A single 10-min bout of cold-water immersion therapy after strenuous plyometric exercise has no beneficial effect on recovery from the symptoms of exercise-induced muscle damage. Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running. Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. Effects of cold water immersion on the symptoms of exercise-induced muscle damage. Effects of cold-water immersion on physical performance between successive matches in high-performance junior male soccer players. The use of magnetic resonance imaging to evaluate the effects of cooling on skeletal muscle after strenuous exercise. Effect of whirlpool therapy on the signs and symptoms of delayed-onset muscle soreness. Effect of cold water immersion on postexercise parasympathetic reactivation. Hyperbaric oxygen therapy does not affect recovery from delayed onset muscle soreness. Physiological responses to cold water immersion following cycling in the heat. Effects of intermittent exposure to hyperbaric oxygen for the treatment of an acute soft tissue injury. Immersion in water in the first stage of labor: a randomized controlled trial.
The purpose of this study was to examine the effectiveness of a single bout of cold-water immersion on recovery from exercise-induced muscle damage. Eighteen physically active female volunteers (age 19.9 (+/-0.97 years), height 1.66 (+/-0.05 m), mass 63.7 (+/-10 kg), completed 10 sets of 10 counter-movement jumps to induce muscle damage and were randomly allocated to a control or treatment group. The treatment group was given a single 10-min bout of lower limb cold-water immersion therapy at 10 degrees C immediately following damage-inducing exercise. Indicators of muscle damage (plasma creatine kinase activity, perceived soreness and maximal voluntary contraction of the quadriceps) were assessed immediately prior to counter-movement jumps, and at 1, 24, 48, 72 and 96 h, following the damaging exercise. Significant (p = 0.05) time effects were recorded on all indicators of muscle damage, but there were no significant group or group x time interaction effects found on any of the measured variables. The results indicate that a single bout of cold-water immersion after a damaging bout of exercise has no beneficial effects on the recovery from exercise-induced muscle damage. This study aimed to compare the efficacy of hot/cold contrast water immersion (CWI), cold-water immersion (COLD) and no recovery treatment (control) as post-exercise recovery methods following exhaustive simulated team sports exercise. Repeated sprint ability, strength, muscle soreness and inflammatory markers were measured across the 48-h post-exercise period. Eleven male team-sport athletes completed three 3-day testing trials, each separated by 2 weeks. On day 1, baseline measures of performance (10 m x 20 m sprints and isometric strength of quadriceps, hamstrings and hip flexors) were recorded. Participants then performed 80 min of simulated team sports exercise followed by a 20-m shuttle run test to exhaustion. Upon completion of the exercise, and 24h later, participants performed one of the post-exercise recovery procedures for 15 min. At 48 h post-exercise, the performance tests were repeated. Blood samples and muscle soreness ratings were taken before and immediately after post-exercise, and at 24h and 48 h post-exercise. In comparison to the control and CWI treatments, COLD resulted in significantly lower (p<0.05) muscle soreness ratings, as well as in reduced decrements to isometric leg extension and flexion strength in the 48-h post-exercise period. COLD also facilitated a more rapid return to baseline repeated sprint performances. The only benefit of CWI over control was a significant reduction in muscle soreness 24h post-exercise. This study demonstrated that COLD following exhaustive simulated team sports exercise offers greater recovery benefits than CWI or control treatments. To determine if ice-water immersion after eccentric quadriceps exercise minimises the symptoms of delayed-onset muscle soreness (DOMS).
                A prospective randomised double-blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non-dominant leg.
                Participants were randomised to three 1-min immersions in either ice water (5+/-1 degrees C) or tepid water (24 degrees C).
                Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one-legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann-Whitney U tests.
                No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop-for-distance or serum CK over time. There was a significant difference in pain on sit-to-stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 vs 2.0 mm, respectively, p = 0.009).
