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Cold water immersion as a post-exercise recovery strategy.

Introduction

Adequate proportions between the work load at practice and the recovery are main factors in achieving high level sport performances. By increasing the work load at practice, the recovery time also increases. Athletes and coaches very often don't devote enough time for recovery and rest, which makes the athletes tired for next workout or competitions. Preparations for the most important competitions require more intensive stimulus, few times a week, which exposes the body to training overload. By doing another hard workout, without a proper recovery, may lead to problems with getting into shape for targeted competition, or may cause serious injuries. During high level competitions, the athletes take part in many tournaments, games in a short time period. They compete many times to get to the final through rounds. Because of the fatigue accumulation in body, scientists, coaches and athletes are trying to find a new ways of post workout regeneration, which will shorten the recovery time between practices or competitions. One of the methods is the ice bath (CWI - cold water immersion), is becoming more popular and has been used during many international competitions, such as: Track & Field competitions, European and World Championships, Olympic games (1). Applied after hard training or competitions, CWI is supposed to support recovery, reduce muscle soreness, and help the body to return to its state before exercise (2).

Cryotherapy has been shown to reduce cell necrosis, oedema and neutrophil migration, as well as slow cell metabolism and nerve conduction velocity, which in turn reduces secondary muscle damage (3-5). However, despite evidence for cryotherapy to lessen the inflammatory response, the effect of cryotherapy on muscle soreness and strength following eccentric exercise is unclear. Effects of immersion in ice water for post-exertion, delayed muscle soreness due to the divergence of results remains unclear (3), (4). This article attempts to summarize reports from foreign literature on immersion in ice water and an explanation of the ambiguity of the test results. The aim of this study was to review and summarize studies showing the positive effect of immersion in ice water on post workout recovery.

The formation of pain in muscles

After a hard workout, athletes feel muscle pain, which is the delayed onset muscle soreness (DOMS). These are the microdamages done to muscle fibers that cause pain, stiffness and tightness. These damages can feel like light muscle soreness, gone within hours, or can continue for several days, usually 5-7 with much more significant soreness and a reduction in joint range of motion. The microdamages are caused by high intensity workouts with many eccentric contractions (6-8). DOMS usually forms during a hard workout that the body is not used to and not adopted to. The muscle movements have to be intense and with great force (6).

The muscle pain is caused by lactic acid buildup, local ischemia, higher muscle tightness, damages to connective tissue and muscle inflammation. DOMS can be a significant obstacle in training through swelling, reduction in joint range of motion, and reduction in peak torque. Starting another hard workout, while experiencing the delayed onset muscle soreness can cause negative changes in ligaments and tendons, which can lead to injury eliminating the athlete from practice (7), (8).

Immersion in cold water - impact, application

Immersion in cold water causes a number of physiological processes in the body: the movement of fluids within the blood and cells, decreasing in swelling, increase the capacity of cardiac output without increasing its energy cost, increase blood flow to the tissues for better nutrition and more efficient transport of waste products appears (3). Meeusen i Lievens (9) suggested that an immersion of a limb in water baths of temperature between 42[degrees]C and 14[degrees]C for 15 minutes the blood flow is decreased, but in the water temperature below 10[degrees]C the blood flow in limb increases. 15min immersion at a temperature of 15[degrees]C will lower intramuscular temperature by ~10[degrees]C and potentially have a beneficial effect. Better blood flow through the body improves the drainage of waste products and improves the supply of oxygen and nutrients to the muscles (4).

On the body immersed in the water works the compression strength of the water causing movement of fluids. While body is immersed in the water up to the hips level, the fluids are "escaping" from the lower limbs to the chest region. Because of that phenomenon, the by-products of metabolism can escape from the muscles faster and improve post-workout recovery process (3). Hard vessels should be used for the Ice-bats, like the clay pots used in Track & Field World Championships in Deagu in 2011 (Fig.1).

Body in that kind of vessel, is affected better by the hydrostatic pressure of water. It was observed that with increasing depth of water, the stress of water on the body increases: on the depth of 1 meter the pressure is 981Pa, and on the depth of 0,1 meter the pressure is only 98,1Pa. The pressure difference causes fluid movement from the legs to the chest region. Since our bodies are composed mostly of water, which is not compressed, when the external pressure increases the gases and liquids in our bodies move to the area of lower pressure. As a result of centralization of circulation, fluids from the intercellular space pass into the blood, and further along with the venous return to the upper body. It is possible that in this journey also participate liquid waste products, which speeds up the transport of metabolites, thus regeneration after training, and return of the body to homeostasis (3), (4), (10).

