What are the benefits of cold water immersion on delayed onset muscle soreness (DOMS) after exercise?

From the Guidelines

Cold water immersion is not recommended as a primary treatment for painful post-training muscles due to its potential to decrease nerve conduction and muscle contraction velocities, which may impair athletic performance. The most recent and highest quality study available is from 2015, published in the British Journal of Sports Medicine 1, which discusses the use of cold-water immersion (CWI) for training and competing in the heat. According to this study, CWI protocols involve whole-body immersion for ∼30 min at a water temperature of 22–30°C, or body segment immersion at lower temperatures (10–18°C). However, this study also notes that cooling of the legs/muscles will decrease nerve conduction and muscle contraction velocities, and athletes might therefore need to re-warm-up before competition.

Some key points to consider when evaluating the benefits of cold water immersion for post-training muscle pain include:

• The potential for cold water immersion to reduce inflammation and numb nerve endings, which may provide temporary pain relief
• The potential for cold water immersion to impair long-term muscle adaptation and strength gains
• The importance of proper nutrition, adequate hydration, gentle stretching, and sufficient sleep for optimal recovery
• The need to consult a healthcare provider if muscle pain persists beyond 72 hours or is accompanied by severe swelling or limited range of motion, as these may indicate a more serious injury requiring medical attention. Another study published in Sports Medicine in 2015 1 also discusses the use of CWI protocols, but the British Journal of Sports Medicine study 1 is more relevant to the question of post-training muscle pain.

From the Research

Benefits of Cold Water in Painful Post-Training Muscles

• The use of cold water immersion or whole-body cryotherapy is a common practice for recovery from exercise, with the primary benefit being reduced pain following injury or soreness following exercise 2.
• Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury, although comparable evidence in humans is lacking 2.
• A novel application of cooling with 15 °C phase change material (PCM) has been administered for 3-6 hours with success following exercise, and does not compromise acute adaptation 2.
• The effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased 2.

Comparison with Other Recovery Methods

• Foam rolling is thought to improve muscular performance and flexibility as well as to alleviate muscle fatigue and soreness, but its effects on performance and recovery are rather minor and partly negligible 3.
• Foam rolling can be effective in reducing muscle pain perception and improving recovery of strength performance, but its effects are generally smaller than those of cryotherapy 3, 4.
• Heat therapy can also be effective in reducing pain and disability, particularly in patients with acute low back pain, but its effects on recovery from acute musculoskeletal injury and DOMS are less well established 5.

Mechanisms and Efficacy

• The physiological effects of cold therapy include reductions in pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand 5.
• The mechanisms of action of cryotherapy are not fully understood, but are thought to involve reductions in inflammation and tissue damage, as well as improvements in muscle function and recovery 2, 5.
• More research is needed to fully establish the efficacy and optimal protocols for cryotherapy and other recovery methods, particularly in humans 2, 5.