Practical Applications of

Water Immersion
Recovery Modalities for
Team Sports
Francisco Tavares, MSc,1,2 Owen Walker, MSc,3 Phil Healey, BSc,1 Tiaki Brett Smith, PhD,2,4
and Matthew Driller, PhD2
1
Glasgow Warriors, Glasgow, United Kingdom; 2Faculty of Health, Sport and Human Performance, University of
Waikato, Hamilton, New Zealand; 3Science for Sport, Dartmouth, United Kingdom; and 4Chiefs Rugby Club, Hamilton,
New Zealand

ABSTRACT INTRODUCTION complex biological processes (29) that

he training stimulus can be con- are influenced by a diversity of factors
COLD THERAPIES ARE WIDELY
USED MODALITIES TO ENHANCE
RECOVERY WITHIN AN ATHLETIC
T sidered as a challenge to the
organism, as it disturbs homeo-
stasis (10,29) from a physical perspec-
including training-related aspects (e.g.,
training status), physical aspects (e.g.,
genes and ethnicity), and psychological
POPULATION IN ADDITION TO tive, and typically elicits a catabolic aspects (e.g., psychosocial stress).
OTHER ESSENTIAL COMPONENTS response. Moreover, a temporary Although it is beyond the scope of this
OF RECOVERY. ALTHOUGH THE reduction in performance after differ- review to explore in depth the biological
BENEFITS OF COLD THERAPIES ent training stimuli has been exten- processes involved in training responses
ARE DOCUMENTED IN THE SCIEN- sively demonstrated in the sport and adaptations, and the factors affect-
TIFIC LITERATURE, RECENT science literature (10,13). Training ing such processes, a rationale is pre-
RESEARCH HAS DEMONSTRATED stimuli are structurally implemented sented to justify the role that cold
SOME POTENTIAL HARMFUL EF- in a way that allow for athletes to recovery modalities may have on
FECTS OF SUCH MODALITIES AS recover between sessions or training enhancing recovery during certain peri-
WELL AS INDIVIDUAL RESPONSES phases, leading to physiological adap- ods of training.
TO SIMILAR PROTOCOLS. THIS tations and enhanced perfor-
When a training stimulus is applied,
ARTICLE REVIEWS THE CURRENT mance (18).
a disturbance in the internal equilib-
KNOWLEDGE ON THE DIFFERENT One needs to understand that responses rium is expected (Figure 1). During this
PROTOCOL CHARACTERISTICS to the training stimuli are not only indi- period, acute fatigue is experienced and
AND INDIVIDUAL FACTORS THAT vidual but can also vary within the same performance is inhibited (10,13). This
MAY CONTRIBUTE TO RE- individual during different periods of reduction in performance is temporary,
SPONSES OF COLD THERAPIES, their training career (60). For example, as the organism starts to resist the dis-
PROVIDING PRACTICAL RECOM- the state of anxiety and vigor domains turbance to homeostasis, and seeks to
MENDATIONS BASED ON EXTER- was found to differ between different reestablish equilibrium. From an exer-
NAL FACTORS, SUCH AS THE phases of the season in Paralympic ath- cise standpoint, the resistance phase is
PHASE OF THE SEASON, THE letes (60). Moreover, allostasis (e.g., pro- generally termed “recovery.” Bishop
DENSITY OF THE WEEKLY cesses from the organism involved in the et al. (10) categorized this recovery
SCHEDULE, AND THE ATHLETES’ responses to daily events) leads to differ- period into 3 categories (i.e., immediate
GOALS. ent psychobiological responses (49) that recovery, short-term recovery, and
play a role in the different physiological
systems’ responses and adaptations to
KEY WORDS:
exercise (8). Therefore, it is well estab-
cold-water immersion; contrast baths;
Address correspondence to Francisco Tavares, lished that acute responses and chronic
performance
[email protected]. adaptations are dependent of a series of

