Ice bath

In sports therapy, an ice bath, or sometimes cold-water immersion or cold therapy, is a training regimen usually following a period of intense exercise[1][2] in which a substantial part of a human body is immersed in a bath of ice or ice-water for a limited duration.[3]

Champion weightlifter Karyn Marshall taking an ice bath after the Crossfit Games in 2011.

While it is becoming increasingly popular and accepted among athletes in a variety of sports,[4][5][6][7][8] the method is controversial,[9] with a risk of hypothermia,[10] with the possibility of shock[11] leading to sudden death.[10][12][13] Many athletes have used cold water immersion after an intense exercise workout in the belief that it speeds up bodily recovery; however, the internal physical processes are not well understood and remain elusive.[14] Evidence supporting cold water immersion as part of an athletic training regimen remains inconclusive,[15] with some studies suggesting a mild benefit such as reducing muscle damage and discomfort[16] and alleviating delayed onset muscle soreness,[4][17][18] with other studies suggesting that cold water immersion may slow muscle growth and interfere with an overall training regimen.[19]

Techniques
Ice baths have been used as a part of military training. (Mustang Mudder obstacle course May 5 at Kandahar Airfield, Afghanistan).

Bath

It is done by standing or sitting in a bucket or bath of icy water. One writer advised: "don't overdo it."[20] Wearing rubberized "dive booties" on the feet (to protect toes) as well as rubber briefs to warm the midsection have been recommended. Champion weightlifter Karyn Marshall, who won the world women's weightlifting championship in 1987,[21] described what it was like to take an ice bath after a day of competition at the CrossFit Games in 2011 in Los Angeles:

The first day I went in for twelve minutes, and the second day for fifteen minutes. They kept adding ice to keep the temperature at around 55 degrees (Fahrenheit) ... The hardest part was the first two minutes. Others who do it often told me to just hang in for two minutes and then it would be easier. After two minutes I was numb. Afterwards I was shivering for two hours in the hot California sun with a warm up jacket on.

— Karyn Marshall, 2011

One report suggested that if ice water is circulating, it's even colder such that the water will be colder than measured by a thermometer, and that athletes should avoid overexposure.[22] Physical therapist Nikki Kimball explained a way to make the bath more endurable:

Over those years, I've discovered tricks to make the ice bath experience more tolerable. First, I fill my tub with two to three bags of crushed ice. Then I add cold water to a height that will cover me nearly to my waist when I sit in the tub. Before getting in, I put on a down jacket and a hat and neoprene booties, make myself a cup of hot tea, and collect some entertaining reading material to help the next 15 to 20 minutes pass quickly.

— Runner's World, 2008[23]

Ice bath only versus contrast bath therapy
Iceman Wim Hof in an ice bath in 2007.

Some athletes use a technique known as contrast water therapy or contrast bath therapy, in which cold water and warmer water are alternated.[20] One method of doing this was to have two tubs––one cold (10–15 degrees Celsius) and another hot (37–40 degrees Celsius) ––and to do one minute in the cold tub followed by two minutes in a hot tub, and to repeat this procedure three times.[20]

Temperature and timing

The temperature can vary, but is usually in the range of 50–59 degrees Fahrenheit[7][23] or between 10 and 15 degrees Celsius.[20][24] Some athletes wear booties to keep their toes warm[7] or rubberized coverings around their midsection while immersed. Some drink a warm beverage such as tea.[7] One report suggested that "ten minutes immersed in 15 degree Celsius water" was sufficient.[20]

Accounts vary about how long to be immersed and how often to do them. One adviser suggested that an athlete should take ten two-minute ice bath treatments over a two-week period.[25] One account suggested immersion times should be between ten and twenty minutes.[23] Another suggested that immersion run from five to ten minutes, and sometimes to twenty minutes.[20] There were no sources advocating being immersed for longer than twenty minutes.

Ice baths versus cold baths

Several sources suggest that cold baths (60–75 degrees Fahrenheit, 15.5-22.8°C) were preferable to ice baths. Physiotherapist Tony Wilson of the University of Southampton said that extremely cold temperatures were unnecessary and a "cold bath" would be just as effective as an ice bath.[25] Another agreed that a mere cold bath is preferable to ice baths which are "unnecessary."[20] A third report suggested that cool water (60–75 degrees Fahrenheit, 15.5-22.8°C) was just as good as water at a lower temperature (54–60 degrees Fahrenheit, 12.2-15.5°C) and that eight to ten minutes should be sufficient time, and warned against exceeding ten minutes.[22]

Effectiveness
In summer 2014, the Ice Bucket Challenge went viral on social media to raise money for the ALS Association.

