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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

Chris Bleakley  1 , Suzanne McDonough, Evie Gardner, G David Baxter, J Ty Hopkins, Gareth W Davison
Affiliations

Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise

Chris Bleakley et al. Cochrane Database Syst Rev. .

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.

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Conflict of interest statement

None known.

Figures

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

References to studies included in this review

Bailey 2007 {published data only}
    1. Bailey DM. personal communication November 11 2010.
    1. Bailey DM, Erith SJ, Griffin PJ, Dowson A, Brewer DS, Gant N, et al. Influence of cold water immersion on indices of muscle damage following prolonged intermittent shuttle running. Journal of Sports Sciences 2007;25(11):1163‐70. - PubMed
Buchheit 2009 {published data only}
    1. Buchheit M. personal communication 18 October 2010.
    1. Buchheit M, Peiffer JJ, Abbiss CR, Laursen PB. Effect of cold water immersion on postexercise parasympathetic reactivation. American Journal of Physiology ‐ Heart and Circulatory Physiology 2009;296(2):H421‐7. - PubMed
    1. Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen PB. Effect of cold water immersion on repeated 1‐km cycling performance in the heat. Journal of Science and Medicine in Sport 2010;13(1):112‐6. - PubMed
Cassar 2010 {published data only}
    1. Cassar S, Kidgell D, Pearce A. The effect of hydrotherapy recovery on central fatigue: A preliminary examination using transcranial magnetic stimulation. Journal of Science and Medicine in Sport 2010;12(e1‐1232):Abstract no. 110.
    1. Cassar S, Pearce A. personal communication December 6 2010.
Eston 1999 {published data only}
    1. Eston R. personal communication 4 October 2010.
    1. Eston R, Peters D. Effects of cold water immersion on the symptoms of exercise‐induced muscle damage. Journal of Sports Sciences 1999;17(3):231‐8. - PubMed
Goodall 2008 {published data only}
    1. Goodall S. personal communication 4 October 2010.
    1. Goodall S, Howatson G. The effects of multiple cold water immersions on indices of muscle damage. Journal of Sports Science and Medicine 2008;7:235‐41. - PMC - PubMed
    1. Howatson G, Goodall S, Someren KA. The influence of cold water immersions on adaptation following a single bout of damaging exercise. European Journal of Applied Physiology 2009;105(4):615‐21. - PubMed
Halson 2008 {published data only}
    1. Halson SL. personal communication 12 October 2010.
    1. Halson SL, Quod MJ, Martin DT, Gardner AS, Ebert TR, Laursen PB. Physiological responses to cold water immersion following cycling in the heat. International Journal of Sports Physiology and Performance 2008;3(3):331‐46. - PubMed
Ingram 2009 {published data only}
    1. Ingram J. personal communication 11 October 2010.
    1. Ingram J, Dawson B, Goodman C, Wallman K, Beilby J. Effect of water immersion methods on post‐exercise recovery from simulated team sport exercise. Journal of Science and Medicine in Sport 2009;12(3):417‐21. - PubMed
Jakeman 2009 {published data only}
    1. Jakeman JR, Eston R. personal communication 3 November 2010.
    1. Jakeman JR, Macrae R, Eston R. A single 10‐min bout of cold water immersion therapy after strenuous plyometric exercise has no beneficial effect on recovery from the symptoms of exercise induced muscle damage. Ergonomics 2009;52(4):456‐60. - PubMed
King 2009 {published data only}
    1. King M. personal communication 9 November 2010.
    1. King M, Duffield R. The effects of recovery interventions on consecutive days of intermittent sprint exercise. Journal of Strength and Conditioning Research 2009;23(6):1795‐802. - PubMed
Kuligowski 1998 {published data only}
    1. Kuligowski LA, Lephart SM, Giannantonio FP, Blanc RO. Effect of whirlpool therapy on the signs and symptoms of delayed‐onset muscle soreness. Journal of Athletic Training 1998;33(3):222‐8. - PMC - PubMed
Montgomery 2008 {published data only}
    1. Montgomery PG, Pyne DB, Hopkins WG, Dorman JC, Cook K, Minahan CL. The effect of recovery strategies on physical performance and cumulative fatigue in competitive basketball. Journal of Sports Sciences 2008;26(11):1135‐45. - PubMed
Rowsell 2009 {published data only}
    1. Rowsell G, Coutts A, Reaburn P. Effect of cold water immersion on match running performance in high‐level junior soccer players during a four‐day tournament. Journal of Science and Medicine in Sport 2007;10(October):24.
    1. Rowsell GJ, Coutts AJ, Reaburn P, Hill‐Haas S. Effect of post‐match cold‐water immersion on subsequent match running performance in junior soccer players during tournament play. Journal of Sports Sciences 2011;29(1):1‐6. - PubMed
    1. Rowsell GJ, Coutts AJ, Reaburn P, Hill‐Haas S. Effects of cold‐water immersion on physical performance between successive matches in high‐performance junior male soccer players. Journal of Sports Sciences 2009;27(6):565‐73. - PubMed
Sellwood 2007a {published data only}
    1. Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice water immersion and delayed‐onset muscle soreness: a randomised controlled trial. British Journal of Sports Medicine 2007;41(6):392‐7. - PMC - PubMed
Skurvydas 2006 {published data only}
    1. Skurvydas A. personal communication 13 October 2010.
    1. Skurvydas A, Sipaviciene S, Krutulyte G, Gailiuniene A, Stasiulis A, Mamkus G, et al. Cooling leg muscles affects dynamics of indirect indicators of skeletal muscle damage. Journal of Back and Musculoskeletal Rehabilitation 2006;19(4):141‐51.
Vaile 2008c {published data only}
    1. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. European Journal of Applied Physiology 2008;102(4):447‐55. - PubMed
Yanagisawa 2003a {published data only}
    1. Yanagisawa O, Niitsu M, Yoshioka H, Goto K, Kudo H, Itai Y. The use of magnetic resonance imaging to evaluate the effects of cooling on skeletal muscle after strenuous exercise. European Journal of Applied Physiology 2003;89(1):53‐62. - PubMed
Yanagisawa 2003b {published data only}
    1. Yanagisawa O, Niitsu M, Takahashi H, Goto K, Ital Y. Evaluations of cooling exercised muscle with MR imaging and 31P MR spectroscopy. Medicine and Science in Sports and Exercise 2003;35(9):1517‐23. - PubMed

