1. What is Concussion?
2. How Long Does a Concussion Last?
3. Concussion Signs and Symptoms
4. What are the Physical Signs of a Concussion?
5. How Harmful is a Concussion?
6. What are the 3 Stages of a Concussion?
7. How Long is Concussion Recovery?
8. How to Speed up Concussion Recovery?
9. Conclusion
10. References

Concussions are a significant concern in sport, affecting athletes of all levels. Understanding the intricacies of concussions, from causes and symptoms to treatment and recovery, is crucial for athletes, coaches, and medical professionals. 

What is Concussion?

A concussion is a type of mild traumatic brain injury (TBI) that occurs when a non-penetrating head trauma, such as a blow to the head, or acceleration/deceleration forces, lead to a sudden jolt or shake of the brain. Subsequently, this causes temporary disruption of normal brain function [1]. It is classified as a brain injury that does not typically involve structural damage, such as bleeding or swelling, but instead can alter the brain’s chemical balance, disrupt cellular functioning and cause metabolic changes [2]. Concussions are common in contact sports like Football, Rugby, American Football, Boxing and MMA but can also occur in non-contact sports and everyday activities.

How Long Does a Concussion Last?

The duration of a concussion varies depending on the severity of the injury and the individual’s health. Generally, most symptoms of a concussion resolve within 7 to 14 days; however, some individuals may experience prolonged symptoms of more than 28 days [3].

Increased recovery time has been associated with a history of previous concussions. 30 % of collegiate football players with more than 3 concussions experienced symptoms lasting over 1 week compared with 14.6 % of those with 1 previous concussion [3]. Adults who reported higher scores on the Post-Concussion Symptom Scale (PCSS) (42.5 vs 19.2, p <0.01) and had a greater number of symptoms (13.9 vs 8.9, p = 0.008) had an increased likelihood of suffering concussion symptoms for more than 28 days [4]. 

Paediatric patients aged 10 to 17 years old demonstrated a median recovery length of 17 days. Similar to the adult population, higher symptom scores were associated with prolonged symptom effects. Furthermore, patients with more than 2 previous incidences of concussion also experienced an increased recovery time. Interestingly, females were at greater risk of prolonged recovery than males (odds ratio = 2.08, 95 % confidence interval = 1.49-2.89) [5].

Concussion Signs and Symptoms

Symptoms of Concussion

Concussions manifest through various symptoms that can be categorised into physical, cognitive and emotional/behavioural domains. General symptoms immediately following an injury include headache, dizziness and mental disturbance. These include mental clouding, general confusion or the feeling of being slowed down. Over the next 24 hours, further symptoms can manifest, including nausea, inhibited balance, visual disturbance, confusion, memory loss and fatigue [6]. As time progresses, additional symptoms, including tiredness, irritability, nervousness, anxiety, sleep disturbance and sensitivity to light or even noise, have been reported [7]. It is important to consider that not all symptoms are present in each concussion case; furthermore, athletes with a history of previous concussions display a more varied presentation of symptoms [8].

Do symptoms vary depending on age/gender?

Male and female high school and collegiate athletes experienced different outcomes following a concussion. High school athletes performed worse on both verbal and visual memory tests after a concussion. Furthermore, female athletes performed worse than their male counterparts on visual memory and reported greater post-concussion symptoms [9]. 

Concussion Causes

Concussions can be caused by any significant impact to the head or body. The rapid acceleration and deceleration of the brain within the skull are what leads to a concussion [1]. A study of more than 2000 athletes across 27 high school sports indicated that 62.8 % of concussions were caused by player contact. Player contact also accounted for a larger proportion of concussions in males compared to females (59.1 % versus 39.8 %). Equipment contact was the second largest mechanism of injury, with 66.8 % of these concussions coming from contact with the ball. American Football had the highest overall rates of concussion with 9.21 per 10,000 athlete exposures (AE,) which is significantly higher than a rate of 3.89 per 10,000 AE across all high school sports. The rate of concussion increased during competition for most sports, with 19.87 per 10,000 AE. Interestingly, concussion rates were higher in females vs males in sex-comparable sports [10].  

What are the Physical Signs of a Concussion?

As a coach, athlete, official, or spectator, identifying a concussion promptly is critical to ensuring swift treatment and recovery. The Sport Concussion Assessment Tool, 3^rd Edition (SCAT3) is a standardised tool used by medical professionals to evaluate concussions in athletes and can be used for athletes 13 years and older. Furthermore, pre-season SCAT3 baseline testing is often utilised by professional clubs and organisations to aid the interpretation of post-injury scores. In a study of concussions in Ice Hockey [11], they investigated the prevalence of five on-field signs of a concussion using the SCAT3.

1. Disorientation (68 %)
2. Postural Instability (44 %)
3. Vacant Look (41 %)
4. Amnesia (27 %)
5. Loss of Consciousness (24 %)

Additionally, almost two-thirds of subjects displayed more than one on-field sign of concussion. Despite being the most common on-field sign, disorientation was not associated with cognitive defects. Other signs of concussion include emotional liability, which is often displayed through behaviours such as uncontrollable or inappropriate laughing or crying [8]. 

How Harmful is a Concussion?

As previously discussed, most symptoms of a concussion resolve within 7 to 14 days; however, some individuals may experience prolonged symptoms of more than 28 days, particularly individuals with a history of previous concussion [3]. 

It has been hypothesised that repetitive neurotrauma sustained in boxing is associated with chronic brain damage. This has been described as having a neurological syndrome referred to as ‘punch drunk syndrome’, traumatic encephalopathy, dementia pugilistica, chronic traumatic encephalopathy (CTE) and chronic progressive traumatic encephalopathy. In brief, repetitive head injuries can cause long-term cognitive and emotional difficulties for the athlete [12].

In recent years, there has been much publicity around the long-term effects of heading in Football. According to research [13], former professional footballers are 3.5 times more likely to suffer from dementia than people of the same age range in the general population. Further research [14] found that neurodegenerative disease varies by position and length of career but is not impacted by which decade players competed.  Although footballers have a greater risk of experiencing neurodegenerative disease, it is important to consider there are wider physical and psychological health benefits to playing football.

This research led to The Football Association’s decision to adopt the International Football Association Board trial to remove deliberate heading in grassroots football matches at U12 and below. 

What are the 3 Stages of a Concussion?

Understanding the three stages of concussion can help in managing and monitoring recovery:

Acute Phase

The acute phase is typically the first 24 to 72 hours following a concussion, where symptoms are most pronounced. As previously highlighted, symptoms include headache, dizziness and mental disturbance. As time progresses, further symptoms include nausea, inhibited balance, visual disturbance, confusion, memory loss and fatigue [6]. Prompt recognition of a concussion and appropriate management are crucial to facilitate recovery. 

Recommended management during the acute phase includes immediate removal from activity and physical and cognitive rest. Light physical activity, such as walking, can be reintroduced within the acute phase, providing it does not exacerbate symptoms [15]. Furthermore, continuous monitoring during the acute phase is essential. 

Subacute Phase

The subacute phase is the period that commences immediately following the acute phase and typically lasts around 3-weeks [16]. This phase is characterised by an ongoing recovery process that may not be immediately evident through standard clinical assessments. Specifically, concussed individuals may exhibit decreased activation in the right hemisphere attentional networks shortly after injury, followed by improved activation in these areas as recovery progresses. Subsequently, symptoms often begin to improve for the individual; however, as the brain is still vulnerable, a gradual reintroduction to physical and cognitive activity is important. 

Chronic Phase

The chronic phase of a concussion refers to the period extending beyond the initial weeks following the injury, during which some individuals continue to experience persistent symptoms and cognitive deficits. While many recover within a few weeks, some patients may develop prolonged issues, often termed post-concussion syndrome (PCS) [17].

PCS is characterised by the persistence of concussion-related symptoms beyond three months post-injury. These symptoms can include headaches, dizziness, fatigue, irritability, anxiety, insomnia, and difficulties with concentration and memory. Studies have shown that individuals with PCS may exhibit cognitive deficits, particularly in attention, working memory, and verbal learning, even years after the initial injury. For instance, research indicates that patients assessed between three months to five years post-injury demonstrated reduced cognitive efficiency and increased fatigability, impacting their daily functioning [17].

How Long is Concussion Recovery?

Concussion recovery duration varies among individuals and is influenced by factors such as age, sex, injury severity, and pre-existing medical conditions. While many individuals recover within a few weeks, some may experience symptoms for several months or longer.

