Recovery strategies have become a popular topic, as athletes are always looking for a competitive edge. Trying to expedite the recovery process generally has one of two major aims:

  1. Alleviating the soreness/fatigue of training or competition to return back to a high level of performance
  2. Facilitate a faster healing process following injury

While there are many recovery modalities available, two of the more common ones are use of non-steroidal anti-inflammatories (NSAIDs) and cold water immersion (CWI; e.g. cold tubs). NSAIDs and CWI are primarily used to decrease inflammation and pain.

Cold Water Immersion

When you use this can determine whether you restore performance or waste your training time

NSAIDs May Impair Injury Healing

As a result of the physical demands of sport, NSAID use is common not just post-injury, but also as a method to combat soreness. A 2008 review (Alaranta, Alaranta, & Helenius, 2008) noted NSAID use by 33% and 38% of the Canadian athletes competing at the 1996 and 2000 Summer Olympics, respectively. Further, Mackey, Mikkelsen, Magnusson, and Kjaer (2012) noted that NSAID use generally exceeds the incidence of reported injury, meaning they’re being used for performance purposes in addition to injury recovery.

Given the prevalence of use and the high-stakes environment in which they’re used, it’s imperative to understand the impact NSAID use has on performance and adaptation. While NSAIDs are effective at decreasing an acute inflammatory response, there is little evidence that this facilitates an expedited healing response or return to function.

To the contrary, the inflammatory response may be necessary to facilitate optimal tissue repair.

Inhibiting this response may impair healing in muscle, bone, and ligaments (Alaranta et al, 2008), primarily through a decrease in satellite cell proliferation, and activity of the enzyme cyclooxygenase-2 (COX-2; Mackey, 2013). NSAID use also leads to an attenuation of protein synthesis following exercise. Through these mechanisms, it appears that NSAID use impairs muscular adaptation to resistance training. Indeed, Mackey (2013) summarized two animal studies, and found that a daily NSAID injection or COX-2-specific inhibitor intake decreased the hypertrophy response in the plantaris muscle by 50% and 75%, respectively.

Do NSAIDs decrease soreness?

Investigations into the analgesic (i.e. pain relief) effect of NSAIDs have led to conflicting reports. Mackey et al. (2013) reported that NSAIDs have shown a benefit in decreasing delayed-onset muscle soreness in some studies, but not in others.

They also note a decrease in function loss following muscle damage, but this may come at the expense of long-term healing.

Foster, Taylor, Chrismas, Watkins, and Mauger (2014) compared performance in 8 repetitions of the 30-second Wingate Test, interspersed with 2 minutes of rest, between a group that consumed 1.5g of acetaminophen and a control. The experimental group produced significantly greater mean power throughout the 8 sprints and had less of a drop-off compared to the controls. This was primarily the result of improved performance in the 6th-8th sprints, which the authors attributed to an attenuated pain response to a given workload.

Taken together, these findings suggest that the analgesic effect of NSAIDs could lead to short-term performance improvements in tasks where pain-related inhibition may limit exercise performance, but these improvements may come at the expense of positive adaptation.

Cold Water Immersion Expedites Recovery

Parallel arguments to the use of NSAIDs can be made by examining the effects of other anti-inflammatory methods on performance and adaptation. A recent review from White and Wells (2013) on the effects of CWI on recovery from exercise suggested that cold may facilitate recovery by:

  1. Reducing muscle temperature
  2. Slowing muscle metabolism and associated hypoxic stress
  3. Minimizing the generation of reactive oxygen species (ROS)
  4. Limiting edema and further damage/soreness related to this local swelling
  5. Faster heart rate recovery and restoration of vagal (parasympathetic) tone

With a short turnaround time between competitions, these mechanisms could provide a useful strategy to minimize performance decrements. Takeda et al. (2014) demonstrated that 50-yard dash time increases (i.e. gets worse) following a simulated competition in college rugby players. Players that used CWI following the competition still had an increased 50-yard dash time 24 hours later, but the group that did not use CWI had an even slower time, suggesting that CWI may help minimize 24-hour performance decrements related to the repair of muscle.

CryoSource CryoSauna

Not as cold as it looks

Similarly, Elias et al. (2012) showed that CWI lead to significant reductions in soreness and perceived fatigue 24 and 48 hours following a testing session, compared to a passive recovery. This was accompanied by a faster restoration of repeat sprint ability, as the CWI group had an identical total sprint time 24 hours later, but the comparison groups were significantly slower.

While a more in-depth look at the research shows mixed reports of expedited performance recovery, in general CWI seems effective at minimizing recovery and restoring performance if the next testing/competition is within 24 hours.

