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Acute Response to Hydrotherapy After a Simulated Game of Rugby

Higgins, Trevor R.1; Cameron, Melainie L.2,3; Climstein, Mike4

The Journal of Strength & Conditioning Research: October 2013 - Volume 27 - Issue 10 - p 2851–2860
doi: 10.1519/JSC.0b013e31828151b6
Original Research

Higgins, TR, Cameron, ML, and Climstein, M. Acute response to hydrotherapy after a simulated game of rugby. J Strength Cond Res 27(10): 2851–2860, 2013—Despite lacking clear scientific evidence, hydrotherapies (water treatments) are accepted techniques to help team sport athletes recover from the physical effects of games. The purpose of this study was to assess the comparative effectiveness of cold water immersions (CWIs) and hot-and-cold contrast baths on athletes' recovery after a simulated game of rugby union. Twenty-four experienced, well-trained, male rugby union players were divided into 3 groups to receive recovery interventions: CWI for 1 group, contrast baths for a second group, and passive recovery for a third (control) group. Pregame and postgame measurements included a countermovement jump (normalized as a ratio to body weight), a sit-and-stretch flexibility test (centimeters), thigh circumference (to detect swelling; centimeters), and participants' perception of delayed-onset muscular soreness (DOMS, 100-mm visual analog scale). Statistical analysis included analysis of variance, and the calculation of omnibus effect sizes for each group (

) and the magnitudes of change within and between groups (Cohen's d). The participants in the contrast bath group reported statistically significantly greater measures of DOMS than participants in the control group did at 1 hour postintervention (p = 0.05, control group: d = 1.80; contrast bath: d = 4.75), and than participants in the CWI group did at 48 hours postintervention (p = 0.02, CWI: d = 1.17; contrast bath: d = 1.97). These findings provide modest evidence that contrast baths are a less effective strategy for recovery from rugby union than are CWI or passive recovery. Specifically, 2 × 5-minute CWI is superior to both contrasts baths and passive recovery in alleviating DOMS after exercise-induced muscle damage. Our recommendation for rugby union players aiming to attenuate the effects of DOMS postgames is to take 2 × 5-minute CWIs baths immediately after the game.

1School of Exercise Science (NSW), Australian Catholic University, Sydney, Australia

2Center of Physical Activity Across the Lifespan (CoPAAL), School of Exercise Science, Australian Catholic University, Strathfield, Australia

3School of Health and Sport Sciences, Faculty of Science, Health, and Education, University of the Sunshine Coast, Maroochydore Australia

4Bond University Research Center for Health, Exercise, and Sports Science, Faculty of Health Sciences and Medicine, Gold Coast, Australia

Address correspondence to Trevor Higgins, trevor.higgins@acu.edu.au.

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Introduction

Over the course of an Australian rugby season, union team players are exposed to a cyclic pattern of training, competition, and recovery. The work load and intensity of a competitive rugby game induce high levels of fatigue, muscle damage, and soreness (11,16). Rugby union players must then recover quickly to perform at optimal levels during subsequent training or competitive games (27). Optimizing recovery is of great importance to rugby players and coaches because it has been suggested that insufficient periods of recovery may lead to accumulated levels of player fatigue as a season progresses (11). Despite widespread use, there is limited research into the benefits of hydrotherapy (water therapies) as a recovery strategy for muscle fatigue from the physical demands of rugby union (5,26,27).

Muscle fatigue occurs when microtrauma to muscle tissue compromises the capacity of skeletal muscle to generate force (35). The microtrauma to muscle tissue associated with athletic performance in rugby union is referred to as exercise-induced muscle damage (EIMD) (13,16,31). Exercise-induced muscle damage may be attributed to a number of factors, including the disruption of the sarcolemma, fragmentation of the sarcoplasmic reticulum, lesions of the plasma membrane, cytoskeletal damage, or swollen mitochondria. Tissue inflammation, increases in capillary permeability, and increases in extracellular protein concentration have all been identified as results of microtrauma to muscle tissue (14). To attenuate the effect of EIMD and enhance recovery, a number of hydrotherapy protocols have been implemented in rugby union.

