Indications for Cold Water Immersion

Indications for Cold Water Immersion


  • Many athletes have tight schedules that required them to perform in several training sessions and matches per week with limited recovery opportunities. These demands may influence performance.
  • In a Champions League team, the number of injuries was significantly higher when having two matches per week (1). These results were supported by Bengtsson et al (2) showing increased injury rates in congested periods with ≤4 days compared with ≥6 days’ recovery day.
  • There are several recovery strategies for athletes to reduces there recovery, so they can perform again. Cold Water Immersion (CWI) and massage therapies are considered as some of the popular modalities (3).
  • Regarding this, a survey among 32 French professional football teams showed that CWI and massage were used by 88% and 78%, respectively (4).
  • However according to Leeders(5) the effectiveness of cold water immersion and massage are inconsistent, in spite of wide variations in methods, timing and duration of application of cold water immersion in relating to the effects on clinical and functional outcomes.

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  • Many of the outcomes was concentrated on delayed-onset muscle soreness (DOMS) but DOMS does not usually occur after a normal training session in welltrained athletes and is rare after many competitions Most of the published studies have compared these techniques with other forms of recovery rather than against placebo – though it is admittedly difficult to find a suitable placebo intervention
  • Others studies relied on intermediate markers (skin temperature, microvascular permeability, for example) rather than meaningful outcomes.


  • Another lack of consistents is the camparison between recovery strategy with other forms of recovery strategy rather than against placebo intervention (though it is admittedly difficult to find a suitable placebo intervention)
  • Broatch and colleagues (6) compared CWI against two controls groups. In one of the controls, recovery oil (bath-soap) was added together with false information about a beneficial effect. Subsequently, leg strength was measured over 48h. The result illustrated that CWI and recovery oil were similar to each other and better than the other controls. This may indicate that there is a placebo-effect involved.
  • Additionally, Nédélec (7) found an effect on next-day running performance following CWI immediately post-running, however, the meta-analysis from Leeder et al. (5) did not supported any effect on muscle strength and only a moderate effect on power.
  • Also Vaile and colleagues (8) made a study that compared the effects of cold water immersion (CWI) and active recovery (ACT) on resting limb blood flow, rectal temperature and repeated cycling performance in the heat after 35 minutes repeated cycling bout. These findings indicate that CWI recovery leads to better maintenance of performance during high intensity cycling in hot conditions than ACT. CWI also leads to a reduction in rectal temperature, however CWI was negatively correlated with the performance benefit, indicating that there may be a need to individualise cooling protocols to maximise the performance benefits for individual athletes. In conclusion CWI and
  • In conclusion CWI may have an effect on DOMS. But again, is this a good model? However due to the lack participation blinding in most studies psychological factors may confound the results. Therefore, an individual placebo-effect cannot be excluded. Despite contradictory evidence on some factors, there no risk of harm in using CWI. Based on the current literature, it is recommended to use CWI immediately after an exercise bout

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    1. Dupont G, Nedelec M, McCall A, McCormack D, Berthoin S, Wisløff U. Effect of 2 soccer matches in a week on physical performance and injury rate. Am J Sports Med. 2010 Sep;38(9):1752–8.
    2. Bengtsson H, Ekstrand J, Hägglund M. Muscle injury rates in professional football increase with fixture congestion: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013 Aug;47(12):743–
    3. Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold- water immersion in sports recovery? A systematic review. Br J Sports Med. 2010 Feb;44(3):179–87
    4. Recovery in Soccer Part II—Recovery Strategies, Mathieu Ne´de´lec • Alan McCall • Chris Carling • Franck Legall • Serge Berthoin • Gregory Dupont, Sports Med (2013) 43:9–22 DOI 10.1007/s40279-012-0002-0
    5. Leeder J, Gissane C, van Someren K, Gregson W, Howatson G. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med. 2012 Mar 1;46(4):233–40.
    6. Broatch JR, Petersen A, Bishop DJ. Postexercise Cold Water Immersion Benefits Are Not Greater than the Placebo Effect: Med Sci Sports Exerc. 2014 Nov;46(11):2139–47.
    7. Nédélec M, McCall A, Carling C, Legall F, Berthoin S, Dupont G. Recovery in Soccer: Part II—Recovery Strategies. Sports Med. 2013 Jan;43(1):9–22
    8. 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. Br J Sports Med. 2011 Aug 1;45(10):825–9.
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Andreas Bjerregaard
Articles: 317

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