1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).
After working in the health and fitness industry as a personal trainer/gym instructor for a number of years, I found insufficient answers to a number of areas in regards to exercise and health. To enhance my own knowledge I applied and was accepted into the Bachelor of Exercise Science; Australia Catholic University at a young 36 years of age. My university studies were followed with an additional year obtaining my honours by research.
At this stage I had also begun working in professional rugby union as a Strength and Conditioning Coach. In line with this work, I commenced my PhD, examining adaptation and recovery from competition and training in rugby union. Primarily, my PhD focused on evaluating cold water immersion and contrast baths for recovery from exercise induced muscle damage in rugby union.
2. You recently published an article different forms of hydrotherapy and performance, can you please discuss your findings?
I have had 3 papers from the major study of my PhD published in the past 12 months. These papers have been published in the Journal of Strength and Conditioning Research. We examined the 2 forms of hydrotherapy over the acute phase, and the weekly cycle of games and training in rugby union. The major findings we reported included that when examining recovery of power via a CMJ and 10m and 40m sprints there was little benefit in using either of the interventions as a recovery modality, when compared with passive rest, for the period of the study (1 week).
When examining metabolic fluid shifts and flexibility as markers of recovery, again there was little benefit in using either of the interventions as opposed to passive rest. When examining muscle soreness (DOMS) however we identified a beneficial effect in attenuating muscle pain with the use of cold water immersion (ice baths). Surprisingly, we found contrast baths to be the least effective method in attenuating the effects of muscle pain, in fact, we found passive recovery to offer more than contrast baths.
On further investigations we found supporting literature detailing that short durations of immersion in cold water could lead to increases in free-radial production and subsequent increases in oxidative stress, which would have led to greater stress on muscle than exercise activity alone. This increase in stress
On further investigations we found supporting literature detailing that short durations of immersion in cold water could lead to increases in free-radical production and subsequent increases in oxidative stress, which would have led to greater stress on muscle than the exercise activity alone. This increase in stress on muscle would have a corresponding increase with the inflammatory response and overall recovery time, providing the underlying mechanism responsible for results indicating contrast baths to be the least effective recovery intervention, specifically with DOMS.
We also reported that psychologically, contrast baths led to greater perception of effort doing similar volume and intensity of training when compared with ice baths and passive rest. Our overall recommendations were the discontinued practice of contrast baths for recovery from rugby union. We also reported that ice baths were more beneficial for recovery than either contrast baths or passive recovery, when there was insufficient time (< 48hrs) for recovery between games and/or training sessions.
3. Based on the findings, which form of hydrotherapy do you feel is most beneficial?
Our findings indicated that when you have multiple sessions during the week, with reduced time between sessions, ice baths of 2 X 5 min immersion at 10 degrees Celsius is the most beneficial recovery protocol. However, if an athlete has 48 hours between sessions, then irrespective of interventions applied, recovery in tests of power will occur without significant difference between protocols.
4. What is the physiology behind cold-water immersion?
The mechanisms supporting cryotherapy to accelerate recovery has included the reduction in blood flow through vasoconstriction of the arterioles and venules (Arnheim & Prentice) and a reduction in the inflammation response after exercise induced muscle damage (Burke, et al., 2001; Ingram, Dawson, Goodman, Wallman, & Beilby, 2009). Vasoconstriction of blood vessels occurs within the first 15 minutes of cold been applied, at a temperature of 100C (Arnheim & Prentice). After the application of cold of between 15 to 30 minutes, an intermittent period of vasodilatation will occur for four to six minutes, which generates the return of oxygen to the area via increased blood flow aiding in recovery (Arnheim & Prentice).
In addition cryotherapy reduces tissue temperature which leads to slower rates of chemical reactions (Hubbard, et al., 2004; Peiffer, Abbiss, Nosaka, Peake, & Laursen, 2009). The reduction in the rate of chemical reactions leads to a reduction in the demand for ATP, which reduces the requirement for oxygen (Hubbard, et al., 2004). Following trauma, majority of damage occurring to the cells is a result of hypoxia, a result of compromised circulation resulting from excessive oedema (Arnheim & Prentice; Wilcock, et al., 2006). Cryotherapy acts to decrease the extent of hypoxic, by firstly restricting excessive oedema which restricts the flow of oxygen by compressing capillaries (Yanagisawa, et al., 2003). Secondly, cryotherapy reduces cell metabolism leading to a decrease in oxygen demand, subsequently reducing secondary tissue injury peripheral of the primary injury, resulting in decreased damage of tissue (Arnheim & Prentice; Hubbard, et al., 2004; Wilcock, et al., 2006; Yanagisawa, et al., 2003).
