Long-term Effects of Frequent Cold Water Immersion Therapy Usage

on Leg Strength in Male Collegiate Distance Runners

Dunlap, H., Goslin-Klemme, N., Kauder, P., & Till, J.

Loras College
 Stressing the human body to the point of change is one way

athletes are able to improve in their specific sports. According

to Wolff’s law, a person’s body will adapt, after continuous

stress to a training load, leading to greater efficiency within

one’s body (Boyle & Kim, 2011). Wolff’s law helps explain how a

person’s bones adapt over time to the stress they are put under,

becoming stronger, and thus being able to handle more stress

(Frost, 1990). Furthermore, according to Hall (2014), Wolff’s

law states that as the various forces acting on a person’s bones

increases or decreases, their bone strength will proportionally

increase or decrease as a result. Untrained people have less

dense bones because they put less stress on their skeletal

system. Those who are trained typically have denser bones,

meaning their bones are stronger. This adaptation allows for

athletes’ bodies to adjust to their training. Then athletes can

continue stressing their bodies, which will continue to adapt so

they can better perform.

Even with the body’s adaptation to training, recovery is

still necessary. Research recommends recovery because this

intervention assists athletes in avoiding negative effects of

training exercise such as overtraining, which can lead to larger

problems such as injuries ​ ​(Vetter & Symonds, 2010). Recovery

aids have become a frequently used and accepted part of many

athletic practices. Adequate recovery, then, is the body’s

ability to restore both physiological and psychological

processes to full effect, allowing for peak physical

performance. (Stephens, Halson, Miller, Slater, & Askew, 2017).

Passive recovery is a method of recovery which is best defined

as resting after a given exercise or workout (Joo et al., 2016),

instead of other recovery techniques, like active recovery, cold

water immersion therapy, etc.

Cold water immersion therapy (CWIT) is a common recovery

aid, one of several recovery methods studied. CWIT is the

submersion of individuals in cold water ranging anywhere from

4.4-15.5°C. This, in theory, facilitates muscle recovery

allowing for a lessened inflammatory response which would allow

the body to return to play faster (Kaczmarek, Mucha, & Jarawka,

2013). Research suggests this specific technique is a successful

way to reduce delayed onset muscle soreness (DOMS), and other

short-term muscle fatigue symptoms athletes encounter. DOMS is

the soreness/stiffness effect athletes experience when muscle

fibers undergo micro-tears, after bouts of physical activity

(Cheung, Hume, & Maxwell, 2003). DOMS occurs after a couple

days, hence the delayed response, and the most intense symptoms
generally develop around forty-eight to seventy-two hours after

exercise, before decreasing (J. M. Vaile, Gill, & Blazevich,

2007). However, some research suggests that repeatedly blocking

the inflammatory healing response of muscle over an extended

period will result in fewer long term muscular strength

increases.

While ice baths are a common recovery technique, their

tendency to reduce the inflammatory response may actually hinder

athletes. One group of scientists from Japan hypothesized that

training-induced molecular and humoral adjustments, such as

hyperthermia (increased body temperature), are a normal function

of our body in response to stress, and temporary and crucial for

training effects such as myofiber regeneration, muscle

hypertrophy, and improved vascularization and blood supply. Ice

baths would slow these temperature dependent processes, like

hyperthermia-induced stress protein formation (Yamane, et. al.,

2006). Stress proteins are important in recovery because they

protect cells from stress and apoptosis (cell death) (Li &

Srivastava, 2004). In lessening the immediate production of

stress proteins, more damage would be done to the cells, causing

recovery and adaptations to take longer when an athlete takes an

ice bath. In reality, the opposite of what the athlete intended

to get out of their ice bath is occurring, as they are hindering

their recovery instead of helping. In which case, we believe

cold water immersion therapy will impair leg strength

improvement in college athletes long term. The purpose of this

study is to determine if cold water immersion therapy is not

beneficial in regards to increasing leg strength over a four

month period for male collegiate distance athletes.

Background:

There is much discrepancy in regards to whether CWIT

actually helps with a person’s performance. According to a 2007

study conducted by Crowe, O’Connor, and Rudd, researchers found

that CWIT, as a recovery technique, did not yield any benefits

for the participants, in a pre and post-trial experiment.