References to studies excluded from this review

Banfi 2008a {published data only}
    1. Banfi G, D'Eril GM, Barassi A, Lippi G. N‐terminal proB‐type natriuretic peptide (NT‐proBNP) concentrations in elite rugby players at rest and after active and passive recovery following strenuous training sessions. Clinical Chemisty and Laboratory Medicine 2008;46(2):247‐9. - PubMed
    1. Banfi G, Melegati G. Effect on sport hemolysis of cold water leg immersion in athletes after training sessions. Laboratory Hematology 2008;14(2):15‐8. - PubMed
    1. Banfi G, Melegati G, Valentini P. Effects of cold‐water immersion of legs after training session on serum creatine kinase concentrations in rugby players. British Journal of Sports Medicine 2007;41(5):339. - PMC - PubMed
Chen 2006 {published data only}
    1. Chen TC, Hsieh SS. The effects of stretching and cryotherapy on delayed onset muscle soreness. Medicine and Science in Sports and Exercise 1996;28(5):181 (abstract number 1077).
Clements 2002 {published data only}
    1. Clements JM, Casa DJ, Knight J, McClung JM, Blake AS, Meenen PM, et al. Ice‐water immersion and cold‐water immersion provide similar cooling rates in runners with exercise‐induced hyperthermia. Journal of Athletic Training 2002;37(2):146‐50. - PMC - PubMed
Coffey 2004 {published data only}
    1. Coffey V, Leveritt M, Gill N. Effect of recovery modality on 4‐hour repeated treadmill running performance and changes in physiological variables. Journal of Science and Medicine in Sport 2004;7(1):1‐10. - PubMed
Connolly 2003 {published data only}
    1. Connolly DAJ, Brennan KM, Lauzon CD. Effects of active versus passive recovery on power output during repeated bouts of short term, high intensity exercise. Journal of Sports Science and Medicine 2003;2:47‐51. - PMC - PubMed
Crowe 2007 {published data only}
    1. Crowe MJ, O'Connor D, Rudd D. Cold water recovery reduces anaerobic performance. International Journal of Sports Medicine 2007;28(12):994‐8. - PubMed
Dawson 2005 {published data only}
    1. Dawson B, Cow S, Modra S, Bishop D, Stewart G. Effects of immediate post‐game recovery procedures on muscle soreness, power and flexibility levels over the next 48 hours. Journal of Science and Medicine in Sport 2005;8(2):210‐21. - PubMed
Gill 2006 {published data only}
    1. Gill ND, Beaven CM, Cook C. Effectiveness of post‐match recovery strategies in rugby players. British Journal of Sports Medicine 2006;40(3):260‐3. - PMC - PubMed
Goosey‐Tolfrey 2008 {published data only}
    1. Goosey‐Tolfrey V, Swainson M, Boyd C, Atkinson G, Tolfrey K. The effectiveness of hand cooling at reducing exercise‐induced hyperthermia and improving distance‐race performance in wheelchair and able‐bodied athletes. Journal of Applied Physiology 2008;105(1):37‐43. - PubMed
Gurovich 2006 {published data only}
    1. Gurovich AN, Penailillo L, Reyes A, Plaza P. What is the best treatment to control Delayed Onset Muscle Soreness: Ultrasound, cryotherapy or both on a combined therapy?. Medicine and Science in Sports and Exercise 2006;38(5):689.
Hayashi 2004 {published data only}
    1. Hayashi K, Honda Y, Ogawa T, Wada H, Kondo N, Nishiyasu T. Effects of brief leg cooling after moderate exercise on cardiorespiratory responses to subsequent exercise in the heat. European Journal of Applied Physiology 2004;92(4‐5):414‐20. - PubMed
Heyman 2009 {published data only}
