Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

Effect of Alpha-1 Antitrypsin and Irisin on Post-Exercise Inflammatory Response: A Narrative Review

Physical activity has a positive effect on human health and emotional well-being. However, in both amateur and professional athletes, training poses a risk of acute or chronic injury through repetitive overloading of bones, joints, and muscles. Inflammation can be an adverse effect of intense exercise caused by several factors including oxidative stress. The present narrative review summarizes current knowledge on inflammatory markers induced by physical exercise. Post-exercise recovery may reduce inflammatory responses and is key to effective training and adaptation of muscle tissues to sustained physical exertion.

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

A randomized, double-blind, placebo-controlled, repeated-dose pilot study of the safety, tolerability, and preliminary effects of a cannabidiol (CBD)- and cannabigerol (CBG)-based beverage powder to support recovery from delayed onset muscle soreness (DOMS)

BACKGROUND

Cannabinoid-containing products are marketed to athletes as promoting recovery, in spite of a lack of data on their safety and effects. This randomized, double-blind, placebo-controlled, repeated-dose pilot study tested the safety, tolerability, and preliminary effects on recovery of a formulation containing cannabidiol (CBD; 35 mg), cannabigerol (CBG; 50 mg), beta caryophyllene (BCP; 25 mg), branched-chain amino acids (BCAAs; 3.8 g), and magnesium citrate (420 mg).

METHODS

Exercise-trained individuals (N = 40) underwent an experimental induction of delayed onset muscle soreness (DOMS) and completed follow-up visits 24-, 48-, and 72-hours post-DOMS. Participants were randomized to active or placebo formulation, and consumed the formulation twice per day for 3.5 days.

RESULTS

There was one adverse event (AE) in the active group (diarrhea) and two AEs in placebo (dry mouth; eye rash/swollen eye). There was 100% self-reported compliance with formulation consumption across the two groups. For the primary outcome of interest, the estimate of effect for ratings of average soreness/discomfort 72 hours post-DOMS between active and placebo groups was -1.33 (85% confidence interval = -2.55, -0.10), suggesting moderate evidence of a treatment difference. The estimate of effect for the outcome of ratings of interference of soreness, discomfort, or stiffness on daily activities at work or home 48 hours post-DOMS was -1.82 (95% confidence interval = -3.64, -0.01), indicating a treatment difference of potential clinical importance. There was no significant effect between active and placebo groups on objective measures of recovery, sleep quality, or mood disturbance.

CONCLUSIONS

The tested formulation reduced interference of DOMS on daily activities, demonstrating its improvement on a functional aspect of recovery.

Cold-water immersion and whole-body cryotherapy attenuate muscle soreness during 3 days of match-like tennis protocol

PURPOSE

This study aimed to investigate the effect of whole-body cryotherapy (WBC), cold-water immersion (CWI) and passive recovery (PAS) on tennis recovery.

METHODS

Thirteen competitive male tennis players completed three consecutive match-like tennis protocols, followed by recovery (WBC, CWI, PAS) in a crossover design. Five tennis drills and serves were performed using a ball machine to standardize the fatiguing protocol. Maximal voluntary contraction (MVC) peak torque, creatine kinase activity (CK), muscle soreness, ball accuracy and velocity together with voluntary activation, low- and high-frequency torque and EMG activity were recorded before each protocol and 24 h following the third protocol.

RESULTS

MVC peak torque (- 7.7 ± 11.3%; p = 0.001) and the high- to low-frequency torque ratio (- 10.0 ± 25.8%; p < 0.05) decreased on Day 1 but returned to baseline on Day 2, Day 3 and Day 4 (p = 0.052, all p > 0.06). The CK activity slightly increased from 161.0 ± 100.2 to 226.0 ± 106.7 UA L-1 on Day 1 (p = 0.001) and stayed at this level (p = 0.016) across days with no differences between recovery interventions. Muscle soreness increased across days with PAS recovery (p = 0.005), while no main effect of time was neither observed with WBC nor CWI (all p > 0.292). The technical performance was maintained across protocols with WBC and PAS, while it increased for CWI on Day 3 vs Day 1 (p = 0.017).

CONCLUSION

Our 1.5-h tennis protocol led to mild muscle damage, though neither the neuromuscular function nor the tennis performance was altered due to accumulated workload induced by consecutive tennis protocols. The muscle soreness resulting from tennis protocols was similarly alleviated by both CWI and WBC.

TRIAL REGISTRATION

IRB No. 2017-A02255-48, 12/05/2017.

Retrospective analysis of whole-body cryotherapy adverse effects in Division I collegiate athletes

CONTEXT

Although the physiological effects and the performance of athletes after utilizing whole-body cryotherapy (WBC) have been widely studied, there is a lack of data on its adverse effects. It is important to be aware of the adverse effects of any treatment for its use to be properly recommended.

OBJECTIVES

This study aims to provide insight to any adverse effects that collegiate athletes experienced after utilizing WBC to better utilize this therapeutic modality.

METHODS

After the Institutional Review Board (IRB) deemed exemption, all 457 Division 1-A varsity athletes were recruited via email to participate in a retrospective survey. Participants consented to the study by continuing to the questions. The inclusion criteria were that they must be 18 years of age or older, had completed WBC at that university, and were a student-athlete. The survey was six questions long, and if any of the inclusion criteria was not met, they were redirected to end the survey. The data were analyzed utilizing odds ratios.

RESULTS

Of the 457 student-athletes, 11.2% (n=51) responded and 6.3% (n=29) met the inclusion criteria. Responses were obtained from women's lacrosse (27.6%; n=8), women's gymnastics (24.1%, n=7), field hockey (17.2%, n=5), wrestling (6.9%, n=2), football (6.9%, n=2), women's cross country (3.5%, n=1), men's basketball (3.5%, n=1), women's volleyball (3.5%, n=1), softball (3.5%, n=1), and baseball (3.5%, n=1). Among the responses, 79.3% (n=23) were females and 29.7% (n=6) were males. Within 1 h of WBC, the most frequently reported adverse effects were skin rash (27.6%, n=8), itching (13.8%, n=4), and fatigue (6.9%, n=2). More than 1 h after WBC, the most frequently reported adverse effects were skin rash (20.7%, n=6), itching (10.3%, n=3), and increased energy (6.9%, n=2). When stratified by female and male athletes, for both within 1 h and more than 1 h after WBC, there were increased odds for females reporting adverse effects; however, neither were statistically significant (OR 4.58, p=0.19, 95% CI 0.46 to 45.61) (OR 3.84, p=0.25, 95% CI 0.39 to 38.36). Within 1 h of WBC, 58.6% (n=17) of subjects reported no adverse effects, and more than 1 h after WBC, 65.5% (n=19) subjects reported no adverse effects. The mean satisfaction level rating was 6.34 (range 0-10, n=29). When asked if they would do WBC again, 65.5% (n=19) responded "yes" and 34.5% (n=10) responded "no."

CONCLUSIONS

In this collegiate athlete population, negative adverse effects of WBC commonly included skin burns and itching while potentially proving a beneficial adverse effect of increased energy. Subjects commonly reported no adverse effects after WBC treatment as well.

Efficacy of Cold Tumescent for Prevention of Intraoperative Bleeding in Patients Undergoing Liposuction: A Double-Blind Randomized Controlled Trial-Half-Side Comparison

BACKGROUND

Bleeding, a common intraoperative complication of liposuction, often causes pain and discomfort during recovery. Because of the vasoconstrictive effect of adrenaline in the tumescent solution, bleeding can be reduced; however, reports of postoperative bleeding persist. Cold temperatures also have a vasoconstrictive effect.

OBJECTIVES

This study aimed to determine the efficacy of cold tumescent solution in preventing and reducing intraoperative bleeding.

METHODS

This prospective randomized controlled trial was conducted between June 2018 and June 2019. The liposuction areas in each participant were divided into left and right sides; one side received operative room temperature tumescent solution (25 °C), and the other side received low-temperature tumescent solution (4 °C). The areas of ecchymosis, pain scores, and patient and surgeon satisfaction scores were compared and analyzed.

RESULTS

Ten patients with 36 pairs of liposuction areas were enrolled in the study. Cold tumescent liposuction resulted in a significantly lower lipocrit than was obtained on the standard tumescent side (1.56 ± 0.69 vs 2.92 ± 0.94; P < .001). The ecchymosis area and pain score were significantly lower in the cold tumescent group on days 2, 4, 7, and 14. The satisfaction evaluation scores did not differ between patients and surgeons at 12 months postoperatively.

CONCLUSIONS

The use of cold tumescent anesthesia significantly improved liposuction outcomes by reducing the intraoperative blood loss and the postoperative ecchymosis and pain, with no immediate or short-term complications in low-volume liposuction (<1000 mL) procedures. Furthermore, it generated a standard outcome and good patient satisfaction scores.