Seventeen active subjects, thirteen male and four female,

between the ages of twenty to twenty-three, were randomized into

two groups, and each had to bike for thirty-seconds at maximal

effort, a ten minute cool-down period, and then either an ice

bath, or passive recovery for fifteen minutes. After one hour

passed, they would bike for an additional thirty seconds. After

two to six days, the subjects repeated the test, and their

efforts were recorded. The study actually found a decrease in

performance for those who ice bathed compared to the passive

recovery method, as the group who passively recovered, performed

better than those who ice bathed. A limitation within this study

was that none of the subjects had ever used CWIT before, so they

reported high discomfort when initially immersed in the water.

Another study conducted by Vaile, Halson, Gill, and Dawson

in 2008, looked at endurance cycling to determine which recovery

method was the most beneficial (hot water immersion, CWIT,

contrast water therapy (CWT), and passive recovery.) The

researchers wanted to test the effects of various recovery

techniques after several days of high-intensity training. Twelve

male, endurance trained cyclists, between the ages of

twenty-eight and thirty-six, were put through four different

testing trials, each trial comprising five days. Every day for

five days, the subjects underwent vigorous exercise meant to

exhaust, which consisted of a main workout each day of sixty-six

sprints, between five to fifteen seconds, on the bicycle, with

easier pedaling in between, and finally a nine minute sustained

effort. All in all, after a ten-minute warm-up, the main workout

totaled one-hundred and five minutes, and a five-minute

cool-down after. Then the cyclists underwent one of the four

recovery methods, consistent for each trial, each of the five

days after their cycling bout. Randomized assignments determined

which trial had which method of recovery. Nine days separated

each trial, and during those nine off days, subjects had to keep

a consistent training load to match what they were doing during

the five testing days. The most significant finding from the

study was that CWIT and CWT enabled the subjects to perform

better compared to the other two recovery techniques. Throughout

the exercises, subjects either closely maintained or improved

their performance over the trial period better with CWIT and CWT

day after day, compared to the other two methods. The findings

from this study help to suggest the successful methods of

recovery on repeated sprint performances, and even longer

performances as well. Although, a limitation from this study is

that there were only twelve male subjects, which is not the best

representative data set. Another possible limitation could be

that the subjects went back to back days for each trial and then

had nine days before the next trial. So, their bodies could have

just adapted to the training loads, and become more fatigue

resistant as they did more trials.

A study done by S. Yeung et al.(2016), looked at the

effectiveness of cryotherapy on muscle performance and muscle

oxygenation between two bouts of resistance exercise. In their

study, 20 subjects (n=10 male and n=10 female) avg. age 22 ±

0.52 perform maximal knee flexion and extension until peak

torque decreased below 60%. After the first test they had a 10

minutes of treatment one group cryotherapy with the bath being

12-15°C with their legs extended and the control group sitting

on a mat with their legs extended. After the recovery time,

subjects had a one minute break then start the second test. Data

was taken at rest, after first test, 5-7 minutes into

intervention, before second test, and then after second test.

The study found that heart rate was significantly lower in the

treatment group compared to the control. There was also a

significant increase in muscle oxygenation in the treatment

group. The study found no significant differences in work done,

peak torque, and fatigue rate between the two groups.

There are many different forms of recovery. In this article

conducted by Lane and Wenger(2004), we see described two

categories of recovery. Active recovery, which would include the

time after activities spent in motion to facilitate recovery,

and CWIT. This research article puts emphasis on training

recovery and recovery aids such as CWIT as the key to physical

performance success. The study took ten physically active males

and performed 2 sessions of identical 18 minute cycling

sessions. The only difference the subjects experienced was the

end recovery technique. Half of the participants were given an

active recovery initiative and the other half was given CWIT

treatment. The results of the study determined that after 2

bouts of cycling sessions both active recovery and CWIT

treatments helped with performance 24 hours later. However, the

study was limited to the small number of subjects and number of

sessions. If the study were to be taken over a longer period of

time and more bouts were performed possible differences may be

observed in the effectiveness of treatments.

