Ice bath


Ice bath
Champion weightlifter Karyn Marshall took an ice bath after an event in 2011.

In sports therapy, an ice bath or sometimes a cold-water immersion or cold therapy is a training regimen usually following a period of intense exercise[1][2] in which a substantial part of a human body is immersed in a bath of ice or ice-water for a limited duration. While it is becoming increasingly popular and accepted among athletes in a variety of sports,[3][4][5][6] the method is controversial[7] and potentially dangerous[8][9] with little solid scientific evidence to support or refute its usefulness or to understand its method of operation within the body,[5] although there is speculation about processes within the body regarding vasoconstriction. In medicine, the practice would be classified as cryotherapy which uses low temperatures as medical therapy.

Contents

History

A Polar Bear Club in Massachusetts.

There have been traditions of people ice swimming in the middle of winter on a lake for short stretches, sometimes as part of a Polar Bear Club. Sometimes people taking short swims for thirty seconds or so have felt invigorated afterwards.[8] The Coney Island Polar Bear Club was founded in 1903. A Polar Bear member explained:

It is definitely stimulating. Your feet freeze, your voice changes a few octaves and if you're a man you freeze your balls off.
—Mike Kahlenberg, 2006[8]
Professor Sugarman the "human polar bear" circa 1900

In the 1890s, Russian immigrant Professor Louis Sugarman of Little Falls, NY brought his practice of ice bathing to the United States. He attracted worldwide attention for his daily plunge in the Mohawk River, even when the thermostat hit 23 below zero, earning him the nickname "the human polar bear". [10]

In 1899, an Iowa woman filed for divorce from her husband because he had forced her to undergo ice baths.[11] There has been a tradition in American football of pouring a large bucket of ice water on the winning coach as a victory celebration.[12] And physical therapists have applied ice packs to selected areas of the body to prevent swelling.

Long distance champion Paula Radcliffe is believed to have popularized its use after her victory in Europe in 2002.

Until recently, however, bathing in ice was seen as unusual. One account suggested that ice bath therapy did not become popular until 2002, when marathon runner Paula Radcliffe won the championship in Europe and attributed her victory to its use.[13] She reportedly said "It's absolute agony, and I dread it, but it allows my body to recover so much more quickly."[14] She reported taking ice baths before racing and preferred her pre-race bath temperature to be "very cold."[8] After the Radcliffe comment, the technique has grown in popularity.[13] It is gaining in popularity among athletes,[5][6][13] such that some athletes "swear by it"[15][16][13] but other accounts suggest it may be a fad.[13][8] It has been used by athletes such as A. J. Soares[3] as well as other celebrity endorsers[17] and is getting to become "common practice" among athletes[16][18] from different sports, including association football (soccer),[3][2] long distance running,[19][5][7] rugby,[13][1] tennis,[20] volleyball,[4] and other sports.

There are indications that ice baths may be gaining popularity with groups outside sports, such as dance. The Pittsburgh Post-Gazette reported that some Radio City Rockettes, a precision dance company performing in New York City, use ice baths after a long day of performing as a way to "unwind" and cope with "aches and pains."[21] And there are indications that use of ice baths is spreading to amateur sports, such as high school football.[22]

Ice baths are a part of a broader phenomenon known as cryotherapy––the Greek word cryo (κρυο) means cold––which describes a variety of treatments when cold temperatures are used therapeutically. Cyrotherapy includes procedures where a person is placed in a room with "cold, dry air at temperatures as low as -135°C" for short periods of time, and which has been used in hospitals in Poland as well as a center in London to treat not only muscular ailments, but psychological problems such as depression.[8] Occasionally ice baths have been an ill-advised treatment of fever in young children, but that doctors were counseled not to use this technique because of the risk of hypothermia.[9] Ice baths have been suggested as a way to prevent muscle soreness after shoveling snow.[6]

Iceman Wim Hof in an ice bath in 2007.