LEVEL OF EVIDENCE: 2

Pure Juice Supplementation: Its Effect on Muscle Recovery and Sports Performance

Strenuous exercise causes increased production of reactive oxygen species (ROS), creating an imbalance between ROS and antioxidants. The reduced antioxidant defence leads to defective elimination of ROS and consequently, delayed-onset muscle soreness (DOMS). DOMS due to exhaustive or prolonged exercise typically peaks between 24 h and 72 h after exercise results in soreness, inflammation, pain and decreased muscle function. As a result, muscle strength will be reduced progressively and this situation might be detrimental to one's athletic performance, especially amidst competition season. Therefore, supplementation to improve muscle recovery and sports performance has become a common practice among athletes. However, it is suggested to consume natural-based fruit-derived antioxidants as a more effective and safe nutritional strategy. Fruits containing a high amount of polyphenol protect muscle cells from excessive and harmful ROS due to their anti-inflammatory and antioxidant characteristics. To date, there are several expended studies on the consumption of supplements from various antioxidant-rich fruits to provide evidence on their effectiveness, giving better solutions and wider choices of supplementation to the athletes. Therefore, this review aims to provide a comprehensive overview of nutritional standpoint from previous literature on the effect of fruit juices supplementation on muscle recovery and sports performance.

The Effect of Single Bout Treatment of Heat or Cold Intervention on Delayed Onset Muscle Soreness Induced by Eccentric Contraction

We studied the preventive effects of heat or cold therapy after repeated eccentric contraction against torque reduction, muscle soreness, and range of motion (ROM) due to delayed-onset muscle soreness (DOMS). A total of 42 healthy male subjects were randomly allocated into three groups: the HEAT group received heat therapy using an ultra-short-wave device; the ICE group received ice therapy using an ice pack; the Control group received no intervention. The measurements included maximal voluntary isometric, concentric, and eccentric elbow flexion torque, elbow extension ROM, pressure pain threshold, and muscle soreness with stretching muscle thickness and echo intensity. The measurements were taken before (pre), after (post), after (t-post), one-four days after, and seven days after the muscle damage protocol. The results showed the main effect of time on all measurements, but no significant interactions were observed. The results of this study suggest that heat or cold therapy in the first 30 min after intense eccentric exercise is insufficient to exert a preventive effect against DOMS.

The Use of Cryotherapy in Cosmetology and the Influence of Cryogenic Temperatures on Selected Skin Parameters—A Review of the Literature

Cryotherapy is becoming an increasingly popular method used in medicine, physiotherapy, and cosmetology. It is used in the form of whole-body cryotherapy (WBC) and local cryotherapy. It is a tool for achieving analgesic and anti-inflammatory effects. Since the beginning of its use, its influence on the mental state has also been pointed out. The aim of this study was to analyze the available literature on the effect of cryogenic temperatures on the skin and the mechanisms induced by such a stimulus and its influence on well-being. A literature search of keywords or phrases was performed in PubMed®. Various effects of WBC on skin characteristics (hydration, pH, level of transepidermal water loss), mechanisms of anti-inflammatory effects, and effects on adipocytes were shown. Research on the impact of individual skin characteristics is not consistent. Positive effects on the reduction of inflammation and oxidative stress have been noted. Cryotherapy is also successfully used in dermatology to treat lentil spots, actinic keratosis, and ingrown toenails, remove viral warts, or relieve itching in atopic dermatitis. The results of the review also indicate the effectiveness of WBC as an adjunctive treatment for obesity. The number of papers available on the direct effects of WBC on the skin is still limited, despite the fact that it represents the first contact of the human body with cryogenic temperatures. Available data show that cold as a physical stimulus can be a safe and useful tool in cosmetology.

A combination of cherry juice and cold water immersion does not enhance marathon recovery compared to either treatment in isolation: A randomized placebo-controlled trial

Purpose

Cherry juice (CJ) and cold water immersion (CWI) are both effective recovery strategies following strenuous endurance exercise. However, athletes routinely combine recovery interventions and less is known about the impact of a combined CJ and CWI protocol. Therefore, this study investigated the effects of combining CWI and CJ (a “cocktail” (CT)) on inflammation and muscle damage following a marathon.

Methods

A total 39 endurance trained males were randomly assigned to a placebo (PL), CWI, CJ, or CT group before completing a trail marathon run. Muscle damage (creatine kinase (CK)), muscle function (maximal voluntary isometric contraction (MVIC)), and inflammation (interleukin-6 (IL-6); C-reactive protein (CRP)) were measured at baseline, immediately after marathon (only IL-6), 24 h, and 48 h after marathon.

Results

There were no statistically significant differences between groups and no group × time interaction effects for any of the dependent variables. Confidence intervals (CI) illustrated that CT had unclear effects on inflammation (IL-6; CRP) and MVIC, but may have increased CK to a greater extent than PL and CJ conditions.

Conclusion

There is no evidence of an additive effect of CJ and CWI when the treatments are used in conjunction with each other. On the contrary, combining CJ and CWI may result in slightly increased circulating CK.

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.

Different Cryotherapy Modalities Demonstrate Similar Effects on Muscle Performance, Soreness, and Damage in Healthy Individuals and Athletes: A Systematic Review with Metanalysis

Background: There are extensive studies focusing on non-invasive modalities to recover physiological systems after exercise-induced muscle damage (EIMD). Whole-body cryotherapy (WBC) and Partial-body cryotherapy (PBC) have been recommended for recovery after EIMD. However, to date, no systematic reviews have been performed to compare their effects on muscle performance and muscle recovery markers. Methods: This systematic review with metanalysis compared the effects of WBC and PBC on muscle performance, muscle soreness (DOMS), and markers of muscular damage following EIMD. We used Pubmed, Embase, PEDro, and Cochrane Central Register of Controlled Trials as data sources. Two independent reviewers verified the methodological quality of the studies. The studies were selected if they used WBC and PBC modalities as treatment and included muscle performance and muscle soreness (DOMS) as the primary outcomes. Secondary outcomes were creatine kinase and heart rate variability. Results: Six studies with a pooled sample of 120 patients were included. The methodological quality of the studies was moderate, with an average of 4.3 on a 0–10 scale (PEDro). Results: Both cryotherapy modalities induce similar effects without difference between them. Conclusion: WBC and PBC modalities have similar global responses on muscle performance, soreness, and markers of muscle damage.

Efficacy of Different Cold-Water Immersion Temperatures on Neuromotor Performance in Young Athletes

Cold-Water-Immersion (CWI) has been frequently used to accelerate muscle recovery and to improve performance after fatigue onset. In the present study, the aim was to investigate the effects of different CWI temperatures on neuromuscular activity on quadriceps after acute fatigue protocol. Thirty-six young athletes (16.9 ± 1.4 years-old; 72.1 ± 13.8 kg; 178.4 ± 7.2 cm) were divided into three groups: passive recovery group (PRG); CWI at 5 °C group (5G); and CWI at 10 °C group (10G). All participants performed a fatigue exercise protocol; afterwards, PRG performed a passive recovery (rest), while 5G and 10G were submitted to CWI by means of 5 °C and 10 °C temperatures during 10 min, respectively. Fatigue protocol was performed by knee extension at 40% of isometric peak force from maximal isometric voluntary contraction. Electromyography was used to evaluate neuromuscular performance. The passive recovery and CWI at 5 °C were associated with normalized isometric force and quadriceps activation amplitude from 15 until 120 min after exercise-induced fatigue (F = 7.169, p < 0.001). CWI at 5 °C and 10 °C showed higher muscle activation (F = 6.850, p < 0.001) and lower median frequency (MF) than passive recovery after 15 and 30 min of fatigue (F = 5.386, p < 0.001). For neuromuscular efficiency (NME) recovery, while PRG normalized NME values after 15 min, 5G and 10G exhibited these responses after 60 and 30 min (F = 4.330, p < 0.01), respectively. Passive recovery and CWI at 5 °C and 10 °C revealed similar effects in terms of recovery of muscle strength and NME, but ice interventions resulted in higher quadriceps activation recovery.

Can Post-Exercise Hemodynamic Response Be Influenced by Different Recovery Methods in Paraplegic Sportsmen?

Post-exercise hypotension is of great clinical relevance and also in sports training settings, as recovery speed is important. The aim of this study was to compare the influence of different recovery methods on post-exercise hemodynamic response. Twelve male paraplegic sportsmen (25.40 ± 3.30 years) performed a strength training (ST) session using the bench press exercise. After the ST, three recovery methods were randomly performed over a 15-min period: passive recovery (PR), cold-water (CW) and dry needle (DN). Blood pressure (BP), heart rate (HR) and myocardial oxygen were measured before and post ST, as well as post the recovery method. Results: Dry needling induced lower systolic blood pressure (SBP) immediately after the treatment when compared with the other recovery methods, but the contrary was observed at 50 and 60-min post recovery, where records with DN exhibit higher mean values (η²p = 0.330). There were no differences in post-exercise diastolic BP and mean BP between recovery methods. There was a significantly higher HR after the PR method, when compared with CW and with DN (η²p = 0.426). The same was observed for double product and for myocardial oxygen, though with a larger effect size (η²p = 0.446). We conclude that dry needling seems to induce a faster SBP lowering immediately after the procedure but at 50-min post procedure the cold-water method showed better result. As for HR, both procedures (DN and CW) showed a better recovery when compared with passive recovery, along the several moments of measurement.

