Effects of cryoimmersion in the recovery of post-exercise muscle pain: systematic review with meta-analysis

Postol, Alanis Wunsche; Carnevalli, Chantal; Silveira, Eduarda Luzia Gomes da; Flores, Lucinar Jupir Forner; Buzanello, Márcia Rosângela; Bertolini, Gladson Ricardo Flor

doi:10.63231/2595-0118.20250014-pt

person Alanis Wunsche Postol

Data Collection · Conceptualization · Research · Methodology · Writing - Preparation of the original · Visualization

schoolUniversidade Estadual do Oeste do Paraná, Fisioterapia, Cascavel, PR, Brasil.

0009-0006-8201-8192

person Chantal Carnevalli

Data Collection · Conceptualization · Research · Methodology · Writing - Preparation of the original · Visualization

schoolUniversidade Estadual do Oeste do Paraná, Fisioterapia, Cascavel, PR, Brasil.

0009-0002-2214-8789

person Eduarda Luzia Gomes da Silveira

Data Collection · Conceptualization · Research · Methodology · Writing - Preparation of the original · Visualization

schoolUniversidade Estadual do Oeste do Paraná, Fisioterapia, Cascavel, PR, Brasil.

0000-0002-5694-484X

person Lucinar Jupir Forner Flores

Conceptualization · Research · Methodology · Writing - Review and Editing · Visualization

schoolUniversidade Estadual do Oeste do Paraná, Educação Física, Marechal Cândido Rondon, PR, Brasil.

0000-0002-4010-7596

person Márcia Rosângela Buzanello

Statistical Analysis · Funding Acquisition · Data Collection · Conceptualization · Project Management · Writing - Review and Editing · Software · Validation · Visualization

schoolUniversidade Estadual do Oeste do Paraná, Fisioterapia, Cascavel, PR, Brasil.

0000-0003-0215-3337

person Gladson Ricardo Flor Bertolini

Statistical Analysis · Funding Acquisition · Data Collection · Conceptualization · Resource Management · Project Management · Methodology · Writing - Review and Editing · Software · Supervision · Validation

schoolUniversidade Estadual do Oeste do Paraná, Fisioterapia, Cascavel, PR, Brasil.

0000-0003-0565-2019

personCorrespondence to: Gladson Ricardo Flor Bertolini
gladsonricardo@gmail.com

Conflict of interests:

none.

Associate editor in charge:

Marcelo Lourenço da Silva https://orcid.org/0000-0003-2319-9692

Figures (4)
Tables (3)

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Figure 1 PRISMA flow diagram for new systematic reviews.

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Figure 2 Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies.

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Figure 3 Risk of bias summary: review authors' judgments about each risk of bias item for each included study.

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Figure 4 Forest plot of the comparison between cryoimmersion vs. control at rest - outcome muscle pain intensity.