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 essential factor in the exercise-
adaptation cycle (10).
Highly trained team-sport athletes fre-
quently train 2 or more times daily for
2 or more consecutive days (5,68,69).
The high density of the weekly sched-
ule results in a limited time for recovery
between training sessions. Therefore,
fatigue levels (e.g., muscle damage, de-
layed onset muscle soreness [DOMS],
Figure 1. Schematic representation of the training response. The blue line represents and performance) may not return to
the enhancement in recovery (9,40) and the potential blunting effect on baseline between training sessions
muscle adaptation from the use of cold recovery modalities (59,81). (20,46,69,73). This may lead to an
excessive level of accumulated fatigue
during the week or training phase (20)
long-term recovery). For the nature of coaches to allow for athletes to recover
that could ultimately result in under-
this review, recovery will be defined as between sessions or between training performance during the match or lead
the physiological occurrences between phases (Figure 2B) (10,36). If the recov- to an undesirable fatigue status
the end of 1 training stimulus and the ery time between 2 training sessions is (Figure 2C) (18,21). Previous research
beginning of the next (10,71). The too short, training adaptation will be performed on team sports has demon-
magnitude of the performance reestab- affected (e.g., insufficient recovery will strated high levels of accumulated
lishment period is affected by the result in decreased performance; fatigue during the training week (e.g.,
impact of the training stimulus and volleyball (20), basketball (46), and soc-
Figure 2C), and the risk of overreach-
the characteristics of recovery (e.g., cer (73)). To speed-up recovery, sport
ing, overtraining, and illness and injury
strategies to decrease the impact of scientists and coaches frequently
the training stress). Moreover, as afore- is increased (10,36,39). However, from
a physiological perspective, the target implement recovery strategies (Fig-
mentioned, training and recovery re- ure 1) (7,71). Cold modalities such as
sponses will also be affected by the system(s) require a frequent application
cold-water immersion (CWI) and con-
allostatic load an athlete is exposed of training stimulus to adapt
trast water therapy (CWT) are one of
to (8). It is well described in literature (Figure 2A). Therefore, training adap- the most common acute recovery strat-
that an allostatic overload leads to tation will be highly dependent on the egies used by team-sport athletes
inadequate biochemical responses as equilibrium between the training stim- (68,80). For this reason, there are sev-
a protective mechanism that may limit ulus, the allostatic load, and the recov- eral interventional research studies
responses and adaptations from train- ery characteristics (57). For this reason, (20,56) and reviews (44,64,76) on the
ing (49). Adaptations in these psycho- recovery is well established as an efficacy of cold modalities for recovery.
biological responses differ between
subjects. For example, it was demon-
strated that athletes can tolerate psy-
chosocial stress better than untrained
subjects (58). Ultimately, changes in
performance arising from the training
stimulus will be dependent on the
combination of the biological processes
(e.g., physiological and psychobiologi-
cal), given the combination of these pro-
cesses favors adaptation, an improved
performance is expected. If this cycle is
repeated and sequenced with appropri-
ate recovery, over time an increase from
the baseline will occur for those physical
components of fitness specific to the Figure 2. Schematic representation of hypothetical training capacity/preparedness to
training stimulus, leading to positive train (vertical axis), according to the 3 different intervals between training
stimulus (blue arrow). (A) The interval is too long and no adaptation occurs
adaptation (10) (Figure 2B).
(undertraining); (B) the interval is appropriate and adaptation will occur;
The timing for the next training stim- and (C) the interval is too short and the training capacity decreases as the
ulus must be carefully programmed by accumulated fatigue increases (overreaching) (10,39,57).

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 Water Immersion in Team Sports

