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reach the deep tissue, because the application appears to be localized at the level of the skin (119). Heat application also may increase neural transmission, muscle elastic- ity, joint extensibility, analgesia, and reduce muscle spasm (30, 174). Much anecdotal information can be found about the proposed benefits of thermotherapy, but little scientific research exploring its use as a recovery tool is available.
Thermotherapy does have some contraindications. The most obvious contraindica- tion is that high temperatures can result in burns (119, 174). The application of heat also can increase inflammatory responses, swelling, and edema (119, 174). If hot water immersion is used, ectopic beats, hypotension, heat syncope, excessive tachycardia, and in rare instances death can occur (174). Coaches and athletes must be careful when using thermotherapy for athletes who have open wounds, skin conditions, peripheral vascular disease, impaired circulation, and acute musculoskeletal injuries (119).
When thermotherapy techniques are being employed as a recovery intervention, it is important to be aware that there are specific indications and contraindications for the use of each technique.
• Sauna: A sauna may offer some benefit as a recovery intervention. Scoon and colleagues (138) reported that when a 30 min humid sauna (89.9 ± 2 °C) was used as a recovery tool immediately after training, endurance running perfor- mance improved. Run time to exhaustion was increased by 32%, and 5K time-trial performance was increased by 1.9%. The authors suggested that the increase in performance may partially be explained by an increase in blood volume. The use of a sauna (60-140 °C; 5-15% humidity) two times a week has been recommended as a recovery intervention in response to whole-body fatigue (87).
• Warm or hot water immersion: Water immersion with water temperatures
greater than 36 °C raises the core body temperature (174). This increase in core
temperature coupled with the increased hydrostatic pressure associated with water immersion may result in a cascade of physiological responses that assist in recov- ery. There is very little scientific data to support the effectiveness of warm-water immersion; however a 10 to 20 min immersion has been suggested to improve recovery (18). In therapeutic settings, warm whirlpools are used for 10 to 20 min with temperatures that range from 37 to 40 °C for the leg, 37 to 45 °C for the arm or hand, and 37 to 39 °C for the whole body (119). However, for delayed-onset muscle soreness, cryotherapy or contrast therapy techniques may be more beneficial than thermotherapy (86).
Cryotherapy
Cryotherapy is a technique where cold water immersion or ice baths, ice massage, or ice packs are used to treat acute traumatic injury and facilitate postexercise or competition recovery (40). Limited information is available on the appropriate appli- cation of cryotherapy as a recovery technique (6, 12). The vast majority of research on cryotherapy has focused on its analgesic (i.e., pain-reducing) effect on localized tissue (26). The analgesic effects of cryotherapy are most likely a function of the cold temperature, which reduces the neuronal transmission rate and down-regulates the pain perception to the central nervous system (174). Although the reduction in neural transmission reduces pain, it might also result in a short-term decrease in athletic performance via the reduction of muscular contractile speed or force-generating capacity (135, 178).
Performance likely will be impaired if exercise is performed shortly after cryo- therapy treatment (40, 137). Crowe and colleagues (40) offered evidence that sprint
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cycling performance is significantly impaired 1 hr after cold water immersion. Some investigators have reported that cryotherapy may not speed recovery (115) even though it can promote muscle relaxation and reduction of creatine kinase levels (43). It is pos-
sible the chronic use of cryotherapy as a recovery technique may reduce endurance and resistance training adaptations (176).
Cryotherapy is a useful tool for acute injury, delayed-onset muscle soreness, and pathological damages (119). When compared with no treatment or a warm whirlpool, cold whirlpool therapy has been shown to result in a greater decrease in muscle soreness (86). Additionally, the combination of cryotherapy and active recovery may restore work capacity 24 hr after treatment (177). In support of this contention, Yanagisawa and colleagues (177) demonstrated that 20 min of ice treatments followed by 20 min of active recovery exercises resulted in a greater restoration of muscular strength and reduction of muscle soreness than either ice treatments or active recovery alone. These data suggest that cryotherapy may have a place in a holistic recovery regime.
When cryotherapy techniques are being employed as a recovery interven- tion, it is important to be aware that there are specific indications and contraindica- tions for the use of each technique. •Cold water immersion: When cold water immersion is used as a cryotherapy
technique, core temperature can be maintained with head-out immersion in water temperatures as low as 12 °C for around 20 to 30 min (155, 157). The literature indicates that cold water immersion can be performed for 10 to 20 min at a tem- perature of 12 to 18 °C as a postexercise recovery strategy. However, if the athlete has only a short time between training and competition, cold water immersion may impair performance.
Cold water immersion carries some risk for the athlete (174). Sudden cold immersion can result in hyperventilation, tachycardia, sudden loss of conscious- ness, convulsions, ventricular ectopy, and in rare incidents cardiac arrest and death (100). Athletes who are hypersensitive to cold can have an allergic reaction to immersion, which in the worst case can result in death (174). Wilcock and col- leagues (174) recommended using cold water immersion to treat localized acute injuries and reduce inflammation rather than as a recovery strategy.
• Ice massage: Ice massage can be useful in treating muscle soreness following exercise (69).Treatment usually lasts for 7 to 10 min and is repeated every 20 min. The massage is performed by applying the ice to the athlete’s exposed skin with circular or longitudinal strokes, with each stroke overlapping the previous stroke. Once the skin is numb, the ice massage can stop (120). Interestingly, ice massage Cryotherapy techniques are used to treat
injuries, although their usefulness in terms of recovery is debated. © H um an K in et ic s
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results in a significantly faster decrease in temperature than an ice bag (183). The risk of frostbite is minimal, but if the athlete has diabetes, the duration and inten- sity of the cold application may need to be modified.
• Hydrocollator (cold) pack or ice bag: Ice bags or cold hydrocollator packs usu- ally are used for 2 hr in a repeating pattern of 20 min of cold application followed by the removal of cold treatment for 20 min. Compared with the hydrocollator pack, an ice bag results in a colder application attributable to the melting ice (120). Prentice (119) recommended that the athlete not lie on the ice bag or hydrocollator pack during cold application.