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Eur J Appl Physiol (2008) 102:447–455
DOI 10.1007/s00421-007-0605-6
123
ORIGINAL ARTICLE
EVect of hydrotherapy on the signs and symptoms of delayed
onset muscle soreness
Joanna Vaile · Shona Halson · Nicholas Gill ·
Brian Dawson
Accepted: 19 October 2007 / Published online: 3 November 2007
© Springer-Verlag 2007
Abstract This study independently examined the eVects
of three hydrotherapy interventions on the physiological
and functional symptoms of delayed onset muscle soreness
(DOMS). Strength trained males (n= 38) completed two
experimental trials separated by 8 months in a randomised
crossover design; one trial involved passive recovery (PAS,
control), the other a speciWc hydrotherapy protocol for 72 h
post-exercise; either: (1) cold water immersion (CWI:
n= 12), (2) hot water immersion (HWI: n= 11) or (3) con-
trast water therapy (CWT: n= 15). For each trial, subjects
performed a DOMS-inducing leg press protocol followed
by PAS or one of the hydrotherapy interventions for
14 min. Weighted squat jump, isometric squat, perceived
pain, thigh girths and blood variables were measured prior
to, immediately after, and at 24, 48 and 72 h post-exercise.
Squat jump performance and isometric force recovery were
signiWcantly enhanced (P< 0.05) at 24, 48 and 72 h post-
exercise following CWT and at 48 and 72 h post-exercise
following CWI when compared to PAS. Isometric force
recovery was also greater (P< 0.05) at 24, 48, and 72 h
post-exercise following HWI when compared to PAS. Per-
ceived pain improved (P< 0.01) following CWT at 24, 48
and 72 h post-exercise. Overall, CWI and CWT were found
to be eVective in reducing the physiological and functional
deWcits associated with DOMS, including improved recov-
ery of isometric force and dynamic power and a reduction
in localised oedema. While HWI was eVective in the recov-
ery of isometric force, it was ineVective for recovery of all
other markers compared to PAS.
Keywords Recovery · Eccentric exercise ·
Water immersion · Performance
Introduction
Delayed onset muscle soreness (DOMS) is a well-docu-
mented phenomenon, often occurring as the result of unac-
customed or high intensity eccentric exercise (Connolly
et al. 2003; MacIntyre et al. 1995). Associated symptoms
include muscle shortening, increased passive stiVness,
swelling, decreases in strength and power, localised sore-
ness, and disturbed proprioception (Proske and Morgan
2001). Symptoms will often present within 24 h post-exer-
cise and typically subside after 3–4 days (Clarkson and
Sayers 1999). Elite athletes are often susceptible to muscle
damage due to muscles being regularly subjected to repeti-
tive, high intensity contractions (Allen et al. 2004).
Recently, the use of various forms of hydrotherapy such
as cold water immersion (CWI), hot water immersion
(HWI), and contrast water therapy (CWT) as post-exercise
recovery interventions have gained popularity and are now
a common practice within the elite sporting environments
(Cochrane 2004; Vaile et al. 2007). However, such recovery
interventions are being employed despite lack of scientiWc
J. Vaile (&) · S. Halson
Department of Physiology, Australian Institute of Sport,
PO Box 176, Belconnen, ACT, Australia
e-mail: jo.vaile@ausport.gov.au
N. Gill
School of Sport and Exercise Science,
Waikato Institute of Technology, Hamilton, New Zealand
N. Gill
Division of Sport and Recreation,
Auckland University of Technology, Auckland, New Zealand
B. Dawson
School of Human Movement and Exercise Science,
University of Western Australia, Perth, Australia
448 Eur J Appl Physiol (2008) 102:447–455
123
investigation and evidence regarding their potential beneWts
and/or mechanisms by which they may work.