Table 1 overall recovery process. The character-

Typical CWI and CWT protocol characteristics istics of the water immersion protocols
will be discussed later in this article.
Weeks Temperature Sets Total duration Immersion
Cold-water 8–158C 1–3 5–15 min Whole body or ACUTE AND CHRONIC EFFECTS
immersion lower body When strength and conditioning
only coaches explore the effects of a recov-
Contrast Cold: 8–158C, 3–6 cold 9–15 min (1 min
water Hot: 33.5– and cold; 1–3 min
ery modality, it is recommended to
therapies 458C hot hot) investigate both the acute and chronic
effects (71). The acute effects refer to
Adapted from Refs. 9,40,71. the changes occurring in a short time-
frame, with measurements of fatigue
being collected at different time points
after a fatiguing task (e.g., match or
COLD MODALITIES AND modalities involving immersion in water training session) (24,77). The time
PHYSIOLOGY lead to hydrostatic pressure-induced points used in research include nor-
The most commonly used cold modal- changes in blood flow, with some mally 1 or more of the following peri-
ities to enhance recovery within team- research studies suggesting a beneficial ods: (a) between sessions within the
sport athletes are CWI and CWT effect by promoting metabolic waste same training day (i.e., up to 6–8 hours)
(71,80). Another popular method of removal (11). Nevertheless, as reviewed (4,56); (b) between a late session of 1
cold exposure includes whole-body by Ihsan et al. (33), previous research day and the early session of the follow-
cryotherapy (WBC) (6,17). WBC in- observed no effects on metabolite clear- ing day (i.e., 12–18 hours) (24,77); and
volves short exposure (2–4 minutes) ance; therefore, other mechanisms (c) or the time between 2 sessions sep-
to extreme cold (2110 to 21408C) rather than metabolite clearance may arated by a recovery day (;36 hours)
induced by air (6,17). In addition to the promote recovery after cold exposure. (42,77) (Figure 3).
somewhat invasive nature of WBC, During CWT, athletes alternate Although monitoring the acute time-
this technique is very expensive and between cold and hot water immersion. frame changes on different markers
therefore not regularly used by teams Hot water increases vasodilation, lead- provides the rationale for implement-
and/or athletes. In comparison, water ing to an increase in blood flow and ing a given recovery modality, one
therapies (CWI and CWT) can be low facilitation of oxygen and antibody sup- should not neglect the effects on the
cost and more widely used in team ply, metabolite clearance, and a reduc- longer time-frame (71). Tracking
sports (68,71,80). Therefore, for the tion in muscle spasm and pain changes over longer periods (e.g.,
purpose of this practical review, we will (16,32,79). Alternating, cold and hot throughout various weeks) will provide
focus on the use of water immersion for water immersion (i.e., CWT) results in important information concerning the
recovery. The typical CWI and CWT both vasoconstriction and dilation that chronic effect of certain recovery
protocol characteristics implemented may lead to changes in blood flow and modality use (27,68).
within team sports can be found in reduction in swelling, inflammation, and
Table 1 and are discussed later in this muscle spasm (16,32,79).
ACUTE EFFECTS OF COLD-WATER
review. As cold exposure seems to alter neuro- THERAPIES
The biochemical and physiological physiological mechanisms, the type of Cold modalities (i.e., CWI and CWT)
mechanisms underpinning the application (9), temperature (44,76), dura- have been associated with an
enhancement of recovery due to cold tion (26), and immersion depth (19,74) enhanced recovery as observed by
exposure have been extensively re- used in various cold-water therapy pro- the decrease in muscle damage
viewed elsewhere (11,64,78). Briefly, tocols is expected to have an important markers (25,77) and perceptual levels
the exposure to cold decreases skin, impact on the responses (e.g., decrease in of fatigue, well-being, and soreness
core, and muscle temperatures (78). the core temperature (78)), and thus, the (56,77). Responses in DOMS are of
The reduction in temperature leads to
vasoconstriction which in turn de-
creases swelling and acute inflammation
from muscle damage (16,32,40,79).
Moreover, a reduction in nerve conduc-
tion properties and a decrease in muscle
spasm and pain are also expected
because of reduction in tissue tempera- Figure 3. Rationale for the time frames typically used in studies investigating the
ture (16,32,79). In addition, cold effects of water immersion recovery modalities (4,24,42,56,77).

