Elsevier

Physical Therapy in Sport

Volume 5, Issue 1, February 2004, Pages 26-32
Physical Therapy in Sport

Literary review
Alternating hot and cold water immersion for athlete recovery: a review

https://doi.org/10.1016/j.ptsp.2003.10.002Get rights and content

Abstract

Objectives. The aim of this review was to investigate whether alternating hot–cold water treatment is a legitimate training tool for enhancing athlete recovery. A number of mechanisms are discussed to justify its merits and future research directions are reported. Alternating hot–cold water treatment has been used in the clinical setting to assist in acute sporting injuries and rehabilitation purposes. However, there is overwhelming anecdotal evidence for it's inclusion as a method for post exercise recovery. Many coaches, athletes and trainers are using alternating hot–cold water treatment as a means for post exercise recovery.

Design. A literature search was performed using SportDiscus, Medline and Web of Science using the key words recovery, muscle fatigue, cryotherapy, thermotherapy, hydrotherapy, contrast water immersion and training.

Results. The physiologic effects of hot–cold water contrast baths for injury treatment have been well documented, but its physiological rationale for enhancing recovery is less known. Most experimental evidence suggests that hot–cold water immersion helps to reduce injury in the acute stages of injury, through vasodilation and vasoconstriction thereby stimulating blood flow thus reducing swelling. This shunting action of the blood caused by vasodilation and vasoconstriction may be one of the mechanisms to removing metabolites, repairing the exercised muscle and slowing the metabolic process down.

Conclusion. To date there are very few studies that have focussed on the effectiveness of hot–cold water immersion for post exercise treatment. More research is needed before conclusions can be drawn on whether alternating hot–cold water immersion improves recuperation and influences the physiological changes that characterises post exercise recovery.

Introduction

Recovery is an important aspect of any physical conditioning programme however, many athletes train extremely hard without giving their body time to recover which can lead to over reaching, burnout or poor performances (Mackinnon and Hooper, 1991). Without the necessary recovery interventions it is very difficult for an athlete to maintain a high level of performance on a daily or weekly basis. As athletes look for the leading edge, rest is frequently overlooked for increases in overload, intensity and volume.

Recently a lot of emphasis has been placed on speeding up the recovery process so athletes can proceed to do successive bouts of training or competition without the associated fatigue or burn out effects. Numerous physical, psychological and nutritional methods have been used to accelerate the recovery process (Calder, 1996). There has been an increase in the use of modalities such as massage, floatation, hyperbaric oxygenation therapy and acupuncture with little scientific evaluation of its use and effectiveness for exercise recovery. Alternating hot–cold water immersion is one technique that is very popular and is practised with increased frequency in aiding recovery after physical training and competition (Calder, 2001a). Anecdotal reports from coaches, medical personnel and athletes suggest that this method of water immersion has positive effects on subsequent performance.

The aim of this review was to source the literature and provide the scientific rationale and mechanisms of using alternating hot–cold water immersion for post exercise recovery.

Section snippets

Therapeutic modalities

Ice packs, whirlpools, baths, heat packs, infra-red lamps, paraffin wax and ice massage are various techniques of cryotherapy and thermotherapy that have been used in the sports medicine and rehabilitation fields for the treatment of acute injuries (Prentice, 1999). Additionally, contrast baths, warm and cold packs have also played a major role in injury management but increasingly these modalities are now used for post exercise recovery. Warm spas with cold plunge pools or contrast hot–cold

Physiology of cooling and heating

There is a general consensus that the application of cold ice or water immersion decreases skin, subcutaneous and muscle temperature (Enwemeka et al., 2002, Myrer et al., 1997, Hartvickson, 1962, Johnson et al., 1979, Lowden and Moore, 1975). The decrease in tissue temperature is thought to stimulate the cutaneous receptors causing the sympathetic fibres to vasoconstrict which decreases the swelling and inflammation by slowing the metabolism and production of metabolites thereby limiting the

Recovery

Recovery is defined as ‘the return of the muscle to its pre exercise state following exercise’ (Tomlin and Wenger, 2001). Aerobic metabolism remains elevated in the recovery phase after exercise. Known as excess post-exercise oxygen consumption (EPOC) it assists in replenishing the body stores (Bahr and Maehlum, 1986). EPOC consists of a fast and slow component (Gaesser and Brooks, 1984). The fast component restores 70% of ATP and PCr energy stores within 30 s (Hultman et al., 1967) and reloads

Holistic approach

Training and competition creates an overload to stress the body, which in turn produces fatigue followed by improved performance (Calder, 1996). Depending on the nature of the training or activities; nutritional, physiological, neurological and psychological components are stressed in different ways that result in fatigue. Calder (1995) devised a ranking system to help coaches identify which of the four fatigue components are the most stressed. For endurance training the ranking from the most

Conclusion

Despite the popularity of hot–cold water immersion as a recovery modality, little research has been conducted. hot–cold contrast therapy for acute injuries has been used to explain the purported physiologic effects for post exercise recovery. However, the conflict of literature makes it difficult to give a conclusive mechanism. Additionally, the guidelines of the duration spent in each water condition, the repetitions, temperature, the use of underwater jets, the learning and training effect of

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