Various forms of cryotherapy have been shown to pro-
duce multiple physiological responses, including decreased
swelling (Yanagisawa et al. 2004), tissue temperatures
(Enwemeka et al. 2002), heart rate (HR) and cardiac output
(Sramek et al. 2000), enhanced creatine kinase clearance
(Eston and Peters 1999) and analgesic eVects, resulting in
altered perceptions of pain and discomfort (Bailey et al.
2007). However, there appear to be conXicting conclusions
regarding the eVect of CWI on performance, with some
studies suggesting beneWcial eVects (Bailey et al. 2007;
Burke et al. 2000; Lane and Wenger 2004) and others indi-
cating negligible changes (Isabell et al. 1992; Paddon-Jones
and Quigley 1997; Sellwood et al. 2007; Yamane et al.
2006). In contrast, despite limited research in the area, HWI
aVects the body diVerently resulting in increased HR, car-
diac output and tissue temperatures and may enhance the
inXammatory response (Wilcock et al. 2006). Contrast
water therapy (CWT) incorporates the combined eVect of
both CWI and HWI with athletes alternating between them
for a set period of time. While there is a limited research
investigating the physiological eVects of CWT and its role
on return/ maintenance of performance following damage
or exercise-induced fatigue, current knowledge suggests
CWT to be a promising recovery intervention (CoVey et al.
2004; Gill et al. 2006; Vaile et al. 2007). However, the use
of CWT has previously been criticised due to the unknown
eVects of exposure to both hot and cold water as well as the
eVect of CWT on tissue oedema accumulation.
Consequently, the present studies set out to examine the
eVect of the three hydrotherapy interventions (CWI, HWI,
and CWT) in comparison to a passive rest recovery follow-
ing a controlled exercise task, ensuring identical durations
of recovery, water exposure and temperatures were main-
tained. Functional and physical symptoms of DOMS and
the recovery of performance were assessed.
Methods
Subjects
A total of 38 strength trained males completed two experi-
mental trials separated by 8 months in a randomised cross-
over design; one trial involved passive recovery (PAS,
control), the other a speciWc hydrotherapy protocol. Sub-
jects were randomly assigned to one of the three groups
diVering only in recovery hydrotherapy intervention: (1)
cold water immersion (CWI, 15°C, n= 12), (2) hot water
immersion (HWI, 38°C, n= 11) or (3) contrast water ther-
apy (CWT, 15°C/38°C, n= 15). These interventions were
selected using water temperatures and durations similar to
those used in common practice and to ensure identical dura-
tions of water exposure. The physical and functional symp-
toms of DOMS were monitored throughout a 72 h follow-
up period and compared to pre-exercise values. After an
8 month washout period, the subjects completed the exer-
cise task with the alternate (hydrotherapy or PAS) recovery
protocol.
Experimental design
On two separate occasions (8 months apart; hydrotherapy
vs. PAS), subjects completed a muscle-damaging protocol
(MDP) consisting of seven sets of ten eccentric repetitions
on a leg press machine. Previously it has been demon-
strated that a single bout of eccentric exercise can have a
prophylactic eVect not only on muscle soreness, but also on
blood responses and performance capabilities after a sec-
ond bout of eccentric exercise performed within a few
weeks (Brown et al. 1997; Byrnes and Clarkson 1986; Mair
et al. 1995; Nosaka et al. 2001). Therefore, it was important
to consider this eVect and control it by utilising a crossover
design and selecting athletes who were both familiar and
accustomed to resistance training (Viitasalo et al. 1995). A
substantial washout period of 8 months was chosen to min-
imise the eVect of the Wrst session of eccentric exercise.
Nosaka et al. (2001) investigated the duration of the protec-
tive eVect of eccentric exercise-induced muscle damage,
concluding that the repeated bout eVect for most measures
appeared to last at least 6 months.