In addition, there have been instances of ice bathing as an extreme bodily test by persons vying for an endurance record, such as Dutch Iceman Wim Hof, and Chinese record-holders Chen Kecai[23] and Jin Songhao.[24] These people have spent more than an hour and a half submerged in an ice bath, and survived.[23]

Method of operation

Bath

It is done by standing or sitting in a bucket or bath of icy water. One writer advised: "don't overdo it."[16] Wearing rubberized "dive booties" on the feet (to protect toes) as well as rubber briefs to warm the midsection have been recommended. While there are different types of ice baths, a writer described one arrangement:

The icebath is simple: 2-3 bags of ice from a convenience store ($3-6 USD) put into a half-full bath until the ice is about 80% melted. Beginners should start with immersing the lower body only and progress to spending the second five minutes with the upper torso submerged (fold your legs Indian-style at the end of the tub if you don't have room).
—Tim Ferriss in the Huffington Post, 2008[25]

Champion weightlifter Karyn Marshall, who won the world women's weightlifting championship in 1987,[26] described what it was like to take an ice bath after a day of competition at the CrossFit Games in 2011 in Los Angeles:

The first day I went in for twelve minutes, and the second day for fifteen minutes. They kept adding ice to keep the temperature at around 55 degrees (Fahrenheit) ... The hardest part was the first two minutes. Others who do it often told me to just hang in for two minutes and then it would be easier. After two minutes I was numb. Afterwards I was shivering for two hours in the hot California sun with a warm up jacket on.
—Karyn Marshall, 2011

One report suggested that if ice water is circulating, it's even colder such that the water will be colder than measured by a thermometer, and that athletes should avoid overexposure.[27] Physical therapist Nikki Kimball explained a way to make the bath more endurable:

Over those years, I've discovered tricks to make the ice bath experience more tolerable. First, I fill my tub with two to three bags of crushed ice. Then I add cold water to a height that will cover me nearly to my waist when I sit in the tub. Before getting in, I put on a down jacket and a hat and neoprene booties, make myself a cup of hot tea, and collect some entertaining reading material to help the next 15 to 20 minutes pass quickly.
Runner's World, 2008[19]

Ice bath only versus contrast bath therapy

Accounts differ whether it is best to follow the ice bath with a hot shower; two accounts suggested that a hot shower followed by a massage would be helpful,[20][28] but other reports counsel against such a practice. There are reports that some athletes use this technique, sometimes known as contrast water therapy or contrast bath therapy, in which cold water and warmer water are alternated.[16] One method of doing this was to have two tubs––one cold (10-15 degrees Celsius) and another hot (37-40 degrees Celsius)––and to do one minute in the cold tub followed by two minutes in a hot tub, and to repeat this procedure three times.[16]

Temperature and timing

The temperature can vary, but is usually in the range of 50–59 degrees Fahrenheit[19][5] or between 12 and 15 degrees Celsius.[16][29] Some athletes wear booties to keep their toes warm[5] or rubberized coverings around their midsection while immersed. Some drink a warm beverage such as tea.[5] One report suggested that "ten minutes immersed in 15 degree Celsius water" was sufficient.[16]

Accounts vary about how long to be immersed and how often to do them. One adviser suggested that an athlete should take ten two-minute ice bath treatments over a two-week period.[8] One account suggested immersion times should be between ten and twenty minutes.[19] Another suggested that immersion run from five to ten minutes, and sometimes to twenty minutes.[16] There were no sources advocating being immersed for longer than twenty minutes.

Ice baths versus cold baths

Several sources suggest that cold baths (60–75 degrees Fahrenheit) were preferable to ice baths. Physiotherapist Tony Wilson of the University of Southampton said that extremely cold temperatures were unnecessary and a "cold bath" would be just as effective as an ice bath.[8] Another agreed that a mere cold bath is preferable to ice baths which are "unnecessary."[16] A third report suggested that cool water (60-75 degrees Fahrenheit) was just as good as cold water (54-60 degrees Fahrenheit) and that eight to ten minutes should be sufficient time, and warned against exceeding ten minutes.[27]

Medical efficacy

There is theoretical speculation, although unproved, about how the ice bath technique might operate,[16] as well as differing accounts about how the technique is supposed to help the human body. A common theme is that the cold prompts the body to recover faster from an intense period of activity.[30] According to several accounts, the cold in the ice bath signals temperature receptors to alert the brain to "withdraw blood to the body's core".[8] According to another account, after five to ten minutes, the "icy cold water causes your blood vessels to tighten and drains the blood out of your legs."[14][17][16] Another report suggested that it causes metabolic activity to slow.[16] After getting out of the ice bath, the blood is pumped[28] "vigorously" back to tissues "stimulating oxygen and nutrient supply to areas that need revitalising," according to one assessment,[8] and another suggests that blood flow is speeded up,[16] sometimes described as a "blood rush."[29] A report along these same lines suggested that the benefit came from after the ice bath with "increased blood flow" bringing fresh nutrients to an "inflamed, injured area" which helps the tissues heal.[20] A slightly different explanation was that cold causes the diameters of blood vessels to contract during the period of immersion in the ice water, meaning that more toxins were pumped out of the area, similar to a massage.[8] And blood is a way to bring oxygen to the cells as well as remove waste products from muscular exertion, particularly lactic acid.[14] Here is one description of how it is believed to work:

The muscles will cool and relax after a few minutes in the bath. At the end of the bath you will experience a strong flush of blood circulating through the muscles that were submerged. This sudden increase in circulation speeds up and improves the quality of muscle recovery by quickly flushing out the lactic acids that have built up in the tired muscles.
—Tilman von der Linde in The Vancouver Sun, 2009[4]

Ice baths are generally believed to be a way to help the body recover from a vigorous workout, with one account suggesting helpful effects not only for muscles, but for tendons, bones, nerves, and other tissues as well.[14] An advantage cited is that cold-water immersion is a more "efficient means of cooling large groups of muscles simultaneously" and helps lead to "longer lasting changes in deep tissues."[19] A second report echoed this view and suggested that "immersion allows controlled, even constriction around all muscles."[29]

Ice baths have been a source of medical treatment when a person is suffering from heat illness, and when this happens, sufferers are urged to get into an air conditioned room quickly or get into an ice bath.[31]

Benefits

Benefits are speculative but include the following:

  • Speeds recovery. According to one report, it is believed to decrease the amount of time needed by the muscles of athletes to return to top condition between training sessions.[8][16]
  • Keeps muscles limber.[5] One account suggested it would reduce muscle soreness after heavy exertion, such as after snow shoveling.[6]
  • Reduces inflammation.[5] But one account disputes there is any benefit in fighting inflammation.[5] However, according to Greg Whyte of the English Institute of Sport, inflammation may be good for the body and act as an "important and beneficial part of the muscle's response to training."[13]
  • Feels good afterwards.[5]
  • Less muscle soreness.[29]
  • Induces sleep. A report in the Huffington Post suggested that a ten minute ice bath about an hour prior to bedtime acted like an "elephant tranquilizer."[25]
  • Less muscle stiffness.[13]

Drawbacks

  • Painful. One account suggested "Don't expect it to be pleasant at first."[25]
  • Cold. The "discomfort associated with sitting in a tub full of ice water" can cause many to avoid it.[19]
  • Possibly medically dangerous. Doctor Lisa Silver of Oxfordshire explained that "exposing yourself to prolonged cold" may result in hypothermia[9] or frostbite and that sudden exposure to extreme cold could harm patients with heart problems or asthma and possibly lead to sudden death.[8]

Scientific investigation

There is little solid scientific research to support a case that ice baths are either beneficial or detrimental for athletes.[5][16][8] Professor Kenneth L. Knight of Brigham Young University said there is no evidence to either support or refute the claim that ice-bath treatments, or cryotherapy methods in general, reduces inflammation.[5] Runner's World.com executive editor Mark Remy believes that ice-bath treatments are "bunk" opining that it is an "elaborate practical joke being played on runners."[7] Physiotherapist Chris Bleakley of the University of Ulster reported that there are "no high-level scientific studies that say this is good for the body" although he admitted that athletes had been reporting positive results,[8] and that there is considerable anecdotal evidence from athletes that it makes them "feel better."[17] In contrast, one report suggested that there was scientific research showing that ice baths promote recovery, but no specific studies were cited.[19] There have been smaller-scale studies which either indicate no benefit or a detrimental effect, or that offer "inconclusive or contradictory findings."[16]

Australian study

A study by Australian researchers, publishing in the British Journal of Sports Medicine on a small sample size, suggested that ice bath therapy may "do more harm than good."[32][16][13] The team asked 40 volunteers to undergo leg exercises and gave half ice baths and the other half a dip in tepid water. Researchers measured pain levels, swelling, performance in a "hopping test" and blood chemicals which might indicate damage to muscles, and found no statistically important differences between the two groups, except that the ice therapy treated volunteers experienced more muscular pain,[13][17] specifically in the legs.[16] The study found that:

Ice-water immersion offers no benefit for pain, swelling, isometric strength and function, and in fact may make more athletes sore the next day.
British Journal of Sports Medicine, 2007[17][33]

Study of Cyclists

One study in 2008 in the International Journal of Sports Medicine suggested that cold water immersion and contrast water therapy might help in situations where athletes engaged in "high intensity efforts on successive days", such as weightlifters in a multi-day competition.[16] Researchers studied cyclists during a week of intense training and found that they performed better with these methods than complete rest or hot water baths.[34]

