Sunday, 20 April 2008

Ice and cold water after resistance exercise: are you sure it's a good idea?

As I mentioned in a previous post on this blog I am developing an interest in recovery strategies. I am amazed of how many tools/devices/procedures/methods are nowadays used to provide a "recovery" solution to athletes.

What I am most amazed of is the total lack of rationale behind many recovery strategies, not to mention the lack of scientific evidence for their effectiveness.

It seems to me that many strength and conditioning coaches, physiotherapists, sports scientists sometimes accept some practices without really questioning why they should be using them. Unfortunately most of the times a particular recovery strategy is used just because a winning team or athlete made extensive and public use of it.

Let's talk about Ice Baths and cold water immersion. The following picture shows what happens typically after some heavy training session these days:

Spa-ing partners: Bulldogs players take an ice bath during a recovery session at Canterbury pool. Photo: Craig Golding:Vailable at:


The reasons why athletes have to be exposed to this "torture" are the following as advocated by many S&C coaches and Physios:

  • Helps in reducing DOMS and inflammation
  • Helps in reducing swelling
  • Helps in improving blood flow
  • Helps in favouring recovery

In this article I will focus on the first point. There seems to be nowadays the need to make sure that Athletes have no DOMS (delayed onset of muscle soreness) after a training session and most of all there is a need to avoid inflammation.

With this approach, it seems that the focus of attention is now shifting away from what athletes normally do to improve performance: training!

What is training all about?

Athletes undergo gruelling training sessions to improve performance. They lift weights to get stronger, run/cycle/row to improve their endurance or speed. Simple!

The reason why they do it is to create an overload on their biological system to produce an adaptive response leading to a stronger muscle, a better cardio-respiratory system, stronger bones. They also do it to improve muscle biochemistry which then leads to better muscle function (i.e. buffering systems, metabolic enzymes).

In particular, when athletes lift heavy weights, they do it to determine muscle hypertrophy and to get stronger. The typical consequence of a weight lifting session is muscle damage then followed by an inflammatory phase and a regeneration phase able to determine a stronger muscle (for some interesting reading download this PDF of a review written by Prof. Priscilla Clarkson

So, in simple terms, we want muscle damage, inflammation and swelling as their are the main signaling mechanisms triggering muscle remodelling (

Training-induced molecular and humoral adjustments, including muscle hyperthermia, are physiological, transient and essential for training effects (myofiber regeneration, muscle hypertrophy and improved blood supply). Stopping them may be not a good idea.

So, by reducing DOMS, swelling and inflammation are we stopping adaptations?

Maybe that's the case. Recent studies have shown that applying cryotherapy to muscles after training reduces the training gains. Yamane et al. (2006) exposed two groups of volunteers to the same training programme and a different recovery strategy. One group was in fact asked to rest at room temperature, the other were asked to immerse the trained limbs in cold-water post training. The results showed that the group with a normal recovery improved more and the authors concluded that cooling generally attenuates the temperature-dependent processes generated by training, in particular, hyperthermia-induced HSP formation"


Is cryotherapy actually effective in reducing DOMS?

Science says that:Cryotherapy does not reduce DOMS symptoms (Cheung et al., Sports Med, 2003)

Cold water immersion had NO effect on perception of tenderness and strength loss (Eston & Peters, JSS, 1999)

The use of cryotherapy immediately following damaging eccentric exercise may not provide the same therapeutic benefits commonly attributed to cryotherapy following traumatic muscle injury (Paddon-Jones & Quigley ,1997 IJSM)

Recovery of muscle soreness, flexibility and power at 48 hr post-game was not significantly enhanced by performing an immediate post-game recovery beyond that achieved by performing only next day recovery training (Dawson et al., J Sci Med Sport, 2005)

Sellwood et al (2007) recently concluded that "The protocol of ice-water immersion used in their study was ineffectual in minimising markers of DOMS in untrained individuals (3 x 1min immersion in ice water). This study challenges the wide use of this intervention as a recovery strategy by athletes".

There are of course many others out there...

What can we conclude?

Using cryotherapy and cold water immersion with athletes is a very bad idea if you are training them to get stronger!

If you want to reduce pain and swelling and help with recovery in athletes performing at tournaments then you are better off with other strategies. But this is something to talk about in the next article!



Gareth on 20 April 2008 at 12:09 said...

Interesting article, makes me wonder how many people are being subjected to extreme measures such as this with no scientific backup whatsoever.

GMC on 23 April 2008 at 06:04 said...

In last Thursday's New York Times there was an article that described at length some of the endurance athletes of the Olympic US Team, and their trainer Terrence Mahon. One of the techniques described was that of the ice tub. Your article shows the flaws of such techniques. Bravo!

My follow up question is: is it possible to have any training adaptation without DOMS? In other words, if I don't have DOMS does it mean I'm not training hard enough?