Cryotherapy (e.g., the application of an ice pack or immersion in cold water) is an accepted strategy for treating acute traumatic injury to muscle tissue (3) and is the most common method for reducing inflammation (e.g., pain, heat, redness, swelling) and sports-related musculoskeletal injuries (20). Over the past 20 years, strength and conditioning coaches have adopted various cryotherapy protocols to assist athletes recover from muscle damage associated with exercise, training, and competition (3). Professional rugby union teams have universally adopted cryotherapy; it was reported as the most common recovery method used during the Australian Rugby Championship in 2007 (18).

Research into cryotherapy can be divided into 2 types: its role in recovery after athletic endeavors and its role in the treatment of injury. In the case of the former, the majority of research centers on untrained participants, focusing on their responses to cryotherapy during the acute postexercise period (9,12,14,19). There has been limited research on the beneficial effects of cryotherapy in the recovery of well-trained, uninjured participants from team sports (5,26,27). This study explores that gap.

Research into the beneficial effects of cryotherapy is equivocal or conflicted (16,17,20,22). Previous studies have shown that cold water immersion (CWI) has no beneficial effect on swelling, isometric strength, or functional tests after exercise on eccentric exercise machines (22,29) or in team sport performance (12,28). Several researchers report that CWI significantly increases the severity of the participants' muscle pain, measured 24 hours after an eccentric exercise protocol (16,29,33). Ingram et al. (21), however, report that two 5-minute CWIs were superior to contrast water immersion or no treatment whatsoever. There were significantly lower scores (p < 0.05) for measures of muscle soreness after participation in team sports.

Vaile et al. (41) compare contrast water therapy to passive recovery in 2 groups of 20 participants, reporting that contrast therapy was superior to passive recovery in restoring strength and power. In addition, they report that contrast water therapy attenuated the negative effects of delayed-onset muscle soreness (DOMS). However, details on how DOMS was measured were absent. Furthermore, reduced thigh circumferences were significantly different between groups (p < 0.05; 90–166 cm3 95% confidence interval), associating a reduction in thigh volume with a reduction in DOMS. This reported link between DOMS and thigh volume, without a measurement for DOMS, is questionable.

In contrast, Ingram et al. (21) report that contrast therapy was ineffective in enhancing recovery after participating in team sports. Consistent with those findings, French et al. (15) find little evidence to support the benefit of contrast baths after EIMD, as opposed to passive recovery. However, they report that, based on the large magnitude of the effects, certain physiological patterns after contrast baths warrant further investigation.

The aim of this study is to evaluate the benefits of CWI vs. contrast baths in assisting well-trained rugby athletes to recover during the initial 48 hours after playing in a simulated game of rugby union. We hypothesize that both CWI and contrast baths will be beneficial to the rugby athletes' recoveries as compared with that of the control group (passive).

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Methods

Experimental Approach to the Problem

Despite the widespread use of CWI as a postmatch protocol in rugby, there is relatively little evidence supporting its use. The null hypothesis for this study states that neither CWI nor contrast baths will have a significant effect on recovery. After the use of these recovery methods, and passive recovery, the athletes participated in muscle pain measures, hamstring flexibility, swelling, and power performance. The resulting between-group study examined the effectiveness of the 3 different recovery protocols in preventing the larger concept of fatigue.

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Subjects

The sample for this study consisted of well-trained male participants (n = 24) from an under-20 rugby union team. The average age was 19.5 ± 0.8 years, body mass 82.38 ± 11.12 kg, height 179 ± 6 cm. The study was conducted after 26 weeks of training, which included 10 weeks of preseason training (5.5 hours, 3 sessions weekly), followed by 16 weeks of the scheduled 22-week competition (6.5 hours, 3 sessions weekly).

Preseason training included 2 weekly training sessions, Saturday beach sessions (weeks 1–6), and trial games (weeks 7–9). Training sessions consisted of a 15-minute warm-up followed by 40 minutes (weeks 1–6) and 20 minutes (weeks 7–10) of conditioning. Conditioning focused on speed and acceleration running drills, contact drills, and small-sided games. Work-to-rest ratio ranged from 1: 2–3 (weeks 1–6) to 1:1 and 2:1 (weeks 7–10). After the conditioning phase, the focus of the workouts shifted to rugby skill sets. Intensity of the conditioning elements ranged from 75% of heart rate maximum (HRmax) to 95% HRmax. Skill set drill intensity ranged from 50% HRmax to 70% HRmax.