Benchpress study

A study in 2007 reported in the Journal of Strength and Conditioning Research found that contrast water therapy delayed the onset of muscle soreness after "intense leg press exercise" and found "faster restoration of strength and power in athletes" who used this therapy instead of a merely "passive recovery."[16][35]

English Institute of Sport study

This study suggested that ice baths could help top athletes recover faster during a peak competition but that such methods should not be used during training since it limits the "growth and strengthening of muscle fibers."[15] The authors of the study, including physiologist Jonathan Leeder, counseled against ice bath treatments during training.[15]

See also

Note: the term ice bath has different meanings for chemistry, food preparation, and in medicine

References

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  2. ^ a b YAEL AVERBUCH (2011-04-28). "No Tweeting From the Ice Bath". The New York Times: Soccer. http://goal.blogs.nytimes.com/2011/04/28/no-tweeting-from-the-ice-bath/. Retrieved 2011-08-13. "I tell my body to do a lot of things: Run one more sprint. Strike 50 balls. Push through just 15 more minutes. Warm up. Cool down. Sit in an excruciating ice bath." 
  3. ^ a b c AJ Soares (February 18, 2011). "This California boy welcomes opportunity to play in New England". The Boston Globe. http://www.boston.com/sports/soccer/blog/2011/02/a_california_bo_2.html. Retrieved 2011-08-14. "Hello New England! I am AJ Soares, a new player, or employee as I tell people, at the New England Revolution. ... It’s time for me to dip out, ice bath, and get ready to get to work again tomorrow with the team." 
  4. ^ a b c Tilman von der Linde (25 Feb 2009). "Speeding Up Muscle Recovery - Ice Bath Benefits". The Vancouver Sun. http://communities.canada.com/vancouversun/blogs/sunrunexperts/archive/2009/02/25/speeding-up-muscle-recovery-ice-bath-benefits.aspx. Retrieved 2011-08-14. "Many athletes ... have also discovered the benefits of the icy plunge. Pro Beach Volleyball Players and Marathon Runners have been asked to go stand in the ocean for a few minutes. ..." 
  5. ^ a b c d e f g h i j k l m n Lenny Bernstein (November 9, 2010). "Recovering from high-intensity athletics". Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2010/11/09/AR2010110903278.html. Retrieved 2011-08-13. "...you want to keep those tired muscles limber." 
  6. ^ a b c d George Guerin (January 27, 2011). "Shoveling snow again? Try some of these tips to ease those aches and pains". Newark Star-Ledger. http://blog.nj.com/fitness/2011/01/shoveling_snow_again_try_some_of_these_tips_to_ease_those_aches_and_pains.html. Retrieved 2011-08-13. "If you have been shoveling ... Ice Bath: An ice bath ... can help reduce muscle soreness. This is extremely popular in athletic locker rooms, sometimes even mandatory after rigorous exercise." 
  7. ^ a b c Julie Deardorff (October 12, 2009). "Rules for runners: Skip the ice bath". Chicago Tribune. http://featuresblogs.chicagotribune.com/features_julieshealthclub/2009/10/runners-rules-remy-marathon.html. Retrieved 2011-08-13. "... many of my RW colleagues swear by ice baths after a long run or race. Not me. I still maintain that ice baths are an elaborate practical joke being played on runners ..." 
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  9. ^ a b c Julie Deardorff (May 02, 2010). "Health myths your doctor may believe". Chicago Tribune. http://featuresblogs.chicagotribune.com/features_julieshealthclub/myths/. Retrieved 2011-08-13. "5 percent said children can be given an ice bath to treat a fever -- Risk: hypothermia" 
