Home 2016 March

Making the Case for Training in the Post-Surgery Period

If you were to spend a day at either the MA or FL Cressey Sports Performance location, invariably, you’d see something that might surprise you: athletes training in spite of the fact that they recently had surgery. On a regular basis, we have athletes referred our way after everything from Tommy John surgeries to knee replacements. They may be on crutches, using an ankle boot, in an elbow brace, wearing a shoulder sling, or even rocking a back brace. Working with post-operative athletes has become a big niche for us; we work hand-in-hand with surgeons and rehabilitation specialists to make sure that we deliver a great training effect in spite of these athletes’ short-term limitations.

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Unfortunately, athletes will sometimes run across hyper-protective therapists and doctors who are overly cautious in this period. Certainly, for a period, this is incredibly important, as there are risks of not only the repair being vulnerable to movements and direct pressure, but also it being compromised by infection in the first few weeks. However, in my opinion, it’s absolutely unnecessary to tell an athlete to just take 3-4 months off completely from exercise and instead just “rehab” – and yes, I have heard this before.

With this in mind, I wanted to outline six reasons I think strategically implemented strength and conditioning work in the post-surgery period is incredibly important.

1. It’s important to make an athlete feel like an athlete, not a patient.

There is a different vibe in a physical therapy clinic or training room as compared to a strength and conditioning setting. This isn't intended to be a knock on rehabilitation specialists, but athletes would rather hang out in the latter realm! And, while great therapists make rehabilitation upbeat and keep the athlete's competitive psyche engaged, getting back into the gym affords a big mental boost - a break from their current physical reality - for athletes.

Speaking of mental boosts, I won't even bother to highlight the favorable impacts of exercise on mood and the reduction in risk of a wide variety of chronic diseases. Suffice it to say that there are a ton, and it's important that athletes continue to have these benefits during their rehabilitation period. If you really want to dig deeper, I'd highly recommend this recently published meta-analysis: Exercise as a treatment for depression.

2. Small hinges swing big doors in terms of behaviors.

Most people eat healthier when they train. Whether this is conscious or subconscious is dependent on the individual, but it's something I've seen time and time again.

Likewise, many student athletes perform better in the classroom when exercising regularly, and struggle to stay on task when they’re given too much free time.

What's my point? Effectively, training pushes out certain bad behaviors. Likewise, on a physiological level, it supports better brain activity that makes for more productive members of society.

3. Injuries don’t occur in isolation.

Pitchers don’t just blow out their elbows because of functional deficits at the elbow. Rather, the elbow usually gets thrown under the bus from a collection of physical deficits all along the kinetic chain. As an example, Garrison et al (2013) demonstrated that players with ulnar collateral ligament tears scored significantly worse on the Y-balance test than their healthy peers.

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With this in mind, it would be silly to spend months and months only focusing on rehabilitating the arm to the exclusion of the rest of the body. Unfortunately, physical therapists only have so much time with athletes because of insurance restrictions, so they may not get to these important complementary rehabilitation approaches. This is a great place for a competent strength and conditioning professional to pick up the slack.

4. Training improves body composition, which facilitates a number of favorable outcomes.

It drives me bonkers when I hear about an individual dropping a bunch of muscle mass and gaining substantial body fat during the post-surgery period. This should never happen. 

Just as a healthy body composition will help a grandfather avoid setbacks following a hip replacement, having a good strength-to-body weight ratio will increase the likelihood that a college soccer player will avoid setbacks after a meniscal repair.

These benefits aren't just conferred to weight-bearing scenarios. Remember, obesity is arguably the biggest limitation to diagnostic imaging accuracy. In other words, if you have a setback in your rehabilitation and need an MRI or x-ray, being fatter makes it hard for your radiologist to give you an accurate reading. An ounce of prevention is worth a pound of cure.

5. Exercise facilitates motor learning improvements.

When rehabbing, you’re trying to acquire new, favorable movement patterns. Research (good reads here and here) has demonstrated improved motor learning when new tasks are introduced alongside exercise (particularly aerobic exercise).

Maintaining a robust aerobic system and solid work capacity makes rehabilitation efforts more effective.

6. Contralateral strength training has carryover to immobilized limbs.

Via a mechanism known as cross-transfer (or cross-education), an untrained limb's performance improves when the opposite limb is trained. As an example, if you have knee surgery on your right leg, but do what you can do to safely train your left leg while your right knee is immobilized, you'll still get carryover to the post-surgery (right) side. It won't do much to attenuate the atrophy of muscle mass on an immobilized limb, but it will absolutely reduce the fall-off in strength, power, and proprioception. Effectively, it's "free rehab" that offers a huge leg up with respect to return to play.

As an aside, research on cross-transfer from Hortobagyi et al has demonstrated that the strength carryover seems to be stronger with eccentric exercise, so prioritizing this approach seems to have extra merit.

Some Important Notes

Before I sign off on this one, I should be clear on a few things:

1. Not every trainer and strength and conditioning coach is prepared to take on every injury.

If you’ve never heard the word “spondylolysis,” you shouldn’t be programming for a kid in a back brace. And, if you don’t know the difference between an ulnar nerve transposition and an ulnar collateral ligament reconstruction, you’re not ready to take on a post-op baseball elbow. Don’t be a cowboy.

2. Effective post-operative training mandates outstanding communication.

You should be speaking on a regular basis with the physical therapist or athletic trainer who is overseeing the rehabilitation plan. They’ll let you know if an athlete is prepared for progressions, and also to help you avoid overlapping with what they do in the rehabilitation sessions. I’d even encourage you to sit in on some of their rehabilitation sessions not only to monitor progress, but also as continuing education.

3. When in doubt, hold athletes back.

One of my graduate school professors, Dr. David Tiberio, once said that physical therapists “should be as aggressive as possible, but do no harm.” I’ll take this a step further and say that fitness professionals conditioning “should be conservative and do no harm” during the rehabilitation process. It’s our job to maintain/improve fitness and facilitate return-to-play, but in no way set back the recovery process. In short, let the rehab folks take all the chances when it comes to progressions.

4. Remember that progressions occur via many avenues.

Progressions don’t just come in terms of exercise selection, but also absolute loading, speed of movement, volume, frequency, duration, and a host of other factors. You need to keep all of them in mind when programming and coaching, as even one factor that is out of whack can set a rehabilitation program back. Additionally, there will be times when stress in one area goes up, which means it must be reduced in another area. As an example, during rehabilitation from Tommy John surgery, the stress on the medial elbow increases when an athlete begins throwing at the 4-6 month mark, and many athletes will benefit from a reduction in the amount of gripping they do in their strength training and rehabilitation programs. 