…At the Expense of Adaptation

However, these short-term improvements may occur at the expense of long-term adaptation.

Roberts et al. (2015) demonstrated that an active recovery group experienced significantly larger increases in muscular hypertrophy and strength following a 12-week resistance-training program compared to the CWI group. Similarly, 5 weeks of resistance training led to significantly larger gains in 12-RM in the control leg compared to the leg that underwent CWI post-training. (Frohlich et al, 2014).

These decrements in training adaptation may result from blunting the post-exercise inflammatory response, which is essentially the signal for repair/restructuring, along with decreasing local blood flow, compromising protein synthesis.

Interestingly, Haddad, Laursen, Ahmaidi, and Buchheit (2010) showed that submerging the face in cold water for 5 minutes while breathing through a snorkel was effective at facilitating a faster shift back to a parasympathetic state compared to passive recovery. This may provide a cost-effective method of achieving the desired autonomic response of CWI while avoiding the local mechanical and metabolic effects that may interfere with the desired training adaptation.

Take Home

Strategies designed to blunt the inflammatory response and decrease soreness may lead to short-term improvements at the expense of long-term adaptations. It’s important to consider this when implementing them, as the goal of a given phase will dictate whether any given recovery strategy is appropriate. For example, the benefits of CWI may be very desirable in-season between games, but not during the off-season. At the pro level, CWI may be used after each game throughout a given week, whereas a college team could use CWI only after games on the weekend, but not after training/practices during the week. During times when training adaptation is the primary emphasis, cold water face immersion may offer an alternative recovery strategy to more common CWI methods.

To your success,

Kevin Neeld


Alaranta, A., Alaranta, H., & Helenius, I. (2008). Use of Prescription Drugs in Athletes. Sports Medicine, 38(6), 449-463.

Elias, G., Varley, M., Wyckelsma, V., McKenna, M, Minihan, C., & Aughey, R. (2012). Effects of Water Immersion on Posttraining Recovery in Australian Footballers. International Journal of Sports Physiology and Performance, 7, 357-366.

Foster, J., Taylor, L, Chrismas, B., Watkins, S., & Mauger, A. (2014). The influence of acetaminophen on repeated sprint cycling performance. European Journal of Applied Physiology, 114, 41-48.

Frohlich, M., Faude, O., Klein, M., Pieter, A., Emrich, E., & Meyer, T. (2014). Strength Training Adaptations After Cold-Water Immersion. Journal of Strength and Conditioning Research, 28(9), 2628-2633.

Haddad, H., Laursen, P., Ahmaidi, S., & Buchheit, M. (2010). Influence of cold water face immersion on post-exercise parasympathetic reactivation. European Journal of Applied Physiology, 108, 599-606.

Mackey, A. (2013). Does an NSAID a day keep satellite cells at bay? Journal of Applied Physiology, 115, 900-908.

Mackey, A., Mikkelsen, U., Magnusson, S., & Kjaer, M. (2012). Rehabilitation of muscle after injury – the role of anti-inflammatory drugs. Scandinavian Journal of Medicine and Science in Sports, 22, e8-e14.

Roberts, L., Raastad, T., Markworth, J., Figueiredo, V., Egner, I., Shield, A., … Peake, J. (2015). Post-exercise cold water immersion attenuates acute anabolic signaling and long-term adaptations in muscle to strength training. Journal of Physiology, 593(18), 4285-4301.

Takeda, M., Takashi, S., Tatsushi, H., Shintaku, H., Kato, H., Yamaguchi, Y., & Radak, Z. (2014). The Effects of Cold Water Immersion after Rugby Training on Muscle Power and Biochemical Markers. Journal of Sports Medicine, 13, 616-623.

Torres-Ronda, L, Ric, A., Llabres-Torres, I., de Las Heras, B., Schelling, X. (2015). Position-dependent cardiovascular response and time-motion analysis during training drills and friendly matches in elite male basketball players. Journal of Strength and Conditioning Research, June 1 [Epub ahead of print]

White, G., & Wells, G. (2013). Cold-water immersion and other forms of cryotherapy: Physiological changes potentially affecting recovery from high-intensity exercise. Extreme Physiology & Medicine, 2: 26-36.

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“Kevin Neeld is one of the top 5-6 strength and conditioning coaches in the ice hockey world.”
– Mike Boyle, Head S&C Coach, US Women’s Olympic Team

“…if you want to be the best, Kevin is the one you have to train with”
– Brijesh Patel, Head S&C Coach, Quinnipiac University