Recovery: Part 1 – Ice Baths & Compression Tights

For my money, the ideal post-ride recovery looks something like this:

• Nothing happens before a shower. Wash the grime off first.
• Set the bathtub at full-cold and fill ‘er up!
• Static stretch-down while the tub is filling. 30+ sec all muscle groups lower extremity and neck, upper back, shoulders
• Putter around on Strava
• Bathtub is full. Dump in half-dozen ice trays out of the freezer
• Mentally psych up for 10min at ~10° C waist-deep ice bath
• First 30sec is the worst. Podcasts provide a good distraction. Don’t drop the phone in…
• Emerge, dry off, pull on compression tights
• Complete lower body foam roll-out
• Refuel your energy reserves with proper nutrition. Cookies are necessary, but insufficient
• At least 8 hours of quality sleep – this may be the most critical

These are my recovery protocol of choice. I feel better immediately after and often the next day compared to when I have to skip the full routine, but are these methods supported by the evidence?

I’ve tried to find the latest systematic reviews on these topics to estimate their efficacy for recovery. Again, this isn’t a comprehensive literature review, but just me looking for the most recent, mostly comprehensive review of the evidence.

First up is ice bathing and compression garments. Stretching and foam rolling will follow in Part II. Sleep deserves it’s own Part III and nutrition is a topic I may delve into at some point.

Cold Water Immersion

PLoS One conveniently just published a review & meta-analysis of cryotherapy in September, 2015 (Hohenauer et al, 2015). The paper looked at 36 articles to determine the efficacy of various cryotherapy (cold exposure) methods on recovery, as characterized by both subjective and objective markers.

For all the traditional espousing of using ice for recovery and muscle injuries, the evidence for the efficacy of cold exposure is surprisingly tenuous. The studies examined used a variety of cold application methods, populations, exercise modalities and statistical analyses, producing an undesirably high level of heterogeneity. However the review and meta-analysis is still relevant and broadly applicable for my purposes.

The paper looked at subjective characteristics; delayed onset muscle soreness (DOMS) ratings of perceived exertion (RPE) and objective markers of blood plasma; creatine-kinase (CK) and lactate levels, which are used as indicators of muscle breakdown or trauma. The paper’s main finding concluded:

“Cooling showed significant effects in reducing the symptoms of DOMS (up to 96 hrs) and RPE (up to 24 hrs) compared to passive control interventions. CWI [cold water immersion] achieved the best effect with respect to the other cooling applications… [However] Cooling did not significantly affect the objective recovery outcomes compared to passive control interventions.”

(Hohenauer et al, 2015)

Positive finding, but no conclusive mechanistic explanation of physiological benefits. The authors highlighted the limitations of heterogeneity in the available research and provided some further interesting findings through subanalysis of the target studies:

• The most effective average treatment protocol was cold water immersion (ice bath) for 13min in 10° C water.
• Decreased statistical significance and magnitude of effect was found for females compared to males, however this is likely confounded by far fewer female subjects among the target studies (412 M, 72 F).
• Greater efficacy was found for higher-trained athletes as compared to general population. A possible explanation was that well-trained athletes can push themselves to higher workloads, therefore incurring and recovering from higher rates of DOMS and RPE.
• Only one study measured muscle-lactate as opposed to blood lactate. That study showed a positive treatment effect of local cold exposure, ie. significantly lower muscle lactate-levels (Tucker et al, 2012). It was suggested that “muscle lactate measurement represents a local effect, while the blood lactate measurement represents a dilution effect of the non-involved muscles.” (Hohenauer et al, 2015).
• A recent study (Broatch et al. 2014) found that cold water immersion was no more effective than thermoneutral water immersion placebo for similar subjective markers of recovery, suggesting at least partial placebo effect for the effects of CWI. So if your ice bath might not need to be ice cold at all to be effective for recovery!

Compression Garments

First first systematic review and meta-analysis of the efficacy of compression garments on recovery was published in the British Journal of Sports Medicine in 2014 (Hill et al, 2014).

The paper looked at 12 studies, with subjective (DOMS) and objective markers (muscle strength, power and creatine-kinase concentrations). These few paper still suffered from undesirable moderate heterogeneity even with the review authors rejecting a further 37 papers for inconsistent methodologies. The paper’s main finding concluded:

“The use of compression garments appears to reduce the severity of DOMS, accelerate the recovery of muscle function and attenuate the concentration of CK following strenuous exercise. These findings indicate that wearing a compression garment may improve recovery following intense training and competition; this has implications for both elite athletes and recreational populations.”

(Hill et al, 2014)

Another positive finding but with consideration for insufficient evidence and unknown physiological mechanisms. The review authors provided established and/or proposed mechanisms for the mechanisms of each outcome marker and the paper is worth a read for learning just what recovery means at a physiological and cell level.

Some interesting proposed mechanisms included:

• The application of compressive garments may act through several related mechanisms on tissue inflammatory osmotic pressure and muscle ultrastructure, while also improving circulation.
• Limiting interstitial inflammation and changing the tissue osmotic pressure gradient may help to limit nociceptor sensitization and facilitate (actually double negative; limit inhibition of) voluntary muscle contraction, both characteristics of DOMS.
• Muscle ultrastructure breakdown results in elevated blood plasma markers (CK, lactate) and is thought to contribute to short-term decreased strength and power.
• Circulation and venous return are improved through externally applied increased tissue osmotic pressure and via the muscle pump mechanism  to push interstitial inflammation out of the target muscle tissue.

 

Conclusion

Cold Water Immersion and Compression Garments are effective recovery methods – and that’s the main takeaway. However this conclusion isn’t exactly beyond doubt and the evidence so far is insufficient to fully explain physiological mechanisms, or even completely reject the contribution of a placebo effect.

The best actionable advice I can offer is to do something for recovery; be mindful of how your body feels after a hard ride and consider what will make you feel better – physiologically and psychologically – and ready for tomorrow’s performance. Anything stressful can inhibit recovery. Life may try to get in the way, but do what you can to stay calm, move slowly, take a deep breath and relax.

And remember the Universal aphorism of lazy athletes everywhere:

Don’t walk if you can stand.

Don’t stand if you can sit.

Don’t sit if you can lay down.

 

Resources

• Broatch et al (2014). Postexercise cold water immersion benefits are not greater than the placebo effect. Med Sci Sports Exerc. 2014 Nov;46(11):2139-47. doi: 10.1249/MSS.0000000000000348.
• Hill et al (2014). Compression garments and recovery from exercise-induced muscle damage: a meta-analysis. Br J Sports Med. 2014 Sep;48(18):1340-6. doi: 10.1136/bjsports-2013-092456. Epub 2013 Jun 11.
• Hohenauer et al (2015). The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis. PLoS One. 2015 Sep 28;10(9):e0139028. doi: 10.1371/journal.pone.0139028. eCollection 2015.
• Proske (2005). Muscle tenderness from exercise: mechanisms? J Physiol. 2005 Apr 1; 564(Pt 1): 1.
• Tucker et al (2012). Effect of local cold application on glycogen recovery. J Sports Med Phys Fitness. 2012 Apr;52(2):158-64.
• Urso (2013). Anti-inflammatory interventions and skeletal muscle injury: benefit or detriment? Japplphysiol 15 September 2013 Vol. 115 no. 6, 920-928 DOI: 10.1152/japplphysiol.00036.2013