Cold Vs Warm Water Immersion for DOMS Recovery

February 7, 2025 updated by: Józef Piłsudski University of Physical Education

Comparative Effectiveness of Cold and Warm Water Immersion in Mitigating Delayed Onset Muscle Soreness: a Multi-Arm Randomized Controlled Trial

The study investigates the effectiveness of physical strategies in addressing Delayed Onset Muscle Soreness (DOMS) in physically active individuals. DOMS, a common phenomenon following intense or novel physical activity, is characterized by pain, inflammation, and functional impairments such as reduced range of motion, muscle strength, and endurance. These symptoms peak between 24-72 hours post-exercise and are attributed to micro-damage in muscle and connective tissue, followed by inflammatory responses. Despite extensive research, the efficacy of various therapeutic interventions remains inconclusive due to heterogeneity in study designs, outcome measures, and quality of evidence.

The primary objective of this study is to systematically assess and compare the effectiveness of cold water immersion (CWI) or hot water immersion (HWI), in mitigating DOMS symptoms. This study will utilize a multi-arm, parallel, randomized controlled trial (RCT) design to evaluate therapeutic outcomes against a control group receiving simulated therapy.

By employing a standardized exercise protocol to induce DOMS and unified assessment methodologies (e.g., biomechanical, biochemical, and functional tests), the study aims to provide robust evidence for the efficacy of these interventions. The findings will contribute to optimizing post-exercise recovery strategies, offering reliable therapeutic protocols for both clinical and athletic settings.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

The study is a multi-arm, parallel, randomized controlled trial (RCT) designed to evaluate the effectiveness of cold water immersion (CWI), warm water immersion (WWI), and simulated laser therapy (control group) in mitigating Delayed Onset Muscle Soreness (DOMS). This trial aims to compare the physiological, biochemical, and functional outcomes of these interventions following exercise-induced muscle damage in healthy male participants. DOMS, which arises from eccentric physical activities, presents with symptoms such as muscle pain, stiffness, inflammation, and functional limitations, reaching a peak 24-72 hours post-exercise.

Setting and Duration The study will be conducted at the laboratories of the Faculty of Physical Education and Health at AWF Biała Podlaska between March and May 2024. The laboratory sessions will take place on weekdays from 8:00 AM to 4:00 PM.

Methodology Participants will be randomly assigned to one of three study groups

Cold Water Immersion (CWI):

Participants will submerge their lower limbs in water maintained at 10-12°C for 15 minutes. The water temperature will be regulated with ice additions to ensure consistency. Participants will perform light movements, such as ankle flexion and extension, to stimulate blood flow.

Sessions will occur 1 hour post-exercise, and at 24 and 48 hours.

Hot Water Immersion (HWI):

Participants will immerse their lower limbs in water at 40°C for 15 minutes, maintaining consistent temperature conditions.

Sessions will follow the same schedule as the CWI group (1, 24, and 48 hours post-exercise).

Simulated Laser Therapy (Control Group):

Participants in this group will receive simulated low-level laser therapy (LLLT). A deactivated laser device will be positioned over the muscles to mimic therapy without delivering actual treatment. Simulated sessions will align with the intervention schedule of the other groups.

Study Procedure

The study comprises three phases:

Baseline Measurements (Phase 1):

Conducted in the morning, fasting, followed by standardized functional and biomechanical tests two hours after a light meal.

Measurements include body composition, joint range of motion, muscle stiffness (elastography), pain assessments (VAS scale), and venous blood sampling to measure baseline biochemical markers.

Exercise-Induced Muscle Damage (Phase 2):

Participants will perform eccentric exercises designed to induce DOMS, targeting the quadriceps muscles. The exercise protocol includes five sets of 20 drop jumps from a 60 cm height with a 5-minute rest between sets.

Experienced physiotherapists will ensure the correct execution of exercise.

Post-Exercise Monitoring and Intervention (Phase 3):

Interventions (CWI, WWI, or simulated LLLT) will be administered within an hour post-exercise and repeated at 24 and 48 hours.

Functional tests and blood sampling will be conducted pre-intervention and at 24, 48, 72, and 96 hours post-exercise to assess recovery dynamics.