Two weeks prior to both the trials (separated by
8 months), subjects completed a comprehensive familiari-
sation session to determine maximal strength in the form of
one repetition maximum (1RM) on the leg press machine
and isometric squat 1RM to establish squat jump load (30%
isometric squat) (Nosaka and Newton 2002). Additionally,
subjects were familiarised with squat jump and isometric
squat protocols until no further learning/ improvement was
apparent (this was achieved by a maximum of three inde-
pendent familiarisation sessions). Following each testing
session, and once a day for 72 h post-exercise, subjects per-
formed one of the two recovery interventions (hydrotherapy
or PAS). Prior to participation, all subjects were informed
of the requirement and risks associated with the study and
provided informed written consent. The study was
approved by the Australian Institute of Sport Research
Ethics Committee.
Procedures
The DOMS-inducing exercise protocol consisted of 5 £10
eccentric bi-lateral leg press contractions with a load of
120% of one repetition maximum [1-RM (concentric)] fol-
lowed by 2 £10 at a load of 100% 1-RM. The aforementioned
Eur J Appl Physiol (2008) 102:447–455 449
123
protocol was chosen as eccentric strength has been shown
to be approximately 20–60% greater than concentric
strength and similar protocols have been successfully
employed to induce DOMS (Hortobagyi and Katch 1990).
During each eccentric contraction, the load was resisted
with both legs from full knee extension to a 90° knee angle
(Vaile et al. 2007) with contractions lasting for 3–5 s dura-
tion. After the completion of each eccentric repetition, the
load was raised by an electrical winch. Subjects completed
one contraction every 15 s and had a 3 min rest period
between sets (Nosaka and Newton 2002; Vaile et al. 2007).
Recovery interventions
Following each testing session, and once a day for 72 h
post-exercise, subjects performed one of two recovery
interventions (hydrotherapy or PAS). All subjects com-
pleted PAS recovery and one of the other three hydrotherapy
interventions (subjects wore shorts during the hydrotherapy
intervention and shorts/t-shirt during PAS). These were: (1)
passive recovery/control (PAS) whereby subjects were
seated with minimal movement for 14 min. (2) Cold water
immersion (CWI) where subjects immersed their entire
body (excluding head and neck) in 15°C water for 14 min.
(3) Hot water immersion (HWI) where subjects immersed
their entire body (excluding head and neck) in 38°C water
for 14 min. (4) Contrast water therapy (CWT) where sub-
jects immersed their entire body (excluding head and neck)
and alternated between cold water exposure (15°C 1 min)
and hot water exposure (38°C 1 min) water for a total of
14 min (seven cycles). Subjects were required to transfer
between the hot and cold baths in less than 5 s to ensure
maximal duration of water exposure. Recovery was per-
formed immediately following the post-exercise testing
session, and at 24, 48, and 72 h post-exercise.
Outcome measures
The eVects of the exercise task and subsequent recovery
were assessed through the measurement of isometric squat
force, squat jump performance, blood markers [creatine
kinase (CK), myoglobin (Mb), interleukin-6 (IL-6), lactate
dehydrogenase (LDH)], thigh circumference and perceived
muscle soreness. Measures were recorded pre-exercise, and
immediately post-exercise, as well as at 24, 48 and 72 h
post-exercise.
Recovery assessment
Isometric squat (peak force)
The production of vertical ground reaction forces were
measured via force platform (Kistler Instrumenté, Switzerland)
and assessed though an isometric squat performed against
an immovable bar on a Smith Machine. On each occasion,
subjects performed thee trials, each separated by 3 min,
with the best eVort (indicated by peak vertical force) used
to represent the subject’s isometric squat force. The squat
was performed in an identical position each time, with foot
placement recorded for each individual and maintained
throughout all testing sessions to ensure a straight line from
the temporo-mandibular joint to the lateral malleolus with
the subject in a standing position (Blazevich et al. 2002;
Vaile et al. 2007). The protocol used to assess the isometric
force was found to have ICC = 0.97 and TEM = 2.9%.
Squat jump (peak power)
Subjects were required to perform squat jumps (separated by
2 min) on a Smith machine, which was loaded, to a com-
bined weight equivalent of 30% of their isometric squat
force. The best of the three attempts was recorded for analysis.
