Commentary

Taking the ice bath plunge for muscle soreness -- helpful or not?

By Dev K. Mishra, M.D.

I've noticed for a long time now that adult endurance athletes will often jump into an ice bath after a race or particularly strenuous training session. This practice is common in the triathlon and endurance running community. Like many things touted by elite adult athletes, the youth sports community seems to be giving this a try as well.

I’ve seen this done at youth triathlon, youth running, and I’m now starting to see the ice-bath plunge even at team sport events. So what’s the deal here? What’s supposed to be happening? Is there any evidence to support the claims?

The belief and the theory

I want to be clear that what we’re discussing here is jumping into an ice bath to help reduce muscle soreness, and not using ice for a swollen ankle or knee. Athletes who use ice baths usually do so for about 5 to 10 minutes.

Certain types of repetitive muscle exercise can cause injury to muscle fibers at the microscopic level. The micro damage actually leads to improved muscle performance and muscle growth over weeks of training, but in the first hours or days after intense exercise the muscles can become very sore. Athletes who use ice baths believe they are less sore, recover faster, and have better performance in the next training session.

Here’s what the ice bath is reported to do:

• Constrict blood vessels, speed up removal of exercise related metabolic products like lactic acid.
• Reduce swelling.
• Reduce tissue damage.

Ideally, the legs then go through a re-warming process that is supposed to re-establish good circulation, improve healing, and improve performance.

Is there any evidence for effectiveness?

The published evidence examining ice water baths is not conclusive, but generally favors use of the ice baths to reduce pain. Whether the ice bath actually improves performance though, is debatable.

This review article stated that the use of ice baths is very popular, supported by many national organizations, and seems to improve the athlete’s comfort level. However, they noted that measurements of power production were sometimes reduced after ice baths.

Another study published in 2015 in the Journal of Strength and Conditioning Research examined a blood marker of muscle damage called myoglobin and found significant reductions in myoglobin with cold or heat as compared to no recovery treatment after exercise. The authors concluded that using either heat or cold reduced muscle damage from intense exercise. The interesting part here is that heat worked just as effectively as cold to reduce muscle damage.

There are a number of older studies, similarly showing that ice baths are effective in reducing pain, but inconclusive regarding improved performance.

And finally, there are a few studies that compared active recovery (such as a cool-down jog or light cycling, combined with dynamic or static stretching) to ice bath or cold bath. The few studies available don’t show any substantial benefit to the ice bath compared to active recovery.

Final thoughts

So there are a few things we can take away from this brief review.

• Ice baths done for a brief time (5 to 10 minutes max) seem to be helpful in reducing pain.
• ... But heat might also be helpful in reducing pain.
• Both ice and heat appear to reduce the amount of myoglobin released in the blood, indicating that either ice or heat may reduce muscle damage from exercise.
• An active recovery cool-down is important, regardless of whether ice or heat is used.
• The studies are all done on adult athletes, so I advise caution in young athletes.

Somehow I have a feeling the post-game ice bath will prove to be more fad than fact. But it’s probably not going away any time soon.

* * * * * * * * * *


Key Points:
• Ice baths have been popular with adult endurance athletes for a long time, and are claimed to reduce soreness and improve recovery.
• The available evidence seems to indicate that post-exercise ice -- or heat -- can reduce muscle soreness, and possibly reduce muscle microtrauma.
• There is no consensus regarding improved recovery or performance.
• Active recovery (meaning: a cool-down jog or light cycling) clearly seems to be effective.
• I advise caution for the young athlete, as the published studies are done on adult athletes.
• I have a feeling there is more fad than fact here.

(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.)

4 comments about "Taking the ice bath plunge for muscle soreness -- helpful or not?".
  1. Brendan Coyne, July 25, 2016 at 4:29 p.m.

    I've noticed Kryotherapy at recent youth soccer tournaments, namely spot treatments with a small contraption resembling a shop vac and a heat gun which monitors skin temperatures (I think they look for a skin temp not to go below 32 deg F.
    Anyway, definitely seemed to help a leg cramp on my daughter (she said she did not even feel it the next day, but all her other muscles were still sore). It convinced me to go for a chronic neck pain and I will say I was ibuprofin free for the next 3-4 weeks.
    Yes, I know probably a fad as well.... But my questions is, would Kryotherapy have the same effect as an ice bath at least in theory? I see the pro trainers using the dermablast(tm) cans on the pitch at the pro level. Isn't that the same principle?
    I have to say one reason I liked the Kryo treatment is that it only took a minute or two for the spot treatments to complete and I was on my way (no shivering!)
    Any thoughts on Kryo?

  2. Steven Hulland, July 25, 2016 at 5:41 p.m.

    I will follow the research on this and react accordingly but I would love to hear from a few professional athletes and trainers as I know this process gives some relief from the pain and swelling. Carli is know as the "ice queen" due to using ice baths for recovery. Under 12, it seems excessive but for a long weekend of four games for 13 and up athletes, the baths seem to help and the Dr agrees that no harm if done correctly.

  3. Richard Brown, July 26, 2016 at 12:36 a.m.

    Some professional dancers do it and some don't. The ones that do are true believers.

    I believe in a cool down and a massage after if you have a masseur with your club team.

    Years ago it was an Epsom salt bath and a massage.

    I told another poster here if I did an ice bath at my age today I would probably have a heart attack and expire :)

  4. Bob Ashpole, July 26, 2016 at 2:50 p.m.

    This is a complicated subject. Is recovery compared at 24 hours or at 48 hours? At what point does soreness become injury? I suspect the practice is accepted in extreme distance running because the events greatly stress soft tissue. Which brings to mind the question of why do we subject youth to playing multiple competitions on the same day? Treating pain by any means between youth matches seems to me to be very unwise regardless of whether there are any known long term risks to it.

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