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5. Watch for "accidental" stabilization demands.

Many muscles work reflexively, with the rotator cuff being the absolute best example. After a shoulder surgery, you have to be careful training the opposite side too soon (or with too much loading) because the cuff on the surgery side can turn on reflexively. As the aforementioned cross-transfer effect dictates, it's not as simple as right vs. left training effects; our nervous system governs everything - and in curious ways. 

Wrap-up

I hope that in publishing this article, I made a strong case for the importance of appropriate exercise during the post-surgery period. Remember that what is "appropriate" will be different for each individual, and should be determined via a collaborative effort with input from a surgeon, rehabilitation specialist, strength and conditioning professional, and the athlete. And, it should always be a fluid process that can be progressed or regressed based on how the athlete is doing.

For the fitness professionals out there, if you're looking for more information, here are a few good reads:

4 Reasons You Must Understand Corrective Exercise and Post-Rehab Training
7 Random Thoughts on Corrective Exercise and Post-Rehab Training


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4 Strategies for Improved Base Stealing Jumps

Today's guest post comes from former Cressey Sports Performance intern and current University of Washington Strength and Conditioning Coach, Dave Rak. Enjoy! -EC

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Coaches often talk about gaining an extra step when it comes to improving speed. For a baseball player an extra step could be the difference between a stolen base or a jog back to the dugout. There are many ways to gain that valuable extra step. Strength training, drill work, and refining technique all play an important part. As a coach you need to help the athlete feel the correct positions in order to maximize efficiency when stealing bases. Here are 4 simple ways to improve common mistakes.

1. Videotape everything.

With almost everyone having a smartphone or a tablet device on them 24/7, cameras are easily accessible, which leaves no excuse as to why you can’t video tape your athletes. Whether you are working 1-on-1 with an athlete, or with all of your position players at once, video feedback will be crucial. This gives the athlete a view from your perspective as to how they could improve their movements. Video feedback will not only allow you to show the athlete what is going on from a technical standpoint, but in a team setting, it will allow you to work efficiently with large groups. As a coach you will be able to see every rep from each of your athletes. This allows you to go back, take notes, and identify what needs to be worked on for each player. The athlete can use this information to better correct movements and execute proper form.

Most importantly, having video allows you to study the athlete’s movement and learn what corrections need to be made. This grows your knowledge on this specific movement. You may not have all the answers right away, but video will help you and your athletes figure out what can be corrected. Video is nothing new in sports and especially baseball; why not use it when trying to gain an extra step on your steal jump?

Video programs such as Hudl Technique (formerly known as Ubersense) and Coach’s Eye are great apps that can be used on a smartphone or tablet to record video It can then be played back in different speeds for the athlete.

2. Overload the movement. 

After breaking down video of my athletes I noticed some players were over reaching or stepping too high with their right foot on their initial leg drive. This is wasted movement that does nothing but prolong the steal jump, and put the athlete in a poor position to accelerate from. The photo below is an example of an ineffective directional step. The foot comes up too high, which prolongs the movement:

steal

By taking a smaller and more direct step the athlete will achieve a better position for acceleration. Below is a video that shows an example of a more efficient step.

To help with this common mistake, you can physically pull the runner towards second base and overload the movement using a bungee cord attached at the waste as seen in the video below.

Lee Taft suggested told me about this drill, and it has been very helpful with allowing my athletes to figure out how to make that direction step more efficient. The pull of the bungee cord forces the runner to be quicker and more direct with their step. The pull of the cord will cause the athlete to shift their weight towards second base and onto the right foot. Once they take a directional step they have to replace the foot quickly, if they don’t they will fall. The bungee cord allows the athlete to feel their mistakes in the moment. After a few repetitions the athlete should be able to make the adjustment on their own.

NOTE: Bungee cords work better than jump stretch bands for these drills.

3. Gently resist the movement.

A lot of time is spent on developing power and becoming more explosive in the weight room. The initial push of the steal jump is a great place to show off these attributes. Using video feedback, you can easily see if an athlete is lacking that “push” when they take off for second base. Yelling “triple extension”, or “push harder” may not always work. Instead give the athlete something to push against. To do this take the bungee cord from our previous drill and instead of overloading the sprint, gently resist the start. This will make the athlete have to overcome the resistance of the bungee cord when they make their first move. This should force the athlete to get better extension with their left leg. The video below is an example.

Again, the bungee cord will work better than a pair of jump stretch bands.

The athlete should feel the resistance of the cord before they start their sprint. This will force them to be aggressive when they push off. The goal is for the athlete to feel how hard they need to push with the lower body. It is also important to note that too much resistance will change the outcome of the drill. We are not weighing down the runner and having the partner get dragged behind. The runner should have to overcome the resistance on the push off and then be able to run normally as they accelerate.

4. Use a towel to teach arm movement.

After speaking with Lee Taft about what I was seeing with my athletes I began to realize how important the arms are, especially in the initial move. Lee helped me to realize that by achieving better arm action, common mistakes will be corrected on their own. These mistakes include: popping up on their first move, weak initial push-off, inability to stay low through the acceleration phase, and not turning the body quick enough to get into a linear sprint.

To help get the athlete to become more aggressive and throw the arms on their initial move we can hold a towel or shirt behind him. One of my former players actually came up with this idea on the spot during a training session. We told him to knock the towel out of his partner’s hand, which forced him to drive his arm back in a more aggressive manner. Originally this athlete did not have an aggressive arm action from the start position, preventing him for getting his body turned efficiently. This drill is an exaggerated movement; keep in mind the goal is to get a feel for what his arms should be doing.

Throwing the arms too much can be a bad thing and can cause the runner to over rotate. Make sure to find a good middle ground.

In addition to the actual action of the arms, the hand placement is also important. Longer arms require a greater distance to be traveled which takes up more time. Instead of letting the arms dangle near the knees, try to move the hands to belt level. This shortens the path of the hands, therefore allowing the runner to drive their arms back faster. This will get he body turned in a quicker fashion.

The purpose of these drills is to allow the athlete to feel mistakes and then provide an opportunity to self-correct. When the runner gets out of position the bungee cords will provide instant feedback. The video will provide visual feedback as well. The towel drill forces the athlete to accomplish a movement with the arms that they previously may not have done. The ultimate goal is for the athlete to feel the correct technique for themselves and carry it over into game time situations.

About the Author

David Rak is in his third year as an assistant strength & conditioning coach at the University of Washington. David directly oversees sports performance for Baseball, Men's & Women's Golf, and Men's Tennis. He can be reached at davidrak25@gmail.com.  

