Taking cold showers is by far one of the most agonizing things to put yourself through, standing under the unforgiving cold water that makes your body flinch and shudder with each splash is pure hell. One would have to be borderline crazy to inflict that type of torture on oneself, right? But a lot of individuals, including star athletes like Lebron James, and even Hollywood celebrities such as Lady Gaga and Jeniffer Aniston swear by the benefits of a painful ice bath.
The idea of subjecting oneself to freezing temperatures derives from the practice of using cold packs for cold compression therapy which is commonly used to reduce inflammation. It's the reason why you apply an ice pack or frozen peas on a sprain or an injury. According to Medical News Today, ice packs lower one’s body temperature, restricting blood flow due to which bleeding slows down, swelling and inflammation reduces and pain is dulled.
However, there's a huge difference between immersing one's whole body in ice water and selectively applying a small ice pack on an injury. So, why do people choose to go through this numbing practice of ice baths? To even begin to understand their reasoning, we need to dip into the concept of an ice bath.
Why did ice baths become popular?
The brave idea of subjecting one's entire body to supercool temperatures for therapeutic reasons began in Japan during the late 1970s. At the time, it was advertised as a potential way of providing relief from joint pain to patients with multiple sclerosis or rheumatoid arthritis. It only started gaining traction in Western Europe in the 1990s and in the past decade has risen to prominence in the sports community in the US and Australia.
Through anecdotes and hearsay, the practice has spread across the professional athlete circles worldwide. Marketing companies are milking the allure of this activity by claiming that it can not only treat pain but many other ailments ranging from asthma to Alzheimer's disease.
However, there isn’t any proof that ice baths can treat the above ailments and up till now has only been proven to treat soft-tissue injuries. According to the Scientific American, clinical studies have found that applying ice to an injury for 5-15 minutes can lower skin temperature to less than 10 degrees Celsius, which helps in dulling the pain signals from the affected nerves.
Ice to injury may have other benefits too as suggested by certain animal studies. According to Chris Bleakley, a sports medicine researcher at Ulster University in Northern Ireland, it can help in combating inflammation after injury by reducing blood flow and the number of white blood cells rushing to the injured part. Reducing inflammation is sometimes needed as prolonged inflammation can extend pain and decrease range of motion.
Why do athletes indulge in ice baths?
In sporting communities, ice baths are taken as part of cold water immersion which involves taking a 10-15 minute dip in extremely cold water (10°C) after a strenuous exercise session or competition. If you are a fitness enthusiast or play sports professionally, you have probably heard of this technique and how it is popularly believed to help reduce muscle pain and soreness.
If you exercise occasionally, this might not make much sense to you since you don't require to heal quickly and can take a few days off to deal with muscle soreness. But marathon runners and professional athletes require to undergo continuous training to which muscle soreness can be a huge hindrance.
In such a situation recovery from exercise is crucial for athletes, especially with repeated bouts of exercise. Enhancing recovery may even provide them with an edge in competitive situations, where athletes compete numerous times over several days. Overall, ice bathing in water is a practice that appears to be catching on among many athletes.
According to Robert Gillanders, D.P.T., a physical therapist at Point Performance and spokesperson for the American Physical Therapy Association, cold therapy constricts blood vessels and decreases metabolic activity, which reduces swelling and tissue breakdown.
What are the possible benefits of an ice bath?
The studies on cold water immersion are varied and have inconclusive results as anecdotal evidence strongly leans in favor of ice baths being beneficial for healing whereas other empirical evidence shows that it doesn't have a significant effect in decreasing muscle soreness.
According to the study 'Post-exercise ice water immersion: Is it a form of active recovery?', there are a few possible mechanisms postulated for the use of cold water immersion therapy post-exercise.
It's mainly used to reduce delayed onset muscle soreness which is a common condition after intense exercise occurring 12-72 hours post-exercise. For instance, you may have noticed a bittersweet soreness in your thighs, the day after an intense squat and lunges workout - this is muscle soreness.
It occurs after intense exercise that often leads to some microtrauma and tears in the muscle fibers which stimulates muscle cell activity and helps in the repair, strengthening, and overall muscle recovery. The pain from this whole muscle repairing process can be a bit of a nuisance for hardcore athletes.