Cryotherapy also reduces the permeability of capillary vessel walls leading to a decrease in metabolic disturbances which may limit performance or reduce recovery. One such metabolic by-product attributed to decreases in performance and delaying recovery is lactic acid (Yanagisawa, et al., 2003). In reducing lactic acid accumulation after exercise, positive effects within intracellular buffering systems including hydrogen ion extrusion mechanisms have been demonstrated with cryotherapy (Yanagisawa, et al., 2003).
Further mechanisms in which hydrotherapy aides recovery from fatiguing exercises, include a significant reduction in core temperature and an associated anticipatory regulatory response to exercise in the heat (Vaile, Halson, Gill, & Dawson, 2008; Peiffer, Abbiss, Nosaka, Peake, & Laursen, 2009). Furthermore cold water temperatures may decrease peripheral blood flow, leading to an increase in blood delivery to working muscles via enhanced central blood flow (Vaile, et al., 2008). Further increases to blood flow by aiding the muscle pump may also be provided with cold and hot water contrast treatment (Vaile, et al., 2008).
5. Do you think there is any psychological component?
Simply put, Yes there probably is a psychological component in any recovery protocol/intervention applied. To what extent that component is I will defer that to the sport psychologists. There are concepts such as the Central Governor theory. Simply put it describes fatigue as occurring as a result of neural commands when physiological overload is approaching.
6. How would you recommend hydrotherapy for swimmers during intense training periods?
In regards to using hydrotherapy for swimmers as a recovery intervention, I am not in a position to clarify one way or the other. My research involved examining cryotherapy as recovery from sport that induces high levels of exercise induced muscle damage. As swimming does not include an eccentric phase the levels of muscle damage occurring would be less. The effect cryotherapy has needs to be investigated fully before claims can be made.
Although swimmers use hydrotherapy for recovery, it is in line with active recovery, or active cool downs. They are generally supported for removal of metabolic waste products and a controlled return of body temperature to resting levels. Only concerns raised have been in regards to glycogen replenishment, when athletes are focussing on restoring glycogen, active recovery may have a negative effect as the athlete burns fuel (glycogen) whilst performing active recovery. Therefore, staging it at the appropriate time with all matters important for recovery considered is fine.
7. How about in between sessions at a competition?
Concerns with cryotherapy between sessions have been raised due to the reduction in body/muscle temperature and the effect that has on neural commands, specifically electrical impulse transmissions to working muscles. The signals have been shown to slow down or reduced, leading to loss of muscle activation and strength/power decrements.
8. Do you think people acclimate to forms of hydrotherapy?
I think athletes may get use to climbing into ice baths, but I don’t see the body adapting to the cold and subsequently making it less effective in reducing body temperature. It is more likely if athletes are competing in varying environments eg: cold climates or hot climates, that their body temperatures post exercise may be different leading to slower or faster responses of the body/muscle temperature to the ice baths.
9. Who is doing the most interesting research hydrotherapy? What are they doing and what do you think of it?
Perhaps I’m biased, but I believe the Australian Institute of Sport recovery centre is leading the way in hydrotherapy research into recovery. Although, I attended the ECCS conference in Brugge last year and met with a number of fellow sport scientists evaluating hydrotherapy for recovery. In general, the majority are looking into cycling and recovery. I think it is easier to control the variables in a study when the participants are on bikes. This allows for tighter control and more definitive answers. However, we have to remember that when looking at any research, do the activities in the study reflect what we do (run, swim, cycle, weights etc etc).
10. Do you know of any athletes using extreme forms of hydrotherapy? If so, what are they doing?
I have only heard general comments by other people that they know such and such does this. One internet blog stated that Paula Radke (English Marathon runner) conducted 30 min ice baths after a marathon. If this was the case, I would be concerned about her developing Hypothermia if that was the case.
11. What mistakes still exist in professional athletes and rehabilitation clinics for hydrotherapy?
Firstly, with hydrotherapy there is a difference between using it as a recovery tool and in rehabilitation. As recovery we look to minimise micro-damage that occurs as a result of exercise activity. In rehabilitation they are working with acute traumatic injury. That is a totally different position to athletes looking at recovery. From the athletes use of hydrotherapy as a recovery, I think the biggest mistake they make is the use of anecdotal support to justify it. There appears that in sport, anecdotal support is better than using evidenced based practices. To further add to the problem, athletes and coaches may use the recommendation from another athlete from a different sport, without considering the differences between sports.
It may sound obvious but I believe athletes and coaches need to look for scientific papers on any topic that directly reflect their sport or activity. This isn’t just for recovery, but for anything associated with sport performance. Swimmers need to examine research into swimming, cyclists need to examine cycling research and footballers need to look at football.
12. What research or projects are you currently working on or should we look from you in the future?
Future research I’m looking into, in the near future includes management of residual fatigue across extended football seasons, multiple repeat tests to measure recovery in rugby union and possibly “old school vs small sided games for anaerobic conditioning.