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Strength and Conditioning Stuff You Should Read: 3/23/16

This will be a light content week at EricCressey.com, as I'm on a "pseudo" vacation. After a few days visiting family in Florida, I'm now out in Arizona checking on some of our guys at Spring Training. The good news is that I've got some friends around the 'Net who have provided some excellent content recently:

Lessons Learned - This is an outstanding post from former US Women's Soccer athlete and gold medalist Lori Lindsey. I was fortunate to work with Lori a bit during her career, and it's awesome to see her doing great things in the fitness industry now that she's retired from soccer.

What Were You Doing a Year Ago Today - Cressey Sports Performance coach Tony Bonvechio authored this excellent post to remind us that progress may not always be linear or rapid, but when you look back, it's progress nonetheless! It's okay to take some time to smell the roses.

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4 Things We Did Before Worrying About Brand Development - My business partner, Pete, just published the other day, and he included some interesting numbers on our early business days. To be honest, I had no idea that our facility was actually in business for 293 days before we had a functioning website. This will be a good read for the fitness business folks out there.

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Building Core Control with “The Bear”

Today's guest post comes from Mike Robertson, who just introduced his new resource, Complete Core Training. It's on sale through the end of the day today, and Mike gives you a little sampling of one of his favorite core stability exercise progressions today. -EC

When I teach seminars with other fitness professionals, I'm often asked questions about the concept of rounding out the lower back. Unfortunately, many of us are so scared of lumbar flexion that we never do it - ever - even if there's potential benefit involved. When it comes to lumbar flexion, here are my rules:

1. I don't do it repeatedly (i.e. sit-ups),
2. I don't do it under load (i.e. round back deadlifts).


However, putting someone in a small degree of lumbar flexion and/or posterior tilt isn't going to cause a spontaneous disc herniation. In fact, I would argue that getting someone better control over the lumbar spine and pelvis is going to get them out of extension, and actually allow their lower back to feel better. It's going to relieve pressure on both the discs and facets, which are getting crushed when you're locked in extension.

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The bottom line is a little bit of work in this position could provide massive benefits going forward. This is one reason why I love to teach "The Bear" as a core stability exercise.

The Bear

With this drill, you get the benefits of reaching (serratus anterior recruitment, better rib positioning), plus a ton of lower ab involvement. Now you may be wondering, why the obsession with lower abs? Well for all my clients and athletes, I'm trying to develop stability and control over the lumbar spine, pelvis and hips. The lower abs (internal obliques and transverse abdominus) are critical for this, as they have a ton of "real estate" on the pelvis. Quite simply, if you want to control the pelvis (and, in turn, the lumbar spine and hips), you need a strong set of lower abs.  With that being said, doing draw-ins all day isn't going to fix the problem. The best way to engage an IO or TVA is to set position via an exhale first.

To do The Bear, set-up in a quadruped position and think about reaching long through the upper back. Round out the spine slightly, and tuck the pelvis underneath you. From this position, pick the knees up 1" off the ground, and then hold for a certain period of time (like you would in a plank).

Knees Extended Bear

Once you've mastered The Bear, you'll want to find something more challenging. Enter the Knees Extended Bear! The set-up here is identical to the first, but once those knees are up, you simply straighten them out. As you can see you'll end up in a pike position, with the hips as the highest point. This exercise is a lot tougher than you might expect, so be sure to start with the standard bear first.

Core training exercises might be a dime-a-dozen, but that doesn't mean all of them are worth their salt. These two variations of The Bears are some of my favorites, and I think you'll love them as well.  Enjoy!

As I mentioned, Mike Robertson's new resource, Complete Core Training, is now on sale with an introductory $50 off discount this week.  I'm reviewing it myself, and it's excellent. If you're looking for some help with your core stability exercise progressions - and the rationale for these approaches - look no further! For more information, click here.

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5 “Combo” Core Stability Exercises

Core stability exercises are kind of like visits to the dentist. You know you need to do them - and they keep you healthy - but they aren't really all that sexy and enjoyable. With this in mind, I think the concept of "minimum effective dose" is an especially important consideration when it comes to programming core stability exercises. We want to pick the drills that give the biggest bang for one's buck: a great training effect in only a few sets.

Fortunately, if we understand how to classify core stability exercises, we can quick recognize that there are ways to deliver more efficient training prescriptions. Speaking broadly, you have four core stability exercise categories: anterior core stability, posterior core stability, lateral core stability, and rotary core stability.

Anterior core stability exercises teach the body to resist excessive lumbar spine extension (arching), and encompass a variety of drills, starting with the likes of curl-ups, prone bridges/planks, and reverse crunches. In prepared individuals, they progress all the way up through more advanced exercises like stability ball rollouts, and TRX flutters and fallouts.

Rollouts

Posterior core stability exercises train the body to resist excessive lumbar spine flexion (rounding).  These drills include everything from the birddog all the way up through more conventional strength training exercises like deadlift variations.

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Lateral core stability exercises teach you how to resist lateral flexion; in other words, your goal is to avoid tipping over. These drills may start with basic side bridging drills and progress all the way up through more advanced TRX drills and 1-arm carrying variations.

Rotary core stability exercises teach you to resist excessive rotation through the lumbar spine. Examples include drills like landmines, lifts, and chops.

Once you appreciate what each of these core stability exercise categories entail in terms of functional demands, you realize that you can combine these drills into options that train 2-3 at a time. Here are a few examples:

1. Reverse Crunch to Dead Bug - A reverse crunch would be considered anterior core drills, but in adding the dead bug component, you get an increased challenge to rotary stability because of the alternating leg/arm component. Of course, the dead bug is already a solid "combination" core stability exercise by itself.

2. 1-leg TRX Fallouts - As I noted early, fallouts are a great anterior core training progression. Going to a single-leg stance makes this an awesome rotary stability and lateral core challenge, too.

3. Tall Kneeling Cable Press to Overhead Lift - Asymmetrical presses are usually only a big challenge to rotary and lateral core stability, but adding the overhead reach component kicks up the anterior core challenge.

4. Lateral Lunge with Band Overhead Reach - This one gets some extra bonus points because it's an excellent hip mobility challenge, too. It takes a lateral and rotary core stability drill and incorporates more anterior core because of the overhead reach. It's a game-changer when an athlete can own the frontal plane with sagittal plane control, too.

5. Dumbbell Suitcase Deadlift - You won't find a better posterior core stability exercise than a properly performed deadlift. You won't be able to load it as much in the suitcase set-up, but you'll definitely increase the challenge to lateral core stability.

