Kyle Levers, M.S., CSCS
While sports performance and training have become increasingly competitive and demanding, recovery techniques continues to rely on existing therapies. Many athletes find water therapies helpful to hasten the recovery process in order to return to bouts of exercise sooner, while minimizing fatigue and injury.
Two of the most common water immersion therapy techniques used in the recovery from fatiguing exercise are cold water immersion (cryotherapy) and contrast water immersion. Water immersion therapies may be preferred after exercise bouts incorporating newly introduced techniques due to elevated muscle soreness, during periods of increased training volume and intensity (i.e. pre-season), and after training in elevated temperature conditions. The physiological effects currently accounting for the effectiveness of water immersion therapy are principally attributed to changes in temperature and hydrostatic pressure.
COLD WATER IMMERSION
Cold water immersion therapy, or cryotherapy, is performed by submerging specific body parts or the entire body below head level in water temperatures ≤ 59º F. Cold water immersion causes a decrease in tissue temperature due to the stimulation of the skin thermal receptors. The thermal receptors, in response to the cooling, cause a localized sympathetic vasoconstriction of the vasculature structures at the tissue level leading to a decrease in swelling and inflammation. Applying ice packs following a tissue injury to control the resultant swelling uses a similar response mechanism. The decrease in swelling and inflammation due to the reduction of fluid diffusion from the damaged tissues as a result of the localized vasoconstriction can reduce pain, and metabolite production, but can cause a loss in force generation in a maximal power bout or a repeated sprint performance.
Cold water immersion also has been shown to reduce the blood concentration of creatine kinase, thus potentially reducing tissue damage due to the effects of vasoconstriction. The cold water temperatures also have an effect on neural factors by slowing nerve conduction speed. The slowing of nerve conduction speed has a positive effect in the pain perception pathway, but can also decrease muscle contraction speed.
CONTRAST WATER IMMERSION
Contrast water immersion therapy alternates hot and cold water baths. Most protocols specify durations of 30-300 seconds of extreme temperature immersion before moving directly to the opposite temperature extreme for the same duration.
The mechanism behind contrast water therapy as an effective recovery protocol is relatively unknown. A proposed alternating muscular contraction theory occurring as a result of immersion temperature fluctuation states that the vaso-pumping action would increase blood flow, metabolite removal, and ultimately enhance recovery. However, unlike muscular pumping that occurs as a result of active recovery, the alternation in vasoconstriction and vasodilation that occurs as a result of contrast water therapy would most likely not have a great effect due to its slow frequency and inability to act at the deep tissue level. The vasodilation as a result of the warm water promotes immune function by increasing antibody and antioxidant supply to the damaged muscle tissue, while the cold water, leading to vasoconstriction, has similar effects to what was previously discussed.
Recent research has found that cold water immersion can be more beneficial post-exercise compared to contrast water therapy. Contrast water therapy does not produce the intramuscular temperature changes necessary to have any significant physiological effect. Cold water immersion results in significantly later muscle soreness ratings 24 to 48 hours post-exercise with closer replication of baseline leg force production values compared to contrast water immersion. However, athletes competing in multiple events over the course of a day should not use cold water immersion until after the final exercise bout due to the effects on nerve conduction velocity, muscle blood flow, and sustained changes in muscle temperature. Further investigation is necessary to define the most effective cryotherapy practice.
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