A study provided possible proof of ice bath therapy helping runners reduce swelling in their legs. In the study, participants were asked to immerse one leg into an ice bath after a tiring run and to leave the other one out with no treatment. The results showed that swelling reduced in the freezing cold leg as compared to the bare leg.
Ice bath therapy may hinder muscle repair and growth
Since ice baths slow down the natural and necessary inflammation process and muscle repair, it may decrease those gains in strength and muscle growth you've been working so hard at the gym for. A 2015 study published in the Journal of Physiology showed a marked decrease in long-term gains in muscle mass and strength similar to a 2014 study in the Journal of Strength & Conditioning Research which showed decreases in strength using cold immersion.
On the surface, the idea of going through the agonizing but rewarding process of an ice bath may sound like a tried and tested and reliable way of relieving oneself of pain but for body-builders and keen amateur athletes, it may be eating away their dreams of gaining muscle.
In other words, these attempts to mitigate inflammation could be counterproductive as it can slow down muscle gains and strengthen. Ice therapy or immersion in cold water is known to reduce blood flow and this could slow down muscle protein synthesis, where the muscle rebuilds itself after injury or strain.
According to BBC Future, in order to reap the benefits of doing weights and strength training is to let inflammation occur as it aids in muscle recovery. Reducing inflammation on the other hand may slow down repair. A review of several studies concluded that a certain amount of inflammation is necessary, however, research hasn't ascertained how much inflammation is best and at which time during the process of recovery it’s most beneficial.
Age is also a deciding factor when it comes to the effect of anti-inflammatory methods on muscle gains. In a study, for older people, that are above 65 years, anti-inflammatories actually boosted muscle volume than it those who took a placebo. So, taxing therapies such as cold water therapy may be worth the effort for the older demographic.
In the case of younger, fitter people, studies show that muscle repair will, unfortunately, slow down under anti-inflammatory methods. As discussed, for an average person working out to keep healthy, this might be trivial and not worth the pain. However, for a professional athlete who's goal is to keep getting as strong as possible and focus on their long-term fitness plan, it might be better to avoid it in the long run.
This practice of ice baths, however, works on rats like a charm without any fallouts. When the ice was applied to the rats' muscles, inflammation decreased without any reduction in the speed of muscle generation.
A 2016 study on ice baths compared the practice to athletes ending their workout with a gentle warm down (which is what many athletes do in practice) and the study raised questions on whether ice baths even lead to a reduction in inflammation.
A study shows that ice baths may not even reduce inflammation
The study named 'The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise' had 9 active men that took part in a 45-minute session of lunges, squats, and other exercises.
For a week, they were instructed to spend 10 minutes sitting up to their waists in an inflatable bath with cold water after their workouts. After the ice bath, they were banned from showering for at least two hours, so that they didn't warm up too quickly.
The next week, their post-exercise regime needed them to spend 10 minutes cycling slowly on an exercise bike - a much more pleasant warm down.
At various intervals before and after the exercise sessions and the ice bath, the researchers took blood samples from the nine men and took their thigh tissue to conduct muscle biopsies. Markers of inflammation and stress response in the muscle increased after exercise however, the ice bath seemed to have made no noticeable difference to these levels. Surprisingly, the cold water didn’t reduce inflammation.
The researchers noted that there were two arising issues here - whether an ice bath does reduce inflammation and whether athletes should even opt for reducing inflammation as it might slow down muscle repair. The lead researcher, Jonathan Peake from the Queensland University of Technology suggests that athletes should rethink their strategies.
Although, he admits to the notion that ice baths may provide quick recovery to athletes between events during a competition but should be avoided if you want to gain muscle mass and get stronger in the long-term.
However, the trend is still booming and flourishing and ice baths are being commercialized into cryotherapy centers, where people are provided with more advanced technology to cool down after a workout.
There are cryotherapy centres in the US but the FDA hasn't approved of the practice
One of the largest US distributors of whole-body cryotherapy machines is the Dallas-based CryoUSA founded in 2011. Unlike immersing oneself in a tub filled with ice cubes, cryotherapy uses gasified liquid nitrogen to cool the air around the recipient who stands in an enclosed chamber, taking temperatures as low as 200 degrees F.