After exercise, there is some evidence that taking an ice bath may reduce delayed onset muscle soreness and perceptions of fatigue, but no good evidence of any other benefit.[17][26] Chronic use of the ice bath may be beneficial for athletes who are in high volume training periods.[27] Research has shown that ice baths four times per week in a congested training schedule of professional rugby players reduced muscle soreness while attenuating the decline in jump performance compared to those who didn't ice bath.[28]

Safety

There is agreement in the medical and scientific communities that ice baths can pose serious risks to health. Risks include hypothermia,[10] shock[11] and the possibility of sudden cardiac death.[10][12][13][29]

History

Marathon runner Paula Radcliffe won the 10,000m event at the 2002 European championships and attributed her victory to the use of ice baths.[30] She reportedly said "It's absolute agony, and I dread it, but it allows my body to recover so much more quickly."[31] She reported taking ice baths before racing and preferred her pre-race bath temperature to be "very cold."[25] After the Radcliffe comment, the technique has grown in popularity.[30] It is gaining in popularity among athletes,[7][8][30] such that some athletes "swear by it"[30][32][33] but other accounts suggest it may be a fad.[25][30]

It has been used by athletes such as A. J. Soares[5] and Olympic swimmer Michael Phelps[34] as well as other celebrity endorsers[35] and is getting to become "common practice" among athletes[20][33][36] from different sports, including American football,[37] association football (soccer),[2][5] long distance running,[7][9][23] rugby,[1][30] tennis,[38] volleyball,[6] and other sports. There was a report that sports equipment manufacturers are considering different designs for ice baths.[39] In the summer of 2014, as a fundraising method, the nonprofit ALS Association, which raises money for research and public awareness of amyotrophic lateral sclerosis or ALS, also known as Lou Gehrig's disease, began the Ice Bucket Challenge which involved donors filming themselves and challenging other donors to participate and then being doused with a bucket of ice cold water; as a fundraising effort, it raised $16 million over a 22-day period.[40][41]

There are indications that ice baths may be gaining popularity with groups outside sports, such as dance. The Pittsburgh Post-Gazette reported that some Radio City Rockettes, a precision dance company performing in New York City, use ice baths after a long day of performing as a way to "unwind" and cope with "aches and pains."[42] One report suggested that entertainer Madonna used ice baths after her performances.[43] And there are indications that use of ice baths is spreading to amateur sports, such as high school football.[44]

Explorer and athlete Fiann Paul is known for using ice baths as part of his training routine.[45]

Ice baths are a part of a broader phenomenon known as cryotherapy—the Greek word cryo (κρυο) means cold—which describes a variety of treatments when cold temperatures are used therapeutically. Cryotherapy includes procedures where a person is placed in a room with "cold, dry air at temperatures as low as −135 °C" for short periods of time, and which has been used in hospitals in Poland as well as a center in London to treat not only muscular ailments, but psychological problems such as depression.[25] Basketball player Manny Harris reportedly used a Cryon-X machine featuring extreme low temperatures around minus 166 degrees Fahrenheit, but used it with wet socks resulting in a serious freezer burn.[46]

Occasionally ice baths have been an ill-advised treatment of fever in young children, but that doctors were counseled not to use this technique because of the risk of hypothermia.[47] Ice baths have been suggested as a way to prevent muscle soreness after shoveling snow.[8]

In addition, there have been instances of ice bathing as an extreme bodily test by persons vying for an endurance record, such as Dutch Iceman Wim Hof,[48] and Chinese record-holders Chen Kecai[49] and Jin Songhao.[50] According to reports, doctors and scientists are studying how these people can spend an hour and a half submerged in an ice bath, and survive; for almost all humans, such tasks are impossible.

See also
  • Cryotherapy
  • Dousing
  • Ice bucket challenge
  • Polar bear plunge
  • Winter swimming