Beach sessions were structured around conditioning elements only. Each session commenced with a 15-minute warm-up followed by 70 minutes of conditioning. The conditioning included speed and agility drills, wrestling drills, small-sided games, and team-based relay shuttles. Intensity of the beach sessions ranged between 70% HRmax and 90% HRmax with a work-to-rest ratio of 1:3.

After 6 weeks, the beach training sessions were replaced with trial games for 3 weeks. The last Saturday before the competition commenced was a scheduled rest day to mark the end of preseason training. Trial games were played under standard laws of the game. However, the first 2 trials were played with 20-minute periods, not the 30-minute periods of standard rugby games. The players rotated throughout the day, with most players competing in three 20-minute periods. The third trial was played under standard laws with 30-minute periods. The players rotated throughout the day, with the majority of players competing in two 30-minute periods.

During the competition phase, 2 training sessions were conducted during the week. Training sessions included a 10-minute warm-up followed by a conditioning period of between 10 and 20 minutes. The activities of conditioning sessions varied between sprint work and small-sided games. Intensity of conditioning elements ranged between 85% HRmax and 100% HRmax, with a work-to-rest ratio of 1–3:1. The remainder of the training sessions was structured around skills, rugby union units, team play, and semiopposed runs. Intensity ranged from 50% HRmax to 85% HRmax. The distance covered in training throughout the preseason ranged from 6,000 to 7,200 m and throughout the competition phase of the season from 6,000 to 6,500 m.

The study was conducted over 3 consecutive days during the team's regularly scheduled training sessions at the team's scheduled training time, 18:00 to 20:00. The subjects had no history of recent musculoskeletal injury and were free of illness during the testing period. Each participant signed an informed consent form before taking part in the study, which was approved by The Australian Catholic University's Human Research Ethics Committee, before commencement (N200708-24). We excluded from our participant pool players who were involved in labor-intensive jobs, and those who had either been injured or suffered an illness before or during the study period.

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Research Design

To familiarize the participants with the evaluation techniques, the players conducted trial runs through the circuit on 4 occasions during the 2 weeks preceding the study. The first trial included a verbal explanation of each station followed by a walk-through. The participants then commenced real-time run-throughs at each station at their own pace. Trained researchers gave verbal directions to each participant as needed.

Throughout the study, each station was manned by 2 researchers familiar with each station who assisted with data collection. The researchers were responsible for operating timing gates and the jump mat, and for recording scores on the sprint and passing tasks.

Immediately after a participant completed the simulated game of rugby union, the researchers took capillary lactate samples and downloaded HR data using Polar HR software. The participants then undertook 1 of 3 intervention protocols: CWI, contrast baths, or passive recovery (control). Random assignment had previously been organized through blind allocation, and the participants performed only one of the recovery methods throughout the study.

Figure 1

Figure 1

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Measures

Hamstring Flexibility

Physical testing began with the sit-and-reach test (25). The participants took off their shoes and sat on the floor with their legs straight and feet against the near side of the Sit-n-Reach box. After placing their hands flat together, one on top of the other, the participants bent forward without bending their knees and pushed a marker along the bottom of the Sit-n-Reach box as far as possible. The distance from the marker to the near side of the box was recorded, and the best score of 3 attempts was used in data analysis.

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Thigh Circumference

Circumference of both lower limbs was taken with an anthropometric measuring tape (32) to assess changes in thigh volume (36). To assure consistent measurements from trial to trial, marks were made with a nonpermanent felt marker on the skin of each participant's legs, 5 cm on the superior aspect of the patella and then at a second anatomical point 8 cm superior (29) on both the biceps femoris and rectus femoris.

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Muscle Pain Measures

Players' perceptions of pain were recorded with pressure-to-pain-threshold measurements using a visual analog scale (VAS) (29) and a hand-held pressure algometer using a 1.2-cm diameter head (Chatillon DFX series, FL, USA). Pressure was applied with the algometer at the midpoint between the top of the patella and the superior iliac crest in the rectus femoris and biceps femoris. The participants were instructed to indicate when the pain they felt attained a level 5 on the VAS. The VAS was numbered 1–10, with 1 corresponding to “no pain,” 5 corresponding to “somewhat painful,” and 10 corresponding to “worst pain ever.” The force applied to attain pain level 5 was then recorded in newtons per square meter.