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These are just five of countless variations you can create to cover a few core stability exercise categories with one drill. I've found them to be particularly useful with in-season programs, when athletes have limited time to train. 

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Strength and Conditioning Stuff You Should Read: 3/15/16

Apologies for being a day late in publishing this, but we had a busy weekend as we hosted the First Annual Spring Seminar at Cressey Sports Performance - Florida. Here are some good resources to check out this week:

Complete Core Training - Mike Robertson just released this resource, and I'm reviewing it myself now. Speaking candidly, I think the world needs another core training product like I need a hole in my head, but this is actually very good. Mike always puts out great content and this is no exception, so I'd definitely recommend it to any of my fitness professional readers.   

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The 3 Worst Health and Fitness Goals You Must Avoid - Dr. John Berardi wrote this up for Precision Nutrition, and I especially like the attention he paid to emphasizing behaviors over outcomes.

Sidestepping the Paradox of Success - My business partner, Pete, wrote up a great blog that effectively answers the question, "Why have you opened 150 Cressey Sports Performance facilities around the country?" 

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Random Thoughts on Sports Performance Training – Installment 16

With all our Major League Baseball affiliated athletes having left for spring training, things are a bit quieter at Cressey Sports Performance.

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At this time of year, I always like to look back and reflect on the offseason and some of the lessons we've learned. Invariably, it leads to a blog of random thoughts on sports performance training! Here are some things that are rattling around my head right now:

1. Just getting a baseball out of one's hand improves shoulder function - even if an athlete doesn't actually do any arm care or "corrective exercises."

If you look at the glenohumeral joint (ball-and-socket of the shoulder), stability in a given situation is essentially just a function of how well the ball stayed in good congruency with the socket. This congruency is governed by a number of factors, most notably the active function of the scapular stabilizers and rotator cuff. This is what good arm care work is all about.

However, what many folks overlook is that there are both passive (ligamentous) and active (muscular) structures that dramatically influence this congruency. In the throwing shoulder, we're talking predominantly about the inferior, middle, and superior glenohumeral ligaments and long head of the biceps tendon; collectively, the provide anterior (front) stability to the joint so that the ball doesn't fly forward too far in the socket in this position:

layback

These ligaments and biceps tendon are always working hard as superior (top) stabilizers of the joint at this point, especially in someone with a shoulder blade that doesn't upwardly rotate effectively. By the end of a long season, these ligaments are a bit looser and the biceps tendon is often cranky. Good arm care exercises shifts the stress to active restraints (cuff and scapular stabilizers) that can protect these structures.

What often gets overlooked is the fact that simply resting from throwing will improve shoulder function in overhead athletes. When you avoid a "provocative" position and eliminate any possibility of pain, joint function is going to improve. And, ligaments that need to stiffen up are going to be able to do so and offer more passive stability.

shoulder

This is a huge argument in favor of taking time off from throwing at the end of a season. It's effectively "free recovery" and "free functional improvements." Adding good arm care work on top of abstaining from throwing makes the results even better.

*Note: this isn't just a shoulder thing; the ulnar collateral ligament at the elbow can regain some passive stability with time away from throwing as well. 

2. Coaches need to find ways to be more efficient - and shut up more often.

Each year, we start up three intern classes at both the Florida and Massachusetts facilities. As such, we have an opportunity to interact with approximately 30 up-and-coming strength and conditioning coaches. Mentoring these folks is one of my favorite parts of my job - and it has taught me a lot about coaching over the years.

Most interns fall into one of two camps: they either coach too much (the "change the world" mentality) or too little (the "don't want overstep my bounds" mentality). This is an observation - not a criticism - as we have all "been there" ourselves. I, personally, was an over-coacher back in my early strength and conditioning years.

The secret to long-term coaching success is to find a sweet spot in the middle. You have to say enough to create the desired change, but know when to keep quiet so as to not disrupt the fun and continuity of the training process. My experience has been that it's easier to quickly improve the under-coacher, as most folks will develop a little spring in their step when it's pointed out that they're missing things. That adjustment usually puts them right where they need to be.

The over-coacher is a different story, though. It's hard to shut off that "Type A" personality that usually leads someone in this direction. My suggestion to these individuals is always the same, though:

Don't let the game speed up on you. Before you say anything, pause - even take a deep breath, if you need to - and then deliver a CLEAR, CONCISE, and FIRM cue. Try to deliver the important message in 25% as many words as you normally would.

The athletes don't get overwhelmed, but just as importantly, the coach learns what the most efficient cues are. You might talk less, but you actually deliver more.

3. Use the "hands and head together" cue with rollouts and fallouts.

One of the biggest mistakes we'll see with folks when they do stability ball rollouts is that the hands will move forward, but the hips will shoot back. This reduces the challenge to anterior (front) core stability, and can actually drive athletes into too much lumbar extension (lower back arching). By cueing "hand and hips move together," you make sure they're working in sync - and then you just have to coach the athlete to resist the impacts of gravity on the core.

Rollouts

You can apply this same coaching cue to TRX fallouts, too:

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4. Ages 28-30 seems to be a "tipping point" on the crappy nutrition front.

I should preface this point by saying that there is absolutely nothing scientific about this statement; it's just an observation I've made from several conversations with our pro guys over the winter. In other words, it's purely anecdotal, but I'd add that I consider myself one of the "study" subjects.

We all know that many young athletes seem to be able to get away with absolutely anything on the nutrition front. We hear stories about pro athletes who eat fast food twice a day and still succeed at the highest levels in spite of their nutritional practices.

One thing I've noticed is that I hear a lot more observations about "I just didn't feel good today," "my shoulder is cranky," or any of a host of other negative training reports in the days after a holiday. The pro baseball offseason includes Halloween, Thanksgiving, Christmas, New Year's Eve/Day, and Valentine's Day. Perhaps unsurprisingly, these observations almost always come from guys who are further along in their career - and as I noted, it's something I've felt myself.

If you eat crap, you're going to feel like crap.

Why does it seem to be more prevalent in older athletes? Surely, there are many possible explanations. More experienced athletes are usually more in-tune with their bodies than younger ones. Recovery is a bigger issue as well, so they might not have as much wiggle room with which to work as their younger counterparts. Older athletes also generally have more competing demands - namely kids, and the stress of competing at the highest levels - that might magnify the impacts of poor nutrition.

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Above all, though, I think the issue is that many young athletes with poor nutritional practices have no idea what it's like to actually feel good. They might throw 95mph or run a 40 under 4.5 seconds, but they don't actually realize that their nutrition is so bad that they're actually competing at 90-95% of their actual capacity for displaying and sustaining athleticism. It's only later - once they've gotten on board with solid nutrition - that they have something against which they can compare the bad days. 