Subjects were instructed to lower the weighted bar to a 90°
knee angle, pause for 2 s, and then jump upward for maxi-
mum height (Vaile et al. 2007). Peak power was measured
using a GymAware system (Kinetic Performance, Australia).
When assessed on ten subjects, this peak power protocol was
acceptably reliable (ICC = 0.94, TEM = 6.1%).
Blood markers
Venous blood samples were collected pre-exercise and at
each of the four post-exercise time-points. Each blood sam-
ple (8 mL) was collected from a superWcial forearm vein
using standard venipuncture techniques. All samples were
collected directly into serum separator collection tubes
(Greiner Bio-one; Frickenhausen, Germany) and serum
separated by centrifugation at 4,000 rpm for 5 min. Serum
samples were stored frozen at ¡80°C until analysis. Crea-
tine kinase (CV 0.6%) and LDH (CV 0.8%) concentrations
were determined using a Hitachi 911 automated clinical
chemistry analyser (Roche Diagnostics Corporation; India-
napolis, IN, USA) and commercially available reagents
(Roche Diagnostics Corporation; IN, USA). Myoglobin
(CV 2.6%) and IL-6 (CV 3.5%) concentrations were deter-
mined using an Immulite 1000 (Diagnostics Products Cor-
poration, CA, USA) solid-phase chemiluminescent enzyme
immunoassay system and commercially available assay kits
(Diagnostics Products Corporation, CA, USA).
Thigh circumference
A non-stretch anthropometric measuring tape (Lufkin,
USA) was used to measure circumference at three sites on
the upper leg: above-knee, mid-thigh and sub-gluteal. Mea-
surement sites were marked with a permanent marker to
450 Eur J Appl Physiol (2008) 102:447–455
123
ensure re-test reliability (0, 24, 48 and 72 h). Circumfer-
ence measurements were taken as an indicator of acute
changes in thigh volume (Brown et al. 1997; Chen and
Hsieh 2000; Chleboun et al. 1998; Eston and Peters 1999),
likely to occur from osmotic Xuid shifts or inXammation,
which has often been associated with muscle-damage and
eccentric exercise (Fielding et al. 2000). For the purposes
of presentation, mid-thigh girth was selected for representa-
tion of all upper leg measurements (above-knee, mid-thigh,
and sub-gluteal) as it closely resembled changes throughout
all the measured sites. When ten subjects were tested and
re-tested using identical methodology as used in the present
study the reliability of these measurements was ICC = 1.00
and TEM = 0.1%.
Perceived soreness
A visual analogue scale (VAS; 1–10) was used to assess the
subjects perceived soreness whereby they were required to
rank their perception of soreness on a scale of 0 to 10, with
0 being “normal” and 10 being “extremely sore”. This
method has been used previously as a non-invasive way to
monitor changes in perceived pain following muscle-
damaging protocols (Cleak and Eston 1992; Harrison et al.
2001; Vaile et al. 2007). Prior to reporting their VAS rank-
ing, subjects were required to perform a standardised half
squat to ensure all subjects were experiencing the same
movement/sensation.
Statistical analysis
Each part of the present study (CWI vs. PAS; HWI vs.
PAS; CWT vs. PAS) was independently analysed. Mean
eVects were calculated using a spreadsheet via the unequal-
variances t statistic computed for change scores between
pre- and post-tests of the two groups (Batterham and Hop-
kins 2005). Each subject’s change score was expressed as a
percentage of baseline score via analysis of log-trans-
formed values, in order to reduce bias arising from non-uni-
formity of error. Baseline values (for all variables) from the
two trials, 8 months apart were also compared, with no sig-
niWcant diVerence observed over time.
Results
Isometric squat
No diVerences were observed between any interventions at
baseline or immediately post-exercise (P> 1.3) (Table 1).