Participatory Landscape Design and Water Management—A Sustainable Strategy for Renovation of Vernacular Baths and Landscape Protection in Szeklerland, Romania

Szeklerland is a historical-ethnic region located on the eastern border of the Carpathian Basin, in the central region of Romania. In Szeklerland, thanks to its varied topography and a network of small settlements, landscape management is still carried out using traditional methods. Szeklerland is a macro-region rich in natural resources. Among its natural treasures, the mineral water springs with healing properties are of particular importance: around 40 percent of Romania’s mineral water resources are found here. This richness in hydrogeological features is due to the fact that the post-volcanic activities in the young tertiary mountain ranges in the region still produce large quantities of carbon dioxide, which dissolves beneficial minerals from the earth. When dissolved in water, these minerals produce mineral waters that can be used to cure various types of diseases. For centuries, the medicinal properties of the mineral waters of Szeklerland have been regularly used by the local population. In addition to their consumption, small and larger vernacular baths were built in the settlements with medicinal springs, and their regular use led to the development of a traditional, local cold-water bathing culture in the region. However, the vernacular baths were destroyed in the world wars, and their traditional use was abolished by the apparatus of the 20th century communist regime, which had no respect to natural and cultural heritage. After the political change in 1989, the attention of the society turned back to tradition and values. Alongside (or as part of) nature and landscape conservation initiatives, the reinterpretation and restoration of the intangible and practical values of vernacular baths in Szeklerland also began. Over the past decades, the renovation of vernacular baths, which started as a professional–civic initiative, has grown into an independent heritage conservation programme: dozens of vernacular baths have been renovated in Szeklerland over the past twenty years with public participation initiated and led by professionals. In the course of the renovations, baths used by local communities have been rebuilt using nature- and environment-friendly techniques, materials and in a way that they are also related to the physical environment and the mythology of the region. The project has won prestigious awards both in Romania and internationally, and has become a successful and exemplary movement in landscape heritage conservation.

Utilisation of performance markers to establish the effectiveness of cold-water immersion as a recovery modality in elite football

Optimal strategies for recovery following training and competition in elite athletes presents ongoing debate. The effects of cold-water immersion (CWI) compared to passive recovery (PR) though a triad of performance measures after fatiguing exercise within a normal micro-cycle, during mid-competitive training cycle, in elite male footballers were investigated. Twenty-four elite footballers (age 20.58 ± 2.55 years; height 179.9 ± 5.6 cm; weight 75.7 ± 7.5 kg; body fat 6.2 ± 1.7%) were randomly assigned to CWI or PR following a fatiguing training session. Objective measures included eccentric hamstring strength, isometric adductor strength, hamstring flexibility and skin surface temperature (T sk ). Subjective measures included overall wellbeing. Data were collected at match day+3, immediately post-training, immediately post-intervention and 24 hrs post-intervention. Physiological, biomechanical and psychological measures displayed significant main effects for timepoint for eccentric hamstring strength, T sk , overall wellbeing, sleep, fatigue, stress and group for eccentric hamstring strength, T sk and sleep (groups combined). Group responses identified significant effects for timepoint for CWI and PR, for eccentric hamstring strength peak force, sleep, fatigue, and muscle soreness for CWI. Significant differences were displayed for eccentric hamstring strength (immediately post-intervention and immediately post-training) for peak force and between CWI and PR eccentric hamstring strength immediately post-intervention. Linear regression for individual analysis demonstrated greater recovery in peak torque and force for CWI. CWI may be useful to ameliorate potential deficits in eccentric hamstring strength that optimise readiness to train/play in elite football settings. Multiple measures and individual analysis of recovery responses provides sports medicine and performance practitioners with direction on the application of modified approaches to recovery strategies, within mid-competitive season training cycles.

The Prevalence of Use of Various Post-Exercise Recovery Methods after Training among Elite Endurance Athletes

There is now compelling evidence of the effectiveness of a range of post-exercise recovery techniques, including extended nights of sleep, cold water immersion, massage, and compression garments. Currently, limited information is available on post-exercise recovery methods used by elite endurance athletes. Therefore, this study investigated the actual methods of recovery used in this group of athletes. Google Forms were used to collect information on the recovery methods used by elite endurance track and field athletes (n = 153, 61.4% men, 38.6% women; average age: 22.7 ± 4.6 years). The most used methods of recovery were sauna bathing (96.7%), massage (86.9%), daytime nap (81.0%), and long night sleep (at least 9h) (61.4%). Recovery methods with proven effectiveness such as cold water immersion and compression garments were rarely used (15.0% and 7.8%, respectively). Overall, recovery methods were used more often when the tiers of the track and field athletes were higher. Massage and sauna bathing were the most used methods of post-exercise recovery among Russian endurance track and field athletes. In most cases, they were used in conjunction with short daytime nap and long night sleep. Higher tier athletes were more likely to use sauna bathing, massage, long night sleep, and daytime nap but not cold water immersion and compression garments as recovery methods; however, all these methods except for cold water immersion were widely used among elite-tier athletes.

Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis

OBJECTIVE

To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis.

METHODS

Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers.

RESULTS

A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first.

CONCLUSION

Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

Predictive Ability of Body Fat Percentage and Thigh Anthropometrics on Tissue Cooling During Cold-Water Immersion

CONTEXT

Cold-water immersion (CWI) is a common aid in exercise recovery. The effectiveness of CWI depends on the magnitude of muscle and core cooling. Individual cooling responses to CWI vary and are likely influenced by the CWI dose and individual physiological characteristics.

OBJECTIVE

To evaluate body fat percentage and thigh anthropometric values as predictors of intramuscular and skin-cooling responses to CWI.

DESIGN

Descriptive laboratory study.

SETTING

Sports medicine research center.

PATIENTS OR OTHER PARTICIPANTS

Sixteen young adults (8 males, 8 females, age = 24.3 ± 1.84 years, height = 176.4 ± 12.7 cm, mass = 86.6 ± 29.4 kg).

INTERVENTION(S)

Body fat percentage was measured using a 3-site skinfold assessment. Thigh length, thigh circumference, anterior thigh adipose thickness, anterior thigh muscle thickness, and thigh volume were estimated using manual and ultrasound methods. Using sterile techniques, we placed thermocouple probes in the belly of the rectus femoris (2-cm deep to the subadipose tissue) and on the anterior midthigh surface. Participants cycled on an ergometer for 30 minutes at a target heart rate of 130 to 150 beats/min. Postexercise, participants were placed in CWI (immersion depth to the iliac crest; 10°C) until intramuscular temperature was 7°C below pre-exercise baseline temperature, with a maximum immersion duration of 30 minutes.

MAIN OUTCOME MEASURE(S)

Intramuscular rectus femoris and thigh skin temperatures measured postexercise, after 10 and 15 minutes of CWI, and post-CWI.

RESULTS

Body fat percentage significantly predicted the rectus femoris cooling magnitude and rate after 10 minutes of CWI, 15 minutes of CWI, and post-CWI (P < .001; R2 range = 0.58-0.67). Thigh anthropometric values significantly predicted the thigh skin-cooling rate post-CWI (P = .049; R2 = 0.46).

CONCLUSIONS

A simple 3-site skinfold assessment may improve the effective prescription of CWI by allowing estimation of the dose required for minimal muscle tissue cooling.

Assessment of the Dynamics of Temperature Changes in the Knee Joint Area in Response to Selected Cooling Agents in Thermographic Tests

Although local cryotherapy (LC) is performed with various cooling agents (C_Ag) such as ice, water, and gasses, in clinical practice, it is mostly performed with cooling gasses. Presently, LC with cooling gasses is very popular but the inference about the thermal (stimulus) effect on the tissues is mainly based on research carried out using ice packs. The proposed objective of the study was to evaluate the dynamics of temperature changes in the knee joint area in response to a 3-min exposure to liquid nitrogen vapors (LNVs), cold air (CA) and ice bag (IB). The study group included 23 healthy volunteers with an average age of 26.67 ± 4.56. The exposed (ROI_E) and contralateral (ROI_NE) areas of the knee joint after exposure to C_Ag were observed. Immediately after 3 min of LC, the ROI_E temperature dropped by 10.11 ± 0.91 °C after LNV, 7.59 ± 0.14 °C after IB and 6.76 ± 1.3 °C after CA. Significant tissue cooling was maintained up to 15 min after LNV (p < 0.01), 10 min after IB (p < 0.05) and 5 min after CA (p < 0.05). LC causes significant temperature changes both in ROI_E and ROI_NE. The greatest cooling potential was demonstrated for LNV and the lowest for CA.

Intramuscular Temperature Changes in the Quadriceps Femoris Muscle After Post-Exercise Cold-Water Immersion (10°C for 10 min): A Systematic Review With Meta-Analysis

Post-exercise cold-water immersion (CWI) is a widely accepted recovery strategy for maintaining physical performance output. However, existing review articles about the effects of CWI commonly pool data from very heterogenous study designs and thus, do rarely differentiate between different muscles, different CWI-protocols (duration, temperature, etc.), different forms of activating the muscles before CWI, and different thickness of the subcutaneous adipose tissue. This systematic review therefore aimed to investigate the effects of one particular post-exercise CWI protocol (10°C for 10 min) on intramuscular temperature changes in the quadriceps femoris muscle while accounting for skinfold thickness. An electronic search was conducted on PubMed, LIVIVO, Cochrane Library, and PEDro databases. Pooled data on intramuscular temperature changes were plotted with respect to intramuscular depth to visualize the influence of skinfold thickness. Spearman's rho (r_s) was used to assess a possible linear association between skinfold thickness and intramuscular temperature changes. A meta-analysis was performed to investigate the effect of CWI on pre-post intramuscular temperature for each measurement depth. A total of six articles met the inclusion criteria. Maximum intramuscular temperature reduction was 6.40°C with skinfold thickness of 6.50 mm at a depth of 1 cm, 4.50°C with skinfold thickness of 11.00 mm at a depth of 2 cm, and only 1.61°C with skinfold thickness of 10.79 mm at a depth of 3 cm. However, no significant correlations between skinfold thickness and intramuscular temperature reductions were observed at a depth of 1 cm (r _s = 0.0), at 2 cm (r _s = -0.8) and at 3 cm (r _s = -0.5; all p > 0.05). The CWI protocol resulted in significant temperature reductions in the muscle tissue layers at 1 cm (d = -1.92 [95% CI: -3.01 to -0.83] and 2 cm (d = -1.63 [95% CI: -2.20 to -1.06]) but not at 3 cm (p < 0.05). Skinfold thickness and thus, subcutaneous adipose tissue, seems to influence temperature reductions in the muscle tissue only to a small degree. These findings might be useful for practitioners as they demonstrate different intramuscular temperature reductions after a specific post-exercise CWI protocol (10°C for 10 min) in the quadriceps femoris muscle.