General Recovery Timeline

Adults – Research indicates that adults typically recover from a concussion within 14 to 30 days. A systematic review and meta-analysis found that collegiate athletes reported symptom resolution in approximately 6 days, with cognitive recovery occurring around 5 days post-injury [18].

Adolescents and Children – Younger individuals often require more time to recover. High school athletes, for instance, reported symptom recovery at an average of 15 days, with cognitive recovery around 7 days post-injury [18]. 

Factors Influencing Recovery

Age – Older adults may experience prolonged recovery periods. The Toronto Concussion Study observed that participants over 35 years of age took longer to recover compared to younger individuals [19]. 

Sex – Females have been found to experience more severe initial symptoms and longer recovery durations than males [19]. 

Pre-existing Conditions – A history of migraines is associated with extended recovery times. However, pre-existing psychological conditions, such as anxiety or depression, were not directly linked to prolonged recovery in the same study [19].

How to Speed Up Concussion Recovery?

Accelerating concussion recovery involves a combination of early, appropriate interventions and personalised management strategies. Emerging research highlights several approaches that may facilitate a more rapid and effective recovery:

Early Introduction of Controlled Aerobic Exercise

Recent studies suggest that introducing controlled, sub-symptom threshold aerobic exercise can expedite recovery. A randomised clinical trial demonstrated that adolescents and young adults engaging in early, monitored aerobic exercise experienced faster symptom resolution and returned to normal activities approximately four days sooner than those who performed stretching exercises. The exercise regimen involved activities such as walking or stationary cycling at intensities below the threshold that would exacerbate symptoms [20]. 

Phased Return to Play

Implementing a structured reintroduction physical activity is beneficial. The Consensus Statement on Concussion in Sport recommends a phased return-to-play protocol, which involves progressively increasing exercise intensity and complexity, ensuring that each stage is symptom-free before advancing.

Nutritional Support

Adequate nutrition supports brain healing. Research suggests that certain nutrients, including omega-3 fatty acids and antioxidants, may play a role in brain recovery post-concussion [20].

Sleep Management

Quality sleep is essential for recovery. A study highlighted that sleep disturbances are common after a concussion and can impede recovery, underscoring the need for effective sleep management strategies [20].

Individualised Management

Recovery trajectories can vary based on factors such as age, sex, injury severity, and pre-existing conditions. Personalised treatment plans that consider these factors are crucial. Collaborating with healthcare professionals experienced in concussion management ensures that interventions are tailored to the individual’s needs, optimising recovery outcomes [19].

Conclusion

Concussion management is a critical aspect of sports medicine, given its impact on athletes’ health and performance. While most individuals recover within a few weeks, factors such as age, sex, and injury history can influence recovery duration. Understanding the three stages of concussion helps in implementing appropriate treatment strategies. Emerging research supports early controlled exercise, nutritional support, and individualised management to optimise recovery. With increasing awareness and evolving guidelines, sports organisations and medical professionals continue to refine concussion protocols to enhance player safety and long-term well-being, ensuring a balance between athletic participation and brain health.

The post Concussion Recovery in Sport: A Comprehensive Guide appeared first on Science for Sport.

In episode 137, Siobhan Milner, Strength & Conditioning Coach, joins us.

Specifically Siobhan will be looking at:

• The role of pain
• How pain works physiologically
• Pain without symptoms
• How to deal with pain using science

Is your brain tricking you into more pain than necessary? It’s possible, and you can find out why by delving into the crazy world of pain science.

Pain is part of everyone’s life, especially athletes who can easily pick up bumps, knocks, and injuries.

In order to work out how athletes can use pain science to hack their brains and adjust the impact pain has on their lives, we invited Siobhan Milner on to the Science for Sport Podcast. 

Milner is a Strength and Conditioning Coach with the Dutch Olympic team, having completed a master’s in rehabilitation science. 

It’s her background in rehabilitation science that we wanted to tap into, plus of course how she applies that science in the real world with elite athletes. 

Before we kick off with all the important pain science, it’s important to establish exactly what pain is, because everyone’s perception of it varies.

“There’s an updated definition from the International Association for the Study of Pain. They define it as an unpleasant sensory and emotional experience associated with or resembling actual or potential tissue damage,” Milner said.

Note that vague association with tissue damage, it’s not all about cause and effect, but more on that later.

How does pain work? Well, it turns out you’re making it up. That’s not to say that it doesn’t exist, but that your brain forms the concept of pain in relation to stimulation.

“We have nociceptors throughout the body. And what they do is they sense changes to temperature, pressure, chemical, and mechanical stimuli,” Milner said.

These have been traditionally called pain receptors, however, as you can see above, that’s not entirely accurate.

“So pain receptors don’t actually exist. This is something that is kind of a misnomer for nociceptors,” Milner said.

Following so far? So these Nociceptors detect changes in the body (not pain) and send signals to the brain. 

“That information is interpreted, then it’s then sent back to the spinal cord and nerves to upregulate or downregulate pain,” Milner said.

That seems pretty simple to me, so what makes this all so complex? Well, it turns out that the processing part of your brain can play tricks on you.

“What happens is the brain is interpreting how much protection is needed, and that can be context-specific,” Milner said.

Unfortunately, the brain can interpret things poorly. This means that some people experience high levels of pain for relatively small stimuli, or even lingering pain despite no physical tissue damage. 

So how on earth does that happen? Well, there’s some interesting research that looked at how our situation and mental state can impact pain.

One study looked at how participants responded to the same stimulus (hand plunged into cold water) while viewing a red or blue light. Those viewing the red light experienced more pain than those viewing the blue light, likely because they expected it to be hot.

“Anything that makes you feel unsafe will potentially up-regulate pain and anything that makes you feel safer will potentially down-regulate pain,” Milner said.

How does this transfer to the sporting world? Well, the way an athlete interprets a situation could be massive in their response to pain or injury.

“This is why when an athlete stressed when there’s something else going on in their life, you might also see things like old injuries seem to flare up even though nothing’s happening at a tissue level,” Milner said.

With this in mind, it’s important to ensure athletes have a positive supporting environment and access to good pain (re)education. 

This could mean reading up on the topic or listening to the full podcast with Milner to hear how she helps athletes improve their pain perception in the real world.

In the podcast Milner details how she helps athletes reintegrate back into the gym after an injury or lingering pain, that’s essential listening for anyone involved in the injury rehabilitation process.

The post Episode 137. Pain Science: How you could be tricked into pain, and how to deal with it – Siobhan Milner appeared first on Science for Sport.

In episode 119, Emily Partridge, Special Medical Projects Advisor at the Australian Institute of Sport (AIS), joins us.

Specifically Emily will be looking at:

• How to use Cryotherapy in sport
• Physiology underpinning it’s use
• Budget alternatives

Everyone has seen videos of athletes seemingly freezing themselves like a sci-fi billionaire trying to live forever. But is cryotherapy really a cure for old age and muscle soreness? Or are you just relieving yourself of that hard-earned cash?

To answer that question and potentially save you bundles of dough, we asked Emily Partridge, Special Medical Projects Advisor at the Australian Institute of Sport, to join us on the Science for Sport Podcast. Before working at the AIS, Partridge completed her Ph.D. Investigating the effectiveness of cryotherapy in elite athletes.

With that fantastic knowledge and experience, we wanted to ask her exactly why cryotherapy is used, and whether it’s really worth your hard-earned time and money.

Before we get into the inner workings of cryotherapy, it’s important to discuss exactly what it is, and why on earth anyone would put themselves through it in the first place.

“Cryotherapy is essentially a super-cooled version of an ice bath, using vaporised liquid nitrogen,” Partridge said.

So it sounds pretty fancy from the get-go. But what are we looking at in terms of temperatures?

“The protocol where your head is outside the chamber is normally, say, 3 minutes at -140 degrees,” Partridge said.

Minus 140 is a lot of cold – if you’re scared that you’d be walking out with frozen appendages, me too. Fortunately, Partridge is on hand to explain that our fears are unwarranted.

“It’s dry air. So the difference between that and an ice bath is that the conductivity through air and water are very different. So before you go into a chamber, you have to sort of dry yourself off, make sure you don’t have any sweat, or water on your body, because that can freeze you and that would hurt quite a bit. But because it’s dry air, it’s not actually too bad,” Partridge said.

But why on earth would you put yourself through such a torture device? Well, apparently, it can improve recovery from intense exercise.

“It’s essentially acting like a pump over your muscles. It causes vasoconstriction – your muscles tighten up. And then as soon as you leave that cold environment, your muscles relax, causing vasodilation. And that allows an increased amount of blood flow to go through your muscles,” Partridge said.