However, change in isometric squat performance (%
change from baseline) was signiWcantly less at 24, 48, and
72 h post exercise following both HWI (¡12.8, ¡10.1,
¡3.2%; P< 0.05; Fig. 1b) compared to PAS (¡17.0,
¡16.0, ¡9.8%) and CWT (¡10.3, ¡7.4, ¡2.8%; P<0.01;
Fig. 1c) compared to PAS (¡17.3, ¡14.0, ¡11.5). Addi-
tionally at 48 and 72 h post-exercise, change in isometric
squat performance from baseline was signiWcantly less fol-
lowing CWI (¡7.3, ¡4.3%; P< 0.05; Fig. 1a) when com-
pared to PAS (¡15.7, ¡11.7%).
Weighted squat jump
Compared to PAS, change in peak power performance (%
change from baseline) was signiWcantly less at 48
(P= 0.01) and 72 (P= 0.03) h post-exercise following CWI
(Fig. 2a) and at 24, 48, and 72 h post-exercise following
CWT (P< 0.01; Fig. 2c). However, HWI did not positively
inXuence the recovery of squat jump performance com-
pared to PAS (Table 1). Production of peak power, 72 h
post-exercise was signiWcantly reduced below baseline by
8.2 §4.1% following HWI and 7.7 §3.2% following
PAS; no diVerences were observed between HWI and PAS
(P> 0.05; Fig. 2b) at any time point.
Mid-thigh girth
Mid-thigh girth was signiWcantly reduced at 24, 48 and 72 h
post-exercise following CWI (P< 0.03; Fig. 3a) and CWT
interventions (P< 0.01; Fig. 3c) compared to PAS
(Table 1). However, HWI was not eVective (P>0.05;
Fig. 3b) in reducing post-exercise thigh volume compared
to PAS.
Blood variables
SigniWcant reductions in [CK] were observed 24 h
(P= 0.03) and 72 h (P= 0.04) post-exercise following
CWI, and 48 h (P= 0.04) post-exercise following HWI
when compared to PAS. However, none of the three hydro-
therapy interventions inXuenced post-exercise changes of
Mb, IL-6, or LDH.
Perceived pain (VAS)
Perception of pain was reduced only at 24, 48, and 72 h
post-exercise following CWT (P< 0.01) compared to PAS
(Fig. 4c). Both CWI and HWI (P>0.05) were ineVective in
reducing perceptions of pain following intense eccentric
exercise (Fig. 4a/b).
Discussion
The main Wndings of the present studies were that follow-
ing DOMS-inducing exercise; all the three hydrotherapy
Eur J Appl Physiol (2008) 102:447–455 451
123
interventions (CWI, HWI, and CWT) improved the recov-
ery of isometric force compared to PAS througout the 72 h
post-exercise data collection period. However, compared to
PAS, only CWI and CWT signiWcantly enhanced the
recovery of dynamic power (squat jump), while HWI
appeared to have no eVect on the return of power, following
a similar trend to PAS. In addition to enhancing the recovery
of athletic performance, CWI and CWT (but not HWI)
signiWcantly reduced the degree of post-exercise swelling
when compared to PAS.
To the authors knowledge, the present studies are the
Wrst to independently investigate three commonly pre-
scribed post-exercise hydrotherapy interventions ensuring
identical exercise mode and intensity, duration of water
Table 1 Descriptive statistics (mean §SD) for dependent variables for each intervention and its independent control (CWT vs. PAS, CWI vs.
