Ice bath

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Champion weightlifter Karyn Marshall taking an ice bath after the Crossfit Games in 2011.

In sports therapy, an ice bath, or sometimes cold-water immersion or Cold Therapy, is a training regimen usually following a period of intense exercise[1][2] in which a substantial part of a human body is immersed in a bath of ice or ice-water for a limited duration. While it is becoming increasingly popular and accepted among athletes in a variety of sports,[3][4][5][6] the method is controversial[7] and potentially dangerous,[8][9] with little solid scientific evidence to support or refute its usefulness or to understand its method of operation within the body[5][10] (although there is speculation about processes within the body regarding vasoconstriction). In medicine, the practice would be classified as cryotherapy which uses low temperatures as medical therapy.

History

A Polar Bear Club in Massachusetts.
Two Russian women preparing to bathe in the lake.
File:Professor Sugarman Postcard Little Falls New York.jpg
Professor Sugarman, the "human polar bear", circa 1900.

There have been traditions of people ice swimming in the middle of winter on a lake for short stretches, sometimes as part of a Polar Bear Club. Sometimes people taking short swims for thirty seconds or so have felt invigorated afterwards.[8] The Coney Island Polar Bear Club was founded in 1903. A Polar Bear member explained:

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It is definitely stimulating. Your feet freeze, your voice changes a few octaves and if you're a man you freeze your balls off.

— Mike Kahlenberg, 2006[8]

In the 1890s, Russian immigrant Professor Louis Sugarman of Little Falls, New York, brought his practice of ice bathing to the United States. He attracted worldwide attention for his daily plunge in the Mohawk River, even when the thermostat hit 23 below zero, earning him the nickname "the human polar bear".[11]

In 1899, an Iowa woman filed for divorce from her husband because he had forced her to undergo ice baths.[12] There has been a tradition in American football of pouring a large bucket of ice water on the winning coach as a victory celebration.[13] And physical therapists have applied ice packs to selected areas of the body to prevent swelling.

Long distance champion Paula Radcliffe is believed to have popularized its use after her victory in Europe in 2002.

Until recently, however, bathing in ice was seen as unusual. One account suggested that ice bath therapy did not become popular until 2002, when marathon runner Paula Radcliffe won the championship in Europe and attributed her victory to its use.[14] She reportedly said "It's absolute agony, and I dread it, but it allows my body to recover so much more quickly."[15] She reported taking ice baths before racing and preferred her pre-race bath temperature to be "very cold."[8] After the Radcliffe comment, the technique has grown in popularity.[14] It is gaining in popularity among athletes,[5][6][14] such that some athletes "swear by it"[14][16][17] but other accounts suggest it may be a fad.[8][14] It has been used by athletes such as A. J. Soares[3] and Olympic swimmer Michael Phelps[18] as well as other celebrity endorsers[19] and is getting to become "common practice" among athletes[17][20][21] from different sports, including American football,[22] association football (soccer),[2][3] long distance running,[5][7][23] rugby,[1][14] tennis,[24] volleyball,[4] and other sports. There was a report that sports equipment manufacturers are considering different designs for ice baths.[25] In the summer of 2014, as a fundraising method, the nonprofit ALS Association, which raises money for research and public awareness of amyotrophic lateral sclerosis or ALS, also known as Lou Gehrig's Disease, began the Ice Bucket Challenge which involved donors filming themselves and challenging other donors to participate and then being doused with a bucket of ice cold water; as a fundraising effort, it raised $16 million over a 22-day period.[26][27]

There are indications that ice baths may be gaining popularity with groups outside sports, such as dance. The Pittsburgh Post-Gazette reported that some Radio City Rockettes, a precision dance company performing in New York City, use ice baths after a long day of performing as a way to "unwind" and cope with "aches and pains."[28] One report suggested that entertainer Madonna used ice baths after her performances.[29] And there are indications that use of ice baths is spreading to amateur sports, such as high school football.[30]