After working in the health and fitness industry as a personal trainer/gym instructor for a number of years, I found insufficient answers to a number of areas in regards to exercise and health. To enhance my own knowledge I applied and was accepted into the Bachelor of Exercise Science; Australia Catholic University at a young 36 years of age. My university studies were followed with an additional year obtaining my honours by research.
At this stage I had also begun working in professional rugby union as a Strength and Conditioning Coach. In line with this work, I commenced my PhD, examining adaptation and recovery from competition and training in rugby union. Primarily, my PhD focused on evaluating cold water immersion and contrast baths for recovery from exercise induced muscle damage in rugby union.
2. You recently published an article different forms of hydrotherapy and performance, can you please discuss your findings?
I have had 3 papers from the major study of my PhD published in the past 12 months. These papers have been published in the Journal of Strength and Conditioning Research. We examined the 2 forms of hydrotherapy over the acute phase, and the weekly cycle of games and training in rugby union. The major findings we reported included that when examining recovery of power via a CMJ and 10m and 40m sprints there was little benefit in using either of the interventions as a recovery modality, when compared with passive rest, for the period of the study (1 week).
When examining metabolic fluid shifts and flexibility as markers of recovery, again there was little benefit in using either of the interventions as opposed to passive rest. When examining muscle soreness (DOMS) however we identified a beneficial effect in attenuating muscle pain with the use of cold water immersion (ice baths). Surprisingly, we found contrast baths to be the least effective method in attenuating the effects of muscle pain, in fact, we found passive recovery to offer more than contrast baths.
On further investigations we found supporting literature detailing that short durations of immersion in cold water could lead to increases in free-radial production and subsequent increases in oxidative stress, which would have led to greater stress on muscle than exercise activity alone. This increase in stress
On further investigations we found supporting literature detailing that short durations of immersion in cold water could lead to increases in free-radical production and subsequent increases in oxidative stress, which would have led to greater stress on muscle than the exercise activity alone. This increase in stress on muscle would have a corresponding increase with the inflammatory response and overall recovery time, providing the underlying mechanism responsible for results indicating contrast baths to be the least effective recovery intervention, specifically with DOMS.
We also reported that psychologically, contrast baths led to greater perception of effort doing similar volume and intensity of training when compared with ice baths and passive rest. Our overall recommendations were the discontinued practice of contrast baths for recovery from rugby union. We also reported that ice baths were more beneficial for recovery than either contrast baths or passive recovery, when there was insufficient time (< 48hrs) for recovery between games and/or training sessions.
3. Based on the findings, which form of hydrotherapy do you feel is most beneficial?
Our findings indicated that when you have multiple sessions during the week, with reduced time between sessions, ice baths of 2 X 5 min immersion at 10 degrees Celsius is the most beneficial recovery protocol. However, if an athlete has 48 hours between sessions, then irrespective of interventions applied, recovery in tests of power will occur without significant difference between protocols.
4. What is the physiology behind cold-water immersion?
The mechanisms supporting cryotherapy to accelerate recovery has included the reduction in blood flow through vasoconstriction of the arterioles and venules (Arnheim & Prentice) and a reduction in the inflammation response after exercise induced muscle damage (Burke, et al., 2001; Ingram, Dawson, Goodman, Wallman, & Beilby, 2009). Vasoconstriction of blood vessels occurs within the first 15 minutes of cold been applied, at a temperature of 100C (Arnheim & Prentice). After the application of cold of between 15 to 30 minutes, an intermittent period of vasodilatation will occur for four to six minutes, which generates the return of oxygen to the area via increased blood flow aiding in recovery (Arnheim & Prentice).
In addition cryotherapy reduces tissue temperature which leads to slower rates of chemical reactions (Hubbard, et al., 2004; Peiffer, Abbiss, Nosaka, Peake, & Laursen, 2009). The reduction in the rate of chemical reactions leads to a reduction in the demand for ATP, which reduces the requirement for oxygen (Hubbard, et al., 2004). Following trauma, majority of damage occurring to the cells is a result of hypoxia, a result of compromised circulation resulting from excessive oedema (Arnheim & Prentice; Wilcock, et al., 2006). Cryotherapy acts to decrease the extent of hypoxic, by firstly restricting excessive oedema which restricts the flow of oxygen by compressing capillaries (Yanagisawa, et al., 2003). Secondly, cryotherapy reduces cell metabolism leading to a decrease in oxygen demand, subsequently reducing secondary tissue injury peripheral of the primary injury, resulting in decreased damage of tissue (Arnheim & Prentice; Hubbard, et al., 2004; Wilcock, et al., 2006; Yanagisawa, et al., 2003).
