Home Posts tagged "ice baths for recovery"

CSP Elite Baseball Development Podcast: “To Ice or Not to Ice?” with Gary Reinl

We're excited to welcome Gary Reinl, Director of National Accounts and Professional Athletic Teams for Marc Pro, to this week's podcast. Gary delves into one of the most controversial topics in sports medicine history: icing.

A special thanks to this show's sponsor, Athletic Greens. Head to http://www.athleticgreens.com/cressey and you'll receive a free 20-pack of Athletic Greens travel packets with your first order.

Show Outline

  • How Gary become involved in the realm of sports medicine in 1973
  • How Gary became passionate about the science and practice of recovery
  • Where the belief in icing for recovery began, and how did it became so accepted in the sports medicine community
  • Where the RICE protocol (Rest, Ice, Compress, Elevate) originated
  • What the research says about the use of ice for recovery and the traditional RICE method
  • How Gary formulated his simple and organized system for healing damaged tissue away from the common belief in ice and the RICE protocol
  • Why tissue preservation, tissue regeneration, and angiogenesis are the primary goals when promoting recovery of damaged tissue
  • Why evacuating waste and clearing congestion is important for creating healthy tissue
  • What physiological mechanisms electrical stimulation takes advantage of to push waste out of damaged areas via the lymphatic system
  • How low intensity muscular contractions decongest damaged tissues, avoid the unnecessary killing of healthy tissue, restore circulation, and promote tissue regeneration
  • What benefits e-stim has beyond the recovery of damaged tissue
  • Why sports medicine professionals and the general population often confuse inflammation with degeneration
  • How can individuals maximize the effectiveness of Marc Pro and other e-stim units through pad placement and overall set-up during treatment
  • Where would Gary like to see the Marc Pro used more in the sports medicine world

You can follow Gary on Twitter at @TheAntiIceMan and email him at gary@marcpro.com. Be sure to check out his book, Iced!, and take advantage of the great offer on Marc Pro for podcast listeners by heading to www.MarcPro.com and entering the coupon code CRESSEY at checkout to receive 10% off on your order.

Sponsor Reminder

This episode is brought to you by Athletic Greens. It’s an all-in-one superfood supplement with 75 whole-food sourced ingredients designed to support your body’s nutrition needs across 5 critical areas of health: 1) energy, 2) immunity, 3) gut health, 4) hormonal support, and 5) healthy aging. Head to www.AthleticGreens.com/cressey and claim my special offer today - 20 FREE travel packs (valued at $79) - with your first purchase. I use this product daily myself and highly recommend it to our athletes as well. I'd encourage you to give it a shot, too - especially with this great offer.

Podcast Feedback

If you like what you hear, we'd be thrilled if you'd consider subscribing to the podcast and leaving us an iTunes review. You can do so HERE.

And, we welcome your suggestions for future guests and questions. Just email elitebaseballpodcast@gmail.com.

Thank you for your continued support!

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Strength and Conditioning Stuff You Should Read: 3/31/17

It's almost MLB Opening Day, which is just about my favorite "holiday" of the year. With that in mind, Mike Reinold and I decided to put our Functional Stability Training products on sale for 20% off. Using the coupon code MLBFST, you can pick up the individual components or get an even bigger discount on the entire bundle.

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This sale runs through Monday at midnight; head to www.FunctionalStability.com to take advantage of it.

Good vs. Bad Stiffness - With FST on sale, I thought it would be a good time to "reincarnate" this webinar except from my presentation in the Optimizing Movement component. Relative stiffness is an important concept for all fitness and rehabilitation professionals to understand.

Cryotherapy Doesn't Work - This was an excellent post from Dean Somerset on the topic of icing. It's a great follow-up to the two-part series Tavis Bruce authored up for us last year, too, so be sure to check those out: Cryotherapy and Exercise Recovery: Part 1 and Part 2.

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Work, Sleep, Family, Fitness, or Friends: Pick 3 - This was an interesting article at Inc.com on the topic of balancing life's demands. It resonated with me because it was another good reminder that it's our job as fitness professionals to make people realize they CAN still be fit even if they don't have a ton of time. And, fitness might be a great avenue through which to spend time with family and friends, so it can "check a few boxes" in folks' busy lives.