  10. ^ The Johnstown Daily Republican (April 7, 1899). "Prof. Sugarman's Latest Feat". The Johnstown Daily Republican. http://fultonhistory.com/Newspaper%2011/Johnstown%20NY%20Fulton%20County%20Republican/Johnstown%20NY%20Fulton%20County%20Republican%201896-1899%20Grayscale/Johnstown%20NY%20Fulton%20County%20Republican%201896-1899%20Grayscale%20-%200403.pdf. "Prof. Sugarman of Little Falls, whose river baths in in midwinter have earned him a world wide celebrity and the title of "human polar bear,"..."  The New York Sun (December 25, 1898). "Professor Sugarman's Cold Baths". The New York Sun. http://fultonhistory.com.  The Otsego Farmer (April 7, 1899). "Mid-Winter Bather". The Otsego Farmer. http://fultonhistory.com. "In the coldest day of the winter, when the thermometer registered 23 degrees below zero, [Prof. Sugarman] took his plunge as usual" 
  11. ^ Special to The New York Times (August 02, 1899). "OBJECTS TO ICE WATER BATHS.; Therefore Mrs. Wellington of Omaha Asks for a Divorce.". The New York Times. http://query.nytimes.com/gst/abstract.html?res=F30F13FE3A5416738DDDAB0894D0405B8985F0D3. Retrieved 2011-08-13. "Mrs. William Wellington to-day filed a petition for an absolute divorce, alleging as a reason that her husband made her bathe in ice water...." 
  12. ^ MANNY NAVARRO (2011-01-04). "Future uncertain for Stanford's winning duo". Miami Herald. http://www.miamiherald.com/2011/01/04/1999390/future-uncertain-for-stanford.html. Retrieved 2011-08-13. "Harbaugh took the celebratory ice bath and a victory ride on his players shoulders..." 
  13. ^ a b c d e f g h i j k James Randerson (10 July 2007). "Study pours cold water on theory that ice aids recovery". London: The Guardian. http://www.guardian.co.uk/science/2007/jul/10/uknews.sciencenews. Retrieved 2011-08-13. "But Australian scientists have discovered that not only does the modern treatment have no effect - it may do more harm than good." 
  14. ^ a b c d e Craig Smith (2003-09-30). "The cold benefits of ice baths". BBC News. http://news.bbc.co.uk/sportacademy/hi/sa/treatment_room/features/newsid_3097000/3097114.stm. Retrieved 2011-08-14. "In simple terms, it's about helping the muscles, tendons, bones, nerves and all the different tissues used in sport recover from their workout." 
  15. ^ a b c NewsCore (04 Nov 2010). "Experts Pour Cold Water on Athletes’ Ice-Bath Remedy". Fox Boston. http://www.myfoxboston.com/dpps/health/experts-pour-cold-water-on-athletes-ice-bath-remedy-dpgonc-20101104-fc_10457178. Retrieved 2011-08-14. "... the grueling ritual of the ice bath could reduce the benefits of exercise. ..." 
  16. ^ a b c d e f g h i j k l m n o p q r s t u Elizabeth Quinn (September 30, 2008). "After Exercise - Does an Ice Water Bath Speed Recovery?". About.com. http://sportsmedicine.about.com/od/sampleworkouts/a/Ice-Bath.htm. Retrieved 2011-08-14. "After Exercise Ice Bath - Does It Help Recovery?" 
  17. ^ a b c d e "Sports star ice baths questioned". BBC News. 10 July 2007. http://news.bbc.co.uk/2/hi/health/6287210.stm. Retrieved 2011-08-14. "British Journal of Sports Medicine now claims the opposite may be true. Out of 40 volunteers, those who took an icy plunge reported more pain after 24 hours than those who took a tepid bath. ... Ice baths have become one of the most fashionable ways of recovering after an intense game or marathon. From rugby to tennis players, the bath has a series of celebrity endorsers." 
  18. ^ a b Gordon McKerrow (interviewer) Ryan Babel (interviewee) (April 2, 2008). "Rough diamond: Liverpool's Babel reflects on Ajax, Benítez, ice baths". Sports Illustrated. http://sportsillustrated.cnn.com/2008/writers/world_soccer/04/02/babel.qa/. Retrieved 2011-08-14. "... After a match we have to stand in an ice bath for five minutes. ..." 
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  20. ^ a b c GEOFF MACDONALD (June 24, 2010). "How Do You Recover From 163 Games?". The New York Times: Tennis. http://straightsets.blogs.nytimes.com/2010/06/24/how-to-rest-after-163-games/. Retrieved 2011-08-13. "...the next smart move would be to take a full body ice bath. ..." 
  21. ^ Sara Bauknecht (November 15, 2009). "Rockettes manager strives to keep troupe fit and healthy". Pittsburgh Post-Gazette. http://www.post-gazette.com/pg/09319/1013035-325.stm. Retrieved 2011-08-13. "How do the 200 Radio City Rockettes ... Taking ice baths ... some Rockettes take ice baths to unwind after a long day." 