50 VOLUME 40 | NUMBER 4 | AUGUST 2018

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 particular interest, as an increase in from practitioners on implementing justification for the improvements
muscle soreness is associated with cold modalities to enhance recovery. observed from CWI in highly trained
structural damage to the skeletal mus- Therefore, 2 theories have been pro- cyclists (27). Nevertheless, further inves-
cle and consequent disorganization of posed for the usage of cold modalities tigations in this and other mechanisms
the myofilament alignment which in (27): (a) cold recovery modalities allow are necessary to understand metabolic
turn is associated with loss of neuro- for athletes to perform subsequent responses to cold recovery modalities.
muscular function (15,45). Therefore, training sessions with a greater qual-
cold modalities are believed to enhance ity/quantity (i.e., greater training load) DESIGNING THE WATER
the reestablishment of muscle function leading to a greater response/adapta- IMMERSION PROGRAM
postexercise (24,56,77). However, tem- tion stimulus (24,25,56,77); and (b) The periodization of recovery, in partic-
porary decreases (e.g., immediately cold modalities may decrease adapta- ular, the use of cold modalities, should
after fatiguing exercise) in neuromus- tions to training through a reduction in be carefully designed as happens with
cular performance associated with protein synthesis response (22,59,82). psychological, nutritional, physical,
a reduction in the neural drive and technical, and tactical components
Nevertheless, several limitations have (64). Recovery modalities have been
enzymatic activity have been reported
been raised regarding previous research suggested to be added as a supplement
previously (24). Ultimately, an increase
investigating the chronic effects of cold to the essential components (i.e., sleep,
in muscle function (e.g., mechanical
modalities and their practical applica- hydration, rest, and nutrition) (71). This
output), perceived muscle soreness
tion to athletes (27,71). Briefly, cold pro- is supported by the perceived impor-
and well-being is of utmost importance
tocols used were considerably more tance of different recovery modalities
for athletic performance. Nevertheless,
aggressive to those used in practice in 507 male athletes who have ranked
equivocal results have been found
(e.g., 40 minutes in 58C water); the char- nutrition, sleep, and hydration within
regarding the acute effects of cold ther-
acteristics of the subjects (untrained or the top 6 recovery modalities (75). In
apies on recovery. Although some
studies demonstrated a beneficial effect recreationally trained) were different order for one to incorporate cold
of cold modalities (24,25,56,77), others from an athletic population; training modalities within the recovery program,
failed to find benefits (30,42). Different load was fixed (e.g., load lifted was fixed practitioners must account for the pro-
variables (e.g., sex, body composition, to a % of the maximum) in which sub- tocol characteristics, external factors
etc.) have been suggested to account jects were not allowed to lift heavier such as the phase of the season and
for the individual responses commonly even if they could. Moreover, the train- individual factors such as sex and body
observed (64). ing frequency (2–33 training sessions composition (Table 2) (64,71). As pre-
per week) used in these studies poten- viously mentioned, there is a rationale
CHRONIC EFFECTS OF tially allow for full recovery between for an improvement on endurance per-
COLD-WATER THERAPIES sessions, limiting the rationale for the formance from exposition to cold
Although most studies support the inclusion of cold modalities. In addition, recovery modalities (27); nevertheless,
acute benefits of cold modalities on recent research does not support the research is inconclusive. Therefore, the
recovery, some literature suggests that notion that CWI reduces inflammation, external factors’ section was based on
chronic use of such modalities can at least compared with active recovery requirements for neuromuscular perfor-
negatively influence training adapta- (2,53,55). Given these limitations, fur- mance responses and adaptations.
tion (59,81). The acute fatigue and ther research on the chronic exposure
associated metabolites arising from to cold modalities has been recently PROTOCOL CHARACTERISTICS
exercise has an important role on the suggested (27). It is also important to
signaling of anabolic processes (61). mention that chronic exposition to cold Temperature. Figure 4 displays the tem-
For example, Roberts et al. (59) recovery modalities has been associated perature changes in different tissues
observed a decrease in the activity of with an increase in endurance perfor- (skin, deep muscle, and the core) before,
the mammalian target of rapamycin mance within highly trained athletes during, and after various forms of cryo-
(mTOR) pathway and satellite cells (27). One of the possible mechanisms therapy (78). It is clear that superficial
after 10 minutes of CWI at ;108C. suggested for the beneficial effect of tissues (e.g., skin) cool quicker than
Given this, shortening the recovery pe- cold exposition (27) is the increased deeper tissues (e.g., core) and also return
riods between sessions by implement- response on transcriptional coactivator to their precooling temperatures at
ing cold recovery strategies may lead to peroxisome proliferators–activator a faster rate (78).
a decrease in the training adaptations receptor gamma coactivator-1 alpha As cold exposure seems to reduce
(59,81). The beneficial acute effects of (PGC-1a) to cold temperatures (63). intramuscular inflammation and
cold modalities and the potential for The PGC-1a is involved in the regula- impair anabolic signaling (55,59), expo-
reduced muscle adaptations in their tion of the mitochondrial function sure to colder temperatures is expected
use in the chronic setting has led to and oxidative metabolism; therefore, to cause a greater reduction in the
an extensive debate and questioning it has been suggested as a potential inflammatory response. The potential

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 Water Immersion in Team Sports