In a study conducted by Schaser et al. (2007), research was

done exploring whether or not muscle cooling has a large

difference on muscle micro-tear repair. The study looked into

the inflammatory response and muscle repair of rats with soft

tissue injuries. The rats were split into three groups of seven

male rats with a control group of non-injured rats, a group with

standardized soft tissue injury applied to the left leg with no

cooling treatment, and a group with a standardized left leg

injury in combination with a 6 hour post trauma cooling period.

The effects of cryotherapy were then observed on the rats over

the recovery period of the researcher administered soft tissue

injury. Initially the cryotherapy reduced inflammation and

increased micro-tear healing in the soft tissue injuries of the

rats. However, after prolonged exposure to cryotherapy a

decrease in macrophage activity was measured. Which delayed the

regeneration of skeletal muscle in the rats. Some of the

limitations of this study included the amount of time spent

looking at the rats recovery times. Which were variable

dependant upon the health of the rat, additionally it would be

difficult to maintain consistent injuries when applying a left

leg injury to individual rats. The study also dealt more with

the short term effects of cryotherapy on the rats injuries. Only

dealing with a 6 hour post trauma cooling period. Another

limitation was that the rats were suffering from actual

musculoskeletal injury instead of just microtears.

In a study by Rupp et al.(2012), the researchers looked at

the effects of CWIT compared to a control group, after the

participants went through repeated performance testing.

Twenty-two division one collegiate soccer players, thirteen men

and nine women, between the ages of eighteen and twenty-one,

were put either in the CWIT or control group according to a

randomized assignment. The subjects went through the yo-yo

intermittent recovery test (YIRT) until failure, a common

assessment in evaluating performance in soccer athletes, where

the participants sprint between markers, and gradually are

forced to sprint faster. Then, the subjects recovered according

to their respective group, and then repeated the test again

forty-eight hours later. The CWIT group were immersed for

fifteen minutes in a twelve degree Celsius pool; whereas, the

control group sat quietly for fifteen minutes. The two groups

performed their respective recovery immediately post YIRT, and

twenty-four hours post. This study found no significant

differences between the two groups in regards to their YIRT

testing. Overall, the study found that CWIT, when induced right

after the YIRT, and twenty-four hours post, does not provide

additional benefits for the next performance compared to the

control group. A limitation of the study is that the researchers

used the YIRT, which is said to be a common assessment for

soccer players. Also, with only twenty-two athletes, the sample

size is not the most ideal.

In a study conducted by Jones, Lander, and Brubaker (2013),

research was conducted to measure the effectiveness of 4

different types of recovery aids. Including CWIT treatments,

Active recovery (AR), Passive Recovery (PR), and total combined

recovery (COMB) of all of the other recovery aids. This was

studied across the recovery methods of rugby players. Twelve

rugby players were exposed to twenty countermovement jumps and

thirty second cycle ergometer tests. This test protocol was

continued until participants experienced DOMS. The participants

were then given CWIT treatment along with PR, AR and COMB

treatment. CWI treatment involved subjects being sent into an

ice bath for a period of 10 minutes in temperatures of 10±1°C

the study concluded that CWIT treatment only improved the

perception of recovery compared to AR, PR, and COMB. However, no

differences were observed between the four groups and no one

form of recovery was proven to be more effective than any other.

While CWIT treatment was recommended as an ergogenic aid by the

study. The study only measured the benefits of 10 minute ice

baths once a week with a week break in between. Which limited

the study to a short term study looking at the immediate effects

of ice baths on recovery which showed findings consistent with

other literature that short term CWIT treatment can have some

ergogenic effect on the recovery process. Other limitations

included the difference in fitness of the highly anaerobically

trained rugby players who were subjected to aerobic exercise via

the ergometer bicycling test.

Yamane, Ohnishi, and Matsumoto (2015), studied what happens

when athletes regularly use ice to combat inflammation

post-exercise. Fourteen male subjects participated in

wrist-flexion resistance training for 6 weeks. Seven of the

subjects bathed their arms in cold water (10±1°C) for twenty

minutes after each exercise/training session (iced group) and

the other seven subjects were the control group. Researchers

measured wrist-flexor thickness, brachial-artery diameter,

maximal muscle strength, and local muscle endurance in the upper

extremities before and after the six week training period.