    1. Heyman E, Geus B, Mertens I, Meeusen R. Effects of four recovery methods on repeated maximal rock climbing performance. Medicine and Science in Sports and Exercise 2009;41(6):1303‐10. - PubMed
Higgins 2010 {published data only}
    1. Higgins TR, Heazlewood IT, Climstein M. A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union. Journal of Strength and Conditioning Research 2010; Vol. in press. - PubMed
Hudson 1999 {published data only}
    1. Hudson OD, Loy SF, Vincent WJ, Yaspelkis BB. Blood lactate concentration and rated perceived exertion following active recovery in water. Sports Medicine, Training and Rehabilitation 1999;9(1):41‐50.
Khomenok 2008 {published data only}
    1. Khomenok GA, Hadid A, Preiss‐Bloom O, Yanovich R, Erlich T, Ron‐Tal O, et al. Hand immersion in cold water alleviating physiological strain and increasing tolerance to uncompensable heat stress. European Journal of Applied Physiology 2008;104(2):303‐9. - PubMed
Kinugasa 2009 {published data only}
    1. Kinugasa T, Kilding AE. A comparison of post‐match recovery strategies in youth soccer players. Journal of Strength and Conditioning Research 2009;23(5):1402‐7. - PubMed
Kokkinidis 1998 {published data only}
    1. Kokkinidis E, Tsamourtas A, Buckenmeyer P, Machairidou M. The effect of static stretching and cryotherapy on the recovery of delayed onset muscle soreness. Exercise and Society Journal of Sports Science 1998;19:45‐53.
Lane 2004 {published data only}
    1. Lane KN, Wenger HA. Effect of selected recovery conditions on performance of repeated bouts of intermittent cycling separated by 24 hours. Journal of Strength and Conditioning Research 2004;18(4):855‐60. - PubMed
Lapier 1995 {published data only}
    1. Lapier TK, Sheely SL, Moore R, Hubert CL, Brower C, Barnhard ML, Creelman J. The effects of massage or cryotherapy on isometric torque and perceived pain in muscles with contraction‐induced delayed onset muscle soreness. 12th International Congress World Confederation of Physical Therapy. 1995; Vol. 30:86.
Nosaka 1996 {published data only}
    1. Sakamoto K, Nosaka K, Clarkson P. Effect of reduced muscle temperature on eccentric exercise‐induced muscle damage. Medicine and Science in Sports and Exercise 1996;28(5):188.
Paddon‐Jones 1997 {published data only}
    1. Paddon‐Jones DJ, Quigley BM. Effect of cryotherapy on muscle soreness and strength following eccentric exercise. International Journal of Sports Medicine 1997;18(8):588‐93. - PubMed
Peiffer 2009a {published data only}
    1. Peake J, Peiffer JJ, Abbiss CR, Nosaka K, Okutsu M, Laursen PB, et al. Body temperature and its effect on leukocyte mobilization, cytokines and markers of neutrophil activation during and after exercise. European Journal of Applied Physiology 2008;102(4):391‐401. - PubMed
    1. Peiffer JJ, Abbiss CR, Nosaka K, Peake JM, Laursen PB. Effect of cold water immersion after exercise in the heat on muscle function, body temperatures, and vessel diameter. Journal of Science and Medicine in Sport 2009;12(1):91‐6. - PubMed
Peiffer 2009b {published data only}
    1. Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen PB. Effect of cold water immersion duration on body temperature and muscle function. Journal of Sports Sciences 2009;27(10):987‐93. - PubMed
Peiffer 2010b {published data only}
    1. Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen PB. Effect of a 5‐min cold‐water immersion recovery on exercise performance in the heat. British Journal of Sports Medicine 2010;44(6):461‐5 [Epub 2008 Jun 6]. - PubMed