So using cryotherapy causes the blood vessels to constrict and then relax, filling the tired and/or damaged muscle tissue with blood, which helps to assist in the recovery process.

But considering most cold exposure can provide a similar response, why on earth would you take the coldest option possible?

Interestingly, it’s claimed the mind-blowing -140 degrees is actually preferable to some other alternatives.

“Research that’s looked at relative discomfort shows that it’s a lot better using cryotherapy than ice baths or cold showers. So that’s why you often hear that athletes are using it more because you’re only in for three minutes and it’s not nearly as bad as an ice bath,” Partridge said.

So if some athletes find it preferable to other cooling options, why isn’t there a cryotherapy unit in every gym? It’s very probably due to the monstrous costs associated with its use.

“[For a] top-of-the range, new unit, you could be looking at anywhere up to $AU100,000,” Partridge said.

That’s before you’ve bought the liquid nitrogen to actually cool it down. All things told, users can look forward to a hefty bill when it comes time to square up.

“So in Australia, if you just wanted a three-minute exposure of cryotherapy, you’d be looking at about $90. So that’s $30 a minute,” Partridge said.

So if your wallet doesn’t quite extend that far, what are the alternatives?

Ice baths and cold showers are the obvious competition, and the relative cost of these is very attractive compared to cryotherapy. Which begs the question, which is better?

“Whether cryotherapy is better or not, it’s not really determined. It seems to be that they are all relatively similar,” Partridge said.

So with that in mind, you’re probably better off getting yourself down to the shops and buying a couple of bags of ice, chucking it in a (cleaned) bin, and calling it an elite recovery centre.

If you want to hear some more information on the physiology of cryotherapy and the subtle differences between this and other methods of cooling the body for recovery, check out the full podcast using the link below.

You can download the podcast on any of the big hosting services, including Apple Podcasts and Spotify, or just use this link: https://scienceforsport.fireside.fm/119

The post Episode 119. The cheap alternatives to cryotherapy – Emily Partridgeon appeared first on Science for Sport.

1. What is Hydrotherapy?
2. What are the Benefits of Hydrotherapy?
3. Hydrotherapy for Recovery
4. Hydrotherapy for Rehabilitation
5. Does Hydrotherapy Work?
6. Conclusion

Hydrotherapy, derived from the Greek words “hydro” (water) and “therapeia” (healing), refers to the therapeutic use of water to treat various physical and mental health conditions. Hydrotherapy encompasses a range of treatments, including hydrotherapy massage, hydrotherapy pools, and hydrotherapy exercises, each utilising the properties of water to promote health and well-being.

What is Hydrotherapy?

Hydrotherapy is defined as the external or internal use of water in any form (liquid, steam, or ice) for health purposes such as pain relief, improved circulation, muscle relaxation, improved mobility, reduced stress, improved sleep quality, and fatigue reduction. It involves methods like thermotherapy, cryotherapy, contrast water therapy and thermoneutral therapy (1). Furthermore, aquatic exercise and underwater massage can be used with these methods.

Cryotherapy

Cryotherapy refers to the treatment of injury using extreme cold such as icepacks, or liquid nitrogen, and also includes cold water immersion (CWI) whereby subjects are immersed in cold water < 15 °C. A wide variety of techniques have been used to implement CWI including ice baths, ice bins, and plunge pools (1). More recently, portable ice bathtubs have become a popular and affordable alternative. An immersion duration of between 15-20 minutes has been suggested in research, however, the duration could be as low as 30 seconds due to individual tolerance to cold temperatures (1).

Thermotherapy

Thermotherapy, or hot water immersion (HWI) refers to immersion in warm water > 36 °C to increase core body temperature. This can be implemented using heated baths, spas and pools. An immersion duration of between 10-20 minutes has been suggested in research (1). 

Contrast Water Therapy

Contrast water therapy (CWT) refers to alternating between hot and cold temperatures. For example, an athlete may go from an ice bath to a hot shower. Protocols have varied widely, but often consist of 30-300 seconds at a hot temperature, followed by 30-300 seconds at a cold temperature. This is repeated between 3-7 times and lasts between 4-30 minutes (1).

Thermoneutral Therapy

Thermoneutral therapy is the simplest form of hydrotherapy to apply as temperatures typically range between 16-35°C. Immersion time ranges from between 5 minutes and 6 hours (1).

What are the Benefits of Hydrotherapy?

The benefits of hydrotherapy are multifaceted, encompassing both physical and psychological aspects of health and performance.

Physical Benefits

Reduced Muscle Soreness

CWI, HWI and CWT improved the recovery of maximal isometric squat force compared to a passive recovery group at 24, 48, and 72 hours following an eccentric leg press post-fatigue protocol. The hydrostatic pressure caused by water immersion is believed to displace fluids from the periphery to the central cavity. This causes physiological changes including increased substrate transport, cardiac output and a reduction in peripheral resistance. These changes may increase the removal of waste products, possibly enhancing recovery from exercise-induced muscle soreness. However, only CWI and contrast water therapy enhanced the recovery of squat jump power and post-exercise swelling. This demonstrates that water temperature also appears to affect recovery using hydrotherapy (2).

Improved Strength

Foley et al. (2003) investigated the effects of a 6-week intervention comprising three 30-minute thermoneutral water or gym-based training sessions per week on the strength and function of osteoarthritis patients (3). The same progressive loading strategy was utilised for both water and gym-based interventions. Both interventions successfully improved the physical function and strength of participants, however, gym-based sessions were more effective in improving the muscular strength of the quadriceps. Increased muscle strength around affected joints can improve shock absorption capacity and joint stability. Water resistance can therefore improve physical function and muscular strength without the load associated with land-based weight-bearing physical activity. 

Injury Rehabilitation

Mixed-level athletes suffering from femoroacetabular impingement underwent a hip arthroscopy as they were unable to perform their sport due to debilitating pain and restricted range of movement. Following surgery, the athletes were allocated to a control group comprised of land-based exercises or a hydrotherapy group including thermoneutral water and land-based exercises. The same progression principles and exercises were employed, regardless of group. The hydrotherapy group returned to play at 15 weeks, while the control group took 22.3 weeks, demonstrating an improved return. Furthermore, the athletes’ hip-specific scores and patient satisfaction scores improved considerably, suggesting that hydrotherapy is beneficial in post-operative injury rehabilitation (4).

Pain Relief

A 6-week intervention of one 30-minute thermoneutral hydrotherapy exercise session demonstrated a greater improvement in the Numeric Pain Rating  Scale ( NRPS) when compared with land-based exercises of the same volume and frequency. The hydrotherapy group demonstrated the maximum response compared to the land-based group. However, both interventions elicited a greater improvement in pain compared to the control group. This demonstrates that hydrotherapy offers a non-invasive, drug-free treatment option that can reduce pain and improve quality of life. The reduction in gravitational force allows for easier movement and pain reduction during exercise and therapy sessions (5).

Psychological Benefits

Reduced Anxiety 

Benfield et al. (2001) reviewed the use of hydrotherapy to decrease anxiety and pain during labour. The mean water temperature of the studies was 36 °C, however, temperature varied from 32-42°C (6). After bathing for 15 minutes the anxiety scores of all women in the hydrotherapy group decreased, whereas only 43 % reported a decrease in the control group. Furthermore, the hydrotherapy group demonstrated a mean decrease in anxiety, whereas the control group increased. This anxiety reduction is believed to increase relaxation, which is particularly beneficial during the physiological and psychological effects of labour. Therefore, during labour, immersion in warm water is hypothesised to decrease the production of stress-related hormones such as cortisol, whilst increasing the release of endorphins, which are natural mood enhancers.

Improved Sleep Quality

Patients with fibromyalgia completed a 2-month intervention consisting of 2 x 60-minute hydrotherapy sessions per week in a 32 °C pool. On completion of the intervention, patients reported an improvement in perceived physical function, work absenteeism, pain intensity, fatigue, morning tiredness, stiffness, anxiety, depression, sleep quality and daytime sleepiness. With regards to sleep quality, the Pittsburgh Quality Sleep Index (PSQI) was used to detect sleep disorders in the month leading up to the study. Prior to the intervention sleep disruption was scored at 39.5. Upon conclusion, 80 % of patients reported an improvement in sleep quality, with a mean reduction to a score of 33. It is stipulated that the physiological effects of hydrotherapy originate from the combination of the physical effects of water (thermal/mechanical) and exercise (7).