PAS, and HWI vs. PAS)
Appropriate statistics were completed using log transformed values
*P<0.05
Variable CWT vs. PAS CWT vs. PAS CWT vs. PAS
Jump squat (peak power W)
Baseline 3,938 §871 3,969 §879 4,158 §945 4,170 §947 3,902 §303 3,900 §277
0 h post ex 3,328 §806 3,479 §792 3,547 §1033 3,564 §878 3,446 §351 3,382 §278
24 h post ex 3,675 §741 * 3,389 §750 3,735 §872 3,577 §878 3,459 §389 3,401 §416
48 h post ex 3,805 §821 * 3,473 §755 3,939 §877 * 3,507 §795 3,487 §455 3,460 §370
72 h post ex 3,937 §808 * 3,659 §795 4,080 §914 * 3,857 §846 4,593 §409 3,606 §356
Isometric squat (peak force N)
Baseline 2,068 §446 2,066 § 469 2,110 §472 2,089 §443 1,929 §295 1,916 §350
0 h post ex 1,733 §320 1,750 §389 1,748 §424 1,734 §420 1,592 §262 1,597 §271
24 h post ex 1,857 §405 * 1,711 §396 1,877 §418 1,792 §401 1,685 §286 * 1,598 §342
48 h post ex 1,923 §457 * 1,783 §424 2,077 §465 * 1,769 §412 1,735 §272 * 1,617 §329
72 h post ex 2,018 §477 * 1,833 §436 2,074 §487 * 1,859 §463 1,868 §291 * 1,724 §290
Mid-thigh circumference (cm)
Baseline 56.2 §4.5 56.1 §4.5 56.7 §3.7 56.6 §3.4 57.3 §3.8 57.4 §3.7
0 h post ex 56.8 §4.6 56.7 §4.6 57.4 §3.8 57.1 §3.3 57.8 §3.8 57.9 §3.7
24 h post ex 56.4 §4.5 * 56.9 §4.7 57.1 §3.8 * 57.6 §3.2 58.1 §3.9 58.1 §3.8
48 h post ex 56.3 §4.6 * 56.9 §4.7 56.9 §3.8 * 57.4 §3.3 57.9 §3.9 58.0 §3.7
72 h post ex 56.3 §4.5 * 56.7 §4.7 56.9 §3.8 * 57.1 §3.3 57.6 §3.8 57.8 §3.8
Creatine kinase (U/L)
Baseline 176 §76 218 §168 223 §222 189 §45 199 §241 143 §105
0 h post ex 229 §147 245 §220 203 §175 193 §156 269 §411 165 §105
24 h post ex 736 §1115 737 §361 231 §182 * 570 §263 312 §242 402 §255
48 h post ex 416 §589 361 §318 211 §259 263 §174 225 §221 * 748 §1694
72 h post ex 359 §433 271 §234 204 §343 * 296 §290 151 §57 169 §86
Lactate dehydrogenase (U/L)
Baseline 271 §72 218 §107 236 §82 207 §61 261 §87 256 §93
0 h post ex 280 §87 246 §98 227 §95 208 §52 278 §85 272 §103
24 h post ex 291 §132 270 §123 194 §65 194 §69 271 §90 269 §97
48 h post ex 264 §117 230 §92 177 §71 204 §89 260 §69 280 §68
72 h post ex 254 §109 247 §112 183 §68 219 §75 254 §83 267 §77
Myoglobin (ng/mL)
Baseline 44.1 §22.3 47.8 §38.4 36.4 §17.8 27.2 §7.71 35.6 §22.8 27.3 §7.7
0 h post ex 95.4 §76.6 116.2 §101.1 60.7 §30.1 67.5 §24.9 65.1 §44.3 74.8 §68.1
24 h post ex 67.2 §51.1 69.5 §54.9 44.9 §25.4 38.5 §13.3 39.8 §23.2 47.3 §22.7
Interleukin-6 (pg/mL)
Baseline 1.5 §0.6 1.7 §0.7 3.6 §3.9 2.6 §2.3 1.7 §1.1 2.6 §2.7
0 h post ex 2.2 §0.7 2.6 §1.1 4.5 §6.8 3.4 §3.2 2.3 §1.3 2.7 §2.8
24 h post ex 1.5 §0.9 1.9 §1.0 3.7 §6.3 2.8 §2.5 1.7 §0.9 2.4 §2.1
452 Eur J Appl Physiol (2008) 102:447–455
123
exposure and water temperature (CWI 15°C, HWI 38°C,
CWT 38°C/15°C). The mechanism by which such interven-
tions may be eVective remains largely unknown. However,
there are multiple theories surrounding the eVectiveness of
water immersion.