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Force Production

Peak force production was assessed during a countermovement jump (CMJ) using a portable jump mat (Quattro Jump, Kistler, Switzerland). The highest value achieved from 3 jumps was used in data analysis. The participants then performed three 40-m sprint trials (15) through timing gates (Swift Performance, Sydney, Australia). Once again, the fastest of 3 trials was used in data analysis.

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Procedures

Overview

The study was conducted over 3 days. Initially, baseline testing was conducted before commencement of the simulated game of rugby union. Upon completion of the simulated game, the participants were randomly assigned (blind allocation) to 1 of 3 recovery protocols. Testing was performed 1, 24, and 48 hours after the simulated game (Figure 2).

Figure 2

Figure 2

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Warm-Up

All the participants performed a group warm-up identical to the team's standardized pregame warm-up before competition games. The warm-up commenced with the participants performing dynamic walking lunges for 25 m, followed by walking sumo squats for 25 m. Dynamic flexibility exercises were conducted in a 30-m grid by all the participants simultaneously. The results are depicted in Table 1.

Table 1

Table 1

The participants then performed dynamic flexibility exercises. These exercises included 10 swings of each leg and 10 swings across each leg, dynamic groin lunges and calf pumps.

The participants were then allowed a 1-minute hydration break where they consumed water at ambient temperature. The participants then commenced hand passing drills involving transferring the rugby ball across the line while in motion for a total of 5 minutes. In total, the participants spent 25 minutes warming up before moving on to the simulated game of rugby union.

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Simulated Rugby Union Match

Before commencement of the simulated rugby union game, each participant was taken through the circuit to refamiliarize himself with each station. The participants were then instructed to move to their designated stations. Upon hearing a referee's whistle, each participant began the circuit. The participants worked their way through the 11 stations of the simulated game at intervals of 30 seconds. Four complete rotations were completed twice with a 10-minute half-time rest period between each set of 4 rotations.

The simulated game of rugby union was developed, designed, and verified as representing the demands of a game of rugby union. For a full description of the simulated game, see Stuart et al. (30). A summary of the simulated game of rugby union can be seen in Table 2.

Table 2

Table 2

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Physiological Responses to the Rugby Union Match Simulation

Heart rate was used to monitor exercise intensity during the simulated rugby game (Polar, Inc., Montvale, NJ, USA). Mean and peak HRs for each participant during each half of the simulated game (1 of the 2 periods of play), and the mean and peak HR for the entire simulated game were analyzed using proprietary software (Polar Performance 5.0, Polar).

Ear lobe capillary blood samples were taken with a portable analyzer (Lactate Pro, KDK Corporation, Shiga, Japan) to quantify blood lactate responses to the simulated rugby game. The Lactate Pro has previously been shown to provide a valid and reliable measure of blood lactate (2,24).

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Hydrotherapy Protocols

For the CWI protocol, the participants climbed into cold water and assumed a seated, upright position. The water depth was individualized to reach each participant's superior iliac spines (29). The temperature range was 10–12° C (21,33). The participants underwent two 5-minute immersions, with each immersion separated by 2.5 minutes seated out of the bath at room temperature (21).

The contrast bath protocol had the participants alternating between cold water (temperature range 10–12° C) and warm water (temperature range 38–40° C) for 60 seconds in each. The participants performed 5 cycles in each bath, for a total of 10-minute recovery (33). The CWI and warm water bath were adjacent to one another. The researchers monitored participants' times in each bath using a standard stop watch (Seiko, Tokyo, Japan) and instructed the participants when to change recovery conditions.

Commercially available 220-L storage tubs were used for the CWI and warm water baths. Temperatures were continually monitored with floating temperature gauges; monitors added ice or hot water, respectively, when cold immersion temperatures rose to 11.5° C or warm water baths fell to 38.5° C. The control group initiated a passive recovery strategy involving maintaining a seated position for 10 minutes in a thermoneutral environment.

Baseline tests, including tests of hamstring flexibility, force output, measures of muscle soreness, and circumferences, were conducted 1, 24, and 48 hours after the simulated game of rugby union. Testing was conducted in the same order as was conducted during baseline testing (8,15,29,32). The participants were instructed not to perform any physical activity (other than incidental walking), use saunas or hot spas, or take any nonsteroidal anti-inflammatory drugs or analgesics before or during the 48-hour period after the exercise and recovery period. The participants were also instructed to refrain from consuming alcohol during those 48 hours.