Improved General Health

A hot spring balneotherapy intervention was used for 30 minutes, 2-3 times per week for 5 months with 326 participants classified as ‘sub-healthy’ at two separate springs. The balenotherapy group bathed in a head-out immersion bath with naturally warm water (36-42 °C) mineral water. The research concluded that balenotherapy improved a range of factors including mental stress, women’s health problems, sleep quality and general health. Interestingly, despite mental stress being significantly relieved, bad/low mood, worry and irritability were not relieved. Symptoms of head pain, joint pain, leg or foot cramps and blurred vision were significantly relieved in the intervention group. 

Further analysis also revealed that increased bathing time increased relief and participants in the senior group (56-65 years old) had greater relief from insomnia, fatigue or cramps. Women’s health problems including breast pain, dysmenorrhea and irregular menstruation were significantly relieved in the intervention group possibly because of the thermal effects of spring water can regulate metabolism and blood circulation and metaboric acid can regulate the endocrine system (8).

Hydrotherapy for Recovery

Hydrotherapy has been found to improve the recovery of maximal force, power and swelling 24, 48 and 72 hours post-fatigue protocol (2). This could be particularly beneficial for athletes with short turnaround times between competitive fixtures. Examples include international football tournaments, tennis tournaments, basketball and baseball. 

Twelve cyclists completed five consecutive days of cycling consisting of 105 minutes, including 66 maximal sprints. They then completed a 14-minute recovery intervention consisting of either CWI, HWI, CWT or passive recovery. Sprint and time trial performance were enhanced across the five day period following a CWI and CWT recovery when compared with HWI and passive recovery. CWI and CWT appear to improve recovery from high-intensity cycling and therefore allow maintenance of performance across a five day period (9). 

However, a systematic review investigating the use of CWI post-resistance training stated that less muscle growth was achieved compared to no post-exercise immersion (10). Therefore, it should be considered whether recovery or adaptation is the goal post-exercise.

Hydrotherapy Massage

Hydrotherapy massage involves heated water and mechanical pressure provided by jets or manual manipulation to massage the body. This type of therapy is typically performed in specially designed tubs, hydrotherapy pools, whirlpool baths, and hydromassage tables.

WATSU

WATSU is a passive form of hydrotherapy in chest-deep thermoneutral water (35 °C) combining myofascial stretching, joint mobilisation, massage and shiatsu. A therapist stands in the water, supporting the supine patient with their upper body, slowly moving the patient in circular motion sequences. Simultaneously, the therapist uses their hands to stimulate acupuncture points (11).  

In a systematic review, it was reported that WATSU was predominantly used as an intervention for pain, physical function and mental health with chronic conditions such as fibromyalgia, asthma, neurological conditions and geriatric care. The meta-analyses concluded that WATSU had a beneficial effect on acute and chronic pain, however, this was not statistically significant. Similarly, the analysis concluded that WASTU indicated beneficial mental effects but was not statistically significant. Interestingly, WATSU appears to have moderate effects on physical function, linking to lower muscular tone and stiffness, translating to fewer muscle spasms and increased range of motion (12). 

Hydrotherapy for Rehabilitation

Hydrotherapy has been found to accelerate the return to play time of athletes following a hip arthroscopy. It is stipulated that the buoyancy of water reduces the impact on joints and muscles, making it ideal for individuals in the early stages of rehabilitation (4).

Eighteen male professional athletes who incurred a grade I or II acute ankle sprain began thermoneutral hydrotherapy with hydrogen-rich water (HRW) intervention or a standard RICE (rest, ice, compression, elevation) protocol 24 hours post-injury. The HRW group received 6 x 30-minute ankle baths every 4 hours during the intervention period. The RICE group offloaded the injured leg, administering ice packs for 8 x 20 minutes every 3 hours. HRW was equally as effective for reducing joint swelling and pain while regaining range of motion and balance 24 hours post-acute ankle sprain. Therefore, HRW could be applicable to athletes and healthcare professionals requiring an alternative strategy to reduce swelling and pain (13). Further investigation is required to identify the effectiveness of HRW on other upper and lower-limb injuries.

Patients with osteoarthritis of the knee were allocated into a land-based or thermoneutral water-based exercise group for an 18-week period. Both groups completed similar exercises, consisting of gait training and strengthening and stretching the muscles of the lower extremities 3 times per week for 50 minutes per session. A similar progressive volume-loading strategy was also used by both groups. Both land-based and water-based exercises reduced pain and improved function, showing that water-based exercises could be a suitable alternative to land-based exercises (14). 

Knee and hip implants with telemetric data transmission were used to measure the joint contact forces of twelve elderly participants completing thermoneutral aquatic and land-based exercises. In chest-high water, the buoyant force led to decreases of 65-68 % in body weight. Specifically, a reduction of 58 % was identified in the hip and 62 % in the knee during a one-legged stance. Furthermore, both higher movement velocity and increased water resistance led to an increase in joint forces. This indicates that aquatic exercises can be used for effective muscle activation. Furthermore, these joint forces and muscle activation can be manipulated through exercise selection, movement velocity and utilising additional resistive devices, proving a useful tool in rehabilitation (15).

Hydrotherapy Exercises

Hydrotherapy exercises, performed in water, help improve strength, flexibility, and balance. They are a viable option for individuals recovering from sprains, fractures, or post-surgical intervention. 

Throughout pregnancy, hydrotherapy exercises have also been found to help control heart rate and blood glucose levels, prevent excessive weight gain, and improve balance and mobility. These exercises can be adapted to suit individuals at different stages of recovery, rehabilitation or pregnancy (16). 

Walking or Jogging

Water walking or jogging is particularly beneficial for individuals recovering from lower limb injuries or surgeries. Additionally, it is an excellent method of reintroducing locomotion without the cost associated with equipment such as anti-gravity treadmills (14).

Water Squats

Water squats are performed by standing in the water at different depths, dependent upon the stage of rehabilitation. This exercise targets the lower body muscles and aims to improve strength and stability. The buoyancy of the water reduces the load on the lower limbs, making it easier for individuals with pain or injuries to perform (15).

Aqua Aerobics 

Aqua aerobics involves aerobic exercises performed in water, including jumping jacks, high knees, leg kicks, treading water and arm circles. These exercises can enhance cardiovascular fitness, strength and balance. Aqua aerobics is suitable for individuals of all fitness levels and ages (17,18).

Does Hydrotherapy Work?

There is still some speculation about the use of hydrotherapy for physical and psychological purposes. Furthermore, the method of hydrotherapy (thermotherapy, cryotherapy, contrast water therapy) applied will change the effect it has on an individual.

Cold Water Immersion (CWI)

CWI  has commonly been used to aid post-exercise recovery. A review including 27 studies measured the effects of various cryotherapy on delayed onset muscle soreness (DOMS). Analysis revealed that CWI significantly improves DOMS at 24, 48 and 96 hours post-exercise. It should be noted that CWI reduced DOMS more than cold air and ice packs. Furthermore, male participants responded better than female participants up to 48 hours (19). 

Thermotherapy

Despite its use in a physiotherapy setting, there is less research-based evidence to support thermotherapy. A review by Versey et al. (2013)  found that thermotherapy is unlikely to have a significant positive effect on the recovery of performance (20). However, studies have suggested there are a variety of psychological benefits to thermotherapy.

In labour, the anxiety of all women in hydrotherapy decreased, whereas only 43 % reported a decrease in the control group (6). A hot spring balneotherapy intervention improved a range of factors including mental stress, women’s health problems, sleep quality and general health (8).

Contrast Water Therapy

A review by Higgins et al. including 23 articles investigated the recovery effects of contrast water therapy with well-trained team sport athletes (21). Contrast water therapy did not enhance recovery of perceived muscle soreness 24 hours post-exercise; however, it appeared to reduce the detrimental effects of team sport on countermovement jump performance 24 hours post-exercise but had no additional benefit 48 hours post (21).

Thermoneutral Therapy

Hydrotherapy exercises completed in thermoneutral water have been used with individuals recovering from injury, surgical intervention or patients diagnosed with chronic conditions such as fibromyalgia (3). 

Although water-based exercise has been found to improve both physical function and strength, however, gym-based interventions have been more effective at improving the strength of osteoarthritis patients (3). Silva (2008) also found that hydrotherapy improved physical function and reduced pain similar to land-based exercises (14). Athletes recovering from femoroacetabular (hip) impingement returned to play at 15 weeks following a hydrotherapy intervention, while the control group took 22.3 weeks, demonstrating a significantly improved return to sport (4).

Patients with fibromyalgia reported an improvement in perceived physical function, work absenteeism, pain intensity, fatigue, morning tiredness, stiffness, anxiety, depression, sleep quality and daytime sleepiness (7).