Wrist-flexor thickness improved in each group, showing that the

training intervention was effective in producing hypertrophy;

however, the control group had a significant increase in

wrist-flexor thickness compared to the increase in the iced

group. Also, brachial-artery diameter and maximal muscle

strength increased in the control group, but not in the iced

group. Local muscle endurance increased in both groups, but was

better in the control group (+40% vs. +28%). Together, this led

researchers to believe regular cold application to muscles

post-exercise slows muscular and vascular adaptations to

resistance training (M. Yamane, Ohnishi, & Matsumoto, 2015).

Downsides to this study is that wrist-flexion is an uncommon

exercise to train, so it is hard to say whether larger, more

commonly trained muscle groups would respond in the same way.

Also, it could be that 20 minute ice baths are too long and that
shorter periods of cold application might have a lesser effect

on muscular and vascular adaptations.

In 2016, Aguiar et al. studied CWIT post-high intensity

interval training (HIIT) and measured exercise performance and

several biomarkers related to inflammation and exercise

adaptations. 17 males (age 23±3 years old) performed three HIIT

training sessions per week for four weeks. Nine subjects were

assigned to the control group, and eight were assigned to the

CWI group. After each training session, the CWI group did CWI

for 15 minutes in 10°C. Exercise performance was measured before

and after the HIIT training period with a 15-km cycling time

trial. Both groups finished the post-HIIT time trial faster than

the pre-HIIT time trial (p<0.001), but no difference was found

between groups (p=0.33). Also, CWI increased some markers of

cellular stress response and signaling molecules related to

mitochondrial biogenesis (Aguiar et al., 2016). This suggests

that CWI did not affect HIIT-induced adaptations and improved

several markers of muscle oxidative capacity and cellular

stress, making CWI beneficial in regards to HIIT. Limitations

for this study mainly pertain to how biomarkers were collected

and measured, however, the pre/post time trial comparisons

between the two groups is the main focus of the study.

 When studying CWIT there are many questions yet to be

answered. For example, many studies utilize a wide range of

immersion times and temperatures. No gold standard is apparent

for CWIT use based on the research. In fact, due to the overall

lack of research on CWIT as a recovery technique, most

information is based upon personal testimonies (Wilcock, Cronin,

& Hing, 2006). Some studies have found CWIT treatments reduce

increases in performance. However, many of these studies do not

include commonly trained muscle groups. This is why it is

important that our current study tests leg strength improvement

in relation to CWIT treatments. It is hypothesized that

long-term regular CWIT treatments will impair leg strength

improvements over the course of four months.

Methods:

The design of this study is a cross-sectional experiment

testing CWI and passive recovery after a resistance protocol to

see an increase in leg muscular strength. The independent

variable is CWI or passive recovery (PR). Dependent variable is

maximal leg press lift, where the subjects will do a pre and

post test to see percent change. One of the control variables is

the amount of workouts the subjects will complete.

 Fifty male collegiate distance runners (20± 2 years of age)

from Loras College, University of Dubuque, and Clarke University

were recruited to be subjects for the study. Our study was

vetted and approved by the institutional review board of Loras

College. All subjects signed a written form of consent before

participation. Participants were excluded from the study if they

had a lower extremity injury that will limit their range of

motion or strength. Subjects were then entered into an excel

sheet then randomized into two groups CWI and PR (n=25 CWI and

n=25 PR).

Maximal leg strength data will be tested on a leg press

machine. Subjects will have three chances to get weight up until

legs are fully extended. Once a subject fails to lift the weight

three times the weight lift prior to the last failed attempt

will be used as their one repetition maximum (1RM). For the

purposes of this study we will let muscular leg strength be

defined by 1RM.

The study will be conducted in the Athletic Wellness Center

at Loras College. The first day will be testing the 1RM with a

proper warm-up. Then each subject will do their recovery

technique. The CWI will be done in the athletic training room

with the bath at 7-13˚C for 10-15 minutes. Subjects will have
the bath up past their hips while sitting down with legs

extended. PR group after workout will stretch out with no CWI

after.

After the testing day each group will go through the same

resistance training protocol three days a week for four months.

Each subject has had a past history of resistance training.