Again, this is purely a matter of anecdotal observations, but as I've written before, everyone is invincible until they're not. As coaches, it's our job to make athletes realize at a younger age the profound difference solid nutrition can make. We can't just sit around and insist that they'll come around when they're ready, as that "revelation" might be too late for many of them.

Speaking of nutrition, today is the last day to get the early-bird registration discount on Brian St. Pierre's nutrition seminar at Cressey Sports Performance - MA on April 10. Brian is the director of performance nutrition for Precision Nutrition, and is sure to deliver a fantastic learning experience. You can learn more HERE

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Strength and Conditioning Stuff You Should Read: 3/7/16

Happy Monday, folks. I hope everyone had a great weekend. We brought our twin daughters to their first MLB game yesterday, and they did surprisingly well, behaving through all nine innings! Hopefully, this momentum carries over into the rest of the week. Here's some good strength and conditioning reading to get the ball rolling: 

How to Prepare to Avoid Early Season Pitching Injuries - I was interviewed for this article by Dan Weigel for Sporting News. The second half of the article ran a few days later: The Dangers of Spring Training

Pump the Brakes on Bashing Higher Education for Fitness Professionals - My business partner, Pete, did a solid job of outlining another perspective on the topic of college education in the fitness industry. These come as follow-ups to my popular articles, Is An Exercise Science Degree Worth It - Part 1 and Part 2

7 Truths About Strength Training - This was an excellent post from Jim Wendler for T-Nation. He hit a lot of nails on the head.

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Cryotherapy and Exercise Recovery: Part 2

Today's guest post is the second installment in a series on cryotherapy from Tavis Bruce. In case you missed Part 1, you can check it out HERE. -EC

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In Part 1 of this two-part series on cryotherapy, I summarized the literature to-date on the short- and long-term effects of post-exercise cryotherapy.

To briefly recap:

• Cryotherapy, particularly cold water immersion (CWI) seems to reduce perceptions of fatigue and muscle soreness and increase perceptions of recovery which may benefit performance in the short-term.

• However, chronic use of cryotherapy is contraindicated due to the detrimental effects on long-term training adaptations.

Today, in Part 2, I’m going to discuss more of the practical side of cryotherapy—basically, how to make the most of it, if and when you choose to use it.

But first, I thought I would discuss some baseball-specific research that may be of interest to the baseball players and coaches out there who are reading this article.

Should Pitchers Ice?

As a pitcher, my relationship with ice is definitely what I would describe as hot n’ cold (pun intended). When I was younger, slapping an ice pack on my arm was somewhat of a post-game ritual. But, by the time I got to college, I found myself questioning how much icing my arm actually “helped”. I eventually stopped icing altogether, save maybe a few times when I was particularly sore. Suffice to say, I’ve always been curious what the research had to say about icing after throwing, so I was pretty stoked to find a few studies that looked at exactly that. (If you don’t care about baseball, go ahead and skip to the next section.)

In a study of “highly skilled”* amateur baseball players, Yanagisawa et al. found that light shoulder exercise (20 minutes on an arm ergometer at a low-intensity) was more effective than ice at restoring internal and external shoulder strength and range of motion (ROM) 24 hours after a 7-inning, 98-pitch simulated outing (38,89). However, improvements in shoulder strength, ROM, and muscle soreness were greatest when ice and light shoulder exercise were combined. These results indicate that active recovery (such as light shoulder exercise) may be an effective recovery strategy between pitching appearances, and that ice may provide some additional benefits, particularly relating to the management of delayed-onset muscle soreness (DOMS) in the throwing shoulder after pitching.

*The participants were college-aged, but the authors did not explicitly state if they were college or recreational baseball players, nor did they state average velocities.

Two studies (90,91) looked at the effects of icing the throwing arm between innings of a simulated game. Interestingly, both studies found that pitchers’ velocities dropped off less when they iced their throwing arms between innings compared to when they didn’t. In addition, icing between innings decreased perceived exertion and increased perceived recovery (91) as well as increased the number of innings and the total number of pitches pitchers threw when pitchers threw to volitional fatigue (90).

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While these findings are intriguing, I wouldn’t go icing my arm between innings just yet. It’s certainly possible that cooling the pitchers’ throwing arms modified perceptions of effort and fatigue in a way that allowed for a greater output as the game went on. But, as I alluded to earlier in this article, cooling can disrupt both neuromuscular drive as well as proprioceptive feedback from the arm, both of which have important implications for throwing a baseball fast, accurately, and (perhaps) “safely”. This may be less problematic in low velocity pitchers (with an average fastball of about 70 miles per hour, the pitchers in these two studies weren’t exactly lighting up the radar gun!) but we have no idea how pitchers with elite-level fastball velocities would respond to this kind of protocol.

There is no direct evidence that suggests that ice is detrimental to pitching performance. In particular, ice combined with active recovery strategies such as light shoulder exercise may help reduce DOMS and restore shoulder strength and range of motion between pitching appearances. However, these findings need to be interpreted with caution as the effect of icing after throwing in the elite-level pitcher has not been quantified nor are there any longitudinal studies assessing the long-term effects of icing after throwing on functional or morphological adaptations to a comprehensive, periodized throwing program. Given the detrimental effects of CWI on resistance training adaptations, regular icing of the shoulder is not recommended in the off-season.

Does Cooling Method Matter?

It turns out that how you choose to cool down after exercise may be important. A 2013 meta-analysis by Poppendieck et al. found that CWI was more effective than ice packs and cryogenic chambers for performance recovery in trained athletes (92). This findings may be biased due to the large majority of studies that use CWI as their cooling intervention but there’s a reason for this: CWI is by far the most effective method for cooling the body (93) and, as such, it has become the gold standard in both research and athletic settings.

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Whole-body cold water immersion also appears to be more effective than cooling only the exercised limb(s) (92). This may be due to a greater reduction in core temperature with whole body cooling than with partial-body cooling (94) in addition to the (potentially) therapeutic effects of hydrostatic pressure experienced during water immersion10. If CWI isn’t available, compression wraps can enhance the intramuscular cooling effects of ice packs (95,96) in addition to providing a compression effect (albeit to a far lesser degree than water immersion), although it’s not quite clear what effect (if any) this might have on recovery.

Whole body CWI is not only the most effective way to cool the body, it may also have the greatest therapeutic benefit, due to the temperature-independent effects of water immersion.

