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. 2012 Feb 15;2012(2):CD008262.
doi: 10.1002/14651858.CD008262.pub2.

Cold-water Immersion (Cryotherapy) for Preventing and Treating Muscle Soreness After Exercise

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Free PMC article

Cold-water Immersion (Cryotherapy) for Preventing and Treating Muscle Soreness After Exercise

Chris Bleakley et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise.

Objectives: To determine the effects of cold-water immersion in the management of muscle soreness after exercise.

Search methods: In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts.In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications.

Selection criteria: Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms).

Data collection and analysis: Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model.

Main results: Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events.Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardised mean difference (SMD) -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD -1.70; 95% CI -2.49 to -0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery (MD 0.97; 95% CI -0.10 to 2.05; 10 units scale, worst to best) immediately after the end of cold-water immersion.Five studies compared cold-water with contrast immersion. Pooled data for pain showed no evidence of differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). Similar findings for pooled analyses at 24, 48 and 72 hour follow-ups applied to the four studies comparing cold-water with warm-water immersion. Single trials only compared cold-water immersion with respectively active recovery, compression and a second dose of cold-water immersion at 24 hours.

Authors' conclusions: 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.

Conflict of interest statement

None known.

Figures

Figure 1
Figure 1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 2
Figure 2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figure 3
Figure 3
Forest plot of comparison: 1 Cold water immersion (CWI) versus passive, outcome: 1.1 Pain (muscle soreness: various scales Likert and VAS)
Analysis 1.1
Analysis 1.1
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 1 Pain (muscle soreness: various scales Likert and VAS).
Analysis 1.2
Analysis 1.2
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 2 Pain ‐ random effects analysis (muscle soreness: various scales Likert and VAS).
Analysis 1.3
Analysis 1.3
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 3 Subgroup analysis. Study design: Pain at 24 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.4
Analysis 1.4
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 4 Subgroup analysis. Study design: Pain at 48 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.5
Analysis 1.5
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 5 Subgroup analysis. Study design: Pain at 72 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.6
Analysis 1.6
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 6 Subgroup analysis. Immersion frequency: Pain at 24 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.7
Analysis 1.7
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 7 Subgroup analysis. Immersion frequency: Pain at 48 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.8
Analysis 1.8
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 8 Subgroup analysis. Exercise type: Pain at 24 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.9
Analysis 1.9
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 9 Subgroup analysis. Exercise type: Pain at 48 hours (muscle soreness: various scales Likert and VAS).
Analysis 1.10
Analysis 1.10
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 10 Tenderness (pain on palpation).
Analysis 1.11
Analysis 1.11
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 11 Subjective recovery (10 point or 10 cm VAS).
Analysis 1.12
Analysis 1.12
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 12 Fatigue (10 point / 10 cm VAS).
Analysis 1.13
Analysis 1.13
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 13 Strength (Final value: Nm).
Analysis 1.14
Analysis 1.14
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 14 Strength (% of baseline).
Analysis 1.15
Analysis 1.15
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 15 Power (jump height: centimetres).
Analysis 1.16
Analysis 1.16
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 16 Power (% decrease in jump height over 5 jumps).
Analysis 1.17
Analysis 1.17
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 17 Power (cycle ergometer power: Watts).
Analysis 1.18
Analysis 1.18
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 18 Functional performance (time to complete exercise test: seconds).
Analysis 1.19
Analysis 1.19
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 19 Functional performance (time to fatigue).
Analysis 1.20
Analysis 1.20
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 20 Range of movement (ROM).
Analysis 1.21
Analysis 1.21
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 21 Swelling (limb girth in centimetres).
Analysis 1.22
Analysis 1.22
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 22 Biomarker: creatine kinase.
Analysis 1.23
Analysis 1.23
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 23 Biomarker: lactate dehydrogenase.
Analysis 1.24
Analysis 1.24
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 24 Biomarker: myoglobin.