During the first month each subject will train at 75% of their

1RM. First day focusing on core lift of deadlift with 1x3 (sets

X repetition) at 55%, 1x4 at 65%, then 4x6 at 75% of 1RM. Second

day core lift will be leg press with 1x3 at 55%, 1x4 at 65%,

then 4x6 at 75% of 1RM. The last day of lifting will focus on

back squat as the core lift with 1x3 at 55%, 1x4 at 65%, then

4x6 at 75% of 1RM. Each day will have different accessory lifts,

for example: leg extension, leg flexion, calf raises, step ups,

and lunges. The accessory lifts will be 3x8 and the weight will

be chosen by the subject.

Second month subjects will train at 85% of 1RM. The first

day will focus on leg press with 1x3 at 60%, 1x3 at 70%, then

5x4 at 85% of 1RM. The second days the subjects will perform

back squat with 1x3 at 60%, 1x3 at 70%, then 5x4 at 85% of 1RM.

The last day, subjects will perform deadlift with 1x3 at 60%,
1x3 at 70%, then 5x4 at 85% of 1RM. The same accessory lifts

will be completed during the second month as the first month.

The third month subjects will train at 95% of their 1RM.

The first day will be back squat as the core lift with 1x2 at

60%, 1x2 at 75%, 1x2 at 85%, then 4x2 at 95% of their 1RM. The

second day will be deadlift with 1x2 at 60%, 1x2 at 75%, 1x2 at

85%, then 4x2 at 95% of their 1RM. The last day, the core lift

will be leg press with 1x2 at 60%, 1x2 at 75%, 1x2 at 85%, then

4x2 at 95% of their 1RM. The same accessory lifts will be

completed during this month.

The last month will go down in intensity to 80%. The first

day the core lift will be leg press with 1x3 at 60%, 1x3 at 70%,

then 4x4 at 80%. The second day will be back squat with 1x3 at

60%, 1x3 at 75%, then 4x4 at 80% of 1RM. The last day’s core

lift will be deadlift with 1x3 at 60%, 1x3 at 70%, then 3x4 at

80% of 1RM. The same accessory lifts will continue during the

last month.

Each workout should last around 60mins. CWI group will then

go do the treatment within 10 minutes after finishing each

workout. During each workout there will be a certified personal

trainer supervising the subjects that has no part in the study

other than knowing the workout protocol. The following week

after finishing the protocol each subject will do a 1RM test to

find their percent change.

SPSS will be used to determine and interpret the data to

see significant difference between the CWI and PR groups. The

change (post-1RM/pre-1RM X 100% - 100% = %change in 1RM) in 1RM

was recorded and plugged into an independent T-test. Statistical

significance was set at P<0.05.

Limitations to the study were that we would have to keep

the subjects from exercising outside of our intervention

workouts. It is highly unlikely that any college coach would

allow their athletes to participate in this type of study, as

most collegiate distance runners train year round. Another

limitation is keeping the subjects from dropping out during the

protocol. With it being a four month process subjects may get an

injury or stop showing up to the workouts due to conflicts.

Internal limitations include the number of subjects during the

study. We only have fifty starting excluding dropouts.

 References

Aguiar, P. F., Magalhães, S. M., Fonseca, I. A. T., da Costa

Santos, V. B., de Matos, M. A., Peixoto, M. F. D., … Amorim, F.

T. (2016). Post-exercise cold water immersion does not alter

high intensity interval training-induced exercise performance

and Hsp72 responses, but enhances mitochondrial markers. ​Cell

​ ​21​(5), 793–804.
Stress & Chaperones,

Boyle, C., & Kim, I. Y. (2011). Three-dimensional micro-level

computational study of Wolff’s law via trabecular bone

remodeling in the human proximal femur using design space

​ ​44​(5), 935–942.
topology optimization. ​Journal of Biomechanics,

Cheung, K., Hume, P. A., & Maxwell, L. (2003). Delayed Onset

Muscle Soreness. ​Sports Medicine​, ​33(

​ 2), 145–164.

Crowe, M. J., O’Connor, D., & Rudd, D. (2007). Cold Water

Recovery Reduces Anaerobic Performance. ​International Journal of

Sports Medicine​, ​28(

​ 12), 994–998.
Frost, H. M. (1990). Skeletal structural adaptations to

mechanical usage (SATMU): 2. Redefining Wolff’s Law: The

​ ​226(
remodeling problem. ​The Anatomical Record, ​ 4), 414–422.

Hall, S. (2014). ​Basic Biomechanics​ (7 edition). New York, NY:

McGraw-Hill Education.