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Banco de dados Termos Pubmed (((“Athletic Performance”[Mesh]) OR ((“Athletic Performance”)) OR (“Athletic Performance”[Title/Abstract]) OR ” Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”)) AND (((“Cold Temperature”[Mesh]) OR (“Cold Temperature”)) OR (“Cold Temperature”[Title/Abstract]) OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR “Cold” OR “Cryotherapy”[Mesh] OR “Cryotherapy” OR “Cryotherapies” OR “Cold Therapy” OR “Cold Therapies” OR “Cryostimulation”)) Web of Science (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) (All Fields) and (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR cryotherapie OR “Cold Therapy” OR “Cold Therapies” OR costimulation) Scopus TITLE-ABS-KEY (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) AND TITLE-ABS-KEY (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR cold OR cryotherapy OR cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR cryostimulation) Embase ('athletic performance'/exp OR 'athletic performance' OR 'athletic performances' OR 'sports performance'/exp OR 'sports performance' OR 'sports performances') AND ('cold temperature'/exp OR 'cold temperature' OR 'cold water immersion'/exp OR 'cold water immersion' OR 'cold temperatures' OR 'cold'/exp OR cold OR 'cryotherapy'/exp OR cryotherapy OR cryotherapies OR 'cold therapy'/exp OR 'cold therapy' OR 'cold therapies' OR cryostimulation) Lilacs (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances” OR “Desempenho Atlético” OR “Rendimiento Atlético” OR “Desempenho Esportivo” OR “Performance Atlética” OR “Performance Esportiva” OR Esporte) AND (Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Crioterapia OR “Terapia a Frio” OR “Terapia por Frio” OR “Temperatura Baixa” OR Frío OR Esfriamento OR Frio OR Temperatura Mínima OR “Isquemia fria” OR “Cold Ischemia” OR “Isquemia Fría”) Cochrane Correspondência de ensaios (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) in All Text AND (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation) em Título Resumo Palavra-chave - (Foram pesquisadas variações de palavras) Google scholar (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances” OR “Desempenho Atlético” OR “Rendimiento Atlético” OR “Desempenho Esportivo” OR “Performance Atlética” OR “Performance Esportiva” OR Esporte) AND (Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Crioterapia OR “Terapia a Frio” OR “Terapia por Frio” OR “Temperatura Baixa” OR Frío OR Esfriamento OR Frio OR Temperatura Mínima OR “Isquemia fria” OR “Cold Ischemia” OR “Isquemia Fría”) Open Grey Athletic Performance AND Cryotherapy LIVIVO (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) AND (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation) CAPES Thesis and Dissertation Catalog Athletic Performance AND Cryotherapy

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Table 1 Summary characteristics of the randomized clinical trials included in this review (n = 09).

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Database Terms Pubmed (((“Athletic Performance”[Mesh]) OR ((“Athletic Performance”)) OR (“Athletic Performance”[Title/Abstract]) OR” Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”)) AND (((“Cold Temperature”[Mesh]) OR (“Cold Temperature”)) OR (“Cold Temperature”[Title/Abstract]) OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR “Cold” OR “Cryotherapy”[Mesh] OR “Cryotherapy” OR “Cryotherapies” OR “Cold Therapy” OR “Cold Therapies” OR “Cryostimulation”)) Web of Science (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) (All Fields) and (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR cryotherapie OR “Cold Therapy” OR “Cold Therapies” OR costimulation) Scopus TITLE-ABS-KEY (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) AND TITLE-ABS-KEY (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR cold OR cryotherapy OR cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR cryostimulation) Embase ('athletic performance'/exp OR 'athletic performance' OR 'athletic performances' OR 'sports performance'/exp OR 'sports performance' OR 'sports performances') AND ('cold temperature'/exp OR 'cold temperature' OR 'cold water immersion'/exp OR 'cold water immersion' OR 'cold temperatures' OR 'cold'/exp OR cold OR 'cryotherapy'/exp OR cryotherapy OR cryotherapies OR 'cold therapy'/exp OR 'cold therapy' OR 'cold therapies' OR cryostimulation) Lilacs (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances” OR “Desempenho Atlético” OR “Rendimiento Atlético” OR “Desempenho Esportivo” OR “Performance Atlética” OR “Performance Esportiva” OR Esporte) AND (Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Crioterapia OR “Terapia a Frio” OR “Terapia por Frio” OR “Temperatura Baixa” OR Frío OR Esfriamento OR Frio OR Temperatura Mínima OR “Isquemia fria” OR “Cold Ischemia” OR “Isquemia Fría”) Cochrane Trials matching (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) in All Text AND (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation) in Title Abstract Keyword - (Word variations have been searched) Google scholar (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances” OR “Desempenho Atlético” OR “Rendimiento Atlético” OR “Desempenho Esportivo” OR “Performance Atlética” OR “Performance Esportiva” OR Esporte) AND (Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation OR “Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Crioterapia OR “Terapia a Frio” OR “Terapia por Frio” OR “Temperatura Baixa” OR Frío OR Esfriamento OR Frio OR Temperatura Mínima OR “Isquemia fria” OR “Cold Ischemia” OR “Isquemia Fría”) Open Grey Athletic Performance AND Cryotherapy LIVIVO (“Athletic Performance” OR “Athletic Performances” OR “Sports Performance” OR “Sports Performances”) AND (“Cold Temperature” OR “Cold Water Immersion” OR “Cold Temperatures” OR Cold OR Cryotherapy OR Cryotherapies OR “Cold Therapy” OR “Cold Therapies” OR Cryostimulation) CAPES Thesis and Dissertation Catalog Athletic Performance AND Cryotherapy