  22. ^ Josh Rosenfeld (October 02, 2010). "Westfield 30, Elizabeth 20 (High school Football scores and results)". The Star Ledger. http://highschoolsports.nj.com/news/article/8506580523003148157/westfield-30-elizabeth-20-high-school-football-scores-and-results/. Retrieved 2011-08-14. "Long after most of his teammates had departed Gary Kehler Stadium, A.J. Murray sat in a well-deserved ice bath in a large plastic tub while basking in the sunlight outside the Westfield training room." 
  23. ^ a b "Wim Hof, Dutch 'Iceman,' Plans To Break Ice Bath Record (VIDEO)". Huffington Post. 12-30-10. http://www.huffingtonpost.com/2010/12/30/wim-hof-dutch-iceman-plan_n_802595.html. Retrieved 2011-08-13. "... Though he reportedly set the record for staying in an ice bath for one hour and 44 minutes in January, Hof -- who is listed as running the fastest half-marathon barefoot on ice or snow -- was beaten by Chen Kecai of China, the current champion for full body contact with ice after spending one hour, 48 minutes and 21 seconds in an ice bath March 14." 
  24. ^ "Specials". China Daily. 2011-01-05. http://www.chinadaily.com.cn/china/2011-01/05/content_11800100.htm. Retrieved 2011-08-14. "Jin Songhao dwarfed the previous world record for the longest ice bath by immersing himself in ice for 120 minutes." 
  25. ^ a b c Tim Ferriss (January 28, 2008). "Relax Like a Pro: 5 Steps to Hacking Your Sleep". Huffington Post. http://www.huffingtonpost.com/tim-ferriss/relax-like-a-pro-5-steps-_b_83581.html. Retrieved 2011-08-13. "2. Use ice baths to provoke sleep. ...it's like getting hit with an elephant tranquilizer." 
  26. ^ Julie Carft (July 29, 1989). "Image is Heavy Burden - Weightlifter Karyn Marshall Feels Pressure to Project 'Femininity, Intelligence'". Los Angeles Times. http://articles.latimes.com/1989-07-29/sports/sp-145_1_karyn-marshall. Retrieved 2009-10-02. 
  27. ^ a b Andy Schmitz, USA Triathlon. "8 Ice Bath Dos and Don'ts". Active.com. http://www.active.com/triathlon/Articles/8-Ice-Bath-Dos-and-Donts.htm. Retrieved 2011-08-14. "DO: Be aware that moving water is colder water." 
  28. ^ a b c Andy Hore (2003-02-20). "Warming up...and cooling down". BBC. http://news.bbc.co.uk/sportacademy/hi/sa/rugby_union/features/newsid_2635000/2635911.stm. Retrieved 2011-08-14. "... The combination of a hot shower and a cold bath decreases swelling...." 
  29. ^ a b c d e Stephen Mirarchi (September 2006). "Owner's Manual: Chill Out: Better recovery with ice baths". Running Times Magazine. http://runningtimes.com/Article.aspx?ArticleID=8731. Retrieved 2011-08-14. "... First, immersion allows controlled, even constriction around all muscles, effectively closing microscopic damage that cannot be felt and numbing the pain that can. ..." 
  30. ^ Jonah Fisher (11 May 2010). "World Cup: How an ice bath may help players recover". BBC News. http://news.bbc.co.uk/2/hi/africa/8673231.stm. Retrieved 2011-08-14. "Effective recovery after a big match is crucial, and one technique used to help players with that is the ice bath." 
  31. ^ Steven Reinberg (July 28, 2011). "Heat-Linked Illnesses Strike Thousands Each Year: Report". US News. http://health.usnews.com/health-news/family-health/heart/articles/2011/07/28/heat-linked-illnesses-strike-thousands-each-year-report. Retrieved 2011-08-14. "Signs of possible heat illness ... you need to get these people immediately out of the heat and into air conditioning or an ice bath..." 
  32. ^ "Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial". British Journal of Sports Medicine. 29 January 2007. http://bjsm.bmj.com/content/41/6/392.full. Retrieved 2011-08-14. "Br J Sports Med 2007;41:392-397 # Volume 41, Issue 6" 
  33. ^ Kylie Louise Sellwood, et al. Ice-water immersion and delayed-onset muscle soreness: a randomized controlled trial Br. J. Sports Med., Jun 2007.
  34. ^ Vaile, J.; Halson, S.; Gill, N.; Dawson, B., Effect of Hydrotherapy on Recovery from Fatigue. Int'l J. Sports Medicine, July 2008.
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