I am also interested in your opinion on the effectiveness of EMS to diminish DOMS. According to elite endurance users using EMS protocols such as Active Recovery, they experience a much faster recovery from DOMS. Thus they report of being able to train again sooner after a demanding competition. Do you think that decreasing the inflammatory effect, in this case too, would result in decreased training effect?
Giovanni Ciriani

Dr Liam Kilduff on 24 April 2008 at 12:32 said...

Cuold you please give the full reference details for the Yamane et al. (2006) reference.

D Ball on 10 June 2008 at 04:57 said...

Interesting article Marco and it should be highlighted that there is now a suggestion that cold-water immersion doesn't help recovery from endurance tyoe work either. The current fad is based on the idea that if you reduce the pain then recovery is accelerated. We know that cold-water immersion reduces inflammation (which may not be the best thing if the idea is adaptation) and the pain receptors will be affected by reducing their output to the CNS. There will be a paper coming out soon in European Journal of Applied Physiology that suggests that repeated bouts of eccentric exercise do not lead to disruption of the muscle membrane, which makes one think where does the creatine kinase enzyme come from?

Dr. Marco Cardinale on 10 June 2008 at 10:26 said...

What a surprise. Dr. Derek Ball reads my blog!
Absolutely correct about the issue of ice and nociceptors.
As soon as I have time, I promise to write something about this as well. Looking forward to the paper you mentioned.

GMC on 10 June 2008 at 11:13 said...

I passed this article onto a professional trainer to get his comments. He still defended the practice of cold baths, on the grounds that at least it allows an athlete to keep training with the rest of the team. It's like damned if you do, damned if you don't.

If that is true perhaps there is an optimal trade-off, between the two.
Giovanni Ciriani

Dr. Marco Cardinale on 11 June 2008 at 02:49 said...

I don't understand what your friend/colleague means by "at least it allows an athlete to train with the rest of the team".

I try to reason with physiology in mind and this statemente does not make any sense. Why an ice bath allows an athlete to train with the rest of the team? What would be the physiological rationale?

GMC on 11 June 2008 at 04:05 said...

The comment on ice baths I referred to came from one of your readers. He posted in a separate blog (

"I don’t necessarily agree that ice baths are detrimental to training goals. It depends on the training goals. Much will depend on the specific macrocycle/microcycle that the player is involved in. Ice baths help reduce swelling and aid in recovery so that players can train at a practical daily/weekly frequency. In other words, during pre-season training for the soccer team, I want to make sure that everyone is available for training on each consecutive day. If a player chooses to forego the ice bath to (possibly) facilitate muscular adaptation, but cannot train the following day because of DOMS, then he/she will not be able to participate in the necessary technical and tactical work carried out on that day. In my experience, ice baths, provided that they are used correctly and within limits, are not detrimental to athletic development."
Giovanni Ciriani

Dr. Marco Cardinale on 15 June 2008 at 09:23 said...

I find this very puzzling.
If my players are in pre-season, what I am trying to do is to get them stronger. Reducing inflammation and DOMS might impair how they adapt to my training regime. Furthermore, there can be other ways to reduce DOMS and inflammation, such as Non Steroidal Anti-Inflammatory Drugs (NSAIDs), Protein meals (see recent work from Etheridge et al., 2008, Appl. Physiol. Nutr. Met.),Massage (FreiLaw et al., 2008 J Pain), Contrast Water Therapy, Stretching, Ibuprofene, Antioxidants and tons of other possible interventions.
Finally, the repeated bout effect is another well known physiological phenomenon whereby athletes have less DOMS and pain when they keep performing eccentric muscle actions. So, if athletes have DOMS consistently, they are either not well trained, or the training programme is not well planned.

GMC on 19 June 2008 at 07:50 said...

It looks like ice baths are getting flak even in newspapers; the following was at the end of "Swallow This", an article by Gretchen Reynolds, June 1, 2008, New York Times.

Finally, there are ice and heat. Many elite athletes swear by a limb-numbing ice bath, and others prefer a soak in a hot tub — although little scientific evidence supports either remedy. Ice will effectively block the swelling associated with a serious injury, such as a sprain, but has not been proven to speed the healing of muscle tissue stressed by a workout. In a study published last year in the British Journal of Sports Medicine, people treated with ice after strenuous exercise later reported more pain upon standing than people immersed in tepid water. The study’s authors bluntly concluded that their research “challenges the wide use of icing as a recovery strategy by athletes.” Similarly, a study published in March in the European Journal of Applied Physiology found that, when it came to muscle recovery, a hot bath was little better than merely sitting quietly for a while.

Giovanni Ciriani

GMC on 13 November 2008 at 17:06 said...

Have you read the the article comparing different recovery methods, in JSCR, Sep.2008? Effectiveness of Active vs Passive Recovery...

Do you think that EMS Active Recovery is going to disrupt the muscle adaptation process?

Giovanni Ciriani

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