Ice Baths Done Right
Parents of youth athletes increasingly are becoming aware that recovery, or returning the body to its pre-exercise state, is extremely important to their children’s ability to perform optimally. Parents not only want their children to perform well in their athletic events, but also want their children to do so in safe physical condition.
Recently, parents have had questions regarding the use of cold water immersion (CWI), commonly known as “ice baths,” as a form of recovery for youth athletes. “What are the benefits of an ice bath?” - “How do ice baths work?” – “Are there any special considerations for children?” These are just a few questions we commonly hear.
Scientific research has been conducted to help determine the benefits of CWI, and how it is best performed. The following information is based on current evidence regarding the use of ice bath for recovery.
WHAT ARE THE BENEFITS OF AN ICE BATH?
CWI is an effective pain reliever and can reduce symptoms of muscle soreness that may otherwise occur up to 96 hours following high intensity exercise (1)
CWI can result in faster recovery of muscular power that can be lost as a result of strenuous exercise (1)
CWI has no short-term negative effects on recovery from strenuous exercise. The positive effects of soreness relief and accelerated recovery from fatigue validate using CWI as a form of recovery. (1,2,3)
HOW DO ICE BATHS WORK?
A reduction in muscle blood flow and tissue temperature causes a decrease in inflammation that is caused by strenuous exercise. Reducing this inflammation is associated with a reduction of the sensation of pain. (1)
The hydrostatic pressure from the water, or pressure that induces a ‘squeezing’ effect on the body in all directions, will cause blood to flow centrally, or toward the heart. This can also potentially reduce swelling that may be caused by strenuous exercise. (1)
Use of CWI has resulted in decreased levels of creatine kinase, an enzyme produced from muscle breakdown, found in the blood. (1)
Reducing tissue temperature with CWI may reduce secondary tissue damage, or damage to the muscles surrounding the tissue that was most targeted during exercise. (1)
HOW SHOULD THE ICE BATH BE PREPARED TO ATTAIN THE BEST RESULTS?
Temperature should be between 10 and 15 degrees Celsius, or approximately 50-59 degrees Fahrenheit. (2,3)
Duration should range from 5–15 minutes and should depend on the water temperature. The lower the water temperature, the shorter the immersion duration, especially as the athlete builds tolerance. (2,3)
Immersion depth -- the greater the immersion depth, the greater the physiological effect on the body and therefore the potential performance benefits. At maximum, immersion depth should be up to the neck of the athlete. (3)
How soon after exercise – Perform water immersion as soon as possible post exercise to obtain the greatest recovery benefits. The recovery benefits are optimized if immersion occurs within 30 minutes post-exercise, and are reduced when water immersion is performed hours or days after exercise. (3)
Time to subsequent exercise – athletes should allow sufficient time for internal body temperature to increase after using CWI so subsequent exercise performance is not compromised. Exercise should not be performed within 45 minutes of cold water immersion because exercise performance can decrease. Athletes should always perform an appropriate sports-specific warm-up prior to subsequent exercise, especially after CWI, so performance is not compromised. (3)
ARE THERE ANY SPECIAL CONSIDERATIONS FOR CHILDREN?
In general, both male and female children have a lower amount of muscle mass, body fat and body surface area. Therefore, they will have a decreased tolerance AND an accelerated response to the exposure of cold water. As a result, a less intense protocol for CWI should be applied. This would include immersing in water of higher temperatures, near 15 degrees Celsius or 59 degrees Fahrenheit, for a lesser amount of time, between 5-10 minutes. (4)
It is always necessary to consider individual effects and response of the athlete. If immersion has adverse effects toward a particular child, this may not be the best method of choice for recovery.
To date, research has shown that cold water immersion in the form of ice baths can have positive physiological effects on athletes’ recovery from strenuous exercise. Standard guidelines for ice bath include temperature ranges of 10-15 degrees Celsius or 50-59 degrees Fahrenheit, for 5-15 minutes, with the understanding that the greater the immersion depth, the greater the effect on the body. The optimal time period for immersion is within 30 minutes post-exercise, and immersion should not occur within 45 minutes of the next exercise bout. An appropriate sports-specific warm-up should always be done prior to exercise, and especially after CWI, to ensure the body is prepared for safe performance. Special considerations are to be made for children with respect to their body size, and it is always necessary to consider the child’s individualized response to the cold water treatment when determining whether the modality is appropriate.
Leeder J, Gissane C, Van Someren K, et al. Cold Water Immersion and Recovery from Strenuous Exercise: a Meta-Analysis. Br J Sports Med. 2012; 46: 233-240.
Machado AF, Ferreira PH, Micheletti JK, et al. Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis. Sports Med. 2016; 46: 503-514.
Versey NG, Halson, SL, Dawson, BT. Water Immersion Recovery for Athletes: Effect on Exercise Performance and Practical Recommendations. Sports Med. 2013; 43: 1101-1130.
Stephens JM, Halson S, Miller J, et al. Cold Water Immersion for Athletic Recover: One Size Does Not Fit All. Int J Sports Physiol Perform. 2016
Read More Articles by EXOS Regarding Youth Athletes:
Avoiding Injury in the Year Round Athlete
Concussion: Return to Play Q&A
Concussion Injury Prevention in Youth Sports
Dry Needling the Pediatric Population - Applicability and Safety
Charles Ferruzza, PT, DPT, ATC is a Physical Therapist and Athletic Trainer from New York. He graduated from Sacred Heart University in 2014 and moved to Texas in 2016. He has a special interest in working with athletes and preventing injury.