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Statistical Analyses

All statistical analyses were completed using SPSS (ver 17.0). Because of differences between baseline scores, between groups, analyses of covariance were performed for all outcome measures within each group at 3 time points and between the 3 groups (contrast, cold, control). Baseline scores were treated as covariates to account for inherent differences between groups insufficiently addressed by randomization in a small sample.

Omnibus between-group effects sizes are reported as

(Table 2). Conventions for interpreting

are small = 0.01, moderate = 0.06, large = ≥0.14. The value

can be used to establish the level of group membership that accounts for variation in the mean scores between groups. Standardized scores (Cohen's d) were used to identify trends across dependent variables in relation to the effect the simulated game had on each variable (Table 2). Cohen's d was used to identify the effect that treatments had on each variable across the acute phase. Definitions in previous studies of this sort suggest that a Cohen's d value of 0.20 is trivial, d = 0.50 is moderate, and d = 0.80 is large (1,4,23). Overall effect sizes were calculated as partial (

), representing the variance accounted for by group membership.

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Results

To verify work intensities between groups throughout the simulated games, mean HRs and blood lactate levels (7) were recorded. There was no significant difference in mean scores for HRs between groups in either of the simulated games (game 1; sig dif p = 0.22, game 2; sig dif p = 0.44). The HR mean score in beats per minute for simulated game 1 with CWI recovery methods was 122 ± 14 b·min−1. For contrast baths, the result was 122 ± 14 b·min−1. The control was 135 ± 19 b·min−1. Heart rate mean scores for simulated game 2 were CWI 130 ± 12 b·min−1, contrast baths 137 ± 12 b·min−1, control 140 ± 18 b·min−1. Blood lactate scores (range 3.90–6.10 ±1.7 mmol) also indicated that there was no significant difference between groups in either of the simulated games. With no significant differences between groups during the simulated games, we assert that any differences identified were results of interventions applied in the study.

Both omnibus and univariate analyses were applied to the data from this repeated measures design.

Before analyzing the effect that the interventions had on dependent variables, statistical analysis was conducted on baseline data to provide evidence that the simulated game generated sufficient stress to cause fatigue. Significant differences were identified across time points for muscle pain measures (across all time points, p < 0.000) and thigh circumference (p = 0.001, p = 0.050, and p = 0.020) at 1 hour post, 24 hours post, and 48 hours post, respectively. A significant difference was also identified across time points for hamstring flexibility (p = 0.050 and p = 0.020) at 24 hours post and 48 hours post, respectively. In addition, CMJ reported a significant difference at 1 hour post (p = 0.008).

Line graphs for 4 key dependent variables (CMJ, hamstring flexibility, DOMS, thigh circumference) are presented below (Figures 3–6). These graphs demonstrate both within-group differences over time and between-group differences at each time point.

Figure 3

Figure 3

Figure 4

Figure 4

Figure 5

Figure 5

Figure 6

Figure 6

Table 3 shows that treatment interaction terms were small across dependent variables, with the exception of muscle pain measures. At 1 hour after intervention, the contrast bath group reported higher perceptions of muscle pain than the control group did. The findings are significant, with p = 0.05. In addition, at 48 hours after intervention, the contrast bath group reported higher scores for perceptions of pain than the CWI group. Once again, the findings are significant, at p = 0.02. Group membership accounted for large effects in this outcome at all-time points (1 hour,

; 24 hours,

; 48 hours,

).

Table 3

Table 3

Variances in upper leg circumference scores were largely accounted for by group membership (

) in the right leg at all-time points and in the left leg at 24 hours postgame. Although no significant differences were identified between groups for this variable at the same time points (right leg, p = 0.22, p = 0.30, and p = 0.37; left leg, p = 0.24), all other dependent variables had small to medium effects for group membership across time points, with no significant differences between groups (Table 4).

Table 4

Table 4

Further analysis evaluating the magnitude of change was conducted using Cohen's d within-group effects between baseline scores for 1 hour post, 24 hours post, and 48 hours post for each variable.

