Our Strength & Conditioning collaborator Francisco Tavares is back again to update us on the influence of cold modalities and recovery enhancement in football, after deeply studying this issue under his PhD research project.
If you wish to read more of this SCC content to our project Football Medicine®, take a look to the following articles regarding maximum strength, power and strength diagnosis in football. Stay tuned on our website, great news are about to come!
The rational for the implementation of cold recovery modalities is based upon the necessity of athletes to speed-up recovery in order to increase the readiness on the subsequent training session. This rational and the physiology of cold modalities will be reviewed in brief in the beginning of this article, with a section focusing on the possible harmful effects of cold modalities. Applied recommendations and examples are provided in the final part of this article.
Football is a dynamic sport in which performances depend on physical fitness, psychological factors, technical skills and team tactics (Bangsbo, Mohr, & Krustrup, 2006). The high running volumes and high intensity running characteristics of football leads to increased levels of muscle damage and soreness, and remarkable levels of fatigue (Doeven, Brink, Kosse, & P M Lemmink, 2018).
Figure 1 – Schematic effect of recovery modalities reducing fatigue levels. In scenario A the fatigue levels are prolonged and in scenario B the fatigue levels are reduced due to recovery modalities. The clipart footballer represents a training session, the blue lines represent the fatigue levels, the yellow line represent a theoretical reduction in fatigue from scenario A to scenario B, and the ice represent recovery modalities.
Adaptations from training will result from the balance between the training stimulus and recovery (Bishop, Jones, & Woods, 2008). In team-sports such as football, the time an athlete has to recover is sometimes limited due to subsequent training sessions or competition (figure 1) (Tavares, Walker, Healey, Smith, & Driller, n.d.). Therefore, when time to recovery is limited, practitioners implement a diversity of recovery modalities aiming to enhance recovery (Tavares, Smith, & Driller, 2017). It is however important to mention that factors such as rest, sleep, nutrition and hydration have been recognized as the pillars of a good recovery scheme (Francisco Tavares, Healey, Smith, & Driller, 2017).Therefore, any strategy implemented to enhance recovery will be ineffective if an athlete does not eat, hydrate, sleep and rest properly (Figure 2).
Figure 2 – Schematic demonstration of the hierarchy of some factors influencing recovery
Within other recovery modalities (e.g. compression garments, sports massage, active recovery), cryotherapies are extensively utilized in the applied and have been frequently challenged in the research setting (Tavares et al., 2017; Tavares et al., 2017). This article will focus on the two most common forms of cryotherapy: cold modalities as contrast baths (CWT) and cold-water immersion (CWI).
Physiology of cold modalities
The mechanisms involved in CWI and CWT have been extensively reviewed elsewhere (Bieuzen, Bleakley, & Costello, 2013; Bleakley & Davison, 2010; Leeder, Gissane, van Someren, Gregson, & Howatson, 2012; White & Wells, 2013). In brief, the main mechanism involved in such modalities is associated to a decrease in skin, core and muscle temperatures from exposition to cold. The reduction in temperature due to cold exposure leads to a decrease in muscle swelling, decrease in acute inflammation from muscle damage and a decrease in muscle spasm and pain (Matos et al., 2018).
Moreover, the fact that immersion in water leads to hydrostatic pressure-induced changes in blood flow that can promote metabolic waste removal. When using CWT, athletes alternate immersion in cold and hot water. Immersion in hot water increases vasodilation, blood flow and facilitation of oxygen and antibody supply, metabolite clearance and reduces muscle spasm and pain. When the athlete alternates between cold and hot water, it results in changes in blood flow, reducing swelling, inflammation and muscle spasm.
Possible harmful effect of cold modalities
While the acute effects of cold modalities have been extensively demonstrated (Nédélec et al., 2013), some authors argue that usage of cold modalities may blunt anabolic responses from training, which in turns affects muscle size (Roberts et al., 2015; Yamane et al., 2006). Recently, Roberts et al. (Roberts et al., 2015) observed a decrease in the activity of the mammalian target of rapamycin (mTOR) pathway and satellite cells after 10 minutes of CWI at ~10ºC, which in turn leads to an attenuation in muscle size adaptations. In the other hand, the same authors also observed that CWI enhances recovery of muscle function and allows athletes to complete more work during subsequent training sessions (Roberts, Nosaka, Coombes, & Peake, 2014).
Therefore, a paradox between the implementation of cold modalities to acutely (i.e. 24-48h post-exercise) enhance recovery and readiness to train, and the potential harmful effects on the long-term adaptations to training (i.e. decreases in muscle size) is currently a hot topic in both the applied and research setting (Halson et al., 2014; Matos et al., 2018; Tavares et al., 2017; Tavares et al., n.d.). In our knowledge, the only properly designed randomized control trial performed in elite athletes investigating the chronic effects of exposition to cold modalities (i.e. CWI) is the study from Halson et al. (Halson et al., 2014). In their study, the authors found a likely beneficial effect of CWI during a 21-day intensification phase followed by an 11-day taper period in elite cyclists and reported no evidence of any detrimental effect on performance. Thus, further research investigating the chronic effects of cold modalities are desirable.