Conclusion

Hydrotherapy offers a range of benefits, from physical and psychological improvements to aiding in recovery and rehabilitation. The method of hydrotherapy intervention seems to elicit different responses, therefore the individual’s goal should be considered before selecting a specific method. The therapeutic properties of water make it a versatile treatment option for various conditions. Whether used in clinical settings, sports facilities, or at home, evidence suggests hydrotherapy can enhance health and well-being. As research continues to investigate its efficacy, hydrotherapy remains a valuable tool in the arsenal of modern therapeutic practices.

The post Hydrotherapy appeared first on Science for Sport.

1. Introduction
2. What is a massage gun? 
3. Do massage guns work? 
4. Benefits of using a massage gun
5. Side effects of using a massage gun
6. Can you use it every day? 
7. How to use a massage gun?
8. Which massage gun to purchase?
9. Conclusion

Introduction

Vibration and pressure therapy has been used for health benefits for a considerable amount of time (1), in a variety of forms, with the idea of using a device to apply such targeted methods first came to prominence in the 1950s (2).  Since then, a greater variety of tools have been produced to apply a variety of pressure to musculature, notably the foam roller (3),  and with ever-increasing commonality, the massage gun.

What is a massage gun?

A massage gun is a handheld, portable device that resembles a power drill and comes with a range of attachments.  When applied (and through the attachments), the massage gun applies pressure to the target area, thought to promote blood flow, reduce myofascial restriction and tension, alleviate pain and break up trigger points (4).

Do massage guns work? 

baY-balance test calculatorResearch into the effects of massage guns typically centres around performance and recovery (5).  The use of massage guns did lead to an increase of range of motion (ROM) (6) and flexibility (7), however, they appear to be less effective when improving strength is the goal, with massage guns actually resulting in a decrease in jump height (8).  Massage guns appear ineffective in improving strength, balance, acceleration, agility, and explosive activities (5).

Vibration therapy as a whole-body tool does show promise for attenuating muscle soreness (13), although as the title suggests, this was based on whole-body massage rather than targeted to the level of a massage gun. However,  including massage guns as part of a structured warm-up was suggested to reduce perceived muscle soreness as well as increase range of motion, with no negative impact on muscle activation and force output (9).

Side effects of using a massage gun

Massage guns do not come without their potential side effects, typically as a result of overuse in terms of frequency or intensity. Indeed, one case study highlighted a case of rhabdomyolysis (the breakdown of muscle tissue, potentially releasing harmful chemicals into the bloodstream) following the use of massage guns (10), muscle oedema (12) and other potentially adverse effects from massage therapy in general (11). 

Can you use it every day?

Information on when to use a massage gun has not been widely investigated, but there may be different ideas based on the goal at that time (5).  For recovery, evidence points to greater than 2 minutes per muscle group at low frequencies, whilst for range of motion improvements, brief application at higher frequencies may be more beneficial and it is recommended to avoid massage gun therapy before strength activities due to potentially negative effects on performance (5).  

It may be tempting, especially if the massage gun delivers pain relief to an affected area, to rely on it or use it for longer than needed.  However, spending more time on an area may become detrimental and have negative effects, especially those greater than 30 minutes (5).

How to use a massage gun

It is suggested that a massage gun should be used with “gentle pressure, using the ball-tip attachment, moving dynamically” over affected areas (5), so essentially not pressing too hard, and constantly moving over areas where the user may feel tightness.  It’s important to let the massage gun do the work as opposed to pressing harder with the hope that “more is better” to avoid bruising and unnecessary tissue damage. Bony areas (knees, ankles, etc.) should be avoided, with a focus on the musculature around those joints, just like a massage professional or physical therapist would.

What is the best massage gun?

There are a huge number of different brands of massage gun.  Whilst they all perform the same basic role, there is a range of prices, number of accessories, speeds, battery life, and even decibel level.  Below are a selection of massage guns available on Amazon:

For the Pros

Theragun is perhaps the most well-known, with the elite model coming with 5 attachments, an LED screen and customisable speeds costing USD 399.  The Theragun has an impressive range of features and users can pair it with the accompanying application to get step-by-step routines for individual needs.

The weekend warrior

The Hyperice Hypervolt Go 2 offers 3 speeds, is lightweight and super quiet.  At USD 129.99 it offers significant performance and a 3-hour battery life, more than enough for numerous uses before recharging.   As the partner with a number of professional sports teams and leagues, the Hyperice certainly has pedigree and with the ability to purchase more massage heads, gives the ability to tailor the massage gun to what works best for the individual.

The occasional user

For those looking into massage guns for the first time, it may be prudent to look at a model such as the Arboleaf Massage Gun which offers 6-10 hours of battery life, 8 massage heads and 20 speed levels in addition to low noise for USD 64.99.  

Conclusion

Massage guns are, like a number of health and exercise tools throughout the years, currently trending.  So, is it worth purchasing one? As ever, it is case by case! Level of athletic performance, current injury status, training age, schedule, stage of season or goals may all have an impact on whether to purchase and ultimately use a massage gun.  Including one as a small part of an overall regimen, depending on outcome goals may prove useful.

The post Massage Guns appeared first on Science for Sport.

Some people swear that cold showers can deliver myriad health benefits, from keeping chronic disease at bay to clearer thinking, improved circulation and general wellness improvements. But what does the science have to say about them?

By Dr. Tom Brownlee
Last updated: March 17th, 2025
9 min read

Cold showers: Are they worth the pain?

NOTE: This article refers to cold water exposure. If you are currently experiencing any medical issues, we recommend you speak to your physician before attempting.
Early in September last year, I found myself standing on a beach in County Mayo in the west of Ireland. The air temperature was about 18°C (64°F), which is a little too chilly for the pair of swimming shorts I was wearing. I was being told by my other half’s parents (also wearing swimming gear) that “you get used to the cold quite quickly!”. We were going for a swim. The water temperature was about 15°C (59°F) – so much for a summer’s worth of warming up!
As a physiologist, I know we lose body temperature much more quickly in water than air of the same temperature. Was I excited for what awaited me? No. Was I feeling peer-pressured and at risk of being shown up? You bet!
So, in we got. They do this every day, and marched in as if they were striding into a luxury spa. I tried my best to keep pace but it was tough, especially as certain body parts became submerged. What then followed was a satisfaction curve that followed somewhat of an arc, with a flat top. Ten minutes of hyperventilating and questioning my life choices, 10 minutes of enjoyment coupled with ‘oh, it’s actually quite nice!’ and 10 minutes coming back down the arc as I felt the life being sapped from me. When we got out and (finally) warmed up, there was general agreement that it was in fact enjoyable.

I subsequently went in each day I was there, and it did indeed get easier. But it was after the first dip when someone said: “I’m sure it’s supposed to be really good for you … isn’t it?!”. There was talk of all sorts of miracle cures following these cold plunges, from keeping chronic disease at bay to clearer thinking, improved circulation and general wellness improvements. Also, there was a talk of a mystery man named Wim Hof.

So, is there any basis for these claims and who is this fella they call the Ice Man? Let’s find out.

Are cold showers good for you?

This article will consider the purported claims of cold water exposure and also how these statements stack up against the scientific literature.

But before we get to that, let’s back up a bit. You may have heard of colleagues, friends or loved ones telling you how they’ve started to kick their day off with a freezing cold shower in the morning and they “feel great” for it. But how has this crept into the public consciousness? In part, it is likely through one of its top advocates Wim Hof, the Ice Man. Hof is described as a Dutch extreme athlete who is noted for his ability to withstand freezing temperatures. He holds, or has held, a number of world records including being embedded in ice for nearly two hours.

Hof states his ability to achieve such feats stems from a combination of breathing technique work (which he likens to controlled hyperventilation), the cold exposure itself (which he recommends you work up to gradually) and meditation (which he does while doing both the breathing exercises and the cold exposure).

We have Hof to thank for this upsurge in this kind of practice, with many Hollywood A-listers citing use of his techniques. This has further driven up interest and participation across all walks of life. You can find his particular method easily online, but we are going to focus mainly on the cold water immersion.

The supposed benefits of cold water immersion are numerous. Physiologically they include:

The psychological benefits are also numerous and include:

It is also worth mentioning that such practice is not without risk to some individuals. Cold water immersion has been found to sometimes make stiff muscles worse, reduce the impact of some training types and also (unsurprisingly perhaps!) increase the risk of hypothermia.

But if even half of the positive claims were true, then it’s safe to say we would all have something to gain from factoring cold water immersion into our lives. However, this is a long, and at times woolly, list (I actually removed a fair few from my original list as they were even woollier!).