Peñailillo 2006 {published data only}
    1. Peñailillo L, Plaza P, Husak T, Reyes W, Gurovich A. Cryotherapy as control delayed onset muscle soreness treatment. Medicine and Science in Sports and Exercise 2006;38(5):S26.
Price 2004 {published data only}
    1. Price MJ, Mather MI. Comparison of lower‐ vs. upper‐body cooling during arm exercise in hot conditions. Aviation, Space, and Environmental Medicine 2004;75(3):220‐6. - PubMed
Schniepp 2002 {published data only}
    1. Schniepp J, Campbell TS, Powell KL, Pincivero DM. The effects of cold‐water immersion on power output and heart rate in elite cyclists. Journal of Strength and Conditioning Research 2002;16(4):561‐6. - PubMed
Sipaviciene 2007 {published data only}
    1. Sipaviciene S, Skurvydas A, Ramanauskiene I, Senikiene Z, Dumciene A. Cooling makes recovery faster after eccentric‐concentric than concentric exercise [Pasaldymas labiau pagreitina raumens atsigavima po ekscentrinio‐koncentrinio fizinio kruvio nei po koncentrinio]. Medicina (Kaunas) 2008;44(3):225‐31. - PubMed
Taylor 2008 {published data only}
    1. Taylor NA, Caldwell JN, Heuvel AM, Patterson MJ. To cool, but not too cool: that is the question‐‐immersion cooling for hyperthermia. Medicine and Science in Sports and Exercise 2008;40(11):1962‐9. - PubMed
Tessitore 2007 {published data only}
    1. Tessitore A, Meeusen R, Cortis C, Capranica L. Effects of different recovery interventions on anaerobic performances following preseason soccer training. Journal of Strength and Conditioning Research 2007;21(3):745‐50. - PubMed
Udermann 1997 {published data only}
    1. Udermann BE, Graves JE, Reider LR, Meyer JM, Li YH, King GR, et al. Delayed onset muscle soreness in the lumbar extensor muscle. Medicine & Science in Sports & Exercise 1997;29(5):66.
Vaile 2007 {published data only}
    1. Vaile JM, Gill ND, Blazevich AJ. The effect of contrast water therapy on symptoms of delayed onset muscle soreness. Journal of Strength and Conditioning Research 2007;21(3):697‐702. - PubMed
Vaile 2008a {published data only}
    1. Vaile J, Halson S, Gill N, Dawson B. Effect of cold water immersion on repeat cycling performance and thermoregulation in the heat. Journal of Sports Sciences 2008;26(5):431‐40. - PubMed
Vaile 2008b {published data only}
    1. Vaile J, Halson S, Gill N, Dawson B. The effect of hydrotherapy on recovery from fatigue. International Journal of Sports Medicine 2008;29(7):539‐544. - PubMed
Verducci 2000 {published data only}
    1. Verducci FM. Interval cryotherapy decreases fatigue during repeated weight lifting. Journal of Athletic Training 2000;35(4):422‐6. - PMC - PubMed
Webborn 2005 {published data only}
    1. Webborn N, Price MJ, Castle PC, Goosey‐Tolfrey VL. Effects of two cooling strategies on thermoregulatory responses of tetraplegic athletes during repeated intermittent exercise in the heat. Journal of Applied Physiology 2005;98(6):2101‐7. - PubMed
Yamane 2006 {published data only}
    1. Yamane M, Teruya H, Nakano M, Ogai R, Ohnishi N, Kosaka M. Post‐exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation. European Journal of Applied Physiology 2006;96(5):572‐80. - PubMed
Yeargin 2006 {published data only}
    1. Yeargin SW, Casa DJ, McClung JM, Knight JC, Healey JC, Goss PJ, et al. Body cooling between two bouts of exercise in the heat enhances subsequent performance. Journal of Strength and Conditioning Research 2006;20(2):383‐9. - PubMed