Is There an Optimal Temperature or Duration?

There is no definitive evidence on an “optimal” temperature or duration for cryotherapy; however, the available research provides some insight.

In their meta-analysis, Poppendieck et al. concluded that water temperatures of 12-15ᵒC are sufficient to elicit positive effects on post-exercise recovery in trained athletes and that cooler temperatures are not likely to produce any additional benefit (92).

As for duration, 10 minutes of whole body CWI at 12-15ᵒC is more than enough to elicit a reduction in intramuscular temperature (93) and 20 minutes seems to be the upper limit of what is used in the literature (with the exception of warmer immersions, of course). Logically, the less body mass that is exposed to cold, the longer the exposure needs to be to elicit a similar reduction in core body temperature (94). Similarly, colder temperatures require shorter exposures (97).

Further evidence suggests that CWI for longer durations (30 minutes) may exacerbate the inflammatory response to exercise (64) and there are several documented cases of peripheral nerve injury when ice packs are left on for too long (98,99). Don’t be the guy that falls asleep with an ice pack on!

A 10-minute, whole body immersion at 12-15ᵒC is more than enough to reap the benefits of CWI. Cooler temperatures or longer durations are unnecessary and potentially harmful, so always be sure to err on the side of caution.

What About Placebo Effects?

Despite the placebo effect being well-documented in sports (see Beedie et al. [100] for review), there hasn’t really been an attempt to quantify its role in the positive outcomes we (sometimes) see with cryotherapy. Sugar pills are one thing, but it’s not exactly easy to convince someone they’re taking an ice bath—without actually having them take an ice bath! So, when Broatch et al. published their placebo study in 2014 there was a lot of hype on the internets. And for good reason: it was the first study that compared CWI to, what I consider to be, a pretty decent shot at a placebo condition.

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In the study, participants in the placebo group performed 15 minutes of thermoneutral immersion but were led to believe it contained a special “recovery oil” that was just as effective as CWI. And the results were pretty compelling: the thermoneutral placebo was just as effective as CWI at restoring quadriceps strength (MVC) up to 48 hours post-exercise and both groups recovered significantly better than the thermoneutral control group. In addition, both the CWI and the thermoneutral placebo group reported similar subjective ratings of recovery.

Now, we can’t generalize these results to all scenarios because the study looked at recovery of quadriceps strength following four 30-second maximal sprints on a cycle ergometer. We have no idea to what extent placebo effects are involved in recovery from, say, resistance training, endurance exercise, or team sports. I think it’s pretty safe to say they likely play a role, though.

So how do we interpret these results?

Well, we could throw the ice out with bathwater. After all, cold water immersion is no better than placebo, right? But I don’t think that’s necessary. As a coach, I think it’s always important to consider the preferences of your athletes. And I think this study supports the use of CWI with athletes who believe it to have a recovery benefit (e.g., Cook & Beaven found that repeat sprint performance following CWI was related to how much athletes “liked” it [67]). Said differently, there’s not enough solid evidence to encourage your athletes to use CWI, but I see no reason to discourage an athlete who sees value in it either.

This last point comes with one major caveat: as long as an athlete’s use of CWI does not impede on your training goals for that athlete. In this sense, it may be valuable to educate athletes who regularly use CWI on its potentially detrimental effects on long-term training adaptations and explain to them it is best used sparingly throughout the competitive season.

Placebo effects almost certainly play a role in the recovery benefits of cryotherapy, but it’s not clear to what extent. Coaches should pay attention to the preferences of their athletes, and not necessarily discourage an athlete who perceives cryotherapy to be beneficial from using it sparingly, and in a manner that is congruent with their training goals.

Practical Recommendations

If you’re an athlete (or if you coach an athlete) that likes using ice or ice baths for recovery, that’s great! Keep doing what you’re doing. But to make the most of it, I suggest you following my recommendations below:

• Use ice baths over ice packs or other forms of local cooling whenever possible.

• Make sure the water temperature is between 10-15 degrees Celsius but not any colder. Colder does not mean better. Warmer temperatures (up to 20 degrees Celsius) for longer durations can also be used.

• Ice baths should last between 5-15 minutes. The colder the water, the shorter the ice bath should be.

• Submerge your whole body (up to your neck/shoulders), or as much of your body as you can.

• After the ice bath, allow time for rewarming and ensure an adequate warm-up before your next game, event, or training session. Avoid using ice baths immediately (<1 hour) prior to exercise, particularly before training or events involving high-intensity or explosive efforts such as sprinting, jumping, or weightlifting. The exception to this rule would be if you’re competing in an endurance event in warm or hot weather. In this case, precooling may enhance subsequent performance.

• Use ice baths sparingly. Regular ice baths kill strength and muscle mass gains! They’re best saved for strategic use during the competitive season when you’re trying to recover performance within a few hours to a few days.

• Important: Be careful! Cryotherapy does not come without its dangers. Exposing your body to cold temperatures for too long can have potentially dangerous effects. (E.g., don't fall asleep with an ice pack on your shoulder. I used to do this. It’s moronic!) Set yourself a timer and stick to it. And if things start to feel sketchy before the timer goes off, call it quits!

Note: the references for this entire article will be posted as the first comment below.

About the Author

A native of the Great White North, Tavis Bruce (@TavisBruce) is no stranger to the effects of cold on athletic performance. He holds a Bachelor of Kinesiology and Health Science from the University of British Columbia, where he pitched for the Thunderbirds baseball team for three seasons. Tavis is currently the Director of Education for the Baseball Performance Group, where he integrates his passion for sports science with his love of baseball. He can be contacted at tavis.bru@gmail.com.

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Cryotherapy and Exercise Recovery: Part 1

Today's guest post comes from Tavis Bruce. A while back, I asked Tavis to pull together an article examining the literature on cryotherapy with athletes, and as you'll see below, he really overdelivered. Enjoy! -EC

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Sports and ice go together like peanut butter and jelly (or steak and eggs, if you’re into Paleo). From ice packs to ice baths, various forms of “cryotherapy” have long held a sacred place in sports medicine to treat acute injuries and facilitate recovery from training or competition. But despite its popularity and widespread use, the evidence in support of cryotherapy remains equivocal.

More recently, cryotherapy—particularly the use of ice baths, or cold water immersion—has come under increasing scrutiny from both the scientific community and the strength and conditioning industry at large...and rightfully so! However, in the process, we may be swinging the pendulum too far in the other direction, indicated by those who have come to the conclusion that “ice baths are a complete waste of time for every athlete in every sport in every possible situation.” Now, others may disagree with me on this one; but, the evidence (or lack thereof) for cryotherapy appears to be a little more nuanced than that.