However, the Food and Drug Administration (FDA) has not shown any official support for this technology. In 2016, the FDA had issued a public warning stating that there is no evidence of cryotherapy technologies in easing muscle aches, insomnia, anxiety, or any other medical benefit.
It has, however, claimed that this treatment may cause frostbite, burns, eye damage, and even asphyxiation. In an interview with the Scientific American, the FDA added, “The FDA has not approved or cleared any whole-body cryotherapy devices, and we do not have the necessary evidence to substantiate any medical claims being made for these devices.”
This warning is based on the FDA's own review of available literature and generally recognized hazards associated with exposure to the gas that creates the cold conditions in the treatment chamber.
Apart from its murky image, cryotherapy is also expensive as a package of five, two-minute sessions can cost several hundred dollars, as reported in the Scientific American.
Cryotherapy with gasified liquid nitrogen is ineffective in reducing body temperature
Even after spending all the big bucks at the cryotherapy centre, you may not get the desired results as you would with a simple ice bath. While the temperature of the gasified liquid nitrogen is much colder than ice, the cold from ice applied directly to the body has a better chance of penetrating through the layers of your skin and reach the soft tissue compared to icy gas. Since the gas simply swirls around the skin and isn't pressed against it, it makes it harder for the gas to cool down the deeper parts of the body.
This was demonstrated in a 2014 analysis of ice, cold water therapy, and whole-body cryotherapy which showed that ice packs led to the biggest reduction in skin temperature and intramuscular temperature.
According to the lead researcher Bleakley, due to whole-body cryotherapy's inability to cool down intramuscular temperatures, it's unlikely to be as effective as ice to slow down pain signals or cool down the soft tissues to control inflammation.
Other studies only deepen the doubts and skepticism around this recovery method. In a detailed examination of studies on whole-body cryotherapy, exercise physiologist Joe Costello of the University of Portsmouth in England, along with Bleakley and others say they found no significant benefit to the treatment as reported by the Scientific American. “There is insufficient evidence to prove whether whole-body cryotherapy reduces muscle soreness or improves recovery after exercise compared to ... no intervention,” Costello states.
However, the four studies that were examined are not enough to arrive at a concrete conclusion or spread the final word. The studies had limited subjects totaling to around only 64 people and most of them were men in their early 20s. So the gender ratio and age demographic were severely skewed making it impossible to say whether cryotherapy can benefit women or older people.
Bleakley comments on this saying, “Sports scientists really need to pick up this area and align it with the quality of studies in wider medicine.” Studies have also not confirmed other claims such as cryotherapy benefiting the heart rate, blood pressure, and metabolism.
The practice of cryotherapy needs to be medically regulated
If athletes are going to enclose themselves in freezing chambers, it is imperative that the practice is medically regulated by agencies.
Mark Murdock, the managing partner at CryoUSA, agrees that there is a lack of evidence for supplementary benefits of cryotherapy such as weight loss and productivity. He promotes his company's devices as pain reducers and inflammation suppressors but in his view, the use provides "comfort" rather than a medical solution.
He seems to be very honest and unbiased in his approach to this technology and shuns any unproven claims such as the device aiding in weight loss. About the FDA's decision to not support the technology, he says that he believes that the warnings given out by the FDA were reasonable and hopes the agency takes a more active part in weeding out companies that market unproven claims of cryotherapy.
Apart from the FDA's warnings, there have been no other scientific studies observing the associated risks of cryotherapy.
Naresh Rao, the USA Water Polo Olympic team’s physician tells the Scientific American that the practice needs to be medically regulated. People with heart issues or uncontrolled hypertension should not seek out cryotherapy, he warns, because sudden exposure to such cold temperatures could trigger heart attacks or other serious health complications for them.
However, many athletes support the practice with their own experiences as proof of benefits. Rao says this could be a result of their belief in the treatment or the placebo effect.
Overall, there is scope for much more research to take place - large randomized controlled studies to bring out the cold, hard facts about this practice. But the lack of research and its adverse effect on muscle gains leads to the conclusion that ice baths may be more of a hype than fact. So, if you're training for a marathon or a competition, it's not worth freezing yourself in ice water, you may be better off employing other ways to relax and cool down such as stretching.