References to studies awaiting assessment

Ascensao 2011 {published data only}
    1. Ascensao A, Leite M, Rebelo AN, Magalhaes S, Magalhaes J. Effects of cold water immersion on the recovery of physical performance and muscle damage following a one‐off soccer match. Journal of Sports Sciences 2011;29(3):217‐25. - PubMed
Fowles 2003 {published data only (unpublished sought but not used)}
    1. Fowles JR, Boutilier G, Murphy RJ. Post‐exercise cooling has an effect on submaximal performance. Medicine and Science in Sports and Exercise 2003;35(5):S183.
Pournot 2011 {published data only}
    1. Pournot H, Bieuzen F, Duffield R, Lepretre PM, Cozzolino C, Hausswirth C. Short term effects of various water immersions on recovery from exhaustive intermittent exercise. European Journal of Applied Physiology 2011;111(7):1287‐95. - PubMed
Smith 2008 {published data only}
    1. Smith LC, Mroczkowski SA, Buser S, Bemis S, Otterstetter R. Effects Of thermotherapy and cryotherapy on muscle hypertrophy and muscle contraction force following resistance exercise. Medicine & Science in Sports & Exercise 2008;40(5):S258.
Stacey 2010 {published data only}
    1. Stacey DL, Gibala MJ, Martin Ginis KA, Timmons BW. Effects of recovery method after exercise on performance, immune changes, and psychological outcomes. Journal of Orthopaedic & Sports Physical Therapy 2010;40(10):656‐65. - PubMed
Vaile 2011 {published data only}
    1. Vaile J, O'Hagan C, Stefanovic B, Walker M, Gill N, Askew CD. Effect of cold water immersion on repeated cycling performance and limb blood flow. British Journal of Sports Medicine 2011;45(10):825‐9. - PubMed
    1. Vaile J, Stefanovic B, O'Hagan C, Walker M, Gill N, Askew C. Effect of cold water immersion on recovery and limb blood flow following high intensity cycling. Journal of Science and Medicine in Sport 2009;12S:Abstract 58.