Table 2 It is also important to understand that

Protocol characteristics, individual and external factors to be considered superficial tissue temperatures reduce
when designing a water immersion recovery protocol and rewarm significantly quicker than
deeper tissues (78). As a result, repeated
Protocol characteristics Individual factors External factors exposures (e.g., 2 3 5 minutes with
Duration of exposure to Physique traits Phase of the season .10-minute between-bouts) (47) may
cold be a more effective method than a con-
stant exposure (e.g., 1 3 10 minutes) for
Type (CWT/CWI) Sex Density of the weekly schedule reducing deep tissue temperatures.
Immersion depth Age Goals of the athlete (long term and
short term)
Type. When considering the applica-
Temperature used tion of either CWI or CWT, it is impor-
CWI 5 cold-water immersion; CWT 5 contrast water therapy. tant to understand the different
neurophysiological and psychological
effects each of these will have on the
caveat to this is that a greater reduction been shown to reduce blood flow and body. Results from a recent
in the inflammatory response will lead tissue temperature more so than shorter meta-analysis demonstrate that CWI
to a larger attenuation in the anabolic durations (26). This is logical given the is an effective strategy to reduce DOMS
signaling pathways. and improve recovery in muscle power
fact that tissues cool down in a gradual
(40). Similar results to the ones
The results of 2 recent studies (1 meta- manner, as opposed to instantaneously.
found for CWI were also reported in
analysis and 1 randomized control Recall from Figure 4 that superficial tis-
a meta-analysis, investigating the effects
trial) suggest that there may be an sues (e.g., skin) cool quicker than deeper
of CWT (9). When CWI and CWT
ideal zone for water temperature dur- tissues (e.g., core), with skin reaching
were compared, no differences between
ing CWI (between 11 and 158C) when its minimum temperature after 8– interventions were observed in the lev-
attempting to optimize recovery 9 minutes of cooling when using an els of muscle soreness or muscle pain
(31,44,76). If true, it may suggest that ice-pack (34), and deeper tissues (9). No differences were reported for
lower temperatures (e.g., #108C) could reaching minimum temperatures much creatine kinase (CK) at any time points
blunt the inflammatory and anabolic later, even after the cold exposure has (,6 hours up to 72-hour postexercise),
responses to an extent which eventu- finished (47). As a result, duration should lactate dehydrogenase (,6 hours and
ally becomes counterproductive to be an important factor considered when 24-hour postexercise), myoglobin
recovery and adaptation. attempting to reduce the inflammatory (24-hour postexercise), and inflamma-
process of deeper tissues. Given this tory markers (C-reactive protein and
Duration. The duration of exposure is information, it becomes obvious that IL-6; 24- and 48-hour postexercise) (9).
also likely to have an impact on the the exposure duration also plays a signif- A trend was observed for a greater CK
magnitude of the recovery effect. icant part in the intensity of the exposure removal (all time points) after CWI in
When water temperature remained (i.e., increased duration equals greater comparison with CWT (9). CWI has
constant, longer CWI durations have intensity). also been demonstrated to be beneficial
in comparison with CWT on lactate
dehydrogenase clearance after 48 and
72 hours (9). For changes in strength
and power, the differences between
CWI and CWT are inconclusive (9).
Last, in a study which compared the
effects of CWT (alternating 1 minute
immersed in water baths at 388C and
1 minute at 158C for a total of 14 mi-
nutes) with contrast shower therapy
(alternating 1-minute exposure to
shower with water at 388C and 1 minute
at 188C for a total of 14 minutes) and
a passive intervention in elite netballers,
Figure 4. Temperature change at the skin (black full line), core (black dashed line), and the authors found no differences in per-
deep intramuscular (blue line) sites during exercise, cooling, and post- formance among conditions (35). Nev-
cooling. Adapted from Ref. 78. ertheless, perception of recovery was