Author/ Country	Study design	Sample size	Interventions	Follow-up time	Sport	Outcomes Measured	Main conclusion
Alexander et al.¹⁹ United Kingdom	Randomized clinical trial	n = 24 EG: n = n/i CG: n = n/i Age: 20.58 ± 2.55 Gender: M	EG: CWI, 10°C, for 11 min CG: PAS	T0) Pre-Training T1) Immediately post-training T2) Immediately post-intervention T3)24hpost-intervention	Football (Elite)	Muscle soreness: Five-point scale, (1-5))	The present results suggest that cryotherapy, applied as an immediate single bout of cold-water immersion after a soccer match, effectively reduces some biochemical, functional, and perceptual markers of muscle damage.
Ascensão et al.¹² Portugal	Randomized clinical trial	n = 20 EG: n = 10 CG: n = 10 Age: CG: 18.3+0.8 EG: 18.1+1.8 Gender: M	EG: CWI, 10°C, for 10 min CG: 10 min thermoneutral water immersion, 35°C	T0) Baseline T1) 30 min of the end T2) 24h after the match T3) 48h after the match	Soccer (National league teams)	Muscle pain: Scale from 0 (‘‘absence of soreness’’) to 10 (‘‘very intense soreness’’).	Cryotherapy immediately after a soccer match effectively reduces some markers of muscle damage despite conflicting research on muscle adaptation mechanisms.
Coelho et al. ²⁰ Brazil	Randomized clinical trial	n = 25 EG (CWI): n = 09 EG (BIO): n = 08 CG: n = 08 Age: EG (BIO): 22.63 ± 4.2 EG (CWI): 22.63 ± 3.- CG: 20.8 ± 3.2 Gender: M	CWI: 10°C for 10 min BIO: Bioceramic CG: Seated	T0) Baseline T1) Postmatch T2) 24h postmatch T3) 48h postmatch	Soccer (Uviversity level)	Perception of soreness: DOMS (0 – 10) - 0 (‘‘absence of soreness’’) to 10 (‘‘very intense soreness’’) Perceived recovery: Scale of 0 (“very poorly recovered”) and 10 (“very well recovered”)	For 48-hour recovery of muscle damage, BIO and CWI do not provide conclusive evidence of enhancing functional and perceptual recovery after a soccer match, with BIO needing further research to be accepted as an effective recovery modality.
Dantas et al.²¹ Brazil	Double-blind randomized clinical trial	n = 30 EG (I): n = 10 EG (CWI): n = 10 CG: n = 10 Age: EG (IG): 31.71 ±5.43-EG (CWIG):30.28± 6.10 CG: 33.00 ± 4.84 Gender: M	I: Immersed of temperature (29.8°C ± 0.66°C) for 10 min CWI: 10°C for 10 min CG: Rested	T1) Immediately post-running T2) Immediately post-intervention T3) 24h post-intervention	Street racing (recreactional)	Perception of soreness: - VAS (0 - 100 mm)	CWI at 10°C for 10 minutes has been widely used in clinical settings, but it is no more effective than water immersion and rest in recovering functional performance, torque and CK blood concentration in muscles damaged after 10-km street runs.
Getto and Golden¹⁶ USA	Randomized clinical trial	n = 23 EG (CWI): n = 07 CG (AR): n = 08 CG (PAS): n = 08 Age: n/i Gender: 13 M, 10 F	CWI: 10°C for 10 min AR: Active recovery PAS: Passive recovery	T0) Baseline T1) Postexercise T2)24h postintervention	Football, volleyball, basketball (Collegiate athletes)	Perception of soreness: VAS-PS: 1 - 10, with 10 indicating the most soreness.	On the basis of our investigation, neither CWI or AR while immersed were deemed as more advantageous in the recovery of speed or power, compared with passive recovery when implemented after routine conditioning and training.