Jones, B., Lander, J., & Brubaker, D. (2013). The Effects of

Different Recovery Interventions Following a Repeated Rugby

Union (sevens) Game Simulated Protocol. ​Journal of Australian

Strength & Conditioning​, ​21(

​ 4), 5–13.

Joo, C. H., Allan, R., Drust, B., Close, G. L., Jeong, T. S.,

Bartlett, J. D., … Gregson, W. (2016). Passive and post-exercise

cold-water immersion augments PGC-1α and VEGF expression in

human skeletal muscle. ​European Journal of Applied Physiology​,

​ 11–12), 2315–2326.
116(

Kaczmarek, M., Mucha, D., & Jarawka, N. (2013). Cold Water

Immersion as a Post-Exercise Recovery Strategy. ​Medicina

​ ​17(
Sportiva, ​ 1), 35–39.
Lane, K. N., & Wenger, H. A. (2004). Effect of Selected Recovery

Conditions on Performance of Repeated Bouts of Intermittent

Cycling Separated by 24 Hours. ​Journal of Strength &

​
Conditioning Research (Allen Press Publishing Services Inc.),

18​(4), 855–860.

Li, Z., & Srivastava, P. (2004). Heat-shock proteins. ​Current

Protocols in Immunology​, ​Appendix 1,

​ Appendix 1T.

https://doi.org/10.1002/0471142735.ima01ts58

Rupp, K. A., Selkow, N. M., Parente, W. R., Ingersoll, C. D.,

Weltman, A. L., & Saliba, S. A. (2012). The effect of cold water

immersion on 48-hour performance testing in collegiate soccer

​ ​26​(8),
players. ​Journal of Strength and Conditioning Research,

2043–2050.

Schaser, K.-D., Disch, A. C., Stover, J. F., Lauffer, A., Bail,

H. J., & Mittlmeier, T. (2007). Prolonged Superficial Local

Cryotherapy Attenuates Microcirculatory Impairment, Regional

Inflammation, and Muscle Necrosis After Closed Soft Tissue

​ ​35​(1),
Injury in Rats. ​American Journal of Sports Medicine,

93–102.
Stephens, J. M., Halson, S., Miller, J., Slater, G. J., & Askew,

C. D. (2017). Cold-Water Immersion for Athletic Recovery: One

Size Does Not Fit All. ​International Journal of Sports

​ ​12(
Physiology & Performance, ​ 1), 2–9.

Vaile, J. M., Gill, N. D., & Blazevich, A. J. (2007). The effect

of contrast water therapy on symptoms of delayed onset muscle

soreness. ​Journal of Strength and Conditioning Research​, ​21(

​ 3),

697–702.

Vaile, J., Halson, S., Gill, N., & Dawson, B. (2008). Effect of

hydrotherapy on recovery from fatigue. ​International Journal of

Sports Medicine​, ​29(

​ 7), 539–544.

Vetter, R. E., & Symonds, M. L. (2010). Correlations between

injury, training intensity, and physical and mental exhaustion

among college athletes. ​Journal of Strength and Conditioning

​ ​24(
Research, ​ 3), 587–596.
Wilcock, I. M., Cronin, J. B., & Hing, W. A. (2006).

Physiological Response to Water Immersion. ​Sports Medicine​,

36​(9), 747–765.

Yamane, Motoi, Teruya, H., Nakano, M., Ogai, R., Ohnishi, N., &

Kosaka, M. (2006). Post-exercise leg and forearm flexor muscle

cooling in humans attenuates endurance and resistance training

effects on muscle performance and on circulatory adaptation.

​ ​96​(5), 572–580.
European Journal of Applied Physiology,

Yamane, M., Ohnishi, N., & Matsumoto, T. (2015). Does Regular

Post-exercise Cold Application Attenuate Trained Muscle

​ ​36​(8),
Adaptation? ​International Journal of Sports Medicine,

647–653.

Yeung, S. S., Ting, K. H., Hon, M., Fung, N. Y., Choi, M. M.,

Cheng, J. C., & Yeung, E. W. (2016). Effects of Cold Water

Immersion on Muscle Oxygenation During Repeated Bouts of

​ ​95​(1).
Fatiguing Exercise. ​Medicine,