                The protocol of ice-water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes. The aim of this study was to assess the effects of cold-water immersion (cryotherapy) on indices of muscle damage following a bout of prolonged intermittent exercise. Twenty males (mean age 22.3 years, s = 3.3; height 1.80 m, s = 0.05; body mass 83.7 kg, s = 11.9) completed a 90-min intermittent shuttle run previously shown to result in marked muscle damage and soreness. After exercise, participants were randomly assigned to either 10 min cold-water immersion (mean 10 degrees C, s = 0.5) or a non-immersion control group. Ratings of perceived soreness, changes in muscular function and efflux of intracellular proteins were monitored before exercise, during treatment, and at regular intervals up to 7 days post-exercise. Exercise resulted in severe muscle soreness, temporary muscular dysfunction, and elevated serum markers of muscle damage, all peaking within 48 h after exercise. Cryotherapy administered immediately after exercise reduced muscle soreness at 1, 24, and 48 h (P < 0.05). Decrements in isometric maximal voluntary contraction of the knee flexors were reduced after cryotherapy treatment at 24 (mean 12%, s(x) = 4) and 48 h (mean 3%, s(x) = 3) compared with the control group (mean 21%, s(x) = 5 and mean 14%, s(x) = 5 respectively; P < 0.05). Exercise-induced increases in serum myoglobin concentration and creatine kinase activity peaked at 1 and 24 h, respectively (P < 0.05). Cryotherapy had no effect on the creatine kinase response, but reduced myoglobin 1 h after exercise (P < 0.05). The results suggest that cold-water immersion immediately after prolonged intermittent shuttle running reduces some indices of exercise-induced muscle damage. This study independently examined the effects of three hydrotherapy interventions on the physiological and functional symptoms of delayed onset muscle soreness (DOMS). Strength trained males (n = 38) completed two experimental trials separated by 8 months in a randomised crossover design; one trial involved passive recovery (PAS, control), the other a specific hydrotherapy protocol for 72 h post-exercise; either: (1) cold water immersion (CWI: n = 12), (2) hot water immersion (HWI: n = 11) or (3) contrast water therapy (CWT: n = 15). For each trial, subjects performed a DOMS-inducing leg press protocol followed by PAS or one of the hydrotherapy interventions for 14 min. Weighted squat jump, isometric squat, perceived pain, thigh girths and blood variables were measured prior to, immediately after, and at 24, 48 and 72 h post-exercise. Squat jump performance and isometric force recovery were significantly enhanced (P < 0.05) at 24, 48 and 72 h post-exercise following CWT and at 48 and 72 h post-exercise following CWI when compared to PAS. Isometric force recovery was also greater (P < 0.05) at 24, 48, and 72 h post-exercise following HWI when compared to PAS. Perceived pain improved (P < 0.01) following CWT at 24, 48 and 72 h post-exercise. Overall, CWI and CWT were found to be effective in reducing the physiological and functional deficits associated with DOMS, including improved recovery of isometric force and dynamic power and a reduction in localised oedema. While HWI was effective in the recovery of isometric force, it was ineffective for recovery of all other markers compared to PAS. Cryotherapy is an effective treatment for acute sports injury to soft tissue, although the effect of cryotherapy on exercise-induced muscle damage is unclear. The aim of this study was to assess the effects of cold water immersion on the symptoms of exercise-induced muscle damage following strenuous eccentric exercise. After performing a bout of damage-inducing eccentric exercise (eight sets of five maximal reciprocal contractions at 0.58 rad x s(-1)) of the elbow flexors on an isokinetic dynamometer, 15 females aged 22.0+/-2.0 years (mean +/- s) were allocated to a control group (no treatment, n = 7) or a cryotherapy group (n = 8). Subjects in the cryotherapy group immersed their exercised arm in cold water (15 degrees C) for 15 min immediately after eccentric exercise and then every 12 h for 15 min for a total of seven sessions. Muscle tenderness, plasma creatine kinase activity, relaxed elbow angle, isometric strength and swelling (upper arm circumference) were measured immediately before and for 3 days after eccentric exercise. Analysis of variance revealed significant (P < 0.05) main effects for time for all