52 VOLUME 40 | NUMBER 4 | AUGUST 2018

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 enhanced in the CWT and contrast Regarding immersion depth and sur- insulation to thermal transfer in com-
shower therapy in comparison with face area, whole-body immersion parison with skin and muscle; there-
passive recovery. The findings from this seems to reduce core temperature to fore, it is expected that fat has a role
study demonstrate that given the limi- a greater extent than lower-body when athletes are exposed to cold/hot
tations in facilities and logistics in team immersion alone (19,74). Interestingly, water (65). Moreover, BM increases
sports, using contrast shower therapy immersion into very cold-water tem- heat production and retention (3).
can improve perception of recovery to peratures may actually counteract Nevertheless, greater BM is associated
the same extent as CWT (35). some of the positive effects caused by with greater BSA. Knowing that evap-
In conclusion, when comparing the the hydrostatic pressure. It is well oration, convection, and conduction of
ability of CWI versus CWT for known that cold water induces vaso- heat are dependent on BSA, it is ex-
enhancing recovery, numerous studies constriction (16,32,40,79) and upregu- pected that larger BSA leads to in-
have reported CWI as being superior lation of the parasympathetic nervous creases in heat exchange (64). Given
(9). This may not be surprising because system (14), both of which lead to this, it has been suggested that BSA:
CWT only exposes athletes to a reduction in heart rate and thus car- BM be included in research exploring
;5 minutes of cold; therefore, the diac output. This response causes the thermal effects in subjects with differ-
potential for attenuating the inflamma- body to reduce peripheral blood flow, ent physique traits (64,65). Although
tory process is reduced with such short prompting increases in central metab- greater BSA:BM facilitates heat loss,
exposure times. Again, the flipside to olism to maintain this core tempera- lower BSA:BM facilitates heat reten-
this, however, is that the potential for ture (79). So, although hydrostatic tion (64). Increases in the BSA:BM
blunting adaptation is reduced because pressure increases cardiac output and ratio can occur from either an increase
the inflammatory response is barely stroke volume, cold water may have an in the BSA, a reduction in BM, or both.
affected. For these reasons, CWT is opposing effect by causing the body to These characteristics are particularly
expected to be less intense in terms reduce peripheral blood flow in an important in sports where body com-
of reducing the inflammatory and ana- attempt to preserve energy and main- position and size are considerably dif-
bolic responses than CWI. tain core temperature. It is believed ferent (e.g., rugby and American
that an increased central metabolism football).
enhances the production of waste
products and erodes energy stores, Given the association between sex and
Immersion depth. The immersion body fat or BSA:BM (i.e., females .
depth during water therapies is likely both of which are considered negative
and unwanted effects after exercise, males (48)), different responses to
to have an effect on the intensity
and when attempting to enhance water immersion recovery protocols
of the exposure in 1 of 2 ways: (a) the
recovery time (79). are expected for the different sexes.
deeper the immersion, the greater
Furthermore, one should also realize
the impact of hydrostatic pressure on Because of the pressure gradient of that skin temperature (Tsk) and core
the body; and (b) during deeper immer- water, it is expected that increases in temperature (Tc) are sensitive to the
sion, a larger surface area is in contact immersion depth are associated with period of menstrual cycle, with higher
with the cold, meaning more heat trans- further increases in venous and lym- temperatures during the luteal phase in
fers from the body to the water, and thus phatic compression, in addition to ele-
comparison with the follicular phase
having a greater thermal stress. During vations in stroke volume and cardiac
(37). Although these individual factors
immersion, the effects of hydrostatic output. As exposure to larger surface
have been recently identified in the lit-
pressure cause venous and lymphatic areas causes an increased energy loss
erature (64), the dose-response rela-
compression (79), which ultimately lead and thus increases the thermal stress, it
tionship according to these individual
to an increase in cardiac output and may be suggested that greater immer-
factors has yet to be explored. Briefly,
stroke volume (1). Research on diving sion depths increase the intensity of
subjects with lower BSA:BM and
animals (72) supports the notion that the modality.
greater fat mass should be exposed to
greater hydrostatic pressure gradients more severe cold protocols. Given that
will lead to further increases in cardiac INDIVIDUAL FACTORS it is difficult to have cold baths with
output and stroke volume. Although The individual factors of age, sex, psy- different temperatures within the same
immersion depth seems to have no chological, and physique traits lead to environment, increasing the duration
impact on muscle strength recovery, different responses to cold modalities of the protocol is probably the more
power output, inflammatory markers, (64). Essentially, differences in body practical way to increase the intensity
or muscle soreness (41), increasing car- composition (i.e., muscle mass and when individualization is desirable.
diac output and stroke volume may still body fat) and the ratio between body Another important factor when
have beneficial effects on recovery by surface area and body mass (BSA:BM) incorporating cold modalities is the
improving nutrient delivery and facilitat- seem to justify individual responses athletes’ belief of efficacy of a given
ing the removal of metabolites (11). to cold (64). Fat provides greater modality (68), as exposing an athlete

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 Water Immersion in Team Sports