Additional references

Banfi 2008
    1. Banfi G, Melegati G. Effect on sport hemolysis of cold water leg immersion in athletes after training sessions. Laboratory Hematology 2008;14(2):15‐8. [MEDLINE: ] - PubMed
Barnett 2006
    1. Barnett A. Using recovery modalities between training sessions in elite athletes: does it help?. Sports Medicine 2006;36(9):781‐96. - PubMed
Bennett 2005
    1. Bennett MH, Best TM, Babul‐Wellar S, Taunton JE. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD004713.pub2] - DOI - PMC - PubMed
Bleakley 2004
    1. Bleakley CM, McDonough SM, MacAuley DC. The use of ice in the treatment of acute soft‐tissue injury: a systematic review of randomized controlled trials. American Journal of Sports Medicine 2004;32(1):251‐61. - PubMed
Bleakley 2010
    1. Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold‐water immersion in sports recovery? A systematic review. British Journal of Sports Medicine 2010;44(3):179‐87. - PubMed
Chatzinikolaou 2010
    1. Chatzinikolaou A, Fatouros IG, Gourgoulis V, Avloniti A, Jamurtas AZ, Nikolaidis MG, Douroudos I, Michailidis Y, Beneka A, Malliou P, Tofas T, Georgiadis I, Mandalidis D, Taxildaris K. Time course of changes in performance and inflammatory responses after acute plyometric exercise. Journal of Strength and Conditioning Research 2010;24(5):1389‐98. - PubMed
Cheung 2003
    1. Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine 2003;33(2):145‐64. [MEDLINE: ] - PubMed
Cleak 1992
    1. Cleak MJ, Eston RG. Muscle soreness, swelling, stiffness, and strength loss after intense eccentric exercise. British Journal of Sports Medicine 1992;26(4):267‐72. [MEDLINE: ] - PMC - PubMed
Cochrane 2004
    1. Cochrane DJ. Alternating hot and cold water immersion for athlete recovery: A review. Physical Therapy in Sport 2004;5(1):26‐32. [EMBASE: 2004120600]
Deeks 2008
    1. Higgins JPT, Deeks JJ, Altman DG (editors). Chapter 16: Special topics in statistics. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 (updated September 2008). The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Deeks 2008a
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. Section 9.5.2. In: Higgins JPT, Green S (editors). Cochrane Handbook of Systematic reviews of Interventions 5.0.2 (updated September 2008). Available from www.cochrane‐handbook.org.
Deeks 2008b
    1. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta‐analyses. Section 9.6.2. In: Higgins JPT, Green S (editors). Cochrane Handbook of Systematic reviews of Interventions 5.0.2 (updated September 2008). Available from www.cochrane‐handbook.org.
Guyatt 2002
    1. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR, Aaronson N. Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings 2002;77(4):371–83. - PubMed
Herbert 2011
    1. Herbert RD, Noronha M, Kamper SJ. Stretching to prevent or reduce muscle soreness after exercise. Cochrane Database of Systematic Reviews 2011, Issue 7. [DOI: 10.1002/14651858.CD004577.pub3] - DOI - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analysis. BMJ 2003;327(7414):557‐60. - PMC - PubMed
Higgins 2009
    1. Higgins JPT, Altman DG (editors). Chapter 8: Assessing risk of bias in included studies. Section 8.5. In: Higgins JPT, Green S (editors), Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2 [updated September 2009]. Available from www.cochrane‐handbook.org.
Hing 2008
    1. Hing WA, White SG, Bouaaphone A, Lee P. Contrast therapy‐‐a systematic review. Physical Therapy in Sport 2008;9(3):148‐61. - PubMed
