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Contrast Water Therapy and Soreness…Is it Worth It?

Take Home Points on Contrast Water Therapy:
  1. CWT improves muscle soreness.
  2. CWT is not more effective than other treatments for soreness.
Contrast water therapy (CWT) has been suggested to improve exercise induced muscle damage (EIMD) and soreness. The use of contrast water therapy is used by many personal trainers and physical therapists from France to Santa Clara. However, the effectiveness of contrast water therapy is polluted in the literature.

What is Exercise Induced Muscle Soreness?

Before we get into the effectiveness of CWT, understanding EIMD is essential. EIMD often occurs after unaccustomed exercise, particularly the eccentric phase of a contraction. The eccentric phase of a muscle is when the muscle is lengthened and believed to damage the muscle fibers. This is not the only factor and contributor for EIMD, as Cheung (2003) suggests high-intensity exercise, tissue vibrations, collisions or impact, and high metabolic cost or mechanical stress influence EIMD.

What Happens When you are Sore?

EIMD impairs sport and overall function as it decreases force production (Goodall 2008), joint position sense (Paschalis 2007) and athletic performance (Burt 2011). EIMD is believed to peak between 24 and 72 hours and disappear after 5  – 7 days.

Many try ice, anti-inflammatory drugs, stretching and various other modalities to decrease EIMD, but these all have varying effectiveness. CWT consists of alternating cold and warm water immersion with the goal of decreasing EIMD. CWT is theorized to reduce swelling, by altering vasoconstriction and vasodilation to create a “pump”.

So Does CMT Help Soreness?

Overall, CMT appears to significantly improve soreness compared to no intervention. CMT also decreases cell expression of muscle damage, compared to no other intervention.

“The current evidence base suggests that CWT is superior to using passive recovery or rest after  various forms of exhaustive or damaging exercise. The benefits relate to a reduction in muscle soreness, and improved muscle function due to an attenuation of muscle strength loss and muscle power loss after exercise. The magnitudes of these effects seem to be clinically relevant but may be most applicable to elite sport. There are no data available to determine an optimal method of CWT. Furthermore, there seems to be little difference in recovery outcome when CWT is compared to other popular recovery interventions such as cold water immersion, warm water immersion, compression, active recovery and stretching. These conclusions are not definitive based on poor methodological quality and small sample sizes (Bieuzen 2013)”.

Conclusions on CWT

There you have it, CWT is beneficial, but not likely any better than other forms of recovery. This makes individualization and finding what works for you key, especially in elite athletes.

  1. Cheung K, Hume P, Maxwell L (2003) Delayed onset muscle soreness : treatment strategies and performance factors. Sports Med 33: 145–164.
  2. Goodall S, Howatson G (2008) The effects of multiple cold water immersions on indices of muscle damage. J Sports Sci Med 7: 235–241.
  3. Paschalis V, Nikolaidis MG, Giakas G, Jamurtas AZ, Pappas A, et al. (2007) The effect of eccentric exercise on position sense and joint reaction angle of the lower limbs. Muscle Nerve 35: 496–503.
  4. Burt DG, Twist C (2011) The effects of exercise-induced muscle damage on cycling time-trial performance. J Strength Cond Res 25: 2185–2192.
  5. Bieuzen F, Bleakley CM, Costello JT. Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis.PLoS One. 2013 Apr 23;8(4):e62356. doi:  0.1371/journal.pone.0062356. Print 2013. Review.
Dr. John, DPT, CSCS