Cryotherapy also reduces the permeability of capillary vessel walls leading to a decrease in metabolic disturbances which may limit performance or reduce recovery. One such metabolic by-product attributed to decreases in performance and delaying recovery is lactic acid (Yanagisawa, et al., 2003). In reducing lactic acid accumulation after exercise, positive effects within intracellular buffering systems including hydrogen ion extrusion mechanisms have been demonstrated with cryotherapy (Yanagisawa, et al., 2003).
Further mechanisms in which hydrotherapy aides recovery from fatiguing exercises, include a significant reduction in core temperature and an associated anticipatory regulatory response to exercise in the heat (Vaile, Halson, Gill, & Dawson, 2008; Peiffer, Abbiss, Nosaka, Peake, & Laursen, 2009). Furthermore cold water temperatures may decrease peripheral blood flow, leading to an increase in blood delivery to working muscles via enhanced central blood flow (Vaile, et al., 2008). Further increases to blood flow by aiding the muscle pump may also be provided with cold and hot water contrast treatment (Vaile, et al., 2008).
5. Do you think there is any psychological component?
Simply put, Yes there probably is a psychological component in any recovery protocol/intervention applied. To what extent that component is I will defer that to the sport psychologists. There are concepts such as the Central Governor theory. Simply put it describes fatigue as occurring as a result of neural commands when physiological overload is approaching.
6. How would you recommend hydrotherapy for swimmers during intense training periods?
In regards to using hydrotherapy for swimmers as a recovery intervention, I am not in a position to clarify one way or the other. My research involved examining cryotherapy as recovery from sport that induces high levels of exercise induced muscle damage. As swimming does not include an eccentric phase the levels of muscle damage occurring would be less. The effect cryotherapy has needs to be investigated fully before claims can be made.
Although swimmers use hydrotherapy for recovery, it is in line with active recovery, or active cool downs. They are generally supported for removal of metabolic waste products and a controlled return of body temperature to resting levels. Only concerns raised have been in regards to glycogen replenishment, when athletes are focussing on restoring glycogen, active recovery may have a negative effect as the athlete burns fuel (glycogen) whilst performing active recovery. Therefore, staging it at the appropriate time with all matters important for recovery considered is fine.
7. How about in between sessions at a competition?
Concerns with cryotherapy between sessions have been raised due to the reduction in body/muscle temperature and the effect that has on neural commands, specifically electrical impulse transmissions to working muscles. The signals have been shown to slow down or reduced, leading to loss of muscle activation and strength/power decrements.
8. Do you think people acclimate to forms of hydrotherapy?
I think athletes may get use to climbing into ice baths, but I don’t see the body adapting to the cold and subsequently making it less effective in reducing body temperature. It is more likely if athletes are competing in varying environments eg: cold climates or hot climates, that their body temperatures post exercise may be different leading to slower or faster responses of the body/muscle temperature to the ice baths.
9. Who is doing the most interesting research hydrotherapy? What are they doing and what do you think of it?
Perhaps I’m biased, but I believe the Australian Institute of Sport recovery centre is leading the way in hydrotherapy research into recovery. Although, I attended the ECCS conference in Brugge last year and met with a number of fellow sport scientists evaluating hydrotherapy for recovery. In general, the majority are looking into cycling and recovery. I think it is easier to control the variables in a study when the participants are on bikes. This allows for tighter control and more definitive answers. However, we have to remember that when looking at any research, do the activities in the study reflect what we do (run, swim, cycle, weights etc etc).
10. Do you know of any athletes using extreme forms of hydrotherapy? If so, what are they doing?
I have only heard general comments by other people that they know such and such does this. One internet blog stated that Paula Radke (English Marathon runner) conducted 30 min ice baths after a marathon. If this was the case, I would be concerned about her developing Hypothermia if that was the case.
11. What mistakes still exist in professional athletes and rehabilitation clinics for hydrotherapy?
Firstly, with hydrotherapy there is a difference between using it as a recovery tool and in rehabilitation. As recovery we look to minimise micro-damage that occurs as a result of exercise activity. In rehabilitation they are working with acute traumatic injury. That is a totally different position to athletes looking at recovery. From the athletes use of hydrotherapy as a recovery, I think the biggest mistake they make is the use of anecdotal support to justify it. There appears that in sport, anecdotal support is better than using evidenced based practices. To further add to the problem, athletes and coaches may use the recommendation from another athlete from a different sport, without considering the differences between sports.
It may sound obvious but I believe athletes and coaches need to look for scientific papers on any topic that directly reflect their sport or activity. This isn’t just for recovery, but for anything associated with sport performance. Swimmers need to examine research into swimming, cyclists need to examine cycling research and footballers need to look at football.
12. What research or projects are you currently working on or should we look from you in the future?
Future research I’m looking into, in the near future includes management of residual fatigue across extended football seasons, multiple repeat tests to measure recovery in rugby union and possibly “old school vs small sided games for anaerobic conditioning.