Study Type

Interventional

Enrollment (Estimated)

52

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Poland
    • Lubelskie
      • Biała Podlaska, Lubelskie, Poland, 21-500
        • Recruiting
        • Akademia Wychowania Fizycznego w Warszawie
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Healthy males aged 18-25 years
  • BMI between 18.5 and 30 kg/m²
  • Experiencing muscle pain (VAS scale) > 5 for muscle soreness within 12 to 30 hours post-exercise
  • Engage in moderate physical activity 2-5 hours/week, according to the International Physical Activity Questionnaire-Short Form (IPAQ-SF).
  • They must voluntarily sign a written informed consent approved by an ethics/bioethics committee after sufficient explanation prior to participating in the study.

Exclusion Criteria:

  • Inflammatory diseases within the past 6 months
  • Neurological disorders that affect muscle strength
  • Ongoing use of steroids, analgesics, muscle relaxants, or other medications deemed inappropriate by the researchers, including antispasmodics, antidepressants, antidiarrheals, antibiotics, or thrombolytics
  • Unstable medical condition such as cardiovascular disease, respiratory disease, gastrointestinal disease, hepatobiliary disease, metabolic disease, endocrine disease, kidney disease, urinary tract disease, genetic disorders, or issues related to the nervous system or mental health.
  • Participants who have abused alcohol or drugs in the past year, do not wish to follow the study guidelines, or are deemed inappropriate for the study by the researcher will also be excluded.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Sham Comparator: Control group
Participants subjected only to standard biomechanical, functional, and blood measurements, without the use of regenerative therapies.
Other: Simulated Laser Therapy
Deactivated low-level laser therapy (LLLT) device. Applicator positioned over quadriceps muscle belly. Duration: 15 minutes, with no active laser output to simulate treatment conditions.
Experimental: Cold Water Immersion (CWI)
Participants are subjected to a bath in cold water (10-12°C) for 10 minutes with the lower limbs submerged to waist height.
Other: Cold Water Immersion (CWI)
Standard immersion baths with temperature monitoring and ice supplementation. Lower limbs immersed up to the hip. Water temperature maintained at 10-12°C. Duration: 15 minutes per session. Participants perform active ankle flexion/extension to promote circulation.
Other Names:
  • cryotherapy
Experimental: Hot Water Therapy (HOT)
Immersing the whole body in hot (40°C) water.
Other: Hot Water Immersion (HWI)
Controlled immersion baths. Lower limbs immersed up to the hip. Water temperature maintained at 40°C. Duration: 15 minutes per session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Muscle Soreness (VAS Score)
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Muscle Soreness Measured by the Visual Analog Scale (0-10) Description: The Visual Analog Scale (VAS) ranges from 0 ("no muscle pain") to 10 ("worst possible pain"). Higher scores indicate a worse outcome (greater pain).
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Biochemical Markers of Muscle Damage (Creatine Kinase)
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Blood samples will be collected at baseline, 24 h, 48 h, and 72 h post-exercise and analyzed for serum Creatine Kinase (U/L) using standard immunoassay methods.
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Change in Quadriceps Muscle Strength (Nm) measured by Dynamometer at Baseline, 24h, 48h, 72h Post-Exercise
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Change in Quadriceps Muscle Tissue Elasticity (kPa) measured by Ultrasound Elastography at Baseline, 24h, 48h, 72h Post-Exercise
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Change in Biochemical Markers of Muscle Damage: Myoglobin
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Blood samples will be collected at baseline, 24 h, 48 h, and 72 h post-exercise and analyzed for Myoglobin (ng/mL), using standard immunoassay methods.
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Change in Inflammation markers (IL-6, TNF-α)
Time Frame: Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)
Blood samples will be collected at baseline, 24 h, 48 h, and 72 h post-exercise and analyzed for Interleukin 6 (IL-6) and Tumor Necrosis Factor α (TNF-α) (pg/mL), using standard immunoassay methods.
Baseline to 72 hours post-exercise, with measurements at Day 1 (24 hours), Day 2 (48 hours), and Day 3 (72 hours)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Józef Piłsudski University of Physical Education

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 10, 2025

Primary Completion (Estimated)

February 28, 2025

Study Completion (Estimated)

March 31, 2025

Study Registration Dates

First Submitted

January 20, 2025

First Submitted That Met QC Criteria

January 27, 2025

First Posted (Actual)

March 25, 2025

Study Record Updates

Last Update Posted (Actual)

March 25, 2025

Last Update Submitted That Met QC Criteria

February 7, 2025

Last Verified

December 1, 2024

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • SKE 01-80/2023

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Because the study sample is small and participants were locally recruited, there is a heightened risk that individual identities could be inferred. Therefore, we do not plan to share de-identified participant data in order to protect privacy and confidentiality.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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