Effects termed greater than large were reported for muscle pain measures across all 3 treatments and all 3 times. It should be noted that for measuring muscle pain, lower effect size values (Cohen's d) indicate a faster trend in returning to baseline values. Time points indicate that muscle pain measures scores peaked 24 hours post and trended back toward baseline scores at 48 hours post. All other dependent variables suggested trivial to moderate effects across all time points (Table 2).

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Discussion

This study assessed CWI and contrast baths as recovery methods during the initial 48 hours (the acute phase) after a simulated game of rugby union. There were no significant differences between HR and blood lactate, and thus, we were able to draw the following conclusions. First, each group performed the simulated game of rugby union with similar workloads and intensities. Second, any differences between groups across tests after the simulated game of rugby union were a result of the recovery interventions applied.

Only muscle pain measures demonstrated significant differences between groups, with the passive control group showing less muscle pain compared with the contrast baths at 1 hour post. The CWI group showed less muscle pain than did the contrast bath group at 48 hours post. It is important to note that at 48 hours post, all groups' muscle pain measures were below baseline levels. This suggests that complete recovery had still not occurred at 48 hours after the simulated game. The muscle pain measures were −13, −20, and −33% in the CWI, control, and contrast water therapy (CWT) groups, respectively.

These results are similar to previous recovery research findings. In a study of simulated team sports conducted by Ingram et al. (21), they report that CWI fostered significantly lower muscle soreness scores p < 0.05) than did the control group and contrast baths. Furthermore, although measuring the generic term “leg soreness,” rather than using muscle pain measures to a standard stimulus, Rowsell et al. (28) report that CWI fostered significantly lower levels of leg soreness than a thermoneutral bath, measured across the duration of a soccer tournament. In a similar research, albeit a 2-group comparison, Dawson et al. (12) find no significant difference in scores of muscle soreness between control and contrast bath groups 15 hours post and 48 hours post of an Australian Football game.

An emerging trend in athletic research is studying team sports that involve running movement patterns, including sprinting, directional changes, and backpedaling. The rugby match simulations used in this study feature all those aspects. Collectively, these findings suggest that when treating DOMS, contrast baths offer little aid in attenuating muscle pain in the legs, up to 48 hours postactivity.

Indeed, each study (12,21,28) that evaluated contrast baths identified no significant difference between contrast baths and control groups. Although each group recorded increased muscle soreness from baseline scores, the contrast bath group reported a greater level of muscle soreness across all time points in this research. In fact, at 48 hours postsimulated game, the contrast baths' group had recovered the least of the 3 groups, indicating that contrast baths offer the least benefit in minimizing the effects of DOMS. Furthermore, the findings indicate that when CWI is evaluated, contrast baths offer little benefit in comparison with CWI, either in enhancing recovery from muscle pain measures or in attenuating muscle pain effects.

No significant differences were identified (Table 1) between groups at any time point for CMJ, hamstring flexibility, or thigh circumference. Overall, our results indicate that immediately after the simulated game of rugby union, each group suffered decreases in CMJ performance, reductions in hamstring flexibility, and an increase in thigh circumference. At 48 hours after the match simulation, all the groups had demonstrated signs of recovery toward baseline values. The return to baseline values occurred irrespective of the levels of muscle soreness still being recorded.

Although

for CMJ, there are indications that a moderate group association exists (7%) between groups for variations in scores for CMJ at 24 hours post. These trends are not consistent across this study. With only a small effect present at 1 hour post (

) and 48 hours post (

), indications are that recovery of power, as measured by a CMJ, will occur irrespective of the intervention, if time is permitted. These observations agree with Dawson et al. (12) who report that despite showing elevated muscle soreness 48 hours after an Australian Football match, well-trained athletes are able to reach near-baseline levels in one-off tests of power.

This leaves coaches and athletes with 2 crucial decisions to make concerning recovery protocols. First, what is the time frame between game and the next session, whether game or training? Second, what indicator is the most important factor to consider when evaluating an athlete's readiness for their next athletic performance?

If there is ample time between sessions (>48 hours), and power functions are of primary importance, recovery interventions may offer athletes scant benefits in recovery over no treatment whatsoever. However, CWI may be the best option if coaches are concerned about the impact of leg muscle soreness (DOMS). If an athlete's approach to subsequent games and training, while suffering with leg muscle soreness is compromised, then the use of CWI may be the appropriate recovery intervention to apply. Importantly, if there is insufficient time to recover (<48 hours) between games and training, then the recovery intervention of CWI offers more to the athlete in attenuating the effects of DOMS and hastening the return of power in comparison with passive recovery or contrast baths.