The eVect of hydrostatic pressure exerted on the body
during water immersion is becoming more deWned. The
compressive eVect of immersion in water is thought to
create a displacement of Xuids from the periphery to the
central cavity. This results in multiple physiological
changes, including increases in substrate transport and car-
diac output as well as a reduction in peripheral resistance
(Hinghofer-Szalkay et al. 1987; Wilcock et al. 2006). Full
body (head out) water immersion, as prescribed in the pres-
ent studies, has been shown to increase central blood vol-
ume (Hinghofer-Szalkay et al. 1987; Johansen et al. 1997;
Wilcock et al. 2006) and extracellular Xuid volume via
Fig. 1 Percent change in isometric squat performance (peak force)
following CWI (a), HWI (b), and CWT (c). Performance was assessed
pre and post muscle-damaging exercise as well as at 24, 48, and 72 h
post-exercise. *SigniWcant diVerence between hydrotherapy interven-
tion and PAS
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWI
**
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
HWI
**
*
)ataddemrofsnatgol(
egna
hCtnecre
P
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWT
*
**
)ataddemr
o
fsnatgol(egnah
Ctn
ecreP
a
b
c
Fig. 2 Percent change in squat jump performance (peak power) fol-
lowing CWI (a), HWI (b), and CWT (c). Performance was assessed
pre and post muscle-damaging exercise as well as at 24, 48, and 72 h
post-exercise. *SigniWcant diVerence between hydrotherapy interven-
tion and PAS
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWI
**
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
HWI
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
-25
-20
-15
-10
-5
0
5
PAS
CWT
***
)ataddemrofsnatgol(egnahCtnecreP
a
b
c
Eur J Appl Physiol (2008) 102:447–455 453
123
intracellular-intravascular osmotic gradients. Such changes
may increase the removal of waste products with the poten-
tial of enhancing recovery from exercise. Although the
present studies observed post-exercise increases in the
blood markers analysed, the only post-exercise reduction
observed between interventions was in CK response at 24
and 72 h post-exercise following CWI and 48 h post HWI
compared to PAS. In the present study, compared to PAS,
CWI and CWT were eVective in reducing swelling of the
thigh following muscle-damaging exercise. This result indi-
cates a possible increase in the re-absorption of interstitial
Xuid resulting in reduced oedema (Vaile et al. 2007). Simi-
lar to the eVects of compression garments (Bernhardt and
Anderson 2005; Doan et al. 2003; Kraemer et al. 2001),
hydrostatic pressure has been shown to increase the pres-
sure gradient between the interstitial compartment of the
legs and the intravascular space (Wilcock et al. 2006). In
addition, the reduction of post-exercise oedema may not
Fig. 3 Percent change in mid-thigh circumference following CWI (a),
HWI (b), and CWT (c). Circumference was assessed pre and post mus-
cle-damaging exercise as well as at 24, 48, and 72 h post-exercise.
*SigniWcant diVerence between hydrotherapy intervention and PAS
Baseline PostEx 24h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
2.2
2.4
PAS
CWI
*
*
*
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
PAS
HWI
)ataddemrofsnatgol(egnahCtnecreP
Baseline PostEx 24h 48h 72h
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
PAS
CWT
**
*
)ataddemrofsna
tgol(egnahCtnecreP
a
b
c
Fig. 4 Perception of pain CWI (a), HWI (b), and CWT (c). The visual
analogue scale was completed immediately post muscle-damaging
exercise as well as at 24, 48, and 72 h post-exercise. *SigniWcant diVer-
ence between hydrotherapy intervention and PAS
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
CWI
)01-0SAV(elacSeugolanAlausiV
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
HWI
)01-0SAV(elacSeugolanAlausiV
Baseline PostEx 24hr 48hr 72hr
0
1
2
3
4
5
6
7
8
9
10
PAS
CWT
*
*
*
)0
1-0SAV(elacS
e
u
g
o
l
anAlausiV
a
b
c
454 Eur J Appl Physiol (2008) 102:447–455
123
only improve the contractile functions within the muscle
but also decreases the chances of secondary damage to the
tissues that may result from cellular inWltration (Wilcock
et al. 2006). However, immersion in hot water did not have
the same eVect despite identical exposure time and water
depth. Therefore, in addition to hydrostatic pressure, water
temperature appears to play a role in overall recovery
following damaging exercise.