Ice baths are a part of a broader phenomenon known as cryotherapy––the Greek word cryo (κρυο) means cold––which describes a variety of treatments when cold temperatures are used therapeutically. Cryotherapy includes procedures where a person is placed in a room with "cold, dry air at temperatures as low as −135 °C" for short periods of time, and which has been used in hospitals in Poland as well as a center in London to treat not only muscular ailments, but psychological problems such as depression.[8] Basketball player Manny Harris reportedly used a Cryon-X machine featuring extreme low temperatures around minus 166 degrees Fahrenheit, but used it with wet socks resulting in a serious freezer burn.[31]

Occasionally ice baths have been an ill-advised treatment of fever in young children, but that doctors were counseled not to use this technique because of the risk of hypothermia.[9] Ice baths have been suggested as a way to prevent muscle soreness after shoveling snow.[6]

Iceman Wim Hof in an ice bath in 2007.

In addition, there have been instances of ice bathing as an extreme bodily test by persons vying for an endurance record, such as Dutch Iceman Wim Hof,[32] and Chinese record-holders Chen Kecai[33] and Jin Songhao.[34] According to reports, doctors and scientists are studying how these people can spend an hour and a half submerged in an ice bath, and survive; for almost all humans, such tasks are impossible.[citation needed]

Method of operation

Bath

It is done by standing or sitting in a bucket or bath of icy water. One writer advised: "don't overdo it."[20] Wearing rubberized "dive booties" on the feet (to protect toes) as well as rubber briefs to warm the midsection have been recommended. Champion weightlifter Karyn Marshall, who won the world women's weightlifting championship in 1987,[35] described what it was like to take an ice bath after a day of competition at the CrossFit Games in 2011 in Los Angeles:

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The first day I went in for twelve minutes, and the second day for fifteen minutes. They kept adding ice to keep the temperature at around 55 degrees (Fahrenheit) ... The hardest part was the first two minutes. Others who do it often told me to just hang in for two minutes and then it would be easier. After two minutes I was numb. Afterwards I was shivering for two hours in the hot California sun with a warm up jacket on.

— Karyn Marshall, 2011

One report suggested that if ice water is circulating, it's even colder such that the water will be colder than measured by a thermometer, and that athletes should avoid overexposure.[36] Physical therapist Nikki Kimball explained a way to make the bath more endurable:

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Over those years, I've discovered tricks to make the ice bath experience more tolerable. First, I fill my tub with two to three bags of crushed ice. Then I add cold water to a height that will cover me nearly to my waist when I sit in the tub. Before getting in, I put on a down jacket and a hat and neoprene booties, make myself a cup of hot tea, and collect some entertaining reading material to help the next 15 to 20 minutes pass quickly.

— Runner's World, 2008[23]

Ice bath only versus contrast bath therapy

Accounts differ whether it is best to follow the ice bath with a hot shower; two accounts suggested that a hot shower followed by a massage would be helpful,[24][37] but other reports counsel against such a practice. There are reports that some athletes use this technique, sometimes known as contrast water therapy or contrast bath therapy, in which cold water and warmer water are alternated.[20] One method of doing this was to have two tubs––one cold (10–15 degrees Celsius) and another hot (37–40 degrees Celsius) ––and to do one minute in the cold tub followed by two minutes in a hot tub, and to repeat this procedure three times.[20]

Temperature and timing

The temperature can vary, but is usually in the range of 50–59 degrees Fahrenheit[5][23] or between 12 and 15 degrees Celsius.[20][38] Some athletes wear booties to keep their toes warm[5] or rubberized coverings around their midsection while immersed. Some drink a warm beverage such as tea.[5] One report suggested that "ten minutes immersed in 15 degree Celsius water" was sufficient.[20]

Accounts vary about how long to be immersed and how often to do them. One adviser suggested that an athlete should take ten two-minute ice bath treatments over a two-week period.[8] One account suggested immersion times should be between ten and twenty minutes.[23] Another suggested that immersion run from five to ten minutes, and sometimes to twenty minutes.[20] There were no sources advocating being immersed for longer than twenty minutes.

