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Athletes regularly take an ice-water bath after training or playing. It is known as cold water immersion/cryotherapy. It is used to relieve and reduce muscle soreness and pain after intense training or competition. From runners to professional tennis and football players, taking an ice bath is a common recovery practice. Many athletes utilize ice baths to help with faster recovery, prevent injury, and cool down the body. Here we provide some research on cold-water immersion therapy.

Ice Water Bath

Cold Immersion After Exercise or Physical Activity

Exercise causes microtrauma/tiny tears in the muscle fibers. The microscopic damage stimulates muscle cell activity to repair the damage and strengthen the muscles/hypertrophy. However, hypertrophy is linked with delayed onset muscle soreness and pain/DOMS, between 24 and 72 hours after physical activity. An ice water bath works by:

• Constricting the blood vessels.
• Flushes out waste products (lactic acid), out of the muscle tissues.
• Decreases metabolic activity.
• Slows down physiological processes.
• Reduces inflammation, swelling, and tissue breakdown.
• Then, applying heat or warming up the water increases and speeds up blood circulation, improving the healing process.
• There is no current ideal time and temperature for cold immersion, but most athletes and trainers who use the therapy recommend a water temperature between 54 to 59 degrees Fahrenheit and immersion of five to 10 minutes, and depending on the soreness, sometimes up to 20 minutes.

Pros and Cons

The effects of ice baths and cold water immersion on exercise recovery and muscle soreness.

Relieves Inflammation but Can Slow Down Muscle Growth

• A study determined that cold water immersion can disrupt training adaptations.
• Research suggests that icing muscles right after maximum exercise decreases inflammation, but can slow down muscle fiber growth, and delay muscle regeneration.
• Athletes trying to increase muscle size and strength may need to adjust the therapy sessions.

Reduce Muscle Soreness

• A review concluded there was some evidence that ice water immersion reduced delayed onset muscle soreness when compared to resting and rehabilitation or no medical treatment.
• The most effects were seen in running athletes.
• There was no substantial evidence to conclude whether it improved fatigue or recovery.
• The studies did not have a standard for adverse effects or follow-up with the participants regularly.
• There was no difference in muscle soreness between cold water immersion, active recovery, compression, or stretching.

Pain Relief

• Cold water immersion after a physical activity offers temporary pain relief but can help with a faster recovery.
• A study of jiu-jitsu athletes found that following a workout with cold water immersion could lead to decreased muscle aches and help reduce lactate levels.
• Alternating cold water and warm water baths (contrast water therapy), may help athletes feel better and offer temporary pain relief.

Active Recovery Alternative

More research is needed before a firm conclusion can be reached on ice-water bath therapy. However, active recovery is a recommended alternative for athletes looking to recover faster.

• A study suggested that ice baths were equally effective, but not more effective, as active recovery for reducing inflammation.
• Cold water immersion is no greater than active recovery upon local and systemic inflammatory cellular stress.
• Research determined that active recovery is still the most widely used, and currently the best way to recover after intense exercise or physical activity.
• Low-impact workouts and stretches are still considered the most beneficial cool-down methods.

Cold Water Therapy

Ice Bath

• Individuals can use their tub at home to perform cold water therapy.
• Individuals may want to purchase a large bag of ice, but the cold water from the faucet will work.
• Fill the tub with cold water, and if desired, pour in some ice.
• Let the water and ice sit to get the cold temperature.
• Measure the temperature if necessary before getting in.
• Submerge the lower half of the body and adjust the temperature based on feel by adding more water, ice, or warm water if freezing.
• It's like icing with an ice pack, but the whole body swelling reduces and relaxes the muscles.
• Don't overdo it - one review found the best routine was 11 to 15 minutes of immersion at a temperature between 52 and 60 degrees Fahrenheit.

Cold Shower

• A few minutes in a cold shower is another way to perform the therapy.
• Individuals can get in a cold shower or start with warm water and slowly transition to cold.
• This is the easiest and most time-efficient method of cold water therapy.

Safety

• Consult with your doctor or a health care practitioner before practicing cold water therapy.
• Exposure to cold water can affect blood pressure, circulation, and heart rate.
• Cold water immersion can cause cardiac stress and can result in a heart attack.
• Be mindful that exposure to cold temperatures can result in hypothermia.
• Get out of the cold water if you experience numbness, tingling, discomfort, and/or pain.

Optimizing Wellness

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Allan, R, and C Mawhinney. “Is the ice bath finally melting? Cold water immersion is no greater than active recovery upon local and systemic inflammatory cellular stress in humans.” The Journal of Physiology vol. 595,6 (2017): 1857-1858. doi:10.1113/JP273796

Altarriba-Bartes, Albert, et al. “The use of recovery strategies by Spanish first division soccer teams: a cross-sectional survey.” The Physician and sports medicine vol. 49,3 (2021): 297-307. doi:10.1080/00913847.2020.1819150

Bieuzen, François, et al. “Contrast water therapy and exercise-induced muscle damage: a systematic review and meta-analysis.” PloS one vol. 8,4 e62356. 23 Apr. 2013, doi:10.1371/journal.pone.0062356

Fonseca, Líllian Beatriz et al. “Use of Cold-Water Immersion to Reduce Muscle Damage and Delayed-Onset Muscle Soreness and Preserve Muscle Power in Jiu-Jitsu Athletes.” Journal of athletic training vol. 51,7 (2016): 540-9. doi:10.4085/1062-6050-51.9.01

Forcina, Laura, et al. “Mechanisms Regulating Muscle Regeneration: Insights into the Interrelated and Time-Dependent Phases of Tissue Healing.” Cells vol. 9,5 1297. 22 May. 2020, doi:10.3390/cells9051297