Main physiological eVects resulting from immersion in
cold water appear to be localised vasoconstriction and
decreased blood Xow that may reduce oedema (Meeusen
and Lievens 1986). The eVect of cold application through
various mediums has been shown to stimulate an analgesic
eVect, resulting in a decreased perception of pain (Cheung
et al. 2003; Meeusen and Lievens 1986). While the results
of the present study do not indicate an altered perception of
pain compared to PAS, it must be noted that pain ratings
were taken prior to immersion on each of the testing occa-
sions. Therefore, while subjects may have experienced an
acute analgesic eVect immediately post-CWI, any such
eVect had diminished 24 h post-recovery.
Not surprisingly, immersion in hot water has been shown
to demonstrate opposite physiological eVects on the body;
including an increase in blood Xow, HR, and cardiac output,
and a decrease in peripheral resistance (Wilcock et al.
2006). BeneWts such as decreased muscle spasm, stiVness
and increased range of motion have also been reported fol-
lowing the application of heat (Kaul and Herring 1994;
Prentice 1999). However, to the author’s knowledge, no
study has investigated the isolated eVects of hot water
immersion on the recovery of muscle damage in a controlled
environment. The present study found HWI to be beneWcial
only through enhanced recovery of isometric force in com-
parison to PAS. When a speciWc movement (squat jump)
was performed requiring dynamic power HWI did not
appear to provide any improvement in return of performance
to baseline levels. However, in comparison to PAS, CWT
enhanced the recovery of both isometric force production
and squat jump performance. The combined eVects of alter-
nating between hot and CWI appears to be more beneWcial
than when the interventions are prescribed as an isolated
exposure. However, despite a growing body of knowledge,
the physiological eVects arising from CWT remain largely
unknown. Contrast water therapy has been suggested to be
an eVective post-exercise intervention due to increased lac-
tate clearance (Cochrane 2004), decreased oedema (Vaile
et al. 2007), increased blood Xow (Cochrane 2004),
increased stimulation of the central nervous system and
reduced metabolic rate (CoVey et al. 2004; Hamlin 2007;
Vaile et al. 2007). Myrer et al. (1994) and Higgins and
Kaminski (1998) proposed one of the main eVects of CWT
to be a pumping action stimulated by vasodilation and vaso-
constriction of the blood vessels. No study has observed any
form of vasodilation or vasoconstriction during or following
CWT (Higgins and Kaminski 1998; Myrer et al. 1994),
however, this has only been assessed via intramuscular tem-
perature measures, with results indicating no signiWcant
changes following various applications of CWT. Measures
of blood Xow using Doppler ultrasound (or similar) proce-
dures may help to improve knowledge regarding the poten-
tial eVects of CWT on muscle blood Xow.
The present series of studies has contributed to the
limited knowledge base investigating the eVects and mech-
anisms underlying the three popular hydrotherapy interven-
tions. The Wndings indicate CWI and CWT to be eVective
in minimising the physiological and functional deWcits
associated with DOMS, when compared to PAS. While
HWI was eVective in the recovery of isometric force, it was
ineVective for recovery of all other markers compared to
PAS.
Acknowledgments The authors would like to acknowledge the
Australian Institute of Sport and Waikato Institute of Technology for
funding the aforementioned studies. In addition, Professor Will
Hopkins is acknowledged for his assistance with the statistical analysis.
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