Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW
The Cochrane database of systematic reviews · 90 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Meta-analysis (classified by our AI screen)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Funding not disclosed
Publication
- Published
- 2012-02-10 · Cochrane Database Syst Rev · vol. 2012 · issue 2 · p. CD008262
- Publisher
- Elsevier BV
- Cited
- 185 citations · more than 100% of similar papers · 15.0× the field average
- Impact
- Top 10% most cited in its field
- References
- 114 works
- Access
- Free to read
- Research areas
- Exercise and Physiological Responses · Thermoregulation and physiological responses · Infrared Thermography in Medicine
- Keywords
- Cryotherapy, Medicine, Immersion (mathematics), Delayed onset muscle soreness, Hydrotherapy, Physical therapy, Physical medicine and rehabilitation, Muscle damage, Surgery, Internal medicine, Alternative medicine
- MeSH
- humans, muscular diseases, pain, exercise, cryotherapy, immersion, randomized controlled trials as topic, pain management
6 authors
From GB, NZ, US
- Chris BleakleyUniversity of Ulster
- Suzanne McDonoughUniversity of Ulster
- Evie GardnerUniversity of Ulster
- David G. BaxterUniversity of Otago
- J. Ty HopkinsBrigham Young University
- Gareth W. DavisonUniversity of Ulster
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.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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