to a modality he or she dislikes and do (i.e., cold recovery modalities) is likely As with noncompetition periods, also
not believe in may lead to a cascade of to decrease this cascade of mechanisms during the competition periods, one
psychobiological responses that are and potentially decrease training adap- should be mindful when deciding to
harmful for adaptation (49). Future tations. Studies performed in rats sup- include/exclude cold recovery modal-
research should aim to understand port this notion (54). In the few ities. For example, in elite team sports
the physiological responses from ath- mechanistic clinical trials involving such as rugby union, in-season resis-
letes who believe versus those who do cold-water therapies in human partic- tance training programs are designed
not believe in cold modalities. ipants, results have consistently shown to maintain the gains that occurred
a decrease in muscle inflammation and during preparation periods looking
EXTERNAL FACTORS anabolic signaling from cold exposure for further increases in strength,
(55,59). For this reason, during non- power, and speed (5,23). Given this,
Phase of the season (goals of the competition periods that involve train- cold modalities can enhance recovery,
phase). From a resistance training per- ing designed for increases in muscle allowing athletes to be more fresh on
spective, during periods where in- mass, it seems counterproductive to the subsequent training day and conse-
creases in muscle mass and maximal reduce the inflammatory response quently increase the training quality (e.
strength are a key goal (e.g., g., power output) (56,77). Nevertheless,
from exercise by exposing athletes to
off-season and preseason), moderate- during some periods and/or with some
CWI or CWT (71). It is, however,
to high-repetition protocols are nor- athletes (see below; the athlete goals
important to mention that even during
mally implemented to promote muscle section), training programs can be de-
noncompetition periods, different ath-
hypertrophy (70). Mechanisms signed for increases in muscle mass.
letes will be exposed to different types
involved in the hypertrophy of the Given the different intensities and
of training according to individual
muscle cell are believed to be partially aggression of the cold modalities used,
needs (50). For example, some athletes
associated with exercise-induced mus- one can also periodize the specific pro-
cle damage (EIMD) and the conse- can be aiming to increase peak power tocols (Table 3). In this example, during
quent increases in the activity of output. To achieve maximal neural the first phase of preseason, athletes
satellite cells and inflammatory cells stimulus (e.g., peak power), it is impor- refrained from using cold modalities
as well as the increase in the cell swell- tant that each lift is performed maxi- as the goal established for these ath-
ing (61,62). Moreover, EIMD is asso- mally and therefore, sessions must be letes during this phase of the season
ciated with increases in muscle performed with athletes being in a non- was to promote gains in muscle mass,
soreness, temporary muscle damage, fatigued state (38). Given this, during and therefore, muscle damage, associ-
intramuscular protein and passive mus- these training phases, CWI or CWT ated with an increase in DOMS, is
cle tension and decrease in muscular can aid in training quality, therefore desirable. During the second phase of
strength and range of motion (43). increasing the potential for training the preseason, resistance training
These responses to EIMD will mediate adaptations. For this reason, it is impor- would target essentially increases in
various anabolic signaling pathways tant to understand that the advice to maximal strength; therefore, incorpo-
(e.g., Akt/mTOR pathway) that will completely avoid cold modalities rating low-intensity cold recovery
ultimately increase protein synthesis within preseason or other preparatory modalities can enhance recovery,
(61,62). As discussed, exposure to cold period is not conclusive (2,71). increasing training quality.

Table 3
Example of the resistance-training goals of a 9-week pre-season phase and recommendations for use of cold modalities
Period Preseason 1 Preseason 2

Main general Muscle mass and Unload Strength, power, and speed
goals strength
Weeks 1 to 4 5 6 to 9
Intensity of cold + + ++ ++
modalities
Example CWT: 23 (1 min CWT: 33 (1 min CWT: 23 (2 min CWI 1 3
cold:2 min hot) cold:2 min hot) cold:2 min hot) 5 min cold
CWI 5 cold-water immersion; CWT 5 contrast water therapy.

54 VOLUME 40 | NUMBER 4 | AUGUST 2018

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 Competitive level (density of the

Match Day

Very High
weekly schedule). The competitive

High
level of an athlete is often associated

Recover to perform
Very
with the training frequency and den-
sity of the training week, resulting in
a reduction of the time to recovery. It

Recover to perform

CWI: 2 3 5 min
is expected that athletes competing at

(2 min cold:
lower body

lower body
1 min hot);
(11–158C);
a higher level (e.g., professional versus

Day 5

+++

day off

++

CWT: 33
amateur) have a greater number of

Low or
weekly training sessions and training

Low
Example of a cold recovery scheme for elite and amateur team-sport athletes during an in-season week
days when comparing with athletes
competing at lower levels of competi-
tion (68). Given the increase in the

(2 min cold:

(1 min cold:

lower body
1 min hot);

2 min hot);
training density within the week,

full body
Day 4

to High
Moderate

Moderate
to Low
greater fatigue levels can be expected

CWT: 33

CWT: 33
++

+
(68). For example, in a previous study,
it was observed that during a traditional
in-season week, elite rugby athletes
train up to ;11 hours (;7 hours of
Day off

Day off
Day 3

rugby training and ;4 hours of gym

training) and play 1 match, whereas
amateur rugby athletes train for a total

Recover to adapt
of ;6 hours (;3 hours of rugby train-

(1 min cold:

lower body
2 min hot);
ing and ;3 hours of gym training) and

Moderate to
Day 2

play 1 rugby match (68). In addition,

CWT: 33
+
Recover to adapt

High
the demands of a match may differ
High

between elite and amateur levels,

Table 4

increasing the time to recover. For

example, in contact sports, different
Moderate

levels of muscle damage (e.g., CK lev-

Day 1

els) can be observed between elite and

Low to

amateur levels (51,52,66). Using rugby

Low

as an example, after an elite match,

peak CK values ranging from 941 to
Day off

2,194 U/l have been reported

Off

off
Day

(25,51,52), whereas in amateur rugby

CWI 5 cold-water immersion; CWT 5 contrast water therapy.