References
  1. "Photo Replay". The New York Times. July 28, 2011. Retrieved 2011-08-13. Daniel Ianus of Romania's national rugby team took an ice bath after a training session ...
  2. Yael Averbuch (2011-04-28). "No Tweeting From the Ice Bath". The New York Times: Soccer. Retrieved 2011-08-13. I tell my body to do a lot of things: Run one more sprint. Strike 50 balls. Push through just 15 more minutes. Warm up. Cool down. Sit in an excruciating ice bath.
  3. Note: This article only refers to the use of ice baths in sports therapy and not to their use in cold exposure programs like the Wim Hof Method where ice baths are of different temperatures and are used differently.
  4. Christine Kearney, 20 February 2012, Medical News Today, Muscle Soreness – Is Cold Water Immersion Effective For Treatment?, Retrieved October 5, 2016, "...a cold bath may be an effective way to prevent and help sore muscles. ...difficult for researchers to determine exactly how much cold water immersion helps sore muscles, ...The researchers say it is necessary for more studies to be done in order to be sure of the effectiveness of cold water baths in treating muscle soreness. ..."
  5. AJ Soares (February 18, 2011). "This California boy welcomes opportunity to play in New England". The Boston Globe. Retrieved 2011-08-14. Hello New England! I am AJ Soares, a new player, or employee as I tell people, at the New England Revolution. ... It's time for me to dip out, ice bath, and get ready to get to work again tomorrow with the team.
  6. Tilman von der Linde (25 Feb 2009). "Speeding Up Muscle Recovery – Ice Bath Benefits". The Vancouver Sun. Archived from the original on 6 May 2010. Retrieved 2011-08-14. Many athletes ... have also discovered the benefits of the icy plunge. Pro Beach Volleyball Players and Marathon Runners have been asked to go stand in the ocean for a few minutes. ...
  7. Lenny Bernstein (November 9, 2010). "Recovering from high-intensity athletics". Washington Post. Retrieved 2011-08-13. ...you want to keep those tired muscles limber.
  8. George Guerin (January 27, 2011). "Shoveling snow again? Try some of these tips to ease those aches and pains". Newark Star-Ledger. Archived from the original on January 30, 2011. Retrieved 2011-08-13. If you have been shoveling ... Ice Bath: An ice bath ... can help reduce muscle soreness. This is extremely popular in athletic locker rooms, sometimes even mandatory after rigorous exercise.
  9. Julie Deardorff (October 12, 2009). "Rules for runners: Skip the ice bath". Chicago Tribune. Retrieved 2011-08-13. ... many of my RW colleagues swear by ice baths after a long run or race. Not me. I still maintain that ice baths are an elaborate practical joke being played on runners ...
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  15. Rowsell GJ, Reaburn P, Toone R, Smith M, Coutts AJ (2014). "Effect of run training and cold-water immersion on subsequent cycle training quality in high-performance triathletes". Journal of Strength and Conditioning Research. 28 (6): 1664–72. doi:10.1519/JSC.0000000000000455. hdl:10453/41986. PMID 24626137. S2CID 12032750.
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  17. Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW (2012). "Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise". Cochrane Database Syst Rev (Systematic review) (2): CD008262. doi:10.1002/14651858.CD008262.pub2. PMC 6492480. PMID 22336838.
  18. Machado AF, Ferreira PH, Micheletti JK, de Almeida AC, Lemes ÍR, Vanderlei FM, Netto Junior J, Pastre CM (2016). "Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis". Sports Medicine. 46 (4): 503–14. doi:10.1007/s40279-015-0431-7. PMC 4802003. PMID 26581833.
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  20. Elizabeth Quinn (September 30, 2008). "After Exercise – Does an Ice Water Bath Speed Recovery?". About.com. Retrieved 2011-08-14. After Exercise Ice Bath – Does It Help Recovery?
  21. Julie Carft (July 29, 1989). "Image is Heavy Burden – Weightlifter Karyn Marshall Feels Pressure to Project 'Femininity, Intelligence'". Los Angeles Times. Retrieved 2009-10-02.
  22. Andy Schmitz; USA Triathlon. "8 Ice Bath Dos and Don'ts". Active.com. Retrieved 2011-08-14. DO: Be aware that moving water is colder water.
  23. Nikki Kimball; physical therapist (August 1, 2008). "Ice Baths: Cold Therapy – Ice baths are one of the most effective ways to offset the damage done on a run". Runner's World. Archived from the original on August 23, 2011. Retrieved 2011-08-14. One simple way to offset the risks inherent to long bouts of running is cold-water immersion, known to many runners as the ice bath.
  24. Stephen Mirarchi (September 2006). "Owner's Manual: Chill Out: Better recovery with ice baths". Running Times Magazine. Archived from the original on 2012-05-22. Retrieved 2011-08-14. ... First, immersion allows controlled, even constriction around all muscles, effectively closing microscopic damage that cannot be felt and numbing the pain that can. ...
  25. Ellie Levenson (21 November 2006). "It's hot to be cold". The Guardian. London. Retrieved 2011-08-13. Not only has recent research from the Scripps Research Institute in California shown that reducing the core body temperature of mice makes them live for longer...
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  27. "Science Of Ice Bath Recovery For Fighters: In-Depth Guide - Sweet Science of Fighting". Retrieved 2021-10-09.
