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Ice baths: “lab fatigue” vs. “real fatigue”

September 24th, 2011

Ice baths after a hard workout are very popular, but the evidence for them has always been a little shaky. A group of British researchers (including a pair from the English Institute of Sport) have just published a major meta-analysis in the British Journal of Sports Medicine that adds a couple of interesting insights. The analysis covers 14 different studies with a total of 239 athletes.

What I found most interesting is the following distinction they decided to make:

For the purpose of this review, exercise will be subdivided into two categories: ‘eccentric exercise’ that refers to the stress caused from exercise incorporating high mechanical stress (eg, eccentric contractions) and ‘high-intensity exercise’ that refers to stress caused from exercise with a high metabolic cost as well as some elements of eccentric muscle contractions (eg, repeat sprint sports).

It’s well known that the best way to induce muscle soreness is with eccentric muscle contractions, particularly unfamiliar ones. So most lab experiments on muscle soreness involve simple things like lowering a dumbbell or stepping off a box over and over — it may not be exhausting, but it sure leaves you sore. The problem is, this isn’t the kind of damage that most athletes are interested in recovering from — they’re interested in recovering from training sessions that feature familiar but intense exercise.

So is there a difference between the two? Yes: the meta-analysis found dramatically stronger effect on recovery from “high intensity exercise” than from “eccentric exercise.” It’s worth noting that only two studies looked at the former, while 12 looked at the latter. Still, it offers a possible explanation for why so many athletes believe ice baths help them in training, while lab studies of eccentric exercise continue to find ambiguous results.

Speaking of results, what were the overall conclusions? I quite like the use of forest plots to give a quick visual sense of the overall data. Here are the results for perceived recovery from muscle soreness, with each dot representing a study result (some studies appear more than once for results at 24, 48, and 72 hours after exercise, which is why there are more than 14 dots). Dots to the right of the thick line mean that the ice bath group recovered more quickly; dots to the left of the line indicate that the control group recovered more quickly:

Looks pretty convincing, eh? Unfortunately, the picture is a bit muddier if you look at an objective measure like creatine kinase in the blood (a marker of muscle damage), though there’s still a statistically significant effect in favour of ice baths:

Same goes for recovery of strength:

In the end, we’re still plagued by the fact that it’s impossible to placebo-control an ice bath study. The perceived soreness results do look encouraging, but it’s hard to rule out the effects of the fact that most of the subjects probably expected to feel better when they had the ice bath. By no means is the science settled here yet.

Which brings us to another point that’s currently being hotly debated in scientific and athlete circles (as commenter Rich pointed out last time I blogged about ice baths): If inflammation is part of the body’s adaption response to stress, and ice baths reduce inflammation, does that mean ice baths reduce your adaption to hard training? Interestingly, the lead author of the current study, Jonathan Leeder of the English Institute of Sport, commented on this question in an EIS press release last year:

“There’s evidence to suggest that if you constantly decrease the stress in training that the body won’t adapt, so long term use of a recovery technique, such as an ice bath, should be reviewed to avoid any detrimental effects on performance and to ensure that these techniques have their biggest impact when needed during competition” [Leeder] adds.

But is there really evidence to back this hypothesis up? Here’s what Leeder and his co-authors say in the peer-reviewed BJSM:

It has, however, been suggested that the inflammatory response is critical for optimal repair of damaged tissue. Although the mechanisms of training adaptation are not fully understood, it may be detrimental to reduce the commonly accepted damage-repair-adaptation model by diminishing the inflammatory response; however, there is a lack of evidence to support this. This raises the question of whether frequent or habitual use of strategies designed to reduce inflammatory responses can be detrimental for elite athlete adaptation to training.

So that’s where we’re at: no one really knows whether repeated ice baths have a practically significant effect on reducing adaption to training. From what I understand, the English Institute of Sport has been advising its athletes to avoid ice baths after routine sessions during heavy training phases, but to incorporate them during tapering and competition. In other words, periodize your recovery protocols so that you maximize adaption during training periods and maximize recovery during competition periods. Does this work? Maybe we’ll find out at next year’s Olympics!

 

  1. September 24th, 2011 at 15:44 | #1

    There is a few articles I have read about the stress/adaption factor that ice baths take away. There is another side to think about also, most athletes use ice baths to recover their muscle, but when I submerse into ice water the body will redirect some blood away from the muscle towards the vital organs as a way to protect it, like the heart. So if you had stressed the cardiac system then you may well have a great recovery for the heart, but if your intend was recovery of the muscle then you are taken blood away from the muscle when you would probably want more blood there. Ice baths may play a role between races where fast recovery is important, it is a choice you have to make when to use it. There is a very similar argument with using antioxidants for recovery in that the body needs to adapt to the stress to get stronger before you help it along.

  2. jroundel
    September 24th, 2011 at 18:35 | #2

    Interesting stuff there are just so many variables and possibilities. I mean you could say on the other hand that recovery from one workout to the next is as important as letting the inflammatory response work itself out naturally. What if using the ice bath recovered you quicker for your next workout so that you could get a greater stimulus whereas that may not have been possible with a slower recovery? I guess more of a long term study would be required, just a thought.

  3. September 25th, 2011 at 18:25 | #3

    Something I’d be interested in would be long term effects on health of ice bath users, especially regarding incidence of injuries – mostly tendons and joints.

  4. July 29th, 2013 at 13:30 | #4

    At the FIFA Injuries Summit held at Wembley Stadium in April 2013, Greg Dupont of Lille FC and Lille University reported that the main pre-cursor of injury is fatigue. And the main scientifically proven modalities for reducing fatigue were sleep, cold water immersion and diet. These conclusions based on monitoring Champions League players over two seasons. Copy of research available on request. colin@cetcryospas.com

    Regarding Team GB / EIS during London 2012 – they used 6 of our CryoSpas for the whole of the games with great success!

  1. September 25th, 2011 at 05:31 | #1
  2. September 26th, 2011 at 18:46 | #2
  3. July 11th, 2012 at 20:36 | #3