The Impact of Recovery Practices Adopted by Professional Tennis Players on Fatigue Markers According to Training Type Clusters

Introduction: Modern tennis players face congested schedules that force the adoption of various recovery strategies. Thus, recovery must be fine-tuned with an accurate quantification of its impacts, especially with regards to training-induced fatigue. The present study aimed to examine the training type clusters and recovery practices adopted by elite tennis players under ecological training conditions. The respective impacts of training type clusters and recovery techniques on subjective variables, which reflect the players' recovery perceptions, were subsequently determined.

Methods: During 15 consecutive months, a total of 35 elite tennis players filled out questionnaires to report their daily training load, training session content, adopted recovery modalities after training, and perceived recovery.

Results: The hierarchical analysis identified three clusters: “combined tennis and S&C training,” “predominant tennis training” and “predominant S&C training.” Muscle soreness and perceived fatigue were not significantly different among these three clusters (p = 0.07–0.65). Across the 146 recorded training and recovery sessions, players primarily employed a combination of 2 or 3 modalities, with cooling strategies being the most widely used technique (87.6%). Mixed linear models revealed that independent of training clusters, cooling strategies significantly reduced muscle soreness (Δmuscle soreness: β = −1.00, p = 0.02). Among the cooling techniques used, whole-body cryotherapy induced a greater perceived recovery than cold-water immersion (p = 0.02).

Conclusion: These results showed that perceived recovery was not sensitive to training clusters or the associated acute training load. However, cooling strategies were relevant for the alleviation of tennis training-induced soreness. This study represents an initial step toward a periodized approach of recovery interventions, based on the interactions between training load, training contents, and perceived recovery.

Cold Water Immersion After a Handball Training Session: The Relationship Between Physical Data and Sensorial Experience

The aim of this study was to examine the relationship between the physiological data from subjects and their reported sensory experiences during two types of recovery methods following a handball training session. Female handball players (average age: 21.4 ± 1.3 years; weight: 59.2 ± 3.3 kg; height: 158 ± 3 cm; body mass index, 23.4 ± 2.0 kg.m⁻²) carried out an athletic training session (rating of perceived exertion RPE: 14.70 ± 0.89) with either a passive recovery (PR) period or cold water immersion (CWI) for 14 min) (cross-over design). Physiological data were collected during the recovery period: CWI had a greater effect than PR on heart rate (HR; bpm), the higher frequencies (HF) of heart rate variability (HRV: 46.44 ± 21.50 vs. 24.12 ± 17.62), delayed onset muscle soreness (DOMS: 1.37 ± 0.51 vs. 2.12 ± 1.25), and various reported emotional sensations. Spectrum HRV analysis showed a significant increase in HF during CWI. Sensorial experiences during the recovery periods were gathered from verbatim reports 24 h later. Players' comments about CWI revealed a congruence between the physiological data and sensorial reports. They used words such as: “thermal shock,” “regeneration,” “resourcefulness,” “dynamism,” and “disappearance of pain” to describe their sensations. In conclusion, this study demonstrated the link between physiological and experiential data during CWI and we propose that action of the parasympathetic system on the autonomic nervous system can, at least in part, explain the observed correlations between the corporeal data measured and the sensorial experiences reported.

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.

Local cooling for relieving pain from perineal trauma sustained during childbirth

BACKGROUND

Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. This Cochrane Review is an update of a review last updated in 2012.

OBJECTIVES

To evaluate the effectiveness of localised cooling treatments compared with no treatment, placebo, or other cooling treatments applied to the perineum for pain relief following perineal trauma sustained during childbirth.

SEARCH METHODS

We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019) and reference lists of retrieved studies.

SELECTION CRITERIA

Published and unpublished randomised and quasi-randomised trials (RCTs) that compared a localised cooling treatment applied to the perineum with no treatment, placebo, or another cooling treatment applied to relieve pain related to perineal trauma sustained during childbirth.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were double checked for accuracy. The certainty of the evidence was assessed using the GRADE approach.

MAIN RESULTS

We included 10 RCTs that enrolled 1233 women randomised to the use of one cooling treatment (ice, cold gel pad, cooling plus compression, cooling plus compression plus (being) horizontal) compared with another cooling treatment, no treatment, or placebo (water pack, compression). The included trials were at low or uncertain risk of bias overall, with the exception that the inability to blind participants and personnel to group allocation meant that we rated all trials at unclear or high risk for this domain. We undertook a number of comparisons to evaluate the different treatments. Cooling treatment (ice pack or cold gel pad) versus no treatment There was limited very low-certainty evidence that cooling treatment may reduce women's self-reported perineal pain within four to six hours (mean difference (MD) -4.46, 95% confidence interval (CI) -5.07 to -3.85 on a 10-point scale; 1 study, 100 participants) or between 24 and 48 hours of giving birth (risk ratio (RR) 0.73, 95% CI 0.57 to 0.94; 1 study, 316 participants). The evidence is very uncertain about the various measures of wound healing, for example, wound edges gaping when inspected five days after giving birth (RR 2.56, 95% CI 0.58 to 11.33; 1 study, 315 participants). Women generally rated their satisfaction with perineal care similarly following cooling or no treatment. The potential exception was that there may be a trivially lower mean difference of -0.1 on a five-point scale of psychospiritual comfort with cooling treatment, that is unlikely to be of clinical importance. Cooling treatment (cold gel pad) + compression versus placebo (gel pad + compression) There was limited low-certainty evidence that there may be a trivial MD of -0.43 in pain on a 10-point scale at 24 to 48 hours after giving birth (95% CI -0.73 to -0.13; 1 study, 250 participants) when a cooling treatment plus compression from a well-secured perineal pad was compared with the placebo. Levels of perineal oedema may be similar for the two groups (low-certainty evidence) and perineal bruising was not observed. There was low-certainty evidence that women may rate their satisfaction as being slightly higher with perineal care in the cold gel pad and compression group (MD 0.88, 95% CI 0.38 to 1.38; 1 trial, 250 participants). Cooling treatment (ice pack) versus placebo (water pack) One study reported that no women reported pain after using an ice pack or a water pack when asked within 24 hours of giving birth. There was low-certainty evidence that oedema may be similar for the two groups when assessed at four to six hours (RR 0.96, 95% CI 0.50 to 1.86; 1 study, 63 participants) or within 24 hours of giving birth (RR 0.36, 95% CI 0.08 to 1.59). No women were observed to have perineal bruising at these times. The trialists reported that no women in either group experienced any adverse effects on wound healing. There was very low-certainty evidence that women may rate their views and experiences with the treatments similarly (for example, satisfied with treatment: RR 0.91, 95% CI 0.77 to 1.08; 63 participants). Cooling treatment (ice pack) versus cooling treatment (cold gel pad) The evidence is very uncertain about the effects of using ice packs or cold gel pads on women's self-rated perineal pain, on perineal bruising, or on perineal oedema at four to six hours or within 24 hours of giving birth. Perineal oedema may persist 24 to 48 hours after giving birth in women using the ice packs (RR 1.69, 95% CI 1.03 to 2.7; 2 trials, 264 participants; very low-certainty). The risk of gaping wound edges five days after giving birth may be decreased in women who had used ice packs (RR 0.22, 95% CI 0.05 to 1.01; 215 participants; very low-certainty). However, this did not appear to persist to day 10 (RR 3.06, 95% CI 0.63 to 14.81; 214 participants). Women may rate their opinion of treatment less favourably following the use of ice packs five days after giving birth (RR 0.33, 95% CI 0.17 to 0.68; 1 study, 49 participants) and when assessed on day 10 (RR 0.82, 95% CI 0.73 to 0.92; 1 study, 208 participants), both very low-certainty.

AUTHORS' CONCLUSIONS

There is limited very low-certainty evidence that may support the use of cooling treatments, in the form or ice packs or cold gel pads, for the relief of perineal pain in the first two days following childbirth. It is likely that concurrent use of several treatments is required to adequately address this issue, including prescription and non-prescription analgesia. Studies included in this review involved the use of cooling treatments for 10 to 20 minutes, and although no adverse effects were noted, these findings came from studies of relatively small numbers of women, or were not reported at all. The continued lack of high-certainty evidence of the benefits of cooling treatments should be viewed with caution, and further well-designed trials should be conducted.