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  30. James Randerson (10 July 2007). "Study pours cold water on theory that ice aids recovery". The Guardian. London. Retrieved 2011-08-13. But Australian scientists have discovered that not only does the modern treatment have no effect – it may do more harm than good.
  31. Craig Smith (2003-09-30). "The cold benefits of ice baths". BBC News. Retrieved 2011-08-14. In simple terms, it's about helping the muscles, tendons, bones, nerves and all the different tissues used in sport recover from their workout.
  32. NewsCore (4 Nov 2010). "Experts Pour Cold Water on Athletes' Ice-Bath Remedy". Fox Boston. Retrieved 2011-08-14. ... the grueling ritual of the ice bath could reduce the benefits of exercise. ...
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  34. KAREN CROUSE (August 4, 2012). "With One Last Gold, Phelps Caps Career That Inspired a Generation". The New York Times. Retrieved October 25, 2012. ...It is because of Phelps that swimmers like Franklin think nothing of taking an ice bath to expedite their recovery.
  35. "Sports star ice baths questioned". BBC News. 10 July 2007. Retrieved 2011-08-14. British Journal of Sports Medicine now claims the opposite may be true. Out of 40 volunteers, those who took an icy plunge reported more pain after 24 hours than those who took a tepid bath. ... Ice baths have become one of the most fashionable ways of recovering after an intense game or marathon. From rugby to tennis players, the bath has a series of celebrity endorsers.
  36. Gordon McKerrow (interviewer) Ryan Babel (interviewee) (April 2, 2008). "Rough diamond: Liverpool's Babel reflects on Ajax, Benítez, ice baths". Sports Illustrated. Retrieved 2011-08-14. ... After a match we have to stand in an ice bath for five minutes. ... {{cite magazine}}: |author= has generic name (help)
  37. Mike Brown (August 15, 2007). "Survival in the heat: The ice age: On hot days, teams mandate ice baths for athletes". Tulsa World via Highbeam Research. Archived from the original on February 22, 2016. Retrieved October 25, 2012. About half of TU's football players take daily dips in water cooled to between 50 and 55 degrees. ... The muscles start feeling a lot better. Aside from the obvious benefit of cooling down quickly from the heat, ice baths help the legs and muscles recover for the next practice.
  38. Geoff Macdonald (June 24, 2010). "How Do You Recover From 163 Games?". The New York Times: Tennis. Retrieved 2011-08-13. ...the next smart move would be to take a full body ice bath. ...
  39. "Cool ice bath innovation makes waves in sporting circles". The Irish Times via Highbeam Research. June 24, 2011. Archived from the original on February 25, 2016. Retrieved October 25, 2012. ... However the design of conventional ice baths leaves something to be desired.
  40. August 14, 2014, Campbell North, Pittsburgh Post-Gazette, People around the country have ALS challenge down cold, Retrieved Aug. 18, 2014, "...Those who forgo the ice bath are asked to donate to an ALS organization..."
  41. Bill Saporito, Aug. 18, 2014, Time magazine, How the ALS Ice Bucket Challenge Could Change Fundraising Forever, Retrieved Aug. 18, 2014, "...Never mind the ice bath; you could have just written the check...."
  42. Sara Bauknecht (November 15, 2009). "Rockettes manager strives to keep troupe fit and healthy". Pittsburgh Post-Gazette. Retrieved 2011-08-13. How do the 200 Radio City Rockettes ... Taking ice baths ... some Rockettes take ice baths to unwind after a long day.
  43. "Madonna sits in ice bath after concerts". Hindustan Times via Highbeam Research. October 19, 2009. Archived from the original on October 18, 2016. Retrieved October 25, 2012. After her live shows, Pop diva Madonna .. bath of ice to soothe the pain her body has endured after hours of performing on stage.
  44. Josh Rosenfeld (October 2, 2010). "Westfield 30, Elizabeth 20 (High school Football scores and results)". The Star Ledger. Retrieved 2011-08-14. Long after most of his teammates had departed Gary Kehler Stadium, A.J. Murray sat in a well-deserved ice bath in a large plastic tub while basking in the sunlight outside the Westfield training room.
  45. Fiann Paul | Ocean Rowing | Trans World Sport, retrieved 2019-10-21
  46. Darren Rovell of CNBC.com (January 1, 2012). "Did a mistake in New Age ice bath set back NBA player?". USA Today. Retrieved October 25, 2012. In November, Cleveland Cavaliers guard Manny Harris got into a Cryon-X machine on Nike's campus in Beaverton, Ore. When he came out, he had a nasty freezer burn on the side of his right foot. ... In just three minutes, the company that makes it, Millennium ICE, says the machine cranks the temperature inside to minus 166 degrees Fahrenheit, thus oxygenating the blood, helping to reduce fatigue and muscle soreness.
  47. Julie Deardorff (May 2, 2010). "Health myths your doctor may believe". Chicago Tribune. Archived from the original on 2018-10-09. Retrieved 2011-08-13. 5 percent said children can be given an ice bath to treat a fever – Risk: hypothermia
  48. Angier, Joseph (14 April 2009). "Iceman on Everest: 'It Was Easy'". ABC News. Retrieved 18 March 2020.
  49. Young, Trystan (4 January 2011). "Chilly Chinese compete for world ice bathing record". BBC News (Adobe Flash video). Retrieved 18 March 2020.
  50. "Ice bath for 120 minutes". Sina Corp. Xinhua News Agency. 4 January 2011. Retrieved 18 March 2020.
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