Whether its jumping into a cold bath or icing your knees after training, there has been supporters and opponents to the use of cold therapy - lets delve into this a little further...
Key Points
- Cold Therapy reduces inflammation (if you didn't already know that!) so can help reduce soreness and increase recovery for your next session
- However, inflammation is required for tissue repair and pro inflammatory anabolic (muscle building) response
- Timing of cold therapy is probably the most important thing to consider in order to get the anti inflammatory benefits without inhibiting repair mechanisms
Traditionally athletes have used cold water immersion to improve their recovery. There is evidence that cold water immersion (CWI) can reduce inflammation and therefore reduce the severity of delayed onset of muscle soreness (DOMS). The mechanisms by which cold therapy can affect athletic recovery are becoming increasingly well understood. However recently there has been evidence to suggest that inflammation is necessary for the anabolic processes to occur. The mechanisms and evidence of CWI will be explored along with the practical application of it for strength athletes.
Types of Cold Therapy
Cold therapy in athletes if often delivered via CWI or recently, but also less commonly, Cryotherapy. CWI involves the submersion of part or whole of the body (usually with the head out). CWI is different compared to cryotherapy where the body is exposed to much lower temperatures but for as shorter time (cold air temperatures as low as -128°C). Cold water is generally considered less than 15°C (Tipton & Wooler, 2015) and plunge pools in recovery spas are usually 10-12°C (Plunge Pools: Top 4 Features for Successful Outcomes, n.d.). In practical terms this means that CWI is much more practical due to its lower cost and ability to be performed in the bath at home where UK tap water would be sufficient with an average temperature of 7.3°C (‘Record low for water temperature’, 2010). In addition CWI has been shown to be more effective at lowering the body’s temperature than cryotherapy due to the ability to stay in the water longer than in the extremely cold air temperatures offered by cryotherapy (Abaïdia et al., 2017; Hayter et al., 2016).
Mechanisms
Studies on cold water therapy have found that the exposure releases norepinephrine into the bloodstream (Jedema et al., 2008; Moret & Briley, 2011) which is responsible for several positive recovery adaptations. These include the vasoconstriction caused by the release of norepinephrine occurs which helps to remove waste products post exercise. The norepinephrine also reduces inflammation within the body (Hu et al., 1991; Jedema et al., 2008; Moret & Briley, 2011). CWI has been found to influence the release of lymphocytes[1] which boost the immune system when men were exposed to 1 hour of CWI at 14 degrees, this is important given that the immune system’s effectiveness can be reduced post exercise albeit the length of time may be somewhat impractical in daily life (Jansky et al., 1996; Shephard et al., 1994). However a study in humans found that a 20 second exposure to CWI was enough to significantly increase the release of norepinephrine (Leppäluoto et al., 2008).
Good or Bad?
The evidence towards cold therapy’s benefits towards athletic recovery has had conflicting results. There are multiple studies which have demonstrated benefits for endurance training but there are multiple studies showing a loss in strength levels whilst employing cold water immersion post training (Abaïdia et al., 2017; Hayter et al., 2016). The theory behind this is suggested to be the essential need for the anabolic post training inflammatory response, such as the release of pro-inflammatory cytokines, which assists with tissue repair. The activation of the immune cells called macrophages released post exercise has been show to release of the anabolic hormone IGF-1 in mice (Lu et al., 2011). Therefore this post-exercise inflammation appears to be essential for strength based training improvements.
Timing issues
The post-training inflammatory response returns to pre-exercise levels around one hour after recovery (Nemet et al., 2009). All the studies on strength training researched have employed cold therapy immediately post training and therefore may interrupt the pro inflammatory anabolic response (Fonda & Sarabon, 2013; Roberts et al., 2015). Therefore, further studies conducted on strength athletes using cold water immersion more than an hour after training would be essential in demonstrating whether it can be proved to be as useful for strength athletes.
Other Benefits
Other benefits for strength athletes to consider is the increase in thermogenesis caused by CWI. Whilst shivering during cold exposure, the non-shivering thermogenesis may be helpful in boosting metabolism and controlling bodyweight. Brown fat tissue is metabolically active and found in high levels in babies and has been found to be in higher proportions in adults who regular expose themselves to CWI, naturally helping to regulate body temperature (van der Lans et al., 2013; van Marken Lichtenbelt et al., 2009). Consequently it has been found that there is an inverse correlation between those with high levels of brown fat tissues and lower body fat percentage (Virtanen et al., 2009). This would therefore allow weightlifting athletes to burn more energy which may be important in weight class athletes.
Studies have also shown that the use of cold showers can improve work capacity (Verkhoshansky et al., 2009) most likely from similar effects mentioned above as well as the increased blood flow following vasodilation and the increased alertness and focus with the release of norepinephrine. Consequently cold showers might be a good pre warm up for the training session. It has been theorised for several decades that the cold induced muscle contractions (shivering) increased the adrenal gland activity and caused an increase in central nervous system activity to increase athletic performance as well as focus and alertness (which norepinephrine does) (Vorobyev & Federation, 1978).
Conclusion
Theoretically the evidence suggests that cold water therapy could provide a much needed benefit of decreased inflammation and therefore an ability to recover between sessions. However this cold water immersion must avoid the initial one hour after exercise, suggesting that a cool down followed by food intake with a rest prior to the cold water therapy would be theoretically a better approach. Without this delayed cold water immersion the athlete would risk a decrease in strength or hypertrophy gains despite an improved readiness for training the following day. Evidence also suggests that tap water is of a sufficient low temperature in the UK to create the favourable adaptations with studies varying from 20 seconds up to 1 hour. Therefore more investigation is needed in time of application and length of time spent in CWI.