Resistance Training Acutely Impairs Agility and Spike-Specific Performance Measures in Collegiate Female Volleyball Players Returning from the Off-Season

This study examined the acute effects of resistance training (RT) on volleyball-specific performance. Sixteen female volleyball players undertook their initial, pre-season RT bout. Countermovement jump (CMJ), delayed onset of muscle soreness (DOMS), and sport-specific performances (i.e., run-up jump, agility, and spiking speed and accuracy) were measured before, 24 (T24), and 48 (T48) hours after RT. A significant increase in DOMS was observed at T24 and T48 (~207.6% ± 119.3%; p < 0.05; ES = 1.8 (95% CI: 0.94–2.57)), whilst agility was significantly impaired at T48 (1.7% ± 2.5%; p < 0.05; ES = 0.30 (95% CI: −0.99–0.40)). However, there were no differences in CMJ (~−2.21% ± 7.6%; p > 0.05; ES = −0.11 (95% CI: −0.80–0.58)) and run-up jump (~−1.4% ± 4.7%; p > 0.05; ES = −0.07 (95% CI: −0.76–0.63)). Spiking speed was significantly reduced (−3.5% ± 4.4%; p < 0.05; ES = −0.28 (95% CI: −0.43–0.97)), although accuracy was improved (38.3% ± 81.4%: p < 0.05) at T48. Thus, the initial, preseason RT bout compromised agility and spiking speed for several days post-exercise. Conversely, spiking accuracy improved, suggesting a speed–accuracy trade-off. Nonetheless, at least a 48-h recovery may be necessary after the initial RT bout for athletes returning from the off-season or injury.

Water immersion methods do not alter muscle damage and inflammation biomarkers after high-intensity sprinting and jumping exercise

Purpose

The aim of this study was to compare the efficacy of three water immersion interventions performed after active recovery compared to active recovery only on the resolution of inflammation and markers of muscle damage post-exercise.

Methods

Nine physically active men (n = 9; age 20‒35 years) performed an intensive loading protocol, including maximal jumps and sprinting on four occasions. After each trial, one of three recovery interventions (10 min duration) was used in a random order: cold-water immersion (CWI, 10 °C), thermoneutral water immersion (TWI, 24 °C), contrast water therapy (CWT, alternately 10 °C and 38 °C). All of these methods were performed after an active recovery (10 min bicycle ergometer), and were compared to active recovery only (ACT). 5 min, 1, 24, 48, and 96 h after exercise bouts, immune response and recovery were assessed through leukocyte subsets, monocyte chemoattractant protein-1, myoglobin and high-sensitivity C-reactive protein concentrations.

Results

Significant changes in all blood markers occurred at post-loading (p < 0.05), but there were no significant differences observed in the recovery between methods. However, retrospective analysis revealed significant trial-order effects for myoglobin and neutrophils (p < 0.01). Only lymphocytes displayed satisfactory reliability in the exercise response, with intraclass correlation coefficient > 0.5.

Conclusions

The recovery methods did not affect the resolution of inflammatory and immune responses after high-intensity sprinting and jumping exercise. It is notable that the biomarker responses were variable within individuals. Thus, the lack of differences between recovery methods may have been influenced by the reliability of exercise-induced biomarker responses.

Electronic supplementary material

The online version of this article (10.1007/s00421-020-04481-8) contains supplementary material, which is available to authorized users.

Therapeutische Wirksamkeit von Kaltwasserimmersionen auf die Wiederherstellung der Leistungsfähigkeit von Sportlern nach intensiven Lauf- und Fahrradbelastungen – Eine systematische Literaturübersichtsarbeit

Hintergrund Regeneration spielt im Sport eine große Rolle. In diesem Zusammenhang gewinnt die Hydrotherapie immer mehr an Bedeutung. Durch ihre Anwendung in verschiedenen Sportarten ist deren mediale Präsenz und damit die Bekanntheit von Kaltwasserimmersionen in den letzten Jahren gestiegen. Die große Bandbreite von Studien erschwert jedoch das Erkennen eindeutiger Handlungsanweisungen für die Praxis. Existierende Reviews beziehen sich meistens auf mehrere Outcome-Parameter oder untersuchen lediglich die physiologischen Parameter.

Ziel Konkrete Erkenntnisse aus der Praxis gewinnen über die Wirkung von Hydrotherapie auf die Wiederherstellung der körperlichen Leistungsfähigkeit mit spezifischen Angaben für Belastungsintensitäten und -arten. Diese systematische Literaturübersichtsarbeit eruiert die aktuelle Studienlage zur Wirksamkeit von Kaltwasserimmersionen auf die Wiederherstellung der Leistungsfähigkeit von Sportlern nach intensiven Lauf- und Fahrradbelastungen.

Methode Systematische Literaturrecherche in den Datenbanken Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE und Physiotherapy Evidence Database (PEDro). Anhand definierter Ein- und Ausschlusskriterien sichteten zwei unabhängige Gutachter die später in dieser Arbeit eruierten Studien in den drei genannten Datenbanken. Eine Bewertung des Verzerrungsrisikos der eingeschlossenen Studien erfolgte durch das Risk-of-Bias-Tool von Cochrane.

Ergebnisse Insgesamt wurden sechs randomisierte kontrollierte Studien eingeschlossen. Eine Studie konnte einen positiven Effekt von Kaltwasserimmersionen auf Sprintausdauer und Sprintgeschwindigkeit feststellen, eine Studie zeigte keinen Effekt hinsichtlich der maximalen isometrischen Quadricepsanspannung sowie der Counter-Movement-Jump-Höhe und vier Studien fanden für verschiedene Parameter der körperlichen Leistungsfähigkeit positive, negative und keine Effekte.

Schlussfolgerungen Die Effektivität von Kaltwasserimmersionen scheint stark abhängig vom Belastungsprotokoll zu sein, welches dem Regenerationsprozess vorausgeht. Dementsprechend sollten für verschiedene Sportarten auch unterschiedliche Immersionsprotokolle angewendet werden. Wie genau diese Protokolle auszusehen haben, muss in zukünftigen Studien spezifisch untersucht werden.

Does Acupuncture Benefit Delayed-Onset Muscle Soreness After Strenuous Exercise? A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis was designed to evaluate the effects of acupuncture intervention on alleviating delayed onset of muscle soreness (DOMS) after intense exercise.

Method: Randomized controlled trials (RCTs) were searched from online databases including Medline (PubMed), Cochrane Library, Web of Science, Embase, PsycINFO, China Knowledge Resource Integrated Database (CNKI), and Wanfang (Chinese) up to April 2019. Data points were extracted from the eligible RCTs at the time points of 24, 48, and 72 h post strenuous exercise-induced DOMS. The outcomes of muscle soreness rating (MSR), creatine kinase (CK), and maximal isometric force (MIF) were pooled into the meta-analysis to assess the acupuncture intervention on DOMS.

Results: Six eligible RCTs were included in the meta-analysis, and the results showed that acupuncture intervention significantly decreased MSR [standardized mean difference (SMD) −0.49, 95%CI −0.73 to −0.24, P < 0.001, I² = 34%] and the serum level of CK (SMD −0.91, 95%CI −1.27 to −0.56, P < 0.001, I² = 30%), accompanied with the improvement of the muscle strength (MIF) (SMD 0.54, 95%CI 0.16 to 0.93, P = 0.006, I² = 51%) after intense exercise. At the same time, the findings also revealed that acupuncture intervention had a long-lasting effect and tended to accumulate the effect size and that it had the most efficacy on alleviating DOMS at the time point of 72 h post exercise.

Conclusion: The current evidence indicates that acupuncture intervention after intense exercise could be effective for alleviating DOMS and improving muscle recovery. The long-lasting effect of acupuncture intervention on DOMS started from 24 h and would reach a peak on the time point of 72 h post exercise.

Short-Term Resistance Training Supported by Whole-Body Cryostimulation Induced a Decrease in Myostatin Concentration and an Increase in Isokinetic Muscle Strength

The study aimed to determine whether combining cryostimulation with resistance training would effectively increase muscle strength, and if so, whether this adaptation would be related to changes in circulating levels of exerkines (i.e., mediators of systemic adaptation to exercise). Twenty-five students completed 12 sessions of resistance training, each followed by either cryostimulation (n = 15, 3 min exposure at -110 °C) or passive recovery (n = 10). Prior to and post this intervention, participants performed two eccentric cycling bouts (before and after training). At these points, serum concentrations of muscle damage marker (myoglobin), exerkines (interleukin 6 (IL-6), interleukin 15 (IL-15), irisin, brain-derived neurotrophic factor), hypertrophy-related factors (myostatin, insulin-like growth factor 1), and muscle strength were measured. The applied procedure reduced the physiological burden of the second eccentric cycling bout and myoglobin concentrations only in the group subject to cryostimulation. The same group also exhibited decreased levels of myostatin (from 4.7 ± 1.7 to 3.8 ± 1.8 ng·mL^-1, p < 0.05). A significant and large interaction between the group × time was noted in IL-15 concentration (p = 0.01, ηp2=0.27). Training and cryostimulation induced a positive and likely significant improvement of isokinetic muscle strength. Altogether, obtained results support the claim that resistance training combined with cold exposure modified muscle strength through modulation of myostatin and IL-15 concentrations.

