce the magnitude of fatigue and to accelerate the time to fully recover after completion, several recovery strategies are now used in professional soccer teams. During congested fixture schedules, recovery strategies are highly required to alleviate post-match fatigue, and then to regain performance faster and reduce the risk of injury. Fatigue following competition is multifactorial and mainly related to dehydration, glycogen depletion, muscle damage and mental fatigue. Recovery strategies should consequently be targeted against the major causes of fatigue. Strategies reviewed in part II of this article were nutritional intake, cold water immersion, sleeping, active recovery, stretching, compression garments, massage and electrical stimulation. Some strategies such as hydration, diet and sleep are effective in their ability to counteract the fatigue mechanisms. Providing milk drinks to players at the end of competition and a meal containing high-glycaemic index carbohydrate and protein within the hour following the match are effective in replenishing substrate stores and optimizing muscle-damage repair. Sleep is an essential part of recovery management. Sleep disturbance after a match is common and can negatively impact on the recovery process. Cold water immersion is effective during acute periods of match congestion in order to regain performance levels faster and repress the acute inflammatory process. Scientific evidence for other strategies reviewed in their ability to accelerate the return to the initial level of performance is still lacking. These include active recovery, stretching, compression garments, massage and electrical stimulation. While this does not mean that these strategies do not aid the recovery process, the protocols implemented up until now do not significantly accelerate the return to initial levels of performance in comparison with a control condition. In conclusion, scientific evidence to support the use of strategies commonly used during recovery is lacking. Additional research is required in this area in order to help practitioners establish an efficient recovery protocol immediately after matchplay, but also for the following days. Future studies could focus on the chronic effects of recovery strategies, on combinations of recovery protocols and on the effects of recovery strategies inducing an anti-inflammatory or a pro-inflammatory response.

Cooling and performance recovery of trained athletes: a meta-analytical review

PURPOSE

Cooling after exercise has been investigated as a method to improve recovery during intensive training or competition periods. As many studies have included untrained subjects, the transfer of those results to trained athletes is questionable.

METHODS

Therefore, the authors conducted a literature search and located 21 peer-reviewed randomized controlled trials addressing the effects of cooling on performance recovery in trained athletes.

RESULTS

For all studies, the effect of cooling on performance was determined and effect sizes (Hedges' g) were calculated. Regarding performance measurement, the largest average effect size was found for sprint performance (2.6%, g = 0.69), while for endurance parameters (2.6%, g = 0.19), jump (3.0%, g = 0.15), and strength (1.8%, g = 0.10), effect sizes were smaller. The effects were most pronounced when performance was evaluated 96 h after exercise (4.3%, g = 1.03). Regarding the exercise used to induce fatigue, effects after endurance training (2.4%, g = 0.35) were larger than after strength-based exercise (2.4%, g = 0.11). Cold-water immersion (2.9%, g = 0.34) and cryogenic chambers (3.8%, g = 0.25) seem to be more beneficial with respect to performance than cooling packs (-1.4%, g= -0.07). For cold-water application, whole-body immersion (5.1%, g = 0.62) was significantly more effective than immersing only the legs or arms (1.1%, g = 0.10).

CONCLUSIONS

In summary, the average effects of cooling on recovery of trained athletes were rather small (2.4%, g = 0.28). However, under appropriate conditions (whole-body cooling, recovery from sprint exercise), postexercise cooling seems to have positive effects that are large enough to be relevant for competitive athletes.

The reliability of a rugby league movement-simulation protocol designed to replicate the performance of interchanged players

PURPOSE

This study assessed the reliability of a rugby league movement-simulation protocol, relative to interchanged players (RLMSP-i).

METHODS

Fifteen male participants completed 2 trials of the RLMSP-i, separated by 1 wk. The RLMSP-i comprised low- to moderate-intensity running, interspersed by high-intensity sprinting and tackling activity, based on global positioning system (GPS) data recorded during Super League performances.

RESULTS

The lowest coefficient of variation (CV ± 95% CI) was observed for total m/min during both interchange bout 1 (1.1% ± 0.2%) and bout 2 (1.0% ± 0.2%). The percentage of heart rate peak and ratings of perceived exertion demonstrated CVs of 1.2-2.0% and 2.9-3.5%, respectively. The poorest agreement between trials was found for blood lactate concentration (16.2% ± 2.8%). In no case was the CV smaller than the smallest worthwhile change, yet in every case the moderate changes were larger than the CV.

CONCLUSIONS

The RLMSP-i's reliability is sufficient to enable the detection of moderate changes in various performance and physiological measurements that accurately simulate some, but not all, aspects of rugby league matches.