References
Abaïdia, A.-E., Lamblin, J., Delecroix, B., Leduc, C., McCall, A., Nédélec, M., Dawson, B., Baquet, G., & Dupont, G. (2017). Recovery From Exercise-Induced Muscle Damage: Cold-Water Immersion Versus Whole-Body Cryotherapy. International Journal of Sports Physiology & Performance, 12(3), 402–409. SPORTDiscus with Full Text.
Fonda, B., & Sarabon, N. (2013). Effects of whole-body cryotherapy on recovery after hamstring damaging exercise: A crossover study. Scandinavian Journal of Medicine & Science in Sports, 23(5), e270–e278.
Hayter, K. J., Doma, K., Schumann, M., & Deakin, G. B. (2016). The comparison of cold-water immersion and cold air therapy on maximal cycling performance and recovery markers following strength exercises. PeerJ, 4, e1841.
Hu, X. X., Goldmuntz, E. A., & Brosnan, C. F. (1991). The effect of norepinephrine on endotoxin-mediated macrophage activation. Journal of Neuroimmunology, 31(1), 35–42.
Jansky, L., Pospisilova, D., Honzova, S., Ulicny, B., Sramek, P., Zeman, V., & Kaminkova, J. (1996). Immune system of cold-exposed and cold-adapted humans. European Journal of Applied Physiology and Occupational Physiology, 72(5–6), 445–450.
Jedema, H. P., Gold, S. J., Gonzalez-Burgos, G., Sved, A. F., Tobe, B. J., Wensel, T., & Grace, A. A. (2008). Chronic cold exposure increases RGS7 expression and decreases alpha(2)-autoreceptor-mediated inhibition of noradrenergic locus coeruleus neurons. The European Journal of Neuroscience, 27(9), 2433–2443.
Leppäluoto, J., Westerlund, T., Huttunen, P., Oksa, J., Smolander, J., Dugué, B., & Mikkelsson, M. (2008). Effects of long‐term whole‐body cold exposures on plasma concentrations of ACTH, beta‐endorphin, cortisol, catecholamines and cytokines in healthy females. Scandinavian Journal of Clinical and Laboratory Investigation, 68(2), 145–153.
Lu, H., Huang, D., Saederup, N., Charo, I. F., Ransohoff, R. M., & Zhou, L. (2011). Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. FASEB Journal : Official Publication of the Federation of American Societies for Experimental Biology, 25(1), 358–369.
Moret, C., & Briley, M. (2011). The importance of norepinephrine in depression. Neuropsychiatric Disease and Treatment, 7(Suppl 1), 9–13. PubMed.
Nemet, D., Meckel, Y., Bar-Sela, S., Zaldivar, F., Cooper, D. M., & Eliakim, A. (2009). Effect of local cold-pack application on systemic anabolic and inflammatory response to sprint-interval training: A prospective comparative trial. European Journal of Applied Physiology, 107(4), 411–417. PubMed.
Plunge Pools: Top 4 Features for Successful Outcomes. (n.d.). Retrieved 3 April 2020, from https://www.swimex.com/professional/blog/plunge-pools-top-4-features-for-success/
Record low for water temperature. (2010, December 24). BBC News. https://www.bbc.com/news/uk-england-12073944
Roberts, L. A., Raastad, T., Markworth, J. F., Figueiredo, V. C., Egner, I. M., Shield, A., Cameron-Smith, D., Coombes, J. S., & Peake, J. M. (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. The Journal of Physiology, 593(18), 4285–4301.
Shephard, R. J., Rhind, S., & Shek, P. N. (1994). Exercise and the Immune System. Sports Medicine, 18(5), 340–369.
Tipton, M., & Wooler, A. (2015, November). The Science of Beach Lifeguarding—A new book from CRC Press. World Conference on Drowning Prevention 2015.
Van der Lans, A. A. J. J., Hoeks, J., Brans, B., Vijgen, G. H. E. J., Visser, M. G. W., Vosselman, M. J., Hansen, J., Jörgensen, J. A., Wu, J., Mottaghy, F. M., Schrauwen, P., & van Marken Lichtenbelt, W. D. (2013). Cold acclimation recruits human brown fat and increases nonshivering thermogenesis. The Journal of Clinical Investigation, 123(8), 3395–3403. PubMed.
Van Marken Lichtenbelt, W. D., Vanhommerig, J. W., Smulders, N. M., Drossaerts, J. M. A. F. L., Kemerink, G. J., Bouvy, N. D., Schrauwen, P., & Teule, G. J. J. (2009). Cold-activated brown adipose tissue in healthy men. The New England Journal of Medicine, 360(15), 1500–1508.
Verkhoshansky, Y., Siff, M. C., & Yessis, M. (2009). Supertraining. Verkhoshansky.
Virtanen, K. A., Lidell, M. E., Orava, J., Heglind, M., Westergren, R., Niemi, T., Taittonen, M., Laine, J., Savisto, N.-J., Enerback, S., & Nuutila, P. (2009). Functional brown adipose tissue in healthy adults. The New England Journal of Medicine, 360(15), 1518–1525.
Vorobyev, A. N., & Federation, I. W. (1978). Weightlifting. International Weightlifting Federation.
[1] As well as T helper cells, T suppressor cells