Pregnancy, cold water swimming and cortisol: The effect of cold water swimming on obstetric outcomes

Cold water swimming is an activity which has received increased attention in recent years, with advertised benefits including improvements in mood, energy and exercise recovery. Cold water swimmers also report experiencing less stress in daily life, the health implications of which may be far-reaching. This may be of particular interest to expecting mothers, as we explore how stress may negatively impact upon birth outcomes. We present the hypothesis that women who regularly enjoy cold water swimming can expect to experience improved obstetric outcomes over those who do not; cold water swimming is a significant physiologically stressful event which may, on habitual exposure, attenuate the stress response, leading to a reduction in negative birth outcomes.

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.

Omega-3 Polyunsaturated Fatty Acid Supplementation for Reducing Muscle Soreness after Eccentric Exercise: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Purpose

This systematic review and meta-analysis was performed to determine the effectiveness of Omega-3 polyunsaturated fatty acid (n‐3 PUFA) supplement on muscle soreness after eccentric exercise.

Methods

PubMed, EMBASE, CENTRAL, and ISI Web of Science were searched to identify randomized controlled trials (RCTs) that assessed the efficacy of n‐3 PUFA on muscle soreness after eccentric exercise. Mean difference (MD) and the associated 95% confidence interval (95% CI) were calculated by RevMan 5.3 to indicate delayed onset muscle soreness (DOMS) that measured two days after eccentric trainings. Subgroup analyses according to duration and daily dosage of n‐3 PUFA supplements before eccentric exercises were performed to determine whether these factors will influence the overall effect size. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the certainty of evidence. The protocol of this systematic review and meta-analysis was registered at PROSPERO (CRD42018085869).

Results

12 RCTs containing 145 subjects and 156 controls were included in this study. Meta-analysis revealed a significantly decreased DOMS (MD -0.93; 95% CI -1.44, -0.42; P = 0.0004) in n‐3 PUFA supplement groups, while no significant differences in isometric muscle strength and range of motion (ROM) were detected. However, the pooled effect size for DOMS was lower than the minimal clinically important difference (MCID) of 1.4 on the 10-unit VAS, suggesting that the effect size of less muscle soreness with n‐3 PUFA supplements did not appear to be clinically relevant.

Conclusion

There is low-quality evidence that n‐3 PUFA supplementation does not result in a clinically important reduction of muscle soreness after eccentric exercise. Isometric muscle soreness and range of motion were not improved by n‐3 PUFA supplementation either (low-quality evidence). To further elucidate the overall role of n‐3 PUFA on muscle damage in this area, large-scale RCTs are still needed.

Prolonged cooling with phase change material enhances recovery and does not affect the subsequent repeated bout effect following exercise

PURPOSE

The aim of this investigation was twofold: (1) to examine the effect of prolonged phase change material (PCM) cooling following eccentric exercise of the quadriceps on indices of muscle damage, and (2) to elucidate whether application of PCM cooling blunted the acute adaptive response to eccentric exercise, known as the repeated bout effect (RBE).

METHODS

Twenty-six males (25 ± 6 years) performed an initial bout (B1) of 120 eccentric quadriceps contractions on each leg at 90% of their isometric strength and were then randomized to receive PCM packs frozen at 15 °C (treatment) or melted packs (control) worn directly on the skin under shorts for 6 h. The protocol was repeated 14 days later (B2) with all participants receiving the control condition.

RESULTS

PCM cooling provided protection against strength loss in B1 (P = 0.005) with no difference in strength between treatment groups in B2 (P = 0.172; bout by treatment by time P = 0.008). PCM cooling reduced soreness in B1 (P = 0.009) with no difference between treatment groups in B2 (P = 0.061). Soreness was overall lower following B2 than B1 (P < 0.001). CK was elevated in B1 (P < 0.0001) and reduced in B2 (P < 0.001) with no difference between treatments. The damage protocol did not elevate hsCRP in B1, with no difference between treatments or between bouts.

CONCLUSIONS

This work provides further evidence that PCM cooling enhances recovery of strength and reduces soreness following eccentric exercise. Importantly, these data show for the first time that prolonged PCM cooling does not compromise the adaptive response associated with the RBE.

The physiological effects of daily cold-water immersion on 5-day tournament performance in international standard youth field-hockey players

PURPOSE

This study examined the effects of daily post-exercise cold-water immersion (CWI) on match performance, perceptual recovery, and biomarkers of muscle damage and metabolic load during a 5-day international tournament of elite youth field-hockey players.

METHODS

The entire German under-18 national squad (n = 18) was randomly assigned to a daily CWI- (5-min at ~ 6 °C; excluding the head; n = 9) or passive recovery (CON; n = 9) intervention. Training and match performance were assessed using a GPS-tracking system and perceived exertion (RPE). Daily ratings of delayed onset muscle soreness (DOMS), perceived stress and recovery, quality of sleep, heart-rate recovery and serum creatine kinase (CK), lactate dehydrogenase, and urea nitrogen were also recorded. Repeated-sprint ability (RSA) and counter-movement jump (CMJ) were carried out on days 1 and 5.

RESULTS

There was no significance between intervention differences in time-on pitch, total distance, velocity zones, and accelerometer-base parameters during match performance (all p > 0.05). DOMS (p < 0.01), RPE (p < 0.01), and CK (p < 0.01) were significantly elevated over the course of the tournament; however, no between-intervention effects were observed (all p > 0.05). Both groups were able to maintain RSA and CMJ (all p > 0.05).

CONCLUSION

In conclusion, daily post-exercise CWI did not improve match performance, perceptual recovery, or biomarkers of muscle damage and metabolic load in elite youth field-hockey players.

Perfusion of the skin's microcirculation after cold-water immersion (10°C) and partial-body cryotherapy (-135°C)

Background

Investigations of the perfusion of the skin's microcirculation with laser speckle contrast imaging (LSCI) after cold treatments are rare. Therefore, the aim of this study was to compare the effects between cold‐water immersion (CWI) conduction and partial‐body cryotherapy (PBC) convection on perfusion of the microcirculation and skin temperature on the thigh.

Materials and Methods

Twenty healthy males were randomly allocated to CWI (10°C for 10 minutes) or PBC (−60°C for 30 seconds, −135°C for 2 minutes). Perfusion and skin temperature measurements were conducted on the anterior thigh region up to 60 minutes post‐treatment.

Results

Cold‐water immersion decreased perfusion of the microcirculation significantly compared to baseline values between 10 minutes (P = 0.003) and 30 minutes (P = 0.01) post‐treatment. PBC increased perfusion of the microcirculation and decreased skin temperature only at the first measurement interval (0 minute, both P = 0.01) post‐treatment. Additionally, local skin temperature was significantly decreased compared to baseline values only after CWI up to 30 minutes (P = 0.04) post‐treatment.

Conclusion

Cold‐water immersion reduced local skin microcirculation and skin temperature while PBC only slightly increased the perfusion of the microcirculation immediately after the treatment. For cooling purposes, the conduction method seems superior compared to the convection method, assessed with a LSCI device.

Cold water immersion improves recovery of sprint speed following a simulated tournament

It is a common requirement in tournament scenarios for athletes to compete multiple times in a relatively short time period, with insufficient recovery time not allowing full restoration of physical performance. This study aimed to develop a greater understanding of the physiological stress experienced by athletes in a tournament scenario, and how a commonly used recovery strategy, cold water immersion (CWI), might influence these markers. Twenty-one trained male games players (age 19 ± 2; body mass 78.0 ± 8.8 kg) were randomised into a CWI group (n = 11) or a control group (n = 10). To simulate a tournament, participants completed the Loughborough Intermittent Shuttle Test (LIST) on three occasions in five days. Recovery was assessed at specific time points using markers of sprint performance, muscle function, muscle soreness and biochemical markers of damage (creatine kinase, CK), inflammation (IL-6 and C-Reactive Protein) and oxidative stress (lipid hydroperoxides and activity of 6 lipid-soluble antioxidants). The simulated tournament was associated with perturbations in some, but not all, markers of physiological stress and recovery. Cold water immersion was associated with improved recovery of sprint speed 24 h after the final LIST (ES = 0.83 ± 0.59; p = .034) and attenuated the efflux of CK pre- and post-LIST 3 (p < .01). The tournament scenario resulted in an escalation of physiological stress that, in the main, cold water immersion was ineffective at managing. These data suggest that CWI is not harmful, and provides limited benefits in attenuating the deleterious effects experienced during tournament scenarios.

Cold Water Immersion Enhanced Athletes' Wellness and 10-m Short Sprint Performance 24-h After a Simulated Mixed Martial Arts Combat

Objective: The aim of the present study was to examine the effect of Cold Water Immersion (CWI) on the recovery of physical performance, hematological stress markers and perceived wellness (i.e., Hooper scores) following a simulated Mixed Martial Arts (MMA) competition.

Methods: Participants completed two experimental sessions in a counter-balanced order (CWI or passive recovery for control condition: CON), after a simulated MMAs competition (3 × 5-min MMA rounds separated by 1-min of passive rest). During CWI, athletes were required to submerge their bodies, except the trunk, neck and head, in the seated position in a temperature-controlled bath (∼10°C) for 15-min. During CON, athletes were required to be in a seated position for 15-min in same room ambient temperature. Venous blood samples (creatine kinase, cortisol, and testosterone concentrations) were collected at rest (PRE-EX, i.e., before MMAs), immediately following MMAs (POST-EX), immediately following recovery (POST-R) and 24 h post MMAs (POST-24), whilst physical fitness (squat jump, countermovement-jump and 5- and 10-m sprints) and perceptual measures (well-being Hooper index: fatigue, stress, delayed onset muscle soreness (DOMS), and sleep) were collected at PRE-EX, POST-R and POST-24, and at PRE-EX and POST-24, respectively.

Results: The main results indicate that POST-R sprint (5- and 10-m) performances were ‘likely to very likely’ (d = 0.64 and 0.65) impaired by prior CWI. However, moderate improvements were in 10-m sprint performance were ‘likely’ evident at POST-24 after CWI compared with CON (d = 0.53). Additionally, the use of CWI ‘almost certainly’ resulted in a large overall improvement in Hooper scores (d = 1.93). Specifically, CWI ‘almost certainly’ resulted in improved sleep quality (d = 1.36), stress (d = 1.56) and perceived fatigue (d = 1.51), and ‘likely’ resulted in a moderate decrease in DOMS (d = 0.60).

Conclusion: The use of CWI resulted in an enhanced recovery of 10-m sprint performance, as well as improved perceived wellness 24-h following simulated MMA competition.

Whole body cryotherapy, cold water immersion, or a placebo following resistance exercise: a case of mind over matter?

PURPOSE

The use of cryotherapy as a recovery intervention is prevalent amongst athletes. Performance of high volume, heavy load resistance exercise is known to result in disturbances of muscle function, perceptual responses and blood borne parameters. Therefore, this study investigated the influence of cold water immersion (CWI), whole body cryotherapy (WBC) or a placebo (PL) intervention on markers of recovery following an acute resistance training session.

METHODS

24 resistance trained males were matched into a CWI (10 min at 10 °C), WBC (3- and 4 min at - 85 °C) or PL group before completing a lower body resistance training session. Perceptions of soreness and training stress, markers of muscle function, inflammation and efflux of intracellular proteins were assessed before, and up to 72 h post exercise.

RESULTS

The training session resulted in increased soreness, disturbances of muscle function, and increased inflammation and efflux of intracellular proteins. Although WBC attenuated soreness at 24 h, and positively influenced peak force at 48 h compared to CWI and PL, many of the remaining outcomes were trivial, unclear or favoured the PL condition. With the exception of CRP at 24 h, neither cryotherapy intervention attenuated the inflammatory response compared to PL.

CONCLUSION

There was some evidence to suggest that WBC is more effective than CWI at attenuating select perceptual and functional responses following resistance training. However, neither cryotherapy intervention was more effective than the placebo treatment at accelerating recovery. The implications of these findings should be carefully considered by individuals employing cryotherapy as a recovery strategy following heavy load resistance training.

Multiple Cold-Water Immersions Attenuate Muscle Damage but not Alter Systemic Inflammation and Muscle Function Recovery: A Parallel Randomized Controlled Trial

The aim of this study was to investigate the effects of multiple cold-water immersions (CWIs) on muscle function, markers of muscle damage, systemic inflammation and ECM degradation following exercise-induced muscle damage (EIMD). Thirty physically active males were randomly assigned to either a control (n = 15) or cold-water immersion (CWI) group (n = 15). The CWI group performed one immersion (10 °C for 20 min) at post-exercise and every 24 h for the following 72 h, while the control group remained in a seated position during these corresponding periods. Muscle strength, vertical jump height, muscle thickness, delayed-onset muscle soreness (DOMS), systemic creatine kinase (CK), C-reactive protein (CRP), inflammatory cytokines and matrix metalloproteinase-2 (MMP-2) activity were assessed at Pre, Post, 24, 48, 72, 96 and 168 h following EIMD. No significant time × group interaction was obtained for muscle strength, vertical jump height recovery and MMP-2 activity (p > 0.05). At 24 h, muscle thickness from the CWI group returned to baseline and was lower than the control (p = 0.04). DOMS returned to baseline at 168 h for the CWI group (p = 0.109) but not for the control (p = 0.008). At 168 h, CK showed a time-group difference with a greater peak for the control group (p = 0.016). In conclusion, multiple CWIs attenuated muscle damage, but not altered systemic inflammation and muscle function recovery.

Antioxidants for preventing and reducing muscle soreness after exercise

BACKGROUND

Muscle soreness typically occurs after intense exercise, unaccustomed exercise or actions that involve eccentric contractions where the muscle lengthens while under tension. It peaks between 24 and 72 hours after the initial bout of exercise. Many people take antioxidant supplements or antioxidant-enriched foods before and after exercise in the belief that these will prevent or reduce muscle soreness after exercise.

OBJECTIVES

To assess the effects (benefits and harms) of antioxidant supplements and antioxidant-enriched foods for preventing and reducing the severity and duration of delayed onset muscle soreness following exercise.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, SPORTDiscus, trial registers, reference lists of articles and conference proceedings up to February 2017.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials investigating the effects of all forms of antioxidant supplementation including specific antioxidant supplements (e.g. tablets, powders, concentrates) and antioxidant-enriched foods or diets on preventing or reducing delayed onset muscle soreness (DOMS). We excluded studies where antioxidant supplementation was combined with another supplement.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened search results, assessed risk of bias and extracted data from included trials using a pre-piloted form. Where appropriate, we pooled results of comparable trials, generally using the random-effects model. The outcomes selected for presentation in the 'Summary of findings' table were muscle soreness, collected at times up to 6 hours, 24, 48, 72 and 96 hours post-exercise, subjective recovery and adverse effects. We assessed the quality of the evidence using GRADE.

MAIN RESULTS

Fifty randomised, placebo-controlled trials were included, 12 of which used a cross-over design. Of the 1089 participants, 961 (88.2%) were male and 128 (11.8%) were female. The age range for participants was between 16 and 55 years and training status varied from sedentary to moderately trained. The trials were heterogeneous, including the timing (pre-exercise or post-exercise), frequency, dose, duration and type of antioxidant supplementation, and the type of preceding exercise. All studies used an antioxidant dosage higher than the recommended daily amount. The majority of trials (47) had design features that carried a high risk of bias due to selective reporting and poorly described allocation concealment, potentially limiting the reliability of their findings.We tested only one comparison: antioxidant supplements versus control (placebo). No studies compared high-dose versus low-dose, where the low-dose supplementation was within normal or recommended levels for the antioxidant involved.Pooled results for muscle soreness indicated a small difference in favour of antioxidant supplementation after DOMS-inducing exercise at all main follow-ups: up to 6 hours (standardised mean difference (SMD) -0.30, 95% confidence interval (CI) -0.56 to -0.04; 525 participants, 21 studies; low-quality evidence); at 24 hours (SMD -0.13, 95% CI -0.27 to 0.00; 936 participants, 41 studies; moderate-quality evidence); at 48 hours (SMD -0.24, 95% CI -0.42 to -0.07; 1047 participants, 45 studies; low-quality evidence); at 72 hours (SMD -0.19, 95% CI -0.38 to -0.00; 657 participants, 28 studies; moderate-quality evidence), and little difference at 96 hours (SMD -0.05, 95% CI -0.29 to 0.19; 436 participants, 17 studies; low-quality evidence). When we rescaled to a 0 to 10 cm scale in order to quantify the actual difference between groups, we found that the 95% CIs for all five follow-up times were all well below the minimal important difference of 1.4 cm: up to 6 hours (MD -0.52, 95% CI -0.95 to -0.08); at 24 hours (MD -0.17, 95% CI -0.42 to 0.07); at 48 hours (MD -0.41, 95% CI -0.69 to -0.12); at 72 hours (MD -0.29, 95% CI -0.59 to 0.02); and at 96 hours (MD -0.03, 95% CI -0.43 to 0.37). Thus, the effect sizes suggesting less muscle soreness with antioxidant supplementation were very unlikely to equate to meaningful or important differences in practice. Neither of our subgroup analyses to examine for differences in effect according to type of DOMS-inducing exercise (mechanical versus whole body aerobic) or according to funding source confirmed subgroup differences. Sensitivity analyses excluding cross-over trials showed that their inclusion had no important impact on results.None of the 50 included trials measured subjective recovery (return to previous activities without signs or symptoms).There is very little evidence regarding the potential adverse effects of taking antioxidant supplements as this outcome was reported in only nine trials (216 participants). From the studies that did report adverse effects, two of the nine trials found adverse effects. All six participants in the antioxidant group of one trial had diarrhoea and four of these also had mild indigestion; these are well-known side effects of the particular antioxidant used in this trial. One of 26 participants in a second trial had mild gastrointestinal distress.

AUTHORS' CONCLUSIONS

There is moderate to low-quality evidence that high dose antioxidant supplementation does not result in a clinically relevant reduction of muscle soreness after exercise at up to 6 hours or at 24, 48, 72 and 96 hours after exercise. There is no evidence available on subjective recovery and only limited evidence on the adverse effects of taking antioxidant supplements. The findings of, and messages from, this review provide an opportunity for researchers and other stakeholders to come together and consider what are the priorities, and underlying justifications, for future research in this area.

Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control

PURPOSE

Cryotherapy is an increasingly popular recovery strategy used in an attempt to attenuate the negative impact of strenuous physical activity on subsequent exercise. Therefore, this study aimed to assess the effects of whole body cryotherapy (WBC) and cold water immersion (CWI) on markers of recovery following a marathon.

METHODS

Thirty-one endurance trained males completed a marathon. Participants were randomly assigned to a CWI, WBC or placebo group. Perceptions of muscle soreness, training stress and markers of muscle function were recorded before the marathon and at 24 and 48 h post exercise. Blood samples were taken at baseline, post intervention and 24 and 48 h post intervention to assess inflammation and muscle damage.

RESULTS

WBC had a harmful effect on muscle function compared to CWI post marathon. WBC positively influenced perceptions of training stress compared to CWI. With the exception of C-reactive protein (CRP) at 24 and 48 h, neither cryotherapy intervention positively influenced blood borne markers of inflammation or structural damage compared to placebo.

CONCLUSION

The findings show WBC has a negative impact on muscle function, perceptions of soreness and a number of blood parameters compared to CWI, contradicting the suggestion that WBC may be a superior recovery strategy. Further, cryotherapy is no more effective than a placebo intervention at improving functional recovery or perceptions of training stress following a marathon. These findings lend further evidence to suggest that treatment belief and the placebo effect may be largely responsible for the beneficial effects of cryotherapy on recovery following a marathon.

Massage Alleviates Delayed Onset Muscle Soreness after Strenuous Exercise: A Systematic Review and Meta-Analysis

Purpose: The purpose of this systematic review and meta-analysis was to evaluate the effects of massage on alleviating delayed onset of muscle soreness (DOMS) and muscle performance after strenuous exercise.

Method: Seven databases consisting of PubMed, Embase, EBSCO, Cochrane Library, Web of Science, CNKI and Wanfang were searched up to December 2016. Randomized controlled trials (RCTs) were eligible and the outcomes of muscle soreness, performance (including muscle maximal isometric force (MIF) and peak torque) and creatine kinase (CK) were used to assess the effectiveness of massage intervention on DOMS.

Results: Eleven articles with a total of 23 data points (involving 504 participants) satisfied the inclusion criteria and were pooled in the meta-analysis. The findings demonstrated that muscle soreness rating decreased significantly when the participants received massage intervention compared with no intervention at 24 h (SMD: –0.61, 95% CI: –1.17 to –0.05, P = 0.03), 48 h (SMD: –1.51, 95% CI: –2.24 to –0.77, P < 0.001), 72 h (SMD: –1.46, 95% CI: –2.59 to –0.33, P = 0.01) and in total (SMD: –1.16, 95% CI: –1.60 to –0.72, P < 0.001) after intense exercise. Additionally, massage therapy improved MIF (SMD: 0.56, 95% CI: 0.21–0.90, P = 0.002) and peak torque (SMD: 0.38, 95% CI: 0.04–0.71, P = 0.03) as total effects. Furthermore, the serum CK level was reduced when participants received massage intervention (SMD: –0.64, 95% CI: –1.04 to –0.25, P = 0.001).

Conclusion: The current evidence suggests that massage therapy after strenuous exercise could be effective for alleviating DOMS and improving muscle performance.

Enhanced Strength and Sprint Levels, and Changes in Blood Parameters during a Complete Athletics Season in 800 m High-Level Athletes

The purpose of this study was to analyze changes in sprint, strength, hematological, and hormonal parameters in high-level 800 m athletes during a complete athletics season. Thirteen male athletes of national and international level in 800 m (personal best ranging from 1:43 to 1:58 min:ss) participated in this study. A total of 5 tests were conducted during a complete athletics season. Athletes performed sprint tests (20 and 200 m), countermovement jump (CMJ), jump squat (JS), and full squat (SQ) tests. Blood samples (red and white blood profile) and hormones were collected in test 1 (T1), test 3 (T3), and test 5 (T5). A general increase in the performance of the strength and sprint parameters analyzed (CMJ, JS, SQ, 20 m, and 200 m) during the season was observed, with a significant time effect in CMJ (P < 0.01), SQ (P < 0.01), and 200 m (P < 0.05). This improvement was accompanied by a significant enhancement of the 800 m performance from T3 to T5 (P < 0.01). Significant changes in some hematological variables: hematocrit (Hct) (P < 0.01), mean corpuscular volume (MCV) (P < 0.001), mean corpuscular hemoglobin content (MCHC) (P < 0.001), white blood cells count (WBC) (P < 0.05), neutrophils (P < 0.05), monocytes (P < 0.05), and mean platelet volume (MPV) (P < 0.05) were observed throughout the season. The hormonal response and creatin kinase (CK) did not show significant variations during the season, except for insulin-like growth factor I (IGF-1) (P < 0.05). In conclusion, our results suggest the importance of strength levels in middle-distance athletes. On the other hand, variations in some hematological parameters and a depression of the immune system occurred during the season. Therefore, monitoring of the mechanical, hematological and hormonal response in athletes may help coaches and athletes to optimize the regulation of training contents and may be useful to diagnose states of overreaching or overtraining in athletes throughout the season.

The efficacy of cooling with phase change material for the treatment of exercise-induced muscle damage: pilot study

Post-exercise cryotherapy treatments are typically short duration interventions. This study examined the efficacy of prolonged cooling using phase change material (PCM) on strength loss and pain after eccentric exercise. Eight adults performed 120 bilateral eccentric quadriceps contractions (90% MVC). Immediately afterwards, frozen PCM packs (15°C) were placed over the quadriceps, with room temperature PCM packs on the contralateral quadriceps. Skin temperature was recorded continually (6 h PCM application). Isometric quadriceps strength and soreness were assessed before, 24, 48, 72 and 96 h post-exercise. The protocol was repeated 5 months later, with room temperature PCM applied to both legs. There were three treatments: legs treated with 15°C PCM packs (direct cooling), legs treated with room temperature PCM packs contralateral to the 15°C PCM packs (systemic cooling), and legs tested 5 months later both treated with room temperature PCM packs (control). Skin temperature was 9°C-10°C lower with direct cooling versus systemic cooling and control (P < 0.01). Strength loss and soreness were less (P < 0.05) with direct cooling versus systemic cooling and control (strength 101%, 94%, 93%, respectively; pain 1.0, 2.3, 2.7, respectively). Six hours of PCM cooling was well tolerated and reduced strength loss and pain after damaging exercise.

Therapy and Rehabilitation for Upper Extremity Injuries in Athletes

The approach to rehabilitation of upper extremity injuries in athletes differs from traditional rehabilitation protocols. In general, athletes have higher functional demands and wish to return to competitive sport in a timely manner. Comprehensive rehabilitation must therefore be balanced with a timely and safe return to sport. Several rehabilitation programs and adjunctive therapies are available to hasten convalescence while minimizing the athlete's risks of reinjury. Here, we review techniques for soft tissue mobilization and strength training in athletic populations. We also discuss orthotics, taping, and alternative therapies used in rehabilitation and evaluate the evidence in support of these modalities.

Cooling interventions for athletes: An overview of effectiveness, physiological mechanisms, and practical considerations

Exercise-induced increases in core body temperature could negative impact performance and may lead to development of heat-related illnesses. The use of cooling techniques prior (pre-cooling), during (per-cooling) or directly after (post-cooling) exercise may limit the increase in core body temperature and therefore improve exercise performance. The aim of the present review is to provide a comprehensive overview of current scientific knowledge in the field of pre-cooling, per-cooling and post-cooling. Based on existing studies, we will discuss 1) the effectiveness of cooling interventions, 2) the underlying physiological mechanisms and 3) practical considerations regarding the use of different cooling techniques. Furthermore, we tried to identify the optimal cooling technique and compared whether cooling-induced performance benefits are different between cool, moderate and hot ambient conditions. This article provides researchers, physicians, athletes and coaches with important information regarding the implementation of cooling techniques to maintain exercise performance and to successfully compete in thermally stressful conditions.

Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis

Background

Cold water immersion (CWI) is a technique commonly used in post-exercise recovery. However, the procedures involved in the technique may vary, particularly in terms of water temperature and immersion time, and the most effective approach remains unclear.

Objectives

The objective of this systematic review was to determine the efficacy of CWI in muscle soreness management compared with passive recovery. We also aimed to identify which water temperature and immersion time provides the best results.

Methods

The MEDLINE, EMBASE, SPORTDiscus, PEDro [Physiotherapy Evidence Database], and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched up to January 2015. Only randomized controlled trials that compared CWI to passive recovery were included in this review. Data were pooled in a meta-analysis and described as weighted mean differences (MDs) with 95 % confidence intervals (CIs).

Results

Nine studies were included for review and meta-analysis. The results of the meta-analysis revealed that CWI has a more positive effect than passive recovery in terms of immediate (MD = 0.290, 95 % CI 0.037, 0.543; p = 0.025) and delayed effects (MD = 0.315, 95 % CI 0.048, 0.581; p = 0.021). Water temperature of between 10 and 15 °C demonstrated the best results for immediate (MD = 0.273, 95 % CI 0.107, 0.440; p = 0.001) and delayed effects (MD = 0.317, 95 % CI 0.102, 0.532; p = 0.004). In terms of immersion time, immersion of between 10 and 15 min had the best results for immediate (MD = 0.227, 95 % 0.139, 0.314; p < 0.001) and delayed effects (MD = 0.317, 95 % 0.102, 0.532, p = 0.004).

Conclusions

The available evidence suggests that CWI can be slightly better than passive recovery in the management of muscle soreness. The results also demonstrated the presence of a dose–response relationship, indicating that CWI with a water temperature of between 11 and 15 °C and an immersion time of 11–15 min can provide the best results.

Electronic supplementary material

The online version of this article (doi:10.1007/s40279-015-0431-7) contains supplementary material, which is available to authorized users.