Implementation of cold recovery modalities
Before getting into a further detail on when to implement these modalities, and given the possible harmful effects of cold modalities, the following questions should be raised when considering implementing cold recovery modalities:
- How demanding was the training session?
- Athlete was exposed to a demanding session that is likely to lead to significant levels of muscle damage;
- When is the next training session occurring?
- The next training session will occur within the following 36 hours;
- Goals of the subsequent training session?
- In the subsequent training session, the athlete will be required to produce high mechanical outputs – high force and/or velocity; e.g. speed session – and/or to sustain high mechanical outputs for relatively long periods.
Although the previous three questions are mandatory when deciding to include (or not) cold modalities, other questions can and should be raised when trying to understand the full picture (e.g. phase of the season, goals of the athlete, etc.) (Tavares, Walker, Healey, Smith, & Driller, 2018). Moreover, as recently reviewed by us, the type of application,temperature, duration and immersion depth will lead to different responses (e.g. decrease in the core temperature (White & Wells, 2013)). Therefore,the protocol characteristics can increase/decrease the severity (i.e. effectiveness in recovery and increased blunting effect) of the protocol as shown in Table 1 (Francisco Tavares et al., 2018). Lastly, individual factors such as body composition will have a major impact on the physiological effect on responses to cold modalities (Francisco Tavares et al., 2018).
Table 1 – Protocol characteristics to be considered when designing a water immersion recovery protocol. Adapted from Tavares et al. (Tavares et al., 2018). Cold water immersion (CWI), contrast water therapy (CWT).
Duration of exposure to cold
Longer exposure to cold water increases the intensity/severity of the protocol.
Type (CWT / CWI)
CWI may provide some small benefits in comparison to CWT in markers of muscle damage.
Due to the hydrostatic pressure of the water, increases in venous and lymphatic compression, in addition to elevations in stroke volume and cardiac output are also observed concomitantly with increases in body surface area immersion.
Water temperatures should range between 11-15°C, with lower temperatures having a greater potential to blunt adaptations without necessarily enhancing recovery due to reductions in muscle function.
The design of the cold protocol
In order to provide practical recommendations, a few general guidelines are presented in bullet points and some examples are provided bellow.
- The game is the main training stimulus of the week. If the athlete is allowed a full day off post-match and the training occurring on Day 1 is a light training session, practitioners should reconsider the utilization of cold modalities (See Tables 2 and 3).
- If athletes have a day off in-between two training days, implementation of cold modalities post the first training session should be reconsidered.
- If two consecutive training days are performed in a row, cold modalities should be considered. Moderate to high cold intensity protocol
- If a training session with high-volume and/or high-intensity occurs two days before the game, cold modalities should be implemented. High cold intensity protocol
- If a light training session occurs on the day before the game, cold modalities should be implemented. Low to moderate intensity cold modality protocol
Table 2 – Example of a cold modalities protocol severity and periodization in a 1 game scenario
Table 3 – Example of a cold modalities protocol severity and periodization in a 2 games scenario
Apart from these general guidelines, some external and individual factors should also be considered when designing the cold modality protocols (Tavares et al., 2018). Individual factors include the physique traits, sex and age. In this article I will focus in the physique traits as they probably have the greatest influence when designing the cold protocols (Tavares et al., 2018). Particularly, the differences in body composition and the ratio between body surface area (BSA) and body mass (BSA:BM) have been highlighted as primary factors affecting responses to cold protocols. In a nutshell, greater percentages of fat mass, body mass, body surface area, and other body composition characteristics all slow the reduction in body temperature during cold exposure (Godek, Morrison, & Scullin, 2017; Stephens et al., 2017). In addition, athletes with a lower BSA:BM require more severe cold protocols to reduce muscle and core temperature to a same extend than athletes with a greater BSA:BM (Figure 3).
Figure 3 – Cold protocols severity according to BSA:BM ratio
In what concern to the external factors, the phase of the season, density of the weekly schedule and the goals of the athlete should be considered when designing the recovery protocols. As previously mentioned, cold exposure can interfere with anabolic pathways, therefore having a harmful impact on long-term adaptations. Therefore, during non-competitive periods where some accumulated fatigue is expected (and desirable), the implementation of cold recovery modalities should be avoided. However, it is important for the reader to understand that they might be some exceptions when cold modalities can still be implemented, e.g. athletes who main goal is not to increase muscle mass, and training is more oriented to increases in maximal strength or power. On the other hand, during competitive periods, an athlete that is not likely to make the squad and needs to make increases in muscle mass should probably avoid using cold recovery modalities. Lastly, as previously mentioned, the density of the training week (i.e. does an athlete have time to recover without immersing in CWI or CWT?) will determine the inclusion/exclusion and the severity of the cold protocol. While professional senior footballers with three games during the week may require a more severe approach, amateur under-age athletes training 2-3 times a week, with a game on the weekend, may not require any cold exposition.
Author: Francisco Tavares
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