But let’s be honest – this is not a particularly pleasurable experience, certainly at first anyway. So, let’s see what evidence is out there to back up what, for many, is likely a pretty uncomfortable lifestyle change.

The cold, hard facts on cold showers

Relatively, there is quite a lot of specific research out there on what is quite a niche topic. A lot of this centres around Hof himself, who has participated in a lot of the research that is referred to below.

MRI scans of Hof’s brain found that when he is carrying out his breathing technique, he is able in a sense to trick his brain into producing a chemical that puts him into a euphoric state at a time when the rest of us would be feeling intense discomfort. The pain we would typically feel is important, as from an evolutionary sense, it lets us know when a situation is undesirable. Subsequently, this lets us know that we should remove ourselves from it – this is certainly how I felt as the water became waist deep in Ireland!
Our bodies, though, can override this, again for evolutionary reasons.  For example, let’s imagine you’re being chased by a gorilla 10 seconds after standing on a nail that goes right through your foot. Normally, the nail would be extremely painful. In this circumstance though, your brain knows it can worry about your foot later – if you’re able to outrun the gorilla! It seems as though Hof’s breathing technique enables him also to override his pain response, without the need for the ape!
So, is it actually the breathing that is leading to the reduced pain and improved psychological state rather than the water itself? Well, it is argued this initial consequence will only help you for the first couple of minutes in the water. As a result of more prolonged exposure, opioids, serotonin, and dopamine (all of our happy chemicals) kick in, a kind of self-fulfilling positive cycle. These chemicals, it seems, are your reward for getting through that initial pain barrier. They then aid your ability to tolerate longer exposure and potentially bring about some of these further benefits.

But what about some of these other benefits that are claimed? Are they too good to be true?
The changes in the brain referred to above not only seem to allow for greater ability to tolerate the cold but also provide additional chemical responses. This is achieved via what has been described as a controlled stress response characterised by activating the sympathetic nervous system. This appears to reduce the innate immune response and, in turn, leads to reduced inflammation which has subsequently been found in more in-depth research also. Though links are yet to be specifically made, this could lead to many positives linked to some of the physical benefits listed above, from enhanced recovery to reduced likelihood of some disease occurrences.

This manipulation of the body’s immune response could also influence the way the body responds to pathogens such as bacteria and viruses. This was trialled with a group who were trained in Hof’s methods and were found to be able to voluntarily activate their immune response and subsequently showed fewer flu-like symptoms.

The chemical response mentioned above is likely the primary reason for the pleasure experienced by many following their cold showers, alongside serotonin and dopamine chemicals, including adrenaline which have also been found to be ramped up after undertaking Hof’s methods. This cocktail would combine to give effects similar to that felt when on a rollercoaster.

Beyond such acute euphoric benefits listed above are also a handful of specific chronic medical conditions. At this time, it seems evidence to substantiate such claims is often unspecific, and it is suggestions based on broader evidence that triggers them. That is not to say they are untrue, and often in science the research can take time to filter through.

Arthritis is one such condition where this is the case. Linking back to the potential to reduce inflammation in someone practicing these techniques, healthy individuals have been found to be able to reduce chronic inflammation using Hof’s methods. This has prompted researchers to suggest that this proof of concept investigation should now be rolled out further to include diseased populations. This is similar for many other chronic illnesses linked to the above proposed benefits.

Is it time to take the plunge?

Perhaps unsurprisingly, it seems Hof’s success in tolerating extreme cold, and the subsequent benefits it might yield, are driven by training the brain rather than specifically the body. Further investigation into whether his tolerance was a result of the brain or body indeed found that control of the brain may be more possible than first realised and that this may lead to many possible positive outcomes.

This leaves some interesting and exciting proposals that we may genuinely be capable of far more than we think if we can safely train our brain over time to deal with such environments. It seems this may then allow us to reap some of the benefits that may in time be shown to be associated with such mind over matter challenges.

Cold showers: Take-home points

Wim Hof is likely the Usain Bolt of the extreme cold temperature world. Can you expect to build superpowers on the same level as his to be able to withstand such extreme extremes? It’s unlikely. Can you train yourself to be better able to tolerate a cold shower in the morning? That seems a little more likely. And will it live up to every claim? Well, probably not. The science certainly isn’t backing them all up just yet. But that’s not to say evidence won’t be gathered over time as further research is conducted.

It’s also useful to keep in mind that some people will absolutely hate to implement these kinds of techniques. To those, I say you shouldn’t be worried if that’s how you feel as you read this. A lot of the psychological and potentially physical benefits associated with the Wim Hof method can be achieved via other mindfulness techniques such as meditation.

It does seem though, that if you’re able to get through the initial period of discomfort, there likely are some benefits for both the body and mind for the breathing technique, cold water immersion and meditation of the Wim Hof method.

My next trip to Ireland is planned for some time just after Christmas, so I’ve plenty of time to prepare. I’ve just looked, and the water temperatures should be down to 10°C (50°F) by then though. Maybe just a shortie wetsuit?

[optin-monster slug=”nhpxak0baeqvjdeila6a”]

Dr. Tom Brownlee

Tom is an assistant professor in applied sports sciences and has worked with elite sports for over 10 years. Previous roles include working as a sports scientist at Liverpool F.C., where he completed his Ph.D., and working across a number of other sports. He is passionate about physiology, coach communication, and high-performance strategy and systems.

Tom graduated with a BSc in 2011 before undertaking an MSc at Loughborough University. He has published 25 academic papers on strength and conditioning, nutrition, and youth development in Sports Medicine, the Journal of Strength & Conditioning Research, and others. Tom also now supervises a number of his own Ph.D. students around the world embedded within sporting organisations.

More content by Tom

The post Cold showers: Is there any scientific rationale? appeared first on Science for Sport.

Long journeys and jet lag are a concern for many athletes, but what exactly is the impact of long flights on performance, and what strategies are available to counteract these effects?

By Dr. Tom Brownlee
Last updated: March 17th, 2025
7 min read

Jet lag: How can athletes minimise its impact?

When I wrote this article, we were sitting in the time between the Olympic and Paralympic Games in Tokyo. Having previously written about the difficulties of the heat during the Games, I thought I’d consider another issue that was brought up frequently over the past few weeks. As with any Olympics — where people have travelled from far and wide — long journeys and jet lag are a concern for many athletes during the build-up to what could be the biggest few days of their life.

Today I’ll examine the impact of long flights and jet lag on performance. I will look at the underpinning science and strategies we might want to use to limit the effect on our next family holiday, business meeting or gold medal race.

Flying: Jet lag vs. travel fatigue

Firstly, we need to differentiate between two potential issues that may be at play when we consider long-haul travel. If we go on a long journey, let’s say a flight from London to Cape Town, this will mean a 12-hour flight crossing one time zone (during British summer time). The result of this would be travel fatigue. We would be tired from the event but would have different experiences from a 12-hour flight east, say from London to Tokyo, where we would pass through eight time zones. This second trip would be more likely to trigger the infamous jet lag that we heard so much about from British, American and many other athletes at the Tokyo Games.

We’ll start with a little explanation of the physiological difference between the two before diving deeper into the details of avoiding them.

What is actually happening to us up in the air?

Way back in 1997, the Godfather of sports chronobiology (the study of biological rhythms), Professor Tom Reilly, acknowledged the difference between travel fatigue and jet lag. He and colleagues summarised that travel fatigue, achieved via long trips (typically within three time zones of your origin), could be tackled with relative ease. They suggested this state was an acute accelerated tiredness and recommended simple amendments to training schedules and short periods of rest to allow individuals to return to normal following such trips.

They went on to acknowledge that once travelers exceeded three time zones,  experiences were much more noticeable, especially when travelling east. The exact reason for this east/west difference isn’t known, but it likely has something to do with the fact that advancing your body clock is trickier to deal with than delaying it. The general reason for our body struggling following time zone differences is that our internal body clocks become out of sync. Our brain gets confused when trying to determine the difference between where we are and where we think we are. This can also be exaggerated by novel issues such as a change in temperature, altitude, humidity, pollution etc., which has certainly been the case in Tokyo.

Beyond these factors, the key variable messing with our internal clocks is light. This is perhaps no surprise, and it is logical that if your body thinks it’s the middle of the day, but it’s pitch black outside, you may find it harder to go to sleep.

But beyond the annoyance experienced by anyone who’s ever had jet lag, from an athletic performance standpoint is it something we should be concerned with?

Jet lag and athletes: What’s the go?