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The Best of 2016: Guest Posts

I've already highlighted the top articles and videos I put out at EricCressey.com in 2016, so now it's time for the top guest posts of the year. Here goes…  

1. Cryotherapy and Exercise Recovery: Part 1 and Part 2 - Tavis Bruce absolutely crushed it with this heavily researched two-parter on one of the most controversial topics in health and human performance today.

2. Big Toe, Big Problems - Dr. James Spencer took a close look at Functional Hallux Limitus, a common problem that is frequently overlooked in the rehabilitation world.

3. 4 Strategies to Improve Athletes’ Innate Acceleration - Lee Taft introduced some excellent ways to improve your speed and agility coaching.

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4. 4 Ways Hypermobile Individuals Can Improve Their Training - Laura Canteri offered some excellent insights for a very underserved population: loose-jointed clients.

5. Building Better Core Control with “The Bear” - Mike Robertson shared one of his favorite core stability exercises and it was a big hit with the EricCressey.com audience.

I'll be back soon with the top strength and conditioning features from 2016.

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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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Random Monday: Ice Baths for Recovery, Throwing Like a Girl, and Cute Puppies

It's been a while since I did a random thoughts blog; actually, it was October 6 - which is also known as the "Pre-Puppy Era" in the Cressey household.  As such, we have a lot to get to, so let's not waste any time. 1. It's been interesting to watch the Giants - a team without a true superstar (aside from Lincecum, who's only thrown one game) - take control of the World Series.  However, the most interesting part of the World Series for me was when former president George W. Bush came out and threw an absolutely effortless SEED to Nolan Ryan for the first pitch of Game 4.

It was a nice change of pace from what we often see with ceremonial first pitch appearances, as I wrote about previous in Why President Obama Throws Like a Girl.  You almost have to wonder if him busting out the cheddar during election week was a calculated attempt to win some Republican votes! Also, please refrain from political fighting in the comments section, kids; this is a bipartisan blog.  I will, however, encourage everyone to please get out and vote tomorrow, regardless of your candidates of choice. 2. I am still waiting for someone to convince me that cold water immersion post-training does anything for athletes other than cause serious shrinkage and irritate them.  It seems like it becomes more and more of "the rage" with each passing day, but I still haven't seen anything in the scientific literature supporting the efficacy of ice baths for recovery.  This piece came out just recently: Post exercise ice water immersion: Is it a form of active recovery?

We do not advocate cold water immersion for our athletes right now because I feel that there isn't any evidence to suggest that it has any favorable effects, and for such an annoying experience, you need to be getting considerable benefit in order to be using it regularly.  Moreover, I have seen a TON of pitchers who absolutely despise icing their arms after throwing outings, saying that it interferes with their arm bouncing back and gives them stiffness and difficulty warming up in the subsequent throwing outing.  There is going to need to be some definitive evidence supporting cold water immersion before I even consider experimenting with it in any of our athletes. That said, what has your experience been with cold water immersion and ice baths for recovery?  Please share your thoughts in the comments section. 3. Agents paying college football players to sign with them is a very corrupt and unacceptable practice, but the most scary part of this article for me is that three of the 23 players in question were DEAD before they hit 30.  Does anyone else find that a 13% mortality rate among this guy's potential clients kind of odd?  My guess would be that they weren't the most ethical guys in question and probably were involved in some sketchy stuff on the side, but it is still pretty wild that the author of this article just tosses it in there as a quick closing sentence like it's nothing worthy of consideration. 4. We are kicking on all cylinders with our professional baseball training crew.  As of right now, we have 44 guys from all over the country committed to getting after it this winter.  It's shaping up to be a fun time and great atmosphere - especially when you factor in our high school and college baseball guys. 5. Speaking of Cressey Performance, we've got Nick Tumminello coming in this morning to do an in-service for our staff.  Nick's a smart dude who teaches all over the world (he's headed to China right after us), and we're really lucky to have him.  In this dynamic industry, if you aren't getting better, you're falling behind - so be sure to seek out opportunities to watch industry leaders present whenever you can.  For more information on Nick, check out www.NickTumminello.com.  Here's a little taste of some of Nick's stuff:

6. Last, but not least, cute puppy pictures.

Asleep in my slipper:

Asleep in my wife's gym bag:

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