Shadgan, Babak, et al. “Contrast Baths, Intramuscular Hemodynamics, and Oxygenation as Monitored by Near-Infrared Spectroscopy.” Journal of athletic training vol. 53,8 (2018): 782-787. doi:10.4085/1062-6050-127-17

Sutkowy, Paweł, et al. “Postexercise impact of ice-cold water bath on the oxidant-antioxidant balance in healthy men.” BioMed research international vol. 2015 (2015): 706141. doi:10.1155/2015/706141

Thermogenesis and metabolic homeostasis work hand in hand, thanks to BAT’s proper function. Indeed, BAT can metabolize nutrients, such as glucose and fatty acids, and convert them into heat instead of ATP. This mechanism is called non-shivering thermogenesis, and it is made possible by mitochondrial uncoupling protein 1 (UCP-1). Furthermore, proper mitochondrial function and quality are essential for the BAT metabolic and thermogenic processes. Therefore, maintaining mitochondrial homeostasis is crucial for BAT’s metabolic maintenance.

BAT:

Brown adipose tissue (BAT) is a specialized adipocyte group that converts nutrients, like glucose and fatty acids, into heat. Indeed, this thermogenic process is possible due to the high mitochondrial concentration and uncoupling protein 1 (UCP1). 

Furthermore, this thermogenic mechanism is essential to maintain core body temperature and survival when exposed to cold temperatures. Indeed, when exposed to cold weather, brown adipocyte’s mitochondria convert nutrients into protons and stores them in the mitochondrial inner membrane. Consequently, these stored protons are converted into heat by uncoupling protein 1 (UCP1)-mediated proton leak. Lastly, the heat produced by UCP1 is by the blood flow to maintain body temperature. This mechanism is called non-shivering thermogenesis, and it promotes metabolic homeostasis by modulating energy expenditure.

This activation pathway shows that mitochondrial function and quality are essential for thermoregulation and metabolic homeostasis. Furthermore, this positions mitochondrial health in the central stage of human survival mechanisms and energy production. In addition, as mitochondrial integrity becomes paramount for proper BAT function, their biogenesis, repair, and removal are critical for human health.

Clinical applications:

Recent studies have focused on increasing BAT by several mechanisms that have proven to improve mitochondrial function. Furthermore, these studies challenged brown adipocytes from mice with cold temperatures to observe mitochondrial behavior and, most important, quality control.

Cold adaptation:

In the first study, the researchers observed the mitochondrial ultrastructure of mice by electron microscopic (EM) images. Afterward, the mice were divided into two groups; the first was subjected to 4 °C (cold-challenge) vs. 30 °C (thermoneuturality) for seven days.

Furthermore, the EM images reported an increased presence of mitophagosomes in cold-challenged mouse BAT. Also, there was an increased expression of mRNA of mammalian autophagic membrane markers microtubule-associated protein light chain 3 (Map1lc3a) and ubiquitin-interacting protein p62 (Sqstm1). Consequently, these findings coincided with an increased concentration of UCP1, cytochrome c oxidase 1 (mt-Co1), cytochrome c oxidase II (mt-Co2), and ATP-synthase 6 (mt-Atp6). All of these results point to the fact that cold exposure increases mitophagy, which improves mitochondrial quality. Also, this shows that cold exposure increases UCP1 and cytochrome concentration, which can increase BAT’s size and total metabolic capacity.

BAT’s mitochondrial and ER interaction:

The second study focused on the interaction of BAT’s mitochondrial and endoplasmic reticulum (ER) health. Indeed, this study reports how BAT adaptive recruitment process during cold adaptation interacts with ER’s protein and lipid synthesis. Furthermore, they also discuss the importance of a high-fat diet consumption and how this excess nutrient consumption might lead to the whitening of this tissue and reduced metabolic capacity.

ER’s cellular function is to synthesize proteins and lipids, and by doing so, this creates metabolic homeostasis. In addition, ER has its maintenance mechanism mediated by the unfolded protein response (UPR). Indeed, UPR is a molecular network that promotes enhanced protein capacity and reduces protein translation and ER-associated protein degradation (ERAD) of damaged proteins through the ubiquitin-proteosome system (UPS). This system is inhibited in obese patient’s livers, which leads to inflammatory stress pathways. Furthermore, as ER concentration is low in brown adipocytes leads to believe that this pathway is dispensable or that brown adipocytes need an alternative protective pathway.

This study confirmed that the ER-localized transcription factor nuclear factor erythroid-2, like-1 (Nfe2l1, also known as Nrf1), was a critical driver of this quality control system. Also, the cold-induced activation of the Nrf1 pathway increased proteasomal activity, maintained ER homeostasis, thermoregulation, and cellular integrity.

Conditions complex as obesity or an injury have something in common with survival: mitochondrial integrity. As the studies on mitochondrial show their different metabolic or thermoregulatory functions, we notice that they run the show. In Functional Medicine, we seek to treat the root cause of health issues, supplying the right amount of vitamins and minerals to increase mitochondrial function or integrity. Most of the time, this means that we need to restore gut health and fix macro and micronutrient depletion, ultimately leading to restoring membrane function. This has a domino effect that results in fast injury recovery, less pain, inflammation reduction, and wellbeing. – Ana Paola Rodríguez Arciniega, MS

References:

Bartelt, Alexander et al. “Brown adipose tissue thermogenic adaptation require Nrf1-mediated proteasomal activity.” Nature medicine vol. 24,3 (2018): 292-303. doi:10.1038/nm.4481

Lu, Yuan et al. “Mitophagy is required for brown adipose tissue mitochondrial homeostasis during cold challenge.” Scientific Reports vol. 8,1 8251. 29 May. 2018, doi:10.1038/s41598-018-26394-5

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General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*