It’s worth a quick glance at the science here to see what the impact of travel fatigue and jet lag might be on athletic performance. If, for example, our brains feel upside down, but we are still able to optimally perform, then maybe this would be less of an issue.

Starting with travel fatigue, it seems there is limited evidence that it might directly impact performance (assessed via counter-movement jump, yoyo test and technical/tactical performance). However, despite the potentially limited impact on physical markers, it was considered to negatively impact perceptual measures such as alertness, motivation, and mood, which would likely be a concern for athletes and coaches.

When we more specifically look at jet lag, it seems that crossing time zones increases resultant fatigue sufficiently such that performance markers including sprint and jump ability are negatively affected. It’s also suggested your chronotype (whether you’re a night owl who naturally likes a late bedtime, or a morning lark who prefers waking up early) may impact how affected you are, with larks appearing to adapt to eastbound travel more quickly.

Key strategies to reduce the impact of jet lag

Having established that, for long trips, especially when crossing multiple time zones, there are likely negative performance consequences, the big question is, what can we do about it? Below we will consider some pre-, during and post-travel strategies to help shake that funk as best we can.

Prior to travel
Firstly, it is important to try to embark on your journey in as fresh a state as possible. So, attempt to get a good night’s sleep leading up to your journey. It has also been recommended it may be useful to begin to adjust your sleep and waking time by one hour each day in the two or three days leading up to travel (especially when flying east). Greater adjustment than this is likely to be disadvantageous, with periods longer than two to three days likely to be too disruptive to an individual’s days before travel.

During travel
Once on the plane, it is recommended travellers attempt to make themselves as comfortable as possible. Many sports science departments are now taking this very seriously. During the Olympics, we saw special pillows on planes to aid rest, which you can even pick up yourself through the Team GB mattress sponsor. Incidentally, it was recently found that business class travel led to better sleep quality and quantity as well as reducing some jet lag effects – something to keep in mind if you’re looking to barter with the boss!
It has also been recommended athletes change their watches to the time at destination upon travel to aid the mindset shift. Sleep should then ideally take place during the ‘new’ night-time. Specifically, in the hour prior to attempting to sleep, it is advised to restrict computer, TV, and phone use. Loose fitting clothing, an emphasis on hydration and refraining from alcohol and caffeine have also been recommended. These interventions are based on evidence that exposure to light and noise can reduce sleep quality – aim to increase comfort and induce the physiological state required for sleep onset without pharmacological aids.

Upon arrival when having travelled west
Once you arrive at your accommodation, it has been suggested a short nap may be useful. This is aimed at suppressing the desire to go to sleep that can creep in when we extend our days by flying west. It is important, though, to keep this nap short (around 20 mins seems a good estimate) and seek some form of activity in the daytime once you’re up and about. This can lead to greater exposure to daylight, which can also aid the reduction of some jet lag symptoms.

You may also feel like going to bed 1 to 2 hours earlier than usual, subsequently waking earlier too. Don’t fret, though – this should pass after spending a few days in your new time zone.

Upon arrival when having travelled east
Things are a little trickier when we’ve flown east. This is because frustratingly, the time you feel most tired coincides with night-time in your origin time-zone, which is far from ideal if you’ve arrived into glorious sunshine at your destination. The key to cracking this and resynchronising your body clock is through manipulation of light after flying eastwards.

This comes through making the most of the positive effects of natural light at the right time. The problem with crossing many time-zones (e.g., six to nine hours) to the east is that a morning arrival worsens this issue. In such instances, the use of light shades on the plane and dark glasses en route to the immediate accommodation can minimise light exposure and allow the traveller to retire to bed until late morning if necessary after arriving. Subsequently, light exposure in the ‘new’ afternoon is beneficial.

It would also be beneficial to avoid training the first few mornings and train in the late afternoon instead.

Dreaming of gold: Take home points to maximise your performance

Generally, athletes, practitioners and us mere mortals are advised to firstly get the basics right when it comes to combatting jet lag.

[optin-monster slug=”nhpxak0baeqvjdeila6a”]

Dr. Tom Brownlee

Tom is an assistant professor in applied sports sciences and has worked with elite sports for over 10 years. Previous roles include working as a sports scientist at Liverpool F.C., where he completed his Ph.D., and working across a number of other sports. He is passionate about physiology, coach communication, and high-performance strategy and systems.

Tom graduated with a BSc in 2011 before undertaking an MSc at Loughborough University. He has published 25 academic papers on strength and conditioning, nutrition, and youth development in Sports Medicine, the Journal of Strength & Conditioning Research, and others. Tom also now supervises a number of his own Ph.D. students around the world embedded within sporting organisations.

More content by Tom

References

The post Jet lag: The impact and management of flying on athletic performance appeared first on Science for Sport.

Compression garments are everywhere nowadays, from elite athletes down to the average Joe. But what are they supposed to do, do they work, and should you be using them to improve your recovery?

By Dr. Tom Brownlee
Last updated: March 17th, 2025
9 min read

Compression garments: Crucial recovery aid, or just a fashion trend?

I first started taking sport seriously more than 20 years ago now – that makes me feel very old. Back then, I was a track and field athlete – a triple jumper in fact. I was okay at it, but I definitely took it seriously. I trained three to five times a week, on the track and in the gym, and I wanted to be the best I could be. I was a member of my local team, which had a strong pedigree and provided a good environment for me to improve.

As young sportspeople do, I began to pick up some of the traits of my peers at the club – buying similar spikes to them and also copying some of the other clothing choices they made. This included lycra. I don’t remember really considering this to be unusual, but I think at the time it probably was. Back then, unless you did gymnastics, cycling, track and field or were a keen aerobics participant (a type of group exercise class – ask your mum or dad) lycra wasn’t really all that common. How times have changed…
I’m not going to stray into fashion here and start talking about activewear but now, lycra is a staple in most people’s wardrobes. Whether this is to go to the gym in, to wear under your shorts for rugby training, a full kit for the ‘MAMILs’ amongst us, or those weird sleeve-only things that NBA players wear, there’s a lycra option for your needs! 
Rather than listen to my sartorial musings, we’re going to focus today’s blog on a particular kind of lycra clothing – the compression garment. Added to the list of massage guns and GPS devices, one of the most commonly seen bits of sports technology across social media, where so much advertising is done these days, are compression garments. They are supposed to aid with recovery through squeezing the muscles in a way to rid them of their evils – or something like that. They mainly come in the form of socks, shorts and short- and long-sleeve tops and are worn under your normal gear, or sometimes standalone. They’re sold by pretty much all of the big hitters and are also pretty tight – obviously.

So, let’s consider what is going on here. What are they supposed to do, do they work, should you be using them to improve your recovery and was I ahead of my time as a 15-year-old in full-length lycra trousers all those years ago?!

Fresh as a daisy…

When we exercise, especially when we do something we haven’t done before or we ramp up the challenge, we get sore. This soreness is a sign that our body has done something difficult, and it has to repair in a way that makes it able to cope with it should it experience it again. This principle of overload, when sustained during an exercise program, is what enables us to get fitter, stronger, bigger etc. This soreness usually only lasts a day or two but during that period it’s advised that you don’t work those muscles again at a high intensity.

Depending on your goals, this can be frustrating and not aligned to what is required of you. For most of us, this isn’t a huge issue, as we can take a little extra time between sessions. If you’re a professional though, and you have a soccer match on a Sunday and another on a Tuesday, or a tennis Grand Slam match that occurs over two days, you may not appreciate that soreness much at all! As such, methods to relieve this soreness including massage, foam rolling, ice baths and compression garments have crept into use. Some professional soccer clubs now even have members of staff dedicated to heading up recovery strategies, such is the importance of having the best players firing on all cylinders during key periods of the year.

The science of the squeeze

The theory behind the use of compression garments is that they have two main periods of use – during and, more commonly, after exercise. During exercise, it is thought they aid improved blood flow, therefore providing working muscles with more oxygen. The theory here is that as the blood returning from the lower body is having to work against gravity, squeezing the veins increases that pressure, a bit like how squeezing a hosepipe increases the water pressure – it aids the system in becoming more efficient. This would reduce the perceived difficulty of exercise at a given intensity, which we would all appreciate. It is also thought that the factor of wearing tighter-fitting clothing aids our proprioception, or our ability to know where our body is in space. This might sound a little odd but it is thought this will improve our ability to maintain a correct posture, which can help to make us more efficient.

Following exercise, as we’ve alluded to, compression garments aim to minimise delayed onset muscle soreness (DOMS). This is the specific muscle ache we have the day after a hard session. It is thought this is achieved through some of the same mechanisms as having a massage. It is thought they also increase the temperature of the muscle they are around. This also promotes blood flow and can promote healing.