Nunes et al. ¹⁵ Brazil	Randomized clinical trial	n = 19 EG (CWI): n = 11 CG: n = 08 Age: 2.1 ± 1.6 Gender: M	CWI: 10 °C for 10 min CG: Seated	T0) A week before T1) Baseline T2) Post the match T3) 30min after the match T4) 24h after the match T5) 48h after the match T6) 72h after the match	Rugby (Professional)	Perception of soreness: DOMS (0-10) 0 (absence of soreness) to 10 (very intense soreness). Perceived recovery: VAS (0 – 10) - from 0 (very poorly recovered) and 10 (high-perceived recovery).	A single bout of CWI accelerated recovery, especially in inflammation and neuromuscular function. The study suggests using more sensitive and specific markers to measure CWI effects, as some recovery markers in the CWI group were better than in the control group, supporting CWI for postmatch recovery in rugby players.
Krueger et al.¹⁴ Germany	Randomized clinical trial	n = 18 EG (CWI): n = 09 CG: n = 09 Age: 16.6 ± 0.6 Sex: M	CWI: 5 to 8 °C (6.4±0.8 °C) for 5 min CG: PAS	T1) 1 Post day T2) 2 Pre day T3) 2 Post day T4) 3 Pre day T5) 3 Post day T6) 4 Pre day T7) 4 Post day T8) 5 Pre day T9) 5 Post day	Field hockey (Elite)	Perception of soreness: DOMS - VAS (100-mm) - 0 (no soreness) to 100 (severe soreness.).	Daily post-exercise CWI did not improve match performance, perceptual recovery, or biomarkers of muscle damage and metabolic load in elite youth field-hockey players.
Pesenti et al.¹³ Brazil	Blind randomized clinical trial	n = 28 EG (CWI): n = 07 CG (TWI): n = 07 EG (AR): n = 07 CG: n = 07 Age: of 16 and 19 Gender: M	CWI: 10°C for 10 min TWI: 10 min AR: treadmill for 10 min CG: seated for 10 min	T0) Baseline T1) 24h follow up T2) 48h follow up T3) 72h follow up.	Soccer	Perception of soreness: -NSP (0 – 10).	No significant differences in observed variables, including DOMS, were found between interventions, indicating a need for further studies to develop effective recovery strategies for soccer players
Batista et al.²² Brazil	Randomized-crossover placebo-controlled clinical trial	n = 20 Age: 14.05±1.79 Gender: 12 M/8F EG (CWI): n = 19 PG (TWI): n = 16 CG (PAS): n = 16	CWI: 14 ± 1°C TWI: 27 ± 1°C (as placebo) PAS: passive recovery	T1: Baseline T2: wash-out (1-week) T3: before and after each intervention week	Swimming (Competitive team)	Perceptive outcomes: (1 to 5) poor well-being, heaviness, tiredness, discomfort and pain.	The repeated use of CWI over the course of a training week had no impact on the functional or swimming performance outcomes of adolescent competitive swimmers. The preference for CWI as TWI was similar.

[1] (n/i): not informed; M = male; F = female; Age = years; VAS = visual analogue scale; CG = control group; EG = experimental group; PG = placebo group; CWI = Cold-water immersion; NSP = Numerical scale of pain; TWI = Thermoneutral water immersion; ARG = athletes used a treadmill; h = hours; min = minutes; DOMS = delayed-onset muscle soreness; PAS = passive recovery; AR = active recovery; VAS-PS = Visual analogue scale for perceived soreness; BIO = Bioceramics.

Effects of cryoimmersion in the recovery of post-exercise muscle pain: systematic review with meta-analysis

ABSTRACT

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