variables, with increases in muscle tenderness, creatine kinase activity and upper arm circumference, and decreases in isometric strength and relaxed elbow angle. There were significant interactions (P<0.05) of group x time for relaxed elbow angle and creatine kinase activity. Relaxed elbow angle was greater and creatine kinase activity lower for the cryotherapy group than the controls on days 2 and 3 following the eccentric exercise. We conclude that although cold water immersion may reduce muscle stiffness and the amount of post-exercise damage after strenuous eccentric activity, there appears to be no effect on the perception of tenderness and strength loss, which is characteristic after this form of activity. In this study, we investigated the effect of water immersion on physical test performance and perception of fatigue/recovery during a 4-day simulated soccer tournament. Twenty high-performance junior male soccer players (age 15.9 +/- 0.6 years) played four matches in 4 days and undertook either cold-water immersion (10 +/- 0.5 degrees C) or thermoneutral water immersion (34 +/- 0.5 degrees C) after each match. Physical performance tests (countermovement jump height, heart rate, and rating of perceived exertion after a standard 5-min run and 12 x 20-m repeated sprint test), intracellular proteins, and inflammatory markers were recorded approximately 90 min before each match and 22 h after the final match. Perceptual measures of recovery (physical, mental, leg soreness, and general fatigue) were recorded 22 h after each match. There were non-significant reductions in countermovement jump height (1.7-7.3%, P = 0.74, eta(2) = 0.34) and repeated sprint ability (1.0-2.1%, P = 0.41, eta(2) = 0.07) over the 4-day tournament with no differences between groups. Post-shuttle run rating of perceived exertion increased over the tournament in both groups (P < 0.001, eta(2) = 0.48), whereas the perceptions of leg soreness (P = 0.004, eta(2) = 0.30) and general fatigue (P = 0.007, eta(2) = 0.12) were lower in the cold-water immersion group than the thermoneutral immersion group over the tournament. Creatine kinase (P = 0.004, eta(2) = 0.26) and lactate dehydrogenase (P < 0.001, eta(2) = 0.40) concentrations increased in both groups but there were no changes over time for any inflammatory markers. These results suggest that immediate post-match cold-water immersion does not affect physical test performance or indices of muscle damage and inflammation but does reduce the perception of general fatigue and leg soreness between matches in tournaments. The purpose of this study was to investigate the separate effects of cooling during the acute (within 60 min post-exercise) or subacute (24-168 h post-exercise) phase on skeletal muscle after exercise. Twenty-eight male subjects [mean (SD) 23.8 (1.8) years] were randomly assigned to the control (COTG, n=10), cold-water immersion (CWIG, n=9), and double-cold-water immersion groups (DCWIG, n=9). The cold-water immersion (15 min) was administered to the subjects' legs after calf-raise exercise (CWIG: after recording initial post-exercise measures, DCWIG: after recording initial and 24 h post-exercise measures). Magnetic resonance T2-weighted images were obtained to calculate the T2 relaxation time (T2) of the triceps surae muscle before, immediately after, and at the following times post-exercise: 20, 40, and 60 min, and 24, 48, 96 and 168 h. In addition, the ankle joint range of motion, serum creatine kinase and lactate dehydrogenase, and muscle soreness level were investigated before and after exercise. In all groups, significant T2 elevations in the gastrocnemius muscle appeared from immediately after to 60 min after exercise (P<0.05). Thereafter, COTG showed significantly re-elevated T2 levels in the gastrocnemius at 96-168 h post-exercise (P<0.05), while CWIG and DCWIG showed significantly smaller T2 values than the COTG at 96 h post-exercise (P<0.05). In addition, COTG showed larger increases in serum enzymes at 96 h post-exercise (not significant) and significantly greater muscle soreness levels at 48 h post-exercise (P<0.05) than the cooling groups. The results of this study may suggest that cooling has no dramatic effect, but some minor effects on reducing exercise-induced muscle edema in the subacute phase and relieving the extent of the damaged muscle cells. To determine the efficacy of warm whirlpool, cold whirlpool, and contrast therapy in the treatment of delayed-onset muscle soreness.
