Cryotherapy - Ice Baths

Following discussions with senior S&C coaches within a football setting I thought I’d throw my two pence out there regarding ice baths.

Ice baths originated from horse racing, as horses finished the race they were lead through ice cold water as it was hypothesised that this would aid the recovery process by reducing inflammation through vasoconstriction (Knight, Brucker, Stoneman & Rubley, 2000). Like most areas of sport science, this too diffused from equine sciences to the realms of improving human performance.

Cryotherapy or cold water immersion has been suggested to reduce muscle inflammation, soreness and stiffness, therefore speeding recovery and reducing time in between training sessions. Like most things that sound too good to be true …… I’ll let you decide.

The area of cryotherapy demonstrates inconsistencies with protocols, temperatures and durations to which athletes should be exposed. The main mechanism behind cold water immersion is decreasing swelling by inducing vasoconstriction with hydrostatic pressure acting upon the lower limbs which aids circulation, thereby reducing pooling of metabolites (Wilcock, Cronin & Hing, 2006).

This metabolic activity could be a build-up of metabolites (hydrogen ions) or free radicals, and just like supplementing with antioxidants, the aim of the intervention is to clear these “negative” components to recover faster.

I put negative in inverted commas because like using products high in antioxidants to reduce metabolites, they could very well be the reason behind a cascade of adaptations that enable athletes to go further for longer. If we think about the adaptations which could occur as a consequence of not performing cold water immersion such as increasing an athlete’s natural buffering systems (Bicarbonate, Protein and Phosphate), this could ultimately improve their resistance to fatigue and aid recovery in the future!

Staying on that trail of thought, if inflammation is not reduced, this could induce a state of ischemia in localised muscle tissues. Ischemia is a precursor for the release of PGC1-α which is a transcription factor for VEGF-1, thereby encouraging angiogenesis. If there is an increase in capillary density, work capacity of the localised muscles and recovery times are improved.

It has also been suggested that ice baths blunt the hormonal response from exercise (Kaczmarek, Mucha & Jarawka, 2013). Particularly, human growth hormone, which is responsible for the production of tenocytes which are required for the repair of tendons (Hsu & Chang, 2004). Consequently there is a strong possibility that cryotherapy between training sessions could actually increase recovery times in the long term, even if swelling and perception of pain is reduced in the short term.

In summary, even in the short term if cryotherapy can reduce inflammation and perception of pain, it doesn’t make physiological sense to me! If you want to flush metabolites from an athlete, then surely movement is key, increasing the venous return, getting tissues moving will ultimately reduce soreness whilst not compromising additional adaptations that may occur. There is however a chance that ice baths simply offer a placebo affect which some athletes are high responders to, and essentially if it works for them then let it ride!

References:

Hsu, C., & Chang, J. (2004). Clinical implications of growth factors in flexor tendon wound healing. The Journal of Hand Surgery, 29, (4), 551-563.

Kaczmarek, M., Mucha, D., & Jarawka, N. (2013). 2013 Cold water Immersion as a post-exercise recovery strategy. Medicina Sportiva, 17, (1), 35-39.

Knight, K., Brucker, J., Stoneman, P., & Rubley, M. (2000). Muscle injury management with cryotherapy. Athletic Therapy Today, 5, (4), 26-30.

Wilcock, I. M., Cronin, J. B., & Hing, W. A. (2006). Physiological response to water immersion, a method for sport recovery?. Sports Medicine, 36, 747-65.

#icebaths #recovery #cryotherapy