Recovery & Regeneration : Hydrotherapy

Recovery & Regeneration : Hydrotherapy

The following information is an excerpt from the Recovery & Regeneration Presentation given by Matt Furlot at the MTA AGM on April 16, 2011, and previously presented at the Interdisciplinary Sports Medicine Conference for the Vancouver 2010 Olympic and Paralympic Winter Games in May of 2008.

Section: Hydrotherapy.  Cold Water, Warm Water, and Contrasts

Trends in practice along with common treatment rationale for the current use of some popular hydrotherapy techniques will be summarized and compared against the strongest evidence and research currently available on the topic.  Safety concerns will also be highlighted for the various techniques where applicable.  All references are supplied.

Cold Water Immersion

Cold Water Immersion: Ice Bath

Trends in Practice:

Used in a variety of sports, but probably most common in endurance and contact sports post-event.

  • No specific temperature, ranges between 3 – 15ºC
  • No specific duration, ranges from 30 seconds to 20 minutes and depends on % of body submerged & temp.

Common Rationale:

  • Creates vasoconstriction that affects deep tissues.
  • Used to speed recovery of tissue micro-trauma decreasing DOMS, inflammation, and swelling.

Evidence Shows:

  • Vasoconstriction occurs which reduces fluid diffusion into the interstitial space, which helps reduce acute inflammation and swelling from muscle damage.  [Cote et al; Eston & Peters; Enwemeka et al]
  • Vasodilation (CIVD) occurs as a response to extreme cold and longer exposure. [Eston & Peters; Ohata et al]
  • Recent studies show a decrease in strength gains when used as a recovery method.      [Yamane et al; Johnson]
  • Reduced pain temporarily through decreased neural transmission and analgesia. [Smith; Abramson et al; Sauls]
  • No decrease in DOMS. [Cheung et al; Paddon-Jones & Quigley; Howatson et al]

Caution:

  • Risks to athletes are associated with temperature extreme and amount of body immersed. .[Wittmers & Savage]
  • Hyperventilation (up to 5 times resting rate).  [Wittmers & Savage]
  • Tachycardia and acute peripheral vaso-constriction resulting in sudden loss of consciousness, convulsions, or (rare) cardiac arrest.   [Wittmers & Savage; Lloyde]
  • Cold hypersensitivity presenting allergic and even anaphylactic reaction.  [Lloyde; Terrel et al]
  • Para considerations:  CNS impairment, exposure duration and extreme.

Hot Water Immersion

Hot Water Immersion: Soft Tub

Trends in Practice:

  • Baths or Hot Tubs
  • Temperatures range between 38 – 43 Celsius.
  • Duration ranges between 5-30 minutes.
  • Generally used post-event.  May also be social.

Common Rationale:

  • Creates vasodilation to increase blood flow through muscles.
  • Promotes flexibility, joint extensibility, and decrease pain and spasm.

Evidence Shows:

  • No temperature change when measured below 2 cm tissue depth.   [Myrer et al]
  • Increase blood circulation to dermal tissue.  [Bonde-Peterson]
  • At this superficial depth, increased circulation increases permeability of cellular, lymphatic, and capillary vessels, which increases metabolism, increasing nutrient delivery and waste removal.  [Bonde-Peterson]
  • Some studies show that when dermal circulation increases in response to heat, muscle blood flow actually decreases. [Bonde-Peterson]
  • Little to no research to support an increase in muscle elasticity, joint extensibility, analgesia, or decrease of muscle spasm.
  • No increase to flexibility unless used with stretching.  [Sawyer et al; Prentice]

Caution:

  • Protein denatures at temperatures between 45 – 50 Celsius. Therefore temperature for immersion should be below this. [Bonde-Peterson]
  • Heat application during acute inflammation increases swelling (up to 25%), and prolongs recovery. [Cote et al]
  • Emergency conditions resulting from hot water immersion are greatly effected by temperature extreme, duration, and amount of body submerged. [Bonde-Peterson]
  • These may include decreased BP, fainting, heat exhaustion, tachycardia, … infection. [Bonde-  Peterson ]
  • Para considerations: CNS impairment, exposure duration and extreme…

Contrasts

Contrast Bath Tubs

Trends in Practice:

  • Is becoming quite popular. [Cochrane]
  • Protocols vary, ranges between 30-300 seconds of one extreme temperature immediately followed by 30-300 seconds of the contrasting temperature.  Repeated for up to 4 – 30 minutes.
  • Temperatures also vary.

Common Rationale:

  • Creates a vascular pumping effect to speed recovery and decrease DOMS. [Cochrane; Sanders]
  • Stimulate circulation.
  • Relieve stiffness and pain.
  • Reduce inflammation.
  • Increase blood lactate removal.       [Cochrane; Sanders; Coffey et al]

Evidence Shows:

  • Most recent studies show vaso-pumping is unlikely the mechanism occurring. [Wilcock et al]
  • Intramuscular temperature does not change with alternating contrasts, only subdermal. [Myer et al; Higgins & Kaminski]
  • Frequency of “pump” is too low when even compared to walking. [Wilcock et al]
  • The sudden immersion from heat into an extreme cold will cause vasodilation (not vasoconstriction) in a shock response. [Bonde-Peterson]

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