                Subjects performed eccentric contractions of the elbow flexors and received 4 treatments: immediately postexercise and 24, 48, and 72 hours postexercise. Treatments consisted of 24-minute treatments with warm whirlpool, cold whirlpool, contrast therapy, or no treatment.
                Fifty-six sex-matched volunteers from the University of Pittsburgh.
                Measurements were taken at 5 assessment times: pre-exercise (0 hours); prior to treatment at 24, 48, and 72 hours postexercise; and at 96 hours postexercise. Dependent variables were degrees of resting elbow flexion, active elbow flexion, and extension; perceived soreness values on a Graphic Pain Rating Scale; and maximal voluntary isometric contraction. A repeated-measures analysis of variance (group by time) and Tukey post hoc analysis were used to determine which treatment groups differed significantly in returning subjects to pre-exercise values.
                Cold whirlpool and contrast therapy were found to return subjects to baseline values of resting elbow flexion and perceived soreness significantly more than warm whirlpool or no treatment (P < .01). Additionally, warm whirlpool was found to be more effective than no treatment in the return of resting elbow flexion (P < .01).
                These results suggest that cold whirlpool and contrast therapy are more effective than warm whirlpool or no treatment in alleviating delayed-onset muscle soreness in the elbow flexors. The aim of the present study was to assess the effect of cold water immersion (CWI) on postexercise parasympathetic reactivation. Ten male cyclists (age, 29 +/- 6 yr) performed two repeated supramaximal cycling exercises (SE(1) and SE(2)) interspersed with a 20-min passive recovery period, during which they were randomly assigned to either 5 min of CWI in 14 degrees C or a control (N) condition where they sat in an environmental chamber (35.0 +/- 0.3 degrees C and 40.0 +/- 3.0% relative humidity). Rectal temperature (T(re)) and beat-to-beat heart rate (HR) were recorded continuously. The time constant of HR recovery (HRRtau) and a time (30-s) varying vagal-related HR variability (HRV) index (rMSSD(30s)) were assessed during the 6-min period immediately following exercise. Resting vagal-related HRV indexes were calculated during 3-min periods 2 min before and 3 min after SE(1) and SE(2). Results showed no effect of CWI on T(re) (P = 0.29), SE performance (P = 0.76), and HRRtau (P = 0.61). In contrast, all vagal-related HRV indexes were decreased after SE(1) (P < 0.001) and tended to decrease even further after SE(2) under N condition but not with CWI. When compared with the N condition, CWI increased HRV indexes before (P < 0.05) and rMSSD(30s) after (P < 0.05) SE(2). Our study shows that CWI can significantly restore the impaired vagal-related HRV indexes observed after supramaximal exercise. CWI may serve as a simple and effective means to accelerate parasympathetic reactivation during the immediate period following supramaximal exercise. This study investigated whether hyperbaric oxygen therapy (HBOT) improves recovery after exercise-induced muscle injury.
                Healthy male subjects (N = 24) were randomly assigned to either a placebo group or a HBOT group. Subjects were tested for maximal isometric strength (preexercise) of their right elbow flexors. Each subject then completed a high-force eccentric workout of the elbow flexor muscle group to induce delayed onset muscle soreness (DOMS). On the seven successive days after this workout, the subjects were exposed to a hyperbaric environment of 2.5 ATA for 60 min, inspiring either a normoxic mixture (P(I)O2 = 0.2 ATA; placebo group) or a hyperoxic gas mixture (P(I)O2 = 2.5 ATA; HBOT group). Before the eccentric workout and daily for the next 10 d, measurements were obtained regarding: maximal isometric muscle strength of the elbow flexor muscles, right upper arm circumferences, and rating of the perceived muscle soreness.
                Isometric strength decreased significantly from preexercise levels of 25.1 +/- 3.8 kp to postexercise levels of 12.0 +/- 4.6 kp, for the HBOT group, and from 24.6 +/- 3.4 kp to 12.5 +/- 3.7 kp, respectively, for the placebo group. Over the 10-d recovery period, there was no difference in the rate of recovery of muscle strength between the two groups. Perceived soreness peaked at about 48 h after exercise with no difference between groups. Also, the exercise-induced increases in arm circumference were similar in the two groups.