Knight 2000
    1. Knight KL, Brucker JB, Stoneman PD, Rubley MD. Muscle injury management with cryotherapy. Athletic Therapy Today 2000;5(4):26‐30. [EMBASE: 2000225657]
Kunz 2007
    1. Kunz R, Vist GE, Oxman AD. Randomisation to protect against selection bias in healthcare trials. Cochrane Database of Systematic Reviews 2007, Issue 2 10.1002/14651858.MR000012.pub3.. [DOI: 10.1002/14651858.MR000012.pub3] - DOI - PubMed
Lefebvre 2009
    1. Lefebvre C, Manheimer E, Glanville J. Chapter 6: Searching for studies. Box 6.4.d. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.2 (updated September 2009). Available from www.cochrane‐handbook.org.
Low 2000
    1. Low J, Reed A. Electrotherapy explained: principles and practice. 3rd Edition. Oxford: Butterworth and Heinemann, 2000. [ISBN ‐ 0750641495]
McDermott 2009
    1. McDermott BP, Casa DJ, Ganio MS, Lopez RM, Yeargin SW, Armstrong LE, et al. Acute whole‐body cooling for exercise‐induced hyperthermia: a systematic review. Journal of Athletic Training 2009;44(1):84‐93. - PMC - PubMed
Peiffer 2010
    1. Peiffer JJ, Abbiss CR, Watson G, Nosaka K, Laursen PB. Effect of cold water immersion on repeated 1‐km cycling performance in the heat. Journal of Science and Medicine in Sport 2010;13(1):112‐6. - PubMed
Pildal 2007
    1. Pildal J, Hróbjartsson A, Jørgensen KJ, Hilden J, Altman DG, Gøtzsche PC. Impact of allocation concealment on conclusions drawn from meta‐analyses of randomized trials. International Journal of Epidemiology 2007;36(4):847‐57. - PubMed
Proske 2001
    1. Proske U, Morgan DL. Muscle damage from eccentric exercise: mechanism, mechanical signs, adaptation and clinical applications. Journal of Physiology 2001;537(Pt 2):333‐45. [MEDLINE: ] - PMC - PubMed
Rowsell 2011
    1. Rowsell GJ, Coutts AJ, Reaburn P, Hill‐Haas S. Effect of post‐match cold‐water immersion on subsequent match running performance in junior soccer players during tournament play. Journal of Sports Sciences 2011;29(1):1‐6. - PubMed
Sellwood 2007b
    1. Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice‐water immersion and delayed‐onset muscle soreness: a randomised controlled trial. British Journal of Sports Medicine 2007;41(6):392‐7. [MEDLINE: ] - PMC - PubMed
Smith 2005
    1. Smith JE. Cooling methods used in the treatment of exertional heat illness. British Journal of Sports Medicine 2005;39(8):503‐7. - PMC - PubMed
Tashjian 2009
    1. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. Journal of Shoulder and Elbow Surgery 2009;18(6):927‐32. - PubMed
Vaile 2008d
    1. Vaile J, Halson S, Gill N, Dawson B. Effect of cold water immersion on repeat cycling performance and thermoregulation in the heat. Journal of Sports Sciences 2008;26(5):431‐40. [MEDLINE: ] - PubMed
Vaile 2008e
    1. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. European Journal of Applied Physiology 2008;102(4):447‐55. [MEDLINE: ] - PubMed
Van Dam 2008
    1. Dam RM, Li T, Spiegelman D, Franco OH, Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 2008;337:a1440. [MEDLINE: ] - PMC - PubMed
Wilcock 2006
    1. Wilcock IM, Cronin JB, Hing WA. Physiological response to water immersion: a method for sport recovery?. Sports Medicine 2006;36(9):747‐65. [MEDLINE: ] - PubMed
Wood 2008
    1. Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta‐epidemiological study. BMJ 2008;336(7644):601‐5. - PMC - PubMed

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