After working as team physiotherapist across many different sporting codes I have come to find that most sporting clubs, coaches and players across different sports have a general idea of what to do to best help their body recover after intense exercise/competition. But sometimes, like a lot of other theories in physio – this idea is heavily varied and I wanted to know what is actually the best way according to the evidence? Typically you hear of ice baths, ocean recoveries, hot-cold showers, heated hydrotherapy pools etc., as the typical accepted ways to help athlete recovery from muscle soreness and fatigue.
Most football clubs generally recommend ocean recoveries, which is typically completed the next morning as a recovery session. But the evidence would suggest that the earlier the recovery session takes place, the better, with most studies getting the best results when completed within 30 minutes post game. However, in most amateur football clubs most players will have hot showers after a game especially after playing on a cold rainy day. The intention to use the ocean as cold water immersion therapy is definitely a good thing and there is evidence that completing recovery outside of this 30 minute period is still beneficial however there would be much more benefit if completed earlier.
Hot-Cold showers are a much easier and practical recovery technique to do in this environment and accepted as a good recovery method however the evidence does suggest that full water immersion is really required to help get the full gains of hydrostatic pressure to help with increasing blood flow. Therefore transferring between a hot and cold pool’s would really be best especially as showering really has minimal contact on the lower limb.
A systematic review of the evidence on water-based recoveries for athletes was conducted at the Australian Institute of Sport as well as some leading Universities. They reviewed multiple studies that were comparing ice baths, hot- cold pools (contrast water therapy CWT) and hot water therapy.
Cold-water therapy and contrast therapy were found to be more effective in assisting recovery and exercise performance compared to heat therapy. There was insufficient evidence to say which out of cold or contrast therapy was more effective but the evidence did lean towards cold therapy. However, it was mentioned that the effectiveness might depend on the sport.
Cold therapy was found to be most effective with the combination of studies finding that 10-14 degrees was the desired temperature for the best result. A larger water immersion depth was thought to have a greater physiological effect on the body and therefore potential performance benefits due to increase of body circulation. Therefore complete coverage up to the neck in a cold bath, sitting or standing in a cold pool and standing in the ocean rather deep would be the best practical ways of applying this method.
Contrast therapy (hot-cold) was found to be effective however the heating component can exacerbate the inflammatory and swelling response of the body. In my opinion there are some sports where this, although brief, period of heat exposure could be detrimental to recovery due to the very common multiple muscle contusions (“corkies”) and bony bumps taken during contact sport such as AFL football and basketball. Athletes don’t always notice how bad these are at the time as they are not limited enough to stop playing but an ice bath or cold water pool would be much better in aiding their recovery as well as general fatigue.
However, sometimes full immersion in a cold pool or ocean is not always practical due to time and resources etc. Working with the State Netball team this year saw me working with a group of young girls where some were travelling 2-3 hours to come to training. With no access at the stadium to cold pools the best we could do was recommend a cold shower before their car trip home and recommend a stop to a nearby beach or to complete a cold bath or pool session once they arrived home. However, once at our Nationals destination we were able to organise recovery pools that we set up at our accommodation which allowed us to complete full body immersion in ice-cold water directly after each game which was paramount for the girls performance.
Main Practical Recommendations for Sporting Recovery:
- Ice baths/cold water immersion (ocean, pool, bath) – are most effective when at 10-14 degrees.
- Recovery is most effective when completed as soon as practically possible – preferably around 30 minutes post competition. However it is not a waste of time if completed hours later or the next day.
- Water immersion time is best when around 15-20 minutes but can be on and off (in and out of water for example).
- Full water immersion (feet to shoulders rather than just legs) is much more effective as the hydrostatic pressure is likely to cause a faster blood flow to help remove waste products associated with fatigue and provide nutrients to the muscles.
- For the same reasons where possible an active recovery (movement or light stretching movements) whilst in the water has a better effect on blood flow to help recovery rather than being stagnant.
- Using cold-water therapy would be preferable over heat or hot/cold therapy for high contact sports where lots of knocks and bruises may be present.
- Hot water therapy is not the best on the day due to the potential to increase inflammation and swelling. This could be appropriate in 1-2 days to help soothe tight muscles.
- Important not to forget the importance of diet and sleep for recovery.
- With no easy access to pools a cheaper option to take to the sporting club would be a small blow up pool that could be used with some ice and cold water after the game.
Versey, N., Halson, S., & Dawson, B. (2013)
Water Immersion Recovery for Athletes: Effect on Exercise Performance and Practical recommendations. Sports Med, 2013, 43.
Vaile, S., Gill, N., & Dawson, B., (2007). Effect of Hydrotherapy on Recovery from Fatigue. International Journal of Sports Medicine, 29, 539-544.