                These results indicate that HBOT is not an effective therapy for the treatment of DOMS. Cold water immersion (CWI) has become a popular means of enhancing recovery from various forms of exercise. However, there is minimal scientific information on the physiological effects of CWI following cycling in the heat.
                To examine the safety and acute thermoregulatory, cardiovascular, metabolic, endocrine, and inflammatory responses to CWI following cycling in the heat.
                Eleven male endurance trained cyclists completed two simulated approximately 40-min time trials at 34.3 +/- 1.1 degrees C. All subjects completed both a CWI trial (11.5 degrees C for 60 s repeated three times) and a control condition (CONT; passive recovery in 24.2 +/- 1.8 degrees C) in a randomized cross-over design. Capillary blood samples were assayed for lactate, glucose, pH, and blood gases. Venous blood samples were assayed for catecholamines, cortisol, testosterone, creatine kinase, C-reactive protein, IL-6, and IGF-1 on 7 of the 11 subjects. Heart rate (HR), rectal (Tre), and skin temperatures (Tsk) were measured throughout recovery.
                CWI elicited a significantly lower HR (CWI: Delta 116 +/- 9 bpm vs. CONT: Delta 106 +/- 4 bpm; P = .02), Tre (CWI: Delta 1.99 +/- 0.50 degrees C vs. CONT: Delta 1.49 +/- 0.50 degrees C; P = .01) and Tsk. However, all other measures were not significantly different between conditions. All participants subjectively reported enhanced sensations of recovery following CWI.
                CWI did not result in hypothermia and can be considered safe following high intensity cycling in the heat, using the above protocol. CWI significantly reduced heart rate and core temperature; however, all other metabolic and endocrine markers were not affected by CWI. To assess the hypothesis that subjects exposed to intermittent hyperbaric oxygen treatments would recover from signs and symptoms indicative of delayed-onset muscle soreness faster than subjects exposed to normoxic air.
                Randomized, double-blinded study with a 4-day treatment protocol.
                University-based sports medicine clinic.
                Sixteen sedentary female university students.
                All subjects performed 300 maximal voluntary eccentric contractions (30 sets of 10 repetitions per minute) of their nondominant leg (110 to 35 degrees of knee flexion) at a slow speed (30 degrees per second) on a dynamometer to elicit muscle damage and injury. Hyperbaric oxygen treatments consisted of 100% oxygen for 60 minutes at 2.0 atmospheres absolute (ATA), while the control group received 21% oxygen at 1.2 ATA for the same amount of time. Both groups received treatment immediately after the induction of delayed-onset muscle soreness and each day thereafter for a period of 4 days (day 1 postexercise through day 4 postexercise).
                Dependent variables (perceived muscle soreness, isokinetic strength, quadriceps circumference, creatine kinase, and malondialdehyde) were assessed at baseline (preexercise, day 0), 4 hours postexercise (day 1), 24 hours postexercise (day 2), 48 hours postexercise (day 3), and 72 hours postexercise (day 4). Magnetic resonance images (T2 relaxation time/short tip inversion recovery) were assessed at baseline (day 0), 24 hours postexercise (day 3), and 72 hours postexercise (day 5).
                Repeated-measures analysis of variance was performed on all of the dependent variables to assess differences between treatment and control groups. Analyses revealed no significant differences between groups for treatment effects for any of the dependent variables (pain, strength, quadriceps circumference, creatine kinase, malondialdehyde, or magnetic resonance images).
                The findings of this study suggest that hyperbaric oxygen therapy is not effective in the treatment of exercise-induced muscle injury as indicated by the markers evaluated. Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes.
                A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care.
                The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium-stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups.
                Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate.
There was some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention. There was insufficient evidence to conclude on other outcomes or for other comparisons. The majority of trials did not undertake active surveillance of pre-defined adverse events. High quality, well reported research in this area is required.