Comment: The quality of evidence is downgraded by study limitations (lack of blinding, failure to adhere to the intention-to-treat principle, selective outcome reporting), byimprecise results (few patients for each comparison) and by inconsistency.
A Cochrane review [Abstract] 1 on cold-water immersion in the management of muscle soreness after exercise included 17 studies with a total of 366 subjects. Muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise as compared with passive intervention at 24 hour (SMD -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. Studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled data for pain showed no evidence of differences between groups comparing cold-water immersion with contrast immersion (alternating immersions in hot and cold water), with warm-water immersion or with active recovery, compression and a second dose of cold-water immersion at 24 hours.
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