Research findings water immersion- 4/2020
9 June 2020 / 0 comments

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Every month ProCcare extracts the new research studies on water immersion and whole-body cryotherapy. These studies are the basis of our literature database and form the foundation of our ProCcare method. In each newsletter, we provide an overview of the new research studies. Additionally, we offer exciting insights that assist implementation based on the findings of two studies that we selected from the list.

Study 1: Mawhinney, C. et al. Changes in Quadriceps Femoris MusclePerfusion Following Different Degrees of Cold-Water Immersion. Journal of Applied Physiology (2020) doi:10.1152/japplphysiol.00833.2019.

Method: Assessment of blood flow in the quadriceps of 30 healthy men following cold-water immersion at 8°C/46°F, 15°C/59°F, 22°C/72°Ffor 10 minutes immersed to the navel.

Primary findings by the authors: Noxious cold-water immersion temperatures (8°C/46°F) increase perfusion in the deep quadriceps muscle, whereas superficial quadriceps muscle perfusion is reduced in cooler (15°C/59°F) water. Therefore, a less noxious water temperature (15°C/59°F) may be considered a viable option as a treatment for soft tissue injury.

ProCcare's take-home message: Water immersion in practice is used for recovery. Not only concerning performance recovery and regeneration but also for rehabilitation purposes. One of the main mechanisms related to the use of water immersion is to reduce tissue swelling by reduced blood flow through the muscle. The authors identified that noxious cold-water immersion temperatures (8°C/46°F) increase perfusion in the deep quadriceps muscle, whereas superficial quadriceps muscle perfusion is reduced in cooler (15°C/59°F) water. This finding is probably explained by the offset of physiological reactions to maintain its core temperature. "The treat" of the cold exposure to the body causes the body to produce additional heat by shivering. Low-intensity shivering is mainly associated with type 1 fibers, and the deep-lying muscle has a higher portion of these type 1 fibers. The authors identified an increased blood flow following the colder temperature (8°C/46°F), which implies that using less cold temperatures should be considered as the more viable option as a treatment for soft tissue recovery. This study provides evidence that using water immersion as a therapeutic modality needs a tailor-made approach. The practitioner needs to be aware of the physiological mechanisms and principles: too little cooling will result in negligible effects, but too much cooling, i.e., using a water temperature that is too low, could result in reverse effects. As was shown in this study, the low water temperature (8°C/46°F) increases muscle perfusion, where a decrease is warranted for soft tissue injury recovery purposes.

How to apply these findingsIt is known that the use of cryo-kinetics has a superb effect on the recovery process after joint and soft tissue injuries. However, using less cold temperatures should be considered as the more viable option as a treatment for soft-tissue recovery opposite to colder water temperatures or the use of ice. Concerning acute care management of soft tissue injuries, we refer to the acronym of the 'POLICE' (Protection– Optimal Loading – Ice (or cryo) – Compression – Elevation), which was published by Bleakley and colleagues (BJSM, 2012). Within the 'Immediate Care' phase (first 8-10 hours of the injury depending on the magnitude of the injured tissues), compressive cooling is still the better option. Therefore, when using cold water immersion, the compressive bandage should not be removed. As from the 'Transition care,' phase (until day 5 of the injury) we would suggest the use of 12-15°/54-59°F cold water immersion as this would combine the reduced muscle perfusion with creating an optimal 'numbing' effect (see study findings of Mawhinney and colleagues presented). This numbing effect is essential as during this phase optimal loading by encouraging a range of motion within available limits, assist collagen alignment, maintains neurological loop, and decreases the amount of function lost is the primary goal.

Published studies in April 2020 onWater immersion

1.           Rodríguez, M. Á. et al. A Matter of Degrees: A Systematic Review of the ergogenic Effect of Pre-Cooling in Highly Trained Athletes. Int J EnvironRes Public Health 17, (2020).

2.           Mawhinney, C. et al. Changes in Quadriceps Femoris Muscle Perfusion FollowingDifferent Degrees of Cold-Water Immersion. Journal of Applied Physiology(2020) doi:10.1152/japplphysiol.00833.2019.

3.           Alexander, J., Rhodes, D. D., Birdsall, D. & Selfe, P. J. COMPARISON OF CRYOTHERAPYMODALITY APPLICATION OVER THE ANTERIOR THIGH ACROSS RUGBY UNION POSITIONS; AvCROSSOVER RANDOMIZED CONTROLLED TRIAL. Int J Sports Phys Ther 15,210–220 (2020).

4.           Nakamura, D., Muraishi, K., Hasegawa, H., Yasumatsu, M. & Takahashi, H. Effect of a cooling strategy combining forearm water immersion and a low dose of ice slurry ingestion on physiological response and subsequent exercise performance in the heat. J. Therm. Biol. 89, 102530 (2020).

Reed, E. L., Worley, M. L., Sackett, J., Bloomfield, A. C. & Johnson, B. Muscle Sympathetic Nerve Activity during ThermoneutralHead-Out Water Immersion with and without Hyperoxia. The FASEB Journal 34,1–1 (2020).

5.           Ely, B. R., Robinson, V. A. & Havens, C. W. The Impact of Acute Hot or ColdWater Immersion on Post-Exercise Blood Pressure Regulation. The FASEBJournal 34, 1–1 (2020).

6.           Jafarimanesh, H., Vakilian, K. & Mobasseri, S. Thermo-therapy and cryotherapy to decrease the symptoms of restless leg syndrome during the pregnancy: A randomized clinical trial. Complementary Therapies in Medicine 50, 102409(2020).

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