I guess what I’m trying to say is: I’m not so sure I’m ready to throw the ice out with the bathwater just yet. Perhaps, instead of pondering black-and-white questions like, “to ice or not to ice?” we should be asking:

                         “When is ice appropriate?”

I’d like to examine why.

A quick note before we get started: this article will not discuss the use of cryotherapy for the management and/or rehabilitation of acute soft tissue injuries. I am NOT a medical professional; I just play one on Facebook.

As such, this article will only cover the efficacy of cryotherapy as a post-exercise recovery strategy.

Is there a Physiological Rationale for Cryotherapy?

Note: I’m not going to spend much time discussing the physiological rational (the “why”) behind cryotherapy for two reasons. First, the mechanisms are still quite hypothetical. Second, and more importantly, it’s a bit outside the scope of this article to convey practically relevant and actionable information for my fellow coaches and athletes. We can debate the mechanistic stuff until the cows come home, but in my humble opinion, the gold standard measurement for post-exercise recovery is the measurement of performance variables. And, I like to think that most athletes, coaches, and sports scientists would agree with me. That being said, I do think it’s always a good idea to establish if there is at least a physiological rationale for any method we may use with ourselves and/or our athletes. With that said…

Cryotherapy results in various physiological changes (most of which are temperature-dependent) that have long been proposed to exert a therapeutic effect post-exercise. Although the most cited physiological change is a blunted inflammatory response, there exists a range of other effects through which cooling the body after exercise may accelerate the recovery process. Of note, cryotherapy may:

• Improve tissue oxygenation1 and removal of metabolic waste (2) by reversing exercise-induced muscle edema (3,4).
• Reduce reactive oxygen species (ROS)-mediated muscle damage (5) by reducing local metabolism (1).
• Induce analgesia by decreasing nerve conduction velocity (6) in addition to directly activating sensory afferents (7).
• Restore parasympathetic tone by increasing vagal tone (8,9).

In addition, cold water immersion (or “ice baths”), a popular form of cryotherapy, may have additional benefits resulting from the compressive forces experienced during water immersion, but I won’t be covering them in this article (see Wilcock et al. [10] for a good review). For more information on the physiological effects of cold water immersion and other forms of cryotherapy, I encourage you to check out this (open access!) review by White and Wells.

The Effects of Cryotherapy on Recovery from Sport or Exercise

Perceptual Measures of Recovery

Cold water immersion reduces perceptions of fatigue (11-16) and increases perceptions of recovery (17,18) and physical readiness (19) between training sessions; however, it doesn’t seem to have much of an effect on ratings of perceived exertion (RPE) during subsequent training bouts (20-23).*

*Except for when CWI is used as a precooling strategy before exercise. (More on precooling later.)

Delayed-Onset Muscle Soreness

Though it’s pretty well accepted that cooling injured tissue can temporarily reduce or relieve pain (24), it’s not really clear if post-exercise cooling has any effect on delayed-onset muscle soreness (DOMS): the type of soreness you feel in the days following a bout of intense or novel exercise.

There is some evidence that cold water immersion (CWI) alleviates DOMS better than passive recovery (25), particularly when CWI is used following exercise that involves a large degree of metabolic stress (26) (e.g., running, cycling, or team sports). However, this effect is less clear when CWI is compared to warm (27), thermoneutral1 (4,28), or contrast (27,29,30) immersion, and recent evidence suggests that CWI may be no more effective than a placebo (19) for relieving DOMS. Collectively, these findings highlight the perceptual nature of muscle soreness and the importance of athletes’ perceptions of cryotherapy (or any recovery method, for that matter).

Icing and cold water immersion may help reduce delayed-onset muscle soreness after running or team sports, but the effect likely depends on the athlete’s belief in cryotherapy as a method of recovery.

Range of Motion

There is conflicting data on the effect of cooling on range of motion (ROM). Cooling alone does not appear to improve ROM (28,31-38), but it may enhance the effects of stretching (39-43) by increasing stretch tolerance (44). On the one hand, this increased tolerance to stretch does not appear to translate into long-term improvements in ROM (45-47). On the other hand, heat combined with stretching may have more lasting effects than stretching alone (44).

If your goal is to restore lost ROM following exercise, combine heat (not cold!) with stretching.

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Strength

The short-term effects of post-exercise cooling on recovery of strength characteristics are mixed and seem to depend on the type of exercise stress from which you’re trying to recover before you hit the weights.

There is some evidence that CWI may reduce or recover losses in maximal voluntary contraction (MVC) following simulated team sports (48-50) or intermittent sprint exercise (51-53), but not after downhill running (54) or cycling (55,56). And, in the only study of its kind, Broatch et al. found that CWI following high-intensity sprint intervals recovered MVC no better than a thermoneutral placebo (19).

Roberts et al. demonstrated that CWI was effective for restoring submaximal (but not maximal) strength between two lower body training sessions within the same day (57). Vaile et al. found both cold and contrast water immersion were effective at restoring strength up to three days after heavy eccentric strength training (27)*, but most studies show no or non-significant improvements over this time period (28,58-62). However, it’s important to note that all of these studies used (potentially) “less effective” cooling methods (such as when only the exercised muscle is cooled) compared to more therapeutic methods such as whole-body CWI.

*I highlight the study by Vaile et al. because it is the only study that compared multiple hydrotherapy modalities in trained males, and in a cross-over design with a “washout” period between treatments of sufficient duration to eliminate any residual effects of the repeated bout effect. Thumbs up for study quality!

Cold water immersion may help recover muscle contractile properties following running or team sports. Benefits following resistance training are less clear and may require the use of cold water immersion over local cooling of exercised tissue.

Jump Performance

Most studies show significant recovery of jump performance within 24-48 hours post-exercise with no clear additional benefits to CWI (18,49,53,63,64). Furthermore, CWI may impair jump performance within the first two hours (57) possibly due to the acute effects of cold exposure on force production (65).

Here’s the deal: jump performance seems to recover just fine on its own. However, there is some evidence that CWI may maintain jump performance in scenarios of accumulated fatigue, such as during tournament play in team sports. One study of basketball players found that the CWI maintained jump performance better in players who saw more playing time throughout a 3-day tournament (66).

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Sprint Performance

Like jump performance, many studies report that sprint performance returns to baseline within 24 hours after exercise, regardless of treatment intervention (18,49, 61). Accordingly, most studies do not find a benefit in favor of CWI compared to other recovery interventions because the initial exercise bout was not sufficiently intense to elicit a significant 24-hour performance decrement.