Analysis 1.25
Analysis 1.25
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 25 Biomarker: interleukin‐6 (pg/ml).
Analysis 1.26
Analysis 1.26
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 26 Biomarker: C‐reactive protein (mg/dL / mg/L).
Analysis 1.27
Analysis 1.27
Comparison 1 Cold‐water immersion (CWI) versus passive, Outcome 27 Pain (muscle soreness: all converted to 10 cm VAS).
Analysis 2.1
Analysis 2.1
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 1 Pain (muscle soreness: 10 point or 10 or 12 cm VAS).
Analysis 2.2
Analysis 2.2
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 2 Subjective recovery (10 cm VAS).
Analysis 2.3
Analysis 2.3
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 3 Strength.
Analysis 2.4
Analysis 2.4
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 4 Power (squat jump in Watts).
Analysis 2.5
Analysis 2.5
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 5 Power (% decrease in jump performance).
Analysis 2.6
Analysis 2.6
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 6 Functional performance (time to complete running task: seconds).
Analysis 2.7
Analysis 2.7
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 7 Functional performance (time to fatigue).
Analysis 2.8
Analysis 2.8
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 8 Swelling (thigh girth: centimetres).
Analysis 2.9
Analysis 2.9
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 9 Range of movement (degrees).
Analysis 2.10
Analysis 2.10
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 10 Biomarker: creatine kinase (U/L).
Analysis 2.11
Analysis 2.11
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 11 Biomarker: myoglobin.
Analysis 2.12
Analysis 2.12
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 12 Biomarker: lactate dehydrogenase (U/L).
Analysis 2.13
Analysis 2.13
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 13 Biomarker: C‐reactive protein (mg/L).
Analysis 2.14
Analysis 2.14
Comparison 2 Cold‐water immersion (CWI) versus contrast immersion, Outcome 14 Biomarker: interleukin‐6 (pg/mL).
Analysis 3.1
Analysis 3.1
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 1 Pain (muscle soreness: 10 point or 10 or 12 cm VAS).
Analysis 3.2
Analysis 3.2
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 2 Subjective recovery.
Analysis 3.3
Analysis 3.3
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 3 Subjective recovery (Intervention associated with NO benefit for recovery).
Analysis 3.4
Analysis 3.4
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 4 Strength.
Analysis 3.5
Analysis 3.5
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 5 Power.
Analysis 3.6
Analysis 3.6
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 6 Functional performance.
Analysis 3.7
Analysis 3.7
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 7 Range of movement (ROM).
Analysis 3.8
Analysis 3.8
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 8 Swelling.
Analysis 3.9
Analysis 3.9
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 9 Biomarker: creatine kinase (U/L).
Analysis 3.10
Analysis 3.10
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 10 Biomarker: lactate dehydrogenase (U/L).
Analysis 3.11
Analysis 3.11
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 11 Biomarker: myoglobin (ng/mL).
Analysis 3.12
Analysis 3.12
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 12 Biomarker: interleukin‐6 (pg/ml).
Analysis 3.13
Analysis 3.13
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 13 Biomarker: interleukin‐10 (pg/ml).
Analysis 3.14
Analysis 3.14
Comparison 3 Cold‐water immersion (CWI) versus warm‐water immersion (WWI), Outcome 14 Biomarker: interleukin‐1b (pg/ml).
Analysis 4.1
Analysis 4.1
Comparison 4 Cold‐water immersion (CWI) versus active recovery, Outcome 1 Pain (muscle soreness: 10 point VAS).
Analysis 4.2
Analysis 4.2
Comparison 4 Cold‐water immersion (CWI) versus active recovery, Outcome 2 Power (% decrement in jump performance).
Analysis 4.3
Analysis 4.3
Comparison 4 Cold‐water immersion (CWI) versus active recovery, Outcome 3 Functional performance (time to complete running test: seconds).
Analysis 5.1
Analysis 5.1
Comparison 5 Cold‐water immersion (CWI) versus compression, Outcome 1 Pain (muscle soreness: 10 point VAS).
Analysis 5.2
Analysis 5.2
Comparison 5 Cold‐water immersion (CWI) versus compression, Outcome 2 Subjective recovery (rating of fatigue: 10 point VAS ).
Analysis 5.3
Analysis 5.3
Comparison 5 Cold‐water immersion (CWI) versus compression, Outcome 3 Power (vertical jump height: centimetres).
Analysis 5.4
Analysis 5.4
Comparison 5 Cold‐water immersion (CWI) versus compression, Outcome 4 Range of movement (centimetres).
Analysis 5.5
Analysis 5.5
Comparison 5 Cold‐water immersion (CWI) versus compression, Outcome 5 Functional performance (time to complete running test: seconds).
Analysis 6.1
Analysis 6.1
Comparison 6 Cold‐water immersion (CWI) versus double CWI, Outcome 1 Pain (muscle soreness: 5 point VAS).
Analysis 6.2
Analysis 6.2
Comparison 6 Cold‐water immersion (CWI) versus double CWI, Outcome 2 Range of movement (degrees).
Analysis 6.3
Analysis 6.3
Comparison 6 Cold‐water immersion (CWI) versus double CWI, Outcome 3 Biomarker: creatine kinase (U/L).
Analysis 6.4
Analysis 6.4
Comparison 6 Cold‐water immersion (CWI) versus double CWI, Outcome 4 Biomarker: lactate dehydrogenase (U/L).

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