Lastly, there are some rumblings that compression garments are able to reduce injury risk. This is linked to the fact that by aiding the warming of our muscles, we may be less likely to strain or pull a muscle.

Wouldn’t it be great if all of that were backed by science? Well, let’s see what we can unearth.

Starting off with the claims for use during exercise, it doesn’t seem like we are off to a great start. From the limited evidence out there, typically looking at runners, it doesn’t seem there’s much linking compression garments and improved running performance directly. This is likely because our bodies are already pretty good at what they do. When we exercise, the muscles, as well as propelling us around, are squeezing the blood back to our hearts. As a consequence, the addition of a compression garment doesn’t really add much to this system.

It was also hoped that by stopping our muscles from shaking too much when we hit the ground during running, this too may limit the micro-trauma to the muscle, which is associated with soreness. Sadly, it doesn’t seem like there’s too much to this one either. Also, though some studies have found that wearing tighter garments during exercise does indeed improve our proprioception, this hasn’t translated to better performance. Maybe this could be an advantage for those who are trying to overcome serious technique issues but as is often the case with science, we can’t say that for sure just yet.

So, let’s shift our hopes to recovery, and perhaps more where we think these types of clothing can benefit us. Thankfully, here we’re on slightly more solid ground. It does seem there is a link between the wearing of compression garments and reduced muscle soreness and fatigue. This likely is based on more solid foundations as its history lies in the medical rather than sporting realm. Compression has been used for years to reduce swelling after an operation by pushing pooled fluids and blood away from the specific area. This isn’t enough to improve performance during running, as we’ve said, but can be useful during recovery. Often such research points to weight training though, where there is obviously a huge muscular load. The evidence for improved recovery — measured by an ability to reproduce a performance during a 24-hr recovery phase in cycling and running — is limited. There is also limited evidence to suggest that DOMS duration or intensity is reduced following use of compression garments.

Compression garments for sport: Adaptation vs. recovery

One interesting point to consider when thinking about if you need or want compression garments in your life relates to the very thing they are trying to achieve. Compression garments are attempting to rid the system of the chemicals that make us feel sore and stiff. As we said at the start of this blog though, those chemicals are involved in the process of helping us to adapt. This is obviously less of an issue if we’re between matches at Wimbledon or we’ve got the Olympic 100m final tomorrow, but what if we’re trying to train for a four-hour marathon? Surely then we want those chemicals to help us to get fitter, not to dull them down so that we have a few hours where we aren’t so sore.

And this isn’t just the case of elite athletes versus us normals. Consider warm weather training camps that endurance athletes might do, or soccer or rugby players’ pre-seasons – they are very much aiming to adapt. So, this is quite an important consideration for your use of compression garments in sport. But not only that – this logic also applies to ice baths, foam rolling and massage. Sometimes there may be a balancing act between recovery and allowing adaptation but be mindful of your broader goals before you slap on every bell and whistle in pursuit of being 100% for the next session. If your program is correctly periodised and planned, then you won’t always need, or indeed want that to be the case!
Another thing to consider is the specificity of the products themselves. In many of the studies I’ve referred to in this blog, the investigators do not mention the tightness of the products used. As such, it is hard to know how tight they are supposed to be. Potentially, some studies with no positive findings may simply have not used tight enough garments. Scientists do suggest we’re looking for a Goldilocks effect here – it must be tight enough to increase blood flow but not too tight as to stop it. Frustratingly, it doesn’t seem we’re too sure where that level of tightness sits at the moment though.

Despite all of this, I know that some will be confused by reading this. On the other side of this argument is the case for what is probably the strongest reason for compression garments working – the strength of the placebo effect. Maybe the evidence isn’t strong enough to talk you all into purchasing compression garments. And in fact, a lot of them are pretty expensive. But for others, the slightly limited evidence shown here will be irrelevant, as you know it just “works for me”. I would rephrase that as “feel” it works for you rather than “know”, but there’s no doubting the power of placebo.

Maybe I’ll rewrite this in a few years with some more robust studies and we can be more sure one way or the other. For now though it seems that psychological benefits are likely near the top of the list for mechanisms behind any successes linked to compression garments.

Take-home points

It is a shame there isn’t a tighter case to make for the use of compression garments. Having said that, it certainly isn’t the worst sports technology evidence I’ve ever considered. It seems that use during exercise is not as well backed up as it is during post-exercise. It seems that through impacting blood flow, there are positive outcomes in helping people to feel less sore following certain types of exercise. Now you just need to consider whether you actually want to blunt some of these markers of overreaching or whether you’d rather put up with them to benefit from the associated adaptation.

As with so much of sports science, I’m afraid this is a bit of an ‘it depends’ situation. But hopefully now you’re a little clearer on what compression garments are supposed to do, and how close they might be to achieving that.

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Dr. Tom Brownlee

Tom is an assistant professor in applied sports sciences and has worked with elite sports for over 10 years. Previous roles include working as a sports scientist at Liverpool F.C., where he completed his Ph.D., and working across a number of other sports. He is passionate about physiology, coach communication, and high-performance strategy and systems.

Tom graduated with a BSc in 2011 before undertaking an MSc at Loughborough University. He has published 25 academic papers on strength and conditioning, nutrition, and youth development in Sports Medicine, the Journal of Strength & Conditioning Research, and others. Tom also now supervises a number of his own Ph.D. students around the world embedded within sporting organisations.

More content by Tom

The post Compression garments: Do they actually work? appeared first on Science for Sport.

There is good evidence that meditation can play a role in helping athletes achieve a better state of mind when they’re competing, and this translates well across a variety of sports.

By Dr. Tom Brownlee
Last updated: March 23rd, 2025
8 min read

Sports meditation: Yes, no, maybe or sometimes?

Sports stars can be a strange bunch. I suppose it’s fair to say that anyone who is at the top of their industry can behave a little differently to the rest of us (Bezos, Elon and Zuck, I’m looking at you). Sports stars are certainly no different to this rule and whether it’s superstitions around what they eat before they compete, a persona they adopt when they cross the white line, or a desire to be super hyped (Conor McGregor) or calm (Kimi Räikkönen) before they compete, most will have practices they adopt to help them feel ready.

In recent years one of the best pole vaulters in the world has been Yelena Isinbayeva. Between rounds she would lay quietly with a towel over her head with commentators joking she was having a nap. If you’re a ‘get as hyped up as possible’ person you would probably see that and think that she couldn’t be successful, but she was. With two Olympic golds and seventeen World Records, I’m certainly not going to argue with her.

Isinbayeva isn’t the only individual to adopt such tactics either. In tennis we often see players with towels over their heads as they sit quietly between games. Often this includes top players, and their successes suggest that we don’t all need to be shouting and screaming to achieve at the sharp end. Who really knows what’s going on in their heads while the towel is on but with the rise of the use of sports psychologists, it’s not a big stretch to think that some kind of self-talk, focusing and meditation may be happening.

As I mention psychologists it’s time for a disclaimer: I am not one – at all! I am a physiologist. But I’m a physiologist who is interested in helping athletes to maximise their performances. And as such I’m interested in the potential physiological impact of psychological techniques such as meditation. So, let’s learn together and see what the supposed benefits of meditation are, how they affect us physiologically and whether there’s a place for them in our own practice.

First things first – what is meditation?

You probably have an idea for yourself but first of all, what are we actually talking about when we refer to meditation? Historically, I think when people hear the word they will think of mystics sitting cross legged searching for enlightenment. There is likely good reason for this, with evidence of meditation stretching as far back as around 3500 years! More recently we might think of lycra-clad Californian guys and girls searching for their own inner peace between chai lattes.

The actual definition of meditation is quite broad though, being described as a practice of focusing the mind on a particular thought or activity to achieve mental clarity and/or emotional calm. The actual techniques used to practise this are quite varied, but we’ll get to that later.

Benefits of meditation

So, we’ve said that meditation is supposed to help us achieve calm, clarity and a relaxed state. It has also more specifically been shown to lower stress and decrease anxiety, which obviously might be useful in sport. It has also actually been suggested to be able to alter the physical structure of the brain, which I find particularly amazing. This is supposed to be achieved via potentially being able to increase the mass of the corpus callosum and hippocampus, which are responsible for the communication of information between the left and right sides of the brain. They are also important in forming and recalling memories and controlling our emotions. If this is the case, then meditation might be able to help with solving problems, learning skills, and making decisions, which would be very useful for many sportