Can cold water immersion reduce muscle soreness?

Can cold water immersion reduce muscle soreness?

I’m sure you will have heard about the idea of plunging yourself into cold water after exercise (cryotherapy) in order to avoid the dreaded DOMS (Delayed Onset of Muscular Soreness). Have you ever wondered if this actually works? It is one of the most popular anti-DOMS methods, and involves the subject being immersed in water at a temperature below 15oC post-exercise.
The theory behind cryotherapy involves constriction of blood vessels and a reduction in metabolic activity, which acts to reduce swelling and tissue breakdown. Due to the fast return of blood flow to the tissues after being in contact with such cold temperatures, harmful metabolic debris gets flushed from your muscles.

 A recent study (1) attempted to determine the effects of cold-water immersion in the management of muscle soreness after exercise. A plethora of publications were analysed by a number of researchers in order to examine the efficacy of this form of therapy. The authors independently evaluated the quality of each study and obtained the collected data.
Existing publications were sourced from a number of databases and registers, and the authors scrutinized their methods and results. The studies involved randomised and quasi-randomised trials which compared the effect of post-exercise cryotherapy, no intervention, warm water immersion, active recovery, compression, varying duration and contrast immersion. The measurable outcomes were muscle soreness and subjective recovery.
In total there were seventeen trials, which involved 366 participants. It was concluded that the study quality was low as there was variation in the temperature, duration and frequency of cold-water immersion between trials. There was also variation in exercise and settings between trials.

Fourteen studies compared cryotherapy against ‘no intervention’, and pooled results show a statistically significant difference in muscle soreness in favour of cold-water immersion after exercise. Two studies found that cryotherapy resulted in significantly lower rating of fatigue and improved ratings of recovery immediately after immersion.
Five studies comparing cold-water with contrast immersion, showed no differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). There were similar findings from four studies comparing cold-water against warm-water immersion.
The authors of this study concluded that there was some evidence that cold-water immersion can reduce delayed onset of muscular soreness post-exercise, when compared to passive interventions involving rest or no intervention. There was a lack of significant evidence in order to make conclusions about further possible outcomes. Many of the trials failed to carry out sufficient monitoring of pre-defined indicators.

Our Comments

This examination of studies concluded that a lot more research into cryotherapy is required in order to acquire significant data. Many of the studies failed to standardise test variables to ensure that the results could be seen as reliable.

Investigations into therapies such as this, where results are based upon subjective scales, are always going to face scepticism. It is very hard to ensure the validity of subjective tests (such as fatigue and recovery), as feelings can be easily affected day-to-day and can be influenced by uncontrollable factors outside of the trial.
Another recent study (2), which analysed the effects of cold-water therapy after soccer training, also found a lack of significant evidence; however it did find that cryotherapy appeared to reduce the perception of fatigue after the training session.
Further study into cold-water immersion therapy should include a more controlled protocol and implement measures to increase effective repeatability, as well as an increased number of performance indicators.
How could cryotherapy aid in improving muscle development? If application of cryotherapy can reduce fatigue and increase recovery, this would give the potential to increase training intensity and frequency allowing for greater progression in strength and size.
Cryotherapy could prove to be a revolutionary performance enhancing tool, once more evidence has been found to support its effects.
Author: David Rowse
1. Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. (2012) Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. Feb 15;2 2. De Nardi M, La Torre A, Barassi A, Ricci C, Banfi G. (2011) Effects of cold-water immersion and contrast-water therapy after training in young soccer players. J Sports Med Phys Fitness Dec;51(4):609-15
© 2012, David Rowse. All rights reserved.