However, when exercise was sufficiently intense to affect 24-48 hour sprint performance, CWI maintained repeat-sprint performance (a measure of speed-endurance) better than thermoneutral immersion (67), contrast water therapy (12,13,48), and passive recovery (12,13,48,67).

The effect of CWI on absolute speed is less clear. Of the two studies I found, one found no benefit to CWI over passive recovery on immediate and 24-hour recovery of 50-m dash time (68), while the other showed that CWI maintained 20-m speed better than compression or stretching over a 3-day simulated basketball tournament (66).

There’s not a lot of data on the effects of CWI on same-day recovery of sprint performance, but one study showed no significant differences in repeat-sprint performance between CWI and passive recovery immediately and up to two hours after intermittent sprint exercise in the heat (61). This ties in well with the research in sprint cycling that shows neutral—or even detrimental—effects on 30-second Wingate performance following CWI when sufficient re-warming does not occur (69,70). This makes sense: reduced muscle temperature will negatively affect muscle contractile properties (71), impair energy metabolism (72), and slow nerve conduction velocity (6,73), which collectively will negatively affect the force- and power-generating capabilities of muscle. Thus, caution should be taken when using CWI between or prior to exercise that requires a high-degree of muscular force (sprinting, jumping, etc.). Athletes should allow sufficient time to rewarm following CWI and make sure to include a dynamic warm-up before their next event, which has been shown to offset the negative effects of cold exposure on power production in the vertical jump (65).

When exercise is sufficiently intense, CWI may help restore short-term (<48 hour) sprint and jump performance. However, reduced muscular temperatures negatively affect the force-generation capacities of muscle. Thus, when using ice baths between two training sessions or events within the same day, it is important to allow the body sufficient time to re-warm and/or to include an extensive dynamic warm-up.

Endurance Performance

Given the number of endurance athletes that use ice baths to recover between workouts or events, it was somewhat surprising that very few studies looked at endurance performance following recovery periods of 24 hours or longer. Two of those studies showed that CWI improves endurance performance following a 24-hour recovery period (17,74), and two other studies demonstrated similar recovery benefits across 3-day (75) and 5-day (23) training blocks.

Paula_Radciffe_NYC_Marathon_2008_cropped

Most studies that looked at the effects of CWI on recovery from endurance exercise utilized recovery periods of <60 minutes between exercise bouts. But here’s the thing: When an athlete takes an ice bath between two bouts of exercise with a short (<1 hour) duration between bouts that ice bath creates a “precooling” effect for the second bout. Precooling is proposed to increase performance (particularly in hot conditions) by increasing heat storage capacity, reducing thermal strain, and decreasing perceived exertion by reducing core body temperature prior to exercise (76).* And, based on the abundance of data showing a benefit to precooling on endurance performance** (particularly in hot conditions), this is probably why we see such an immediate recovery of endurance performance following CWI (56,77-81). This effect diminishes with longer recovery periods (82), presumably as core body temperature returns to baseline.

*If you’re interested in learning more about precooling check out this (open-access!) systematic review as well as the results of two recent meta-analyses here and here.

**Just to reiterate: the beneficial effect of precooling likely does not hold true for short-duration, maximal efforts (see above).


Ice baths may be useful for recovering endurance performance, particularly when an athlete has to compete in multiple games or events in one day.

The Effect of Regular Cold Water Immersion on Long-Term Training Adaptations

Very few studies have looked at the effects of ice baths on long-term training adaptations. But, the evidence-to-date paints a pretty clear picture:

Strength Training

The evidence is pretty clear on this one: regular use of CWI impairs long-term gains in muscle mass and strength (83-86) at least in part by blunting the molecular response to resistance exercise (84). This seems to apply to both trained (84) and untrained (85,86) individuals.

Ice baths blunt the acute molecular response to resistance training and impair long-term gains in muscle mass and strength. Athletes should reconsider using ice baths after strength training, particularly in the off-season or preparatory period when the focus is on adaptation rather than performance.

Endurance Training

The evidence for the effects of CWI on adaptations to endurance training is not so clear. One study in competitive cyclists found that regular CWI neither enhanced nor interfered with cycling performance over a three-week training block (87). Furthermore, recent evidence suggests that regular CWI may actually enhance molecular adaptations to endurance training (88). However, it’s important to interpret these results with caution, as molecular adaptations do not always reflect functional outcomes and the study did not measure changes in performance. Of note, there is some evidence that regular CWI at very cold temperatures (5ᵒC) for very long durations (>30 minutes) may disrupt local vascular adaptations and attenuate improvements in VO2max to endurance training in untrained subjects (85).

There is no direct evidence to suggest that ice baths enhance nor interfere with endurance training adaptations. In trained athletes, ice baths can be used sparingly after endurance training, but regular use is not recommended, particularly during the preparatory period when the focus of training is on adaptation. Finally, ice baths of excessive duration or at extremely cold temperatures should be avoided.

Major Take-Aways

The evidence for cryotherapy is pretty mixed, but there are some patterns that seem to emerge from the literature:

• Cold water immersion and other forms of cryotherapy reduce exercise-induced inflammation.
• This reduction in inflammation may lead to reduced perceptions of fatigue and muscle soreness and increased perceptions of recovery which may benefit performance in the short-term.
• Importantly, the short-term recovery benefits of cryotherapy may depend considerably on the mode exercise (i.e. the type of stress), the physiological and perceptual qualities one is trying to restore, and (as I will discuss further in Part 2) the athlete’s belief in cryotherapy as a recovery modality.
• Meanwhile, a growing body of evidence indicates that inflammation is a necessary process for tissue regeneration and, as such, regular use of cold water immersion may impair long-term muscular and vascular adaptations to exercise.
• As such, cryotherapy should be used sparingly, particularly in the off-season when the goal is to maximize training adaptations.

In Part 2, I will address:

• whether baseball pitchers should ice their arms
• whether there an optimal cooling method, temperature, or duration
• whether cryotherapy is just one big fat placebo
• practical recommendations for athletes and coaches

Stay tuned for Part 2!

Note: the references for this entire article (including the upcoming part 2) will be posted as the first comment below.

About the Author

A native of the Great White North, Tavis Bruce (@TavisBruce) is no stranger to the effects of cold on athletic performance. He holds a Bachelor of Kinesiology and Health Science from the University of British Columbia, where he pitched for the Thunderbirds baseball team for three seasons. Tavis is currently the Director of Education for the Baseball Performance Group, where he integrates his passion for sports science with his love of baseball. He can be contacted at tavis.bru@gmail.com.
 

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