The magnitude of change from baseline scores to 48 hours postsimulated game shows only trivial effects within groups across CMJ, circumferences, and flexibility (Table 2). Larger effects were reported across all the groups for muscle pain measures, which is consistent with previous research findings (12,21,28). Furthermore, large group membership values (24 hours post

; 48 hours post

) indicates that between 18 and 26% of the variation in scores, is a result of the recovery interventions. These indications of trends suggest that CWI is more beneficial than both contrast baths and no recovery intervention in attenuating the effects of muscle pain measures. This provides further support that CWI is more beneficial in recovery for participants' suffering from muscle pain.

A medium to large effect (

) of the variation of mean scores was reported for hamstring flexibility at 48 hours post and a large effects (

) of the variation for circumferences were reported at 1 hour post. Furthermore, at 24 hours post (

) and 48 hours post (

), medium to large effects identified for group membership accounted for a range of variance between 10 and 14%. Although each group showed decrements followed by recovery over the time period, trends indicate that CWI offers increased recovery of hamstring flexibility and changes in midthigh circumference measurements, compared with contrast baths and no intervention. These findings are similar to those of previous research that has examined recovery from EIMD in simulated team sports (3). Apart from muscle pain measures, performance measures had returned primarily to near baseline levels after 48 hours, irrespective of the recovery intervention employed.

This study indicates that if athletes are experiencing muscle pain, 2 × 5-minute CWI is superior to 5 × (1 minute hot/1 minute cold) contrasts baths and passive recovery in attenuating the effects of muscle pain. Furthermore, effect sizes indicate that after simulated team sports, CWI is superior to both contrast baths and passive recovery in returning participants hamstring flexibility to presimulated game conditions and reducing interstitial fluids associated with EIMD.

Furthermore, it is important for coaches to note, when considering recovery of CMJ performance, hamstring flexibility, midthigh circumference, and muscle pain measures, contrast baths offer fewer benefits to participants in recovery during the acute phase than partaking in passive recovery. The mechanisms for contrast baths to aid recovery have primarily centered on accelerating clearance of waste products by aiding muscle pump function through increased vasodilation and vasoconstriction. Currently, it is believed that immersion times in contrast baths are insufficient to reduce deep muscle temperature sufficiently to increase vasodilation and vasoconstriction and aid muscle pump. However, this would not explain why contrast baths were less effective for recovery than passive recovery specifically in regards to DOMS.

It has been proposed that short durations of immersion in cold water (<3 minutes) may increase free-radical production, leading to oxidative stress (6). Furthermore, in the event of increasing levels of oxidative stress, subsequent increases in muscle stress would occur delaying the recovery process (6).

Bleakley and Davison (6) reported the increase in free-radical production was associated with immersions of <3 minutes. In our research, contrast bath immersions included 5 by 1-minute immersions, alternating from hot and cold. With the continuing exposure to short durations of CWI, free-radical production and subsequent increases in oxidative stress would have led to greater stress on muscle than the exercise activity alone. This increase in stress on muscle would have a corresponding increase with the inflammatory response and overall recovery time, providing the underlying mechanism responsible for results indicating contrast baths to be the least effective recovery intervention. Despite its acceptance as a recovery protocol in professional sports including rugby union, this research indicates that contrast baths should be discontinued as a recovery protocol.

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Practical Applications

The findings in this research support those of previous research indicating that 2 × 5-minute CWI produces results that are superior to both contrasts baths and passive recovery in alleviating muscle pain after EIMD. If coaches and strength and conditioning coaches are concerned that players are adversely affected by muscle pain at their first training session after competition, this study recommends for players in rugby union aiming to attenuate the effects of muscle pain postgames should follow this study's protocol for CWIs, consisting of 2 × 5-minute baths immediately after the game. Further, it should be noted that our research demonstrated that contrast baths were less effective as a recovery modality than either CWI or passive recovery.

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Acknowledgments

The authors thank the contributions of Associate Professor Aaron Coutts (UTS, Australia) to the research design and methodology, and thank the coaches and players from the Eastwood District Rugby Union Football Club for their support and participation is this study.

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Keywords:

cold water immersion; team sport; sports performance; rugby union

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