Ice baths versus cold baths

Several sources suggest that cold baths (60–75 degrees Fahrenheit) were preferable to ice baths. Physiotherapist Tony Wilson of the University of Southampton said that extremely cold temperatures were unnecessary and a "cold bath" would be just as effective as an ice bath.[8] Another agreed that a mere cold bath is preferable to ice baths which are "unnecessary."[20] A third report suggested that cool water (60–75 degrees Fahrenheit) was just as good as cold water (54–60 degrees Fahrenheit) and that eight to ten minutes should be sufficient time, and warned against exceeding ten minutes.[36]

Medical efficacy

In summer 2014, the Ice Bucket Challenge went viral on social media to raise money for the ALS Association.

There is theoretical speculation, although unproven, about how the ice bath technique might operate,[20] as well as differing accounts about how the technique is supposed to help the human body. A common theme is that the cold prompts the body to recover faster from an intense period of activity.[39] According to several accounts, the cold in the ice bath signals temperature receptors to alert the brain to "withdraw blood to the body's core".[8] According to another account, after five to ten minutes, the "icy cold water causes your blood vessels to tighten and drains the blood out of your legs."[15][19][20] Another report suggested that it causes metabolic activity to slow.[20] After getting out of the ice bath, the blood is pumped[20][37] "vigorously" back to tissues "stimulating oxygen and nutrient supply to areas that need revitalising," according to several assessments,[8][22] and another suggests that blood flow is sped up,[20] sometimes described as a "blood rush."[38] A report along these same lines suggested that the benefit came from after the ice bath with "increased blood flow" bringing fresh nutrients to an "inflamed, injured area" which helps the tissues heal.[24] A slightly different explanation was that cold causes the diameters of blood vessels to contract during the period of immersion in the ice water, meaning that more toxins were pumped out of the area, similar to a massage.[8] And blood is a way to bring oxygen to the cells as well as remove waste products from muscular exertion, particularly lactic acid.[15] Here is one description of how it is believed to work:

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The muscles will cool and relax after a few minutes in the bath. At the end of the bath you will experience a strong flush of blood circulating through the muscles that were submerged. This sudden increase in circulation speeds up and improves the quality of muscle recovery by quickly flushing out the lactic acids that have built up in the tired muscles.

— Tilman von der Linde in The Vancouver Sun, 2009[4]

Ice baths are generally believed to be a way to help the body recover from a vigorous workout, with one account suggesting helpful effects not only for muscles, but for tendons, bones, nerves, and other tissues as well.[15] An advantage cited is that cold-water immersion is a more "efficient means of cooling large groups of muscles simultaneously" and helps lead to "longer lasting changes in deep tissues."[23] A second report echoed this view and suggested that "immersion allows controlled, even constriction around all muscles."[38]

Ice baths have been a source of medical treatment when a person is suffering from heat illness, and when this happens, sufferers are urged to get into an air conditioned room quickly or get into an ice bath.[40]

Benefits

Benefits are speculative but include the following:

  • Prevents injury.[5][15][38]
  • Speeds recovery. According to one report, it is believed to decrease the amount of time needed by the muscles of athletes to return to top condition between training sessions.[8][20][41]
  • Keeps muscles limber.[5] One account suggested it would reduce muscle soreness after heavy exertion, such as after snow shoveling.[6]
  • Repairs muscles.[21][37]
  • Reduces inflammation.[5] But one account disputes there is any benefit in fighting inflammation.[5] However, according to Greg Whyte of the English Institute of Sport, inflammation may be good for the body and act as an "important and beneficial part of the muscle's response to training."[14]
  • Less muscle soreness.[10][38][41]
  • Less muscle pain.[14][20]
  • Less muscle stiffness.[14]
  • Treatment for heat-related illnesses such as heat stroke.[42]

Drawbacks

  • Risk of breathing difficulties.[43]
  • Possibly medically dangerous. There are reports that "exposing yourself to prolonged cold" may result in hypothermia[9] or frostbite[43] or shock[10][43] and that sudden exposure to extreme cold could harm patients with heart problems[10] or airway diseases such as asthma and possibly lead to sudden death.[8] One doctor explained:
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From a medical perspective there are two main risks from the cold - hypothermia and frostbite. It's not that difficult to get either of these if exposed to cold for a period of time.