matches, concentrations of CK range
from 375 to 1,081 U/l (28,56,66,67).
CWI: 2 3 5 min

CWI: 2 3 5 min

Therefore, it is not surprising that some

Recovery from

Recovery from
Match day

(11–158C);

(11–158C);

researchers have observed significant

full body

full body
damage

damage
+++

+++
Very High

Very High

increases in CK 120 hours after an elite

rugby match (52), whereas in amateur
rugby, CK values returned to baseline
48 hours after a collegiate match (66).
These differences in the markers of
cold modalities
Intensity of cold

muscle damage support the need for

modalities

an individualized approach when im-

Intensity of

plementing cold recovery modalities

Example

Example
Training

Training
load

load

for different levels of athletes and for

different sports (Table 4).
If the frequency and intensity of the
training sessions and match-play an
Amateur

athlete is exposed to allows for natural

Elite

recovery (e.g., full recovery between

sessions), the usage of cold modalities

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56

Water Immersion in Team Sports

VOLUME 40 | NUMBER 4 | AUGUST 2018

Table 5
Example of a cold recovery scheme for team-sport athletes with a high and low training age during an in-season week

Match-day Off Day 1 Day 2 Day 3 Day 4 Day 5 Match-day

Training load Very high Day Low to High Day off Moderate Low Very high
off moderate to high
High Categorization Recovery Recover to adapt Recover to perform
training from
age damage
Intensity of +++ + + ++ +++
cold
modalities
Example CWI: 2 3 5 min CWT: 33 CWT: 23 CWI: 1 3 5 CWI: 2 3 5 min
(11–158C); (1 min cold: (2 min cold: min cold (11–158C);
full body 2 min hot); 2 min hot); (11– lower body
lower body lower body 158C);
full body
Low Categorization Recovery from Recover to adapt Recover to perform
training damage
age
Intensity of +++ + ++
cold
modalities
Example CWI: 2 3 5 min CWT: 33 CWT: 33
(11–158C); (1 min cold: (2 min cold:
lower body 2 min hot); 1 min hot);
lower body lower body
CWI 5 cold-water immersion; CWT 5 contrast water therapy.

Copyright ª National Strength and Conditioning Association. Unauthorized reproduction of this article is prohibited.
 should be limited. In addition, fatigue, be an option. An example for a training
Phil Healey is
wellness, and soreness levels are rec- week in athletes with different training
the Head of
ommended to be monitored frequently ages during the in-season can be
Strength and
to understand whether the athletes are observed in Table 5.
Conditioning of
fresh when they need to be (e.g.,
CONCLUSION the Glasgow
power training day or match-day). It
Cold modalities are widely imple- Warriors Rugby.
is important to mention that even dur-
ing the training week, one can imple- mented for team-sport athletes and
ment cold modalities at different their effects in enhancing recovery
intensities, or not implement cold from training and competition are
modalities at all, allowing for some well documented. Nevertheless,
residual fatigue and soreness to be recent research suggests that imple- Tiaki Brett
present and therefore promoting adap- menting cold modalities such as CWI Smith is a Senior
tation to occur. In addition, using can be detrimental for chronic train- Lecturer in
different protocols to diminish the ing adaptations in athletes. There- Health, Sport
monotony of recovery sessions may fore, as with any training stimulus, and Human Per-
be appropriate and potentially increase cold recovery protocols must be formance at the
the likelihood of a placebo effect (12). carefully manipulated by practi- University of
As demonstrated in Table 4, on the day tioners to each situation and individ- Waikato, a Sport
before and after the match, more ual to promote greater adaptations Scientist for the
intense cold modalities can be imple- and subsequent performance. Under- Chiefs Rugby and Consultant Sport
mented to enhance recovery to standing the intensity of the training, Scientist for Rowing Australia.
increase performance in the match the density of the week, the athletes’
and to enhance recovery from individual goals and the requirements
the match. during the season will provide the Matthew
rationale for the implementation Driller is a Senior
Goals of the athlete (long term). The and intensity of the cold modali- Lecturer in
goal of an individual athlete is important ties used. Health, Sport
when selecting the use of cold modali- Conflicts of Interest and Source of Funding: and Human Per-
ties and deciding the intensity of the The authors report no conflicts of interest formance at the
protocols to be implemented. For exam- and no source of funding. University of
ple, it is common to observe age-group Waikato and the
athletes training within elite senior Head of Performance Physiology, High
squads. Normally, these athletes have Francisco Performance Sport New Zealand.
lower training ages and therefore have Tavares is
lower body weight and muscle mass in a PhD candi-
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