Body immersed in the water is less affected by gravity. Skeletal-muscular system is relieved. This phenomenon, combined with a slowdown musclenervous conduction, are considered as main factors contributing to the feeling of less fatigue muscles after immersion in ice water (3), (4).

The influence of cryotherapy on post workout muscle inflammation

Post-workout muscle fibers micro trauma initiates immune responses. This leads to local inflammation, which initiates tissue healing (2). Pournot and others (1) are using the cryotherapy with a lower temperature than the temperature used in ice-baths. Based on their results, they assume that using the cryotherapy (-110 [degrees]C) will speed up the post workout recovery by limiting the inflammation. The authors think that shortening and reducing the period of acute inflammation, protects the body against excessive immune response, which then shortens the recovery time after workouts (1), (2). Excessive inflammation caused by the muscle fibers micro trauma can lead to lack of muscle recovery on time, tissue damage and dysfunction leading to affect athletic performance (11).

The influence of cryotherapy on post workout muscle pain and stiffness

Edema occurs as a result of acute inflammation induced by muscle fibers micro trauma. After that, the vascular permeability increases, this in combination with the extracellular concentration of proteins and congestion gives the swelling. Increase of water in the extracellular space due to edema causes pressure on pain receptors. Eston and Peaters (5) observed that with increasing swelling of muscle, the muscle pain also increases. According to the authors, the increased muscle soreness and swelling may contribute to postworkout tissue stiffness.

Immersion in cold water also influences the nervous system. Cooling inhibits conduction of pain (3). Decrease of the temperature of superficial tissues of the lower limbs causes a reduction of nerve conduction due to decreased production of acetylcholine. Immersion in ice bath also affects the reduction of muscle spindle activity. Reduced activity of muscle spindle inhibits the response to stretching, which results in less muscle spasticity. The mentioned above mechanisms reduce the vicious cycle of pain and tension, which likely causes the decrease in muscle soreness (3), (5). However, according to Hjortskov and others (12) increase in the parasympathetic system activity and decrease in sympathetic system activity is responsible for the analgesic effect of immersion in ice water.

Based on the results in Table 1, we can assume that immersion in cold water reduces muscle soreness (10), (13), pain (2), (5), (10), (13-15) and stiffness (5), (10). In control groups, which were resting in a passive way or using other ways of recovery, there was an increase in muscle soreness (10), (13), pain (10), (13) and stiffness (5), (10).


Table 1. Studies showing the positive effect of immersion in ice
water on post workout recovery

Author       Test group    Exertion        Recovery methods

Ascensao et  20 soccer   Soccer        1gr. 10min., 10[degrees]C,
al. 2011     players     match         to iliac crest2gr. 10min.,
                                       35[degrees]C, to iliac crest

Eston i      15 male     Eccentric     Control gr., group CWI
Peaters                  elbow flexor  15min., 15[degrees]C
1999                     work on a     forearm
                         dynamometer

Ingram et    11 male,    Shuttle run   CWT gr., CWI gr. 10[degrees]C
al. 2009     3-day       test, 80min.  to umbilicus, 2x5min. break
             testing     simulated     2,5 min., Control gr.
             trials      team sports
                         exercises

Montgomery   29 male     3-day long    1st gr. Stretching and
et al.       basketball  basketball    carbs2nd gr. CWI 5x1min.
2008         players     tournament    up to neck 11[degrees]C
                         -3 games      break 2min.3rd gr. full leg
                                       compression garments

Pournot et   11          45min.        1st group 3min. WBC
al. 2011     endurance   running       -110[degrees]C every 24th
             trained     uphill        for 96h 2nd group passive
             males                     rcovery

Rowsell et   13 soccer   4-day long    1st gr. 6 soccer players
al. 2011     players     soccer        CWI 5x1min. in 10[degrees]C
                         tournament    break 1min up to neck2nd
                         - 4 games     gr. 7 soccer players TWI
                                       5x1min. in 34[degrees]C
                                       break 1min. up to knees

Vaile et     38 male in  7 series      1st gr. CWI 12 male2nd gr.
al. 2008     two tests   with 10       HWI 11 male3rd gr. CWT 15
             for 8       repetitions   male4th gr. control group
             months      eccentric
                         repetitions
                         of leg work

Author           Test methods         More important
                                          results

Ascensao et  (CK, Mb, CRP, jump,  Gr. CWI: [down
al. 2011     sprint, MIVC         arrow] muscle
             quadriceps, muscle   soreness, faster
             soreness) before,    recovery of
             after, 24h,48h       strength, lower
             after the game       increase in CK
                                  activity, [down
                                  arrow] Mb
                                  concentration,
                                  [down arrow] CRP
Eston i      Muscle tension, CK,  [up arrow] relaxed
Peaters      relaxed arm angle,   arm angle, lower
1999         MIVC, swelling, for  increase in CK
             three days
Ingram et    (MIVC, sprint test,  Gr. CWI: [down
al. 2009     muscle soreness.,    arrow] muscle
             CK, CRP) before,     soreness [down
             after and for 2      arrow] decrease in
             days                 strength [down
                                  arrow] increase in
                                  sprint
                                  performances,
                                  [down arrow]
                                  increase in CK and
                                  CRP activity
Montgomery   Lower leg girth,     [down arrow]
et al.       muscle soreness,     decrease in speed,
2008         vertical jump,       flexibility, and
             sit--and-reach       jump performances,
             test, 20m.           [down arrow]
             acceleration         muscle soreness
                                  and swelling
Pournot et   Pro-inflammatory     [up arrow]
al. 2011     and                  anti-inflammatory
             anti-inflammatory   cytokines
             cytokines            activity, [down
             activity,            arrow]
                                  pro--inflammatory
                                  cytokines
                                  activity,
Rowsell et   Muscle soreness,     Gr. CWI: [down
al. 2011     distance covered,    arrow] muscle
             HR                   soreness., [down
                                  arrow] less
                                  distance covered,
                                  could run further
                                  on higher HR
Vaile et     Weighted squat       CWI gr. [down
al. 2008     jump, isometric      arrow] muscle
             squat, blood         soreness and
             markers, muscle      swelling.,
             soreness and thigh   improved recovery
             girth                of isometric force
                                  and dynamic
                                  power,

Gr. - group; CK - creatine kinase; Mb - myoglobin; CRP - C-reactive
protein MIVC - maximal voluntary isometric contraction; CWI - cold
water immersion; CWT - contrast water therapy; WBC - whole body
cryotherapy, TWI - thermoneutral water immersion; HR - heart rate,
HWI - hot water immersion, CWT - contrast water therapy


The influence of immersion in ice bath on creatine kinase activity

The enzyme used to indicate muscle damage is the level of creatine kinase (CK). Due to heavy exertion, CK emerges from damaged muscle cells into the extracellular space. Effect of immersion in ice water on the level of creatine kinase remains unknown. Eton and Peters (5) suggest that creatine kinase flows from muscles to the lymphatic vessels. It is possible that the reduction of vascular permeability due to cryotherapy slows creatine kinase runoff from muscles to the lymphatic vessels. According to the author, it is also likely that cold therapy slows the flow of lymph.

Based on the data in table 1, it can be conducted that immersion in ice water after exercise reduces the activity of CK. The group using cryotherapy had a smaller increase in CK compared with the control group which rested passively or used other forms of treatments (2), (5), (14).

Discussion

In studies on immersion in ice water all of the results are not clear. Despite the widespread use of these procedures in sport, most studies show no effect of cooling with ice to recover after exercise. The only effect of CWI, which the researchers describe is as an analgesic. This article summarizes research on immersion in ice water, which show a decrease in postexercise soreness, stiffness, swelling and a decrease in creatine kinase levels in muscles. According to the authors dealing with the problem, the ambiguity of the results may correspond to the variety of research procedures. Studies vary in time during which the test was subjected to immersion (1-15min), depth of immersion (partial / overall), water temperature (10-15[degrees]C), a research protocol, ratios tested (CK, CRP, Mb, MIVC, ROM, girth) and the kind of effort to induce damage in the muscle (running on an envelope, Cyklo Ergometr, jumps, squats, football match, swimming competitions, etc.).

Despite the use of this method by well-known teams and clubs there are not many articles describing the impact of CWI for recovery after training. The reasons for the ambiguity of research results can be many. However, some important details should be noted. Most studies used eccentric exercise or effort on ergometer instead of effort in terms of training specific to each discipline. Specialized training involves many muscle groups and has a systemic effect, which is not possible to reproduce in the laboratory. Therefore, research should be conducted during training or competitions. Another important factor is the temperature and immersion time. This research procedure has the most differences. The effectiveness of treatment determines the water temperature should be within the range of 10[degrees]C to 15[degrees]C and immersion time which should not be less than 10 minutes. Probably very important in this research is the immersion time, which if too short can cause the body's recovery process will not commence or their effect will not be significant. The importance of temperature and time of immersion appear to be crucial. Thus, their effects on the body should be particularly examined.

Significant influence on the effects of this research has, also the position of person taking the test. For the pressure difference causing fluids to move from legs to chest region to take place, the person cannot stay in sitting position simply, or be immersed in ice water up to knees. Important to that the pressure difference is also the hardness of the vessel. The vessel should not be deformed during research.

There is no doubt that the explanation of effect of post workout immersion in ice water on the body requires more research. Analgesic effect is known and proven. However, noting the popularity of this procedure (the Olympic Games, European Championships, World Athletics) there should be an attempt to determine its effect on the body.

Declaration of interest

The author declares no conflicts of interest.

References

(1.) Parouty J, Al. Haddad H, Quod M, et al. Effect of cold water immersion on 100-m sprint performance in well-trained swimmers. Eur J Appl Physiol 2010; 109: 483-90.

(2.) Ingram J, Dawson B, Goodman C, et al. Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. J Sci Med Sport 12 2009; 12: 417-21.

(3.) Wilcock IM, Cronin JB, Hing WA. Physiological response to water immersion, a method for sport recovery? Sports Med 2006; 36: 747-65.

(4.) Wilcock IM, Cronin JB, Hing WA. Water immersion: does it enhance recovery from exercise? Int J Sports Physiol Perform 2006; 1:195-206.

(5.) Eston R, Peters D. Effects of cold water immersion on the symptoms of exercise induced muscle damage. J Sports Sci 1999; 17: 231-8.

(6.) Howatson G, van Someren KA. Prevention and Treatment of Exercises-Induced Muscle Damage. Sports Med 2008; 38 (6): 483-503.

(7.) Cheung K, Hume PA, Maxwell L. Delayed Onset Muscle Soreness. Treatment Strategies and Performance Factors. Sports Med 2003; 33 (2): 145-64.

(8.) Barnett A. Using recovery modalities between training sessions in elite athletes. Does it help? Sports Med 2006; 36:781-96.

(9.) Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med 1986; 3 (6): 398-414.

(10.) Montgomery PG, Pyne DB, Hopkins WG, et al. The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball. J Sports Sci 2008; 26(11): 1135-45.

(11.) Pournot H, Bieuzen F, Louis J, et al. Time-Course of Changes in Inflammatory Response after Whole-Body Cryotherapy Multi Exposures following Severe Exercise. PlosOne 2011; 6 (7).

(12.) Hjortskov N, Rissen D, Blangsted AK, et al. The effect of mental stress on heart rate variability and blood pressure during computer work. Eur J Appl Physiol 2004; 92:84-9.

(13.) Vaile J, Halson S, Gill N, et al. Effect of hydrotherapy on recovery from fatigue. Int J Sports Med 2008; 29: 539-44.

(14.) Ascensao A, Leite M, Rebelo AN., et al. Effects of cold water immersion on the recovery of physical performance and muscle damage following a one-off soccer match. J Sports Sci 2011; 29(3): 217-25.

(15.) Rowsell G J, Coutts A J, Reaburn P, et al. Effect of post-match cold-water immersion on subsequent match running performance in junior soccer players during tournament play. J Sports Sci 2011; 29 (1): 1-6.

(16.) Jiang B, Liao R. The paradoxical role of inflammation in cardiac repair and regeneration. J Cardiovasc Transl Res 2010; 3(4): 410-6.

DOI: 10.5604/17342260.1041893

Accepted: March 15, 2013

Published: March 27, 2013

Michal Kaczmarek (1) (B), (D), (E), (F), Dariusz Mucha (2) (B), (D), (E), (F), Natalia Jarawka (3) (E)

(1) PhD student, University School of Physical Education, Krakow, Poland

(2) Institute of Human Physiology, University School of Physical Education, Krakow, Poland

(3) University of Nevada, Reno Bachelor in Health Ecology, Reno, USA

Address for correspondence: Dariusz Mucha

32-091 Michalowice

ul. Gorna 83

nauka@autograf.pl

Michal Kaczmarek: michal_kaczmarek1@wp.pl

Natalia Jarawka: natalia.jarawka@gmail.pl

Authors' contribution

A - Study Design

B - Data Collection

C - Statistical Analysis

D - Data Interpretation

E - Manuscript Preparation

F - Literature Search

G - Funds Collection
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Title Annotation:REVIEW ARTICLE
Author:Kaczmarek, Michal; Mucha, Dariusz; Jarawka, Natalia
Publication:Medicina Sportiva
Article Type:Report
Geographic Code:4EXPO
Date:Mar 1, 2013
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