— Dr. Lisa Silver[8]

Scientific investigation

The consensus view is that there is little solid scientific research to support a case that ice baths are either beneficial or detrimental for athletes.[5][8][20] Professor Kenneth L. Knight of Brigham Young University said there is no evidence to either support or refute the claim that ice-bath treatments, or cryotherapy methods in general, reduces inflammation.[5] Runner's World.com executive editor Mark Remy believes that ice-bath treatments are "bunk" opining that it is an "elaborate practical joke being played on runners."[7] Physiotherapist Chris Bleakley of the University of Ulster reported that there are "no high-level scientific studies that say this is good for the body" although he admitted that athletes had been reporting positive results,[8] and that there is considerable anecdotal evidence from athletes that it makes them "feel better."[19] In contrast, one report suggested that there was scientific research showing that ice baths promote recovery, but no specific studies were cited.[23] There have been smaller-scale studies which either indicate no benefit or a detrimental effect,[44] or that offer "inconclusive or contradictory findings."[20] A report in The New York Times suggested that there had been "little study" of cold therapy versus other treatment regimens such as compression sleeves or ibuprofen.[10] There have been reports that suggest that cryotherapy used before training can reduce the amount of lactic acid produced by the muscles and "speed up its removal" afterwards.[45]

Cochrane survey

A 2012 systemic database review was conducted of either fourteen[46][47] or seventeen[48] existing studies of 366 subjects which compared cold-water immersion following exercise with doing nothing or resting as a way to prevent subsequent muscle soreness. Study variables included the level of soreness, cold water immersion versus no treatment, intensity and duration of exercise, time between exercise and measurement of soreness, and other variables. The authors found evidence that cold water immersion had a slight effect on reducing soreness, not immediately after exercise but at intervals of up to 96 hours after exercise, and that it lowered levels of fatigue and sped up physical recovery, although they noted that these studies did not examine other variables such as possible negative effects on the body. The authors concluded that high quality research was required.[46]

Australian study

A study by Australian researchers, publishing in the British Journal of Sports Medicine on a small sample size, suggested that ice bath therapy may "do more harm than good."[14][20][49] The team asked 40 volunteers to undergo leg exercises and gave half ice baths and the other half a dip in tepid water. Researchers measured pain levels, swelling, performance in a "hopping test" and blood chemicals which might indicate damage to muscles, and found no statistically important differences between the two groups, except that the ice therapy treated volunteers experienced more muscular pain in the leg upon standing from seated position compared to the control group (median change on a 0–100 mm visual analog pain scale of 8.0 vs 2.0 mm, respectively, p = 0.009).[14][19][20][50] The study found that:

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Ice-water immersion offers no benefit for pain, swelling, isometric strength and function, and in fact may make more athletes sore the next day.

— British Journal of Sports Medicine, 2007[19]

Study of cyclists

One study in 2008 in the International Journal of Sports Medicine suggested that cold water immersion and contrast water therapy might help in situations where athletes engaged in "high intensity efforts on successive days", such as weightlifters in a multi-day competition.[20] Researchers studied cyclists during a week of intense training and found that they performed better with these methods than complete rest or hot water baths.[51]

Leg press study

A study in 2007 reported in the Journal of Strength and Conditioning Research found that contrast water therapy delayed the onset of muscle soreness after "intense leg press exercise" and found "faster restoration of strength and power in athletes" who used this therapy instead of a merely "passive recovery."[17]

English Institute of Sport study

This study suggested that ice baths could help top athletes recover faster during a peak competition but that such methods should not be used during training since it limits the "growth and strengthening of muscle fibers."[16][52] The authors of the study, including physiologist Jonathan Leeder, counseled against ice bath treatments during training.[16]

See also

References

  1. ↑ 1.0 1.1 Lua error in package.lua at line 80: module 'strict' not found.
  2. ↑ 2.0 2.1 Lua error in package.lua at line 80: module 'strict' not found.
  3. ↑ 3.0 3.1 3.2 Lua error in package.lua at line 80: module 'strict' not found.
  4. ↑ 4.0 4.1 4.2 Lua error in package.lua at line 80: module 'strict' not found.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 Lua error in package.lua at line 80: module 'strict' not found.
  6. ↑ 6.0 6.1 6.2 6.3 Lua error in package.lua at line 80: module 'strict' not found.
  7. ↑ 7.0 7.1 7.2 Lua error in package.lua at line 80: module 'strict' not found.
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 8.11 8.12 8.13 8.14 8.15 Lua error in package.lua at line 80: module 'strict' not found.
  9. ↑ 9.0 9.1 9.2 Lua error in package.lua at line 80: module 'strict' not found.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Lua error in package.lua at line 80: module 'strict' not found.
  11. ↑ Lua error in package.lua at line 80: module 'strict' not found. Lua error in package.lua at line 80: module 'strict' not found. Lua error in package.lua at line 80: module 'strict' not found.
  12. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  13. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  14. ↑ 14.00 14.01 14.02 14.03 14.04 14.05 14.06 14.07 14.08 14.09 14.10 Lua error in package.lua at line 80: module 'strict' not found.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 Lua error in package.lua at line 80: module 'strict' not found.
  16. ↑ 16.0 16.1 16.2 Lua error in package.lua at line 80: module 'strict' not found.
  17. ↑ 17.0 17.1 17.2 Lua error in package.lua at line 80: module 'strict' not found.
  18. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  20. ↑ 20.00 20.01 20.02 20.03 20.04 20.05 20.06 20.07 20.08 20.09 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 Lua error in package.lua at line 80: module 'strict' not found.
  21. ↑ 21.0 21.1 Lua error in package.lua at line 80: module 'strict' not found.
  22. ↑ 22.0 22.1 Lua error in package.lua at line 80: module 'strict' not found.
  23. ↑ 23.0 23.1 23.2 23.3 23.4 23.5 Lua error in package.lua at line 80: module 'strict' not found.
  24. ↑ 24.0 24.1 24.2 Lua error in package.lua at line 80: module 'strict' not found.
  25. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  26. ↑ August 14, 2014, Campbell North, Pittsburgh Post-Gazette, People around the country have ALS challenge down cold, Retrieved Aug. 18, 2014, "...Those who forgo the ice bath are asked to donate to an ALS organization..."
  27. ↑ Bill Saporito, Aug. 18, 2014, Time magazine, How the ALS Ice Bucket Challenge Could Change Fundraising Forever, Retrieved Aug. 18, 2014, "...Never mind the ice bath; you could have just written the check...."
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  31. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  32. ↑ Joseph Angier, March 7, 2008, ABC News, Iceman on Everest: 'It Was Easy', Accessed April 14, 2014
  33. ↑ BBC News, 4 January 2011, Chilly Chinese compete for world ice bathing record, Accessed April 14, 2014
  34. ↑ Lua error in package.lua at line 80: module 'strict' not found.
  35. ↑ Lua error in package.lua at line 80: module 'strict' not found.
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  48. ↑ Note: This review included 17 studies and 366 total participants and compared the level of soreness at 0, 24, 48, 72, and 96 hours in those with no treatment and those treated with cold water immersion in less than 15 degrees C after many different types, intensities and durations of exercise. The review was limited by selection bias, heterogeneity, inability to subject double-blind restrictions on the participants or personnel, and subjectivity of the pain scale by which soreness was judged. Immediately following treatment, there was no significant difference in soreness between cold water immersion and no interventions (Standardized mean difference -0.07 with confidence interval [-0.43, 0.28]). Cold water immersion was found to significantly reduce muscle soreness at 24 hours (-0.55 [-0.84, -0.27]), 48 hours (-0.66 [-0.97, -0.35]), 72 hours (-0.93 [-1.36, -0.51]), and 96 hours (-0.58 [-1.0, -0.16]). However, the mean soreness difference was less than 1 on a scale of 1 to 10 between cold water immersion and no treatment at each interval.
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  51. ↑ Vaile, J.; Halson, S.; Gill, N.; Dawson, B., Effect of Hydrotherapy on Recovery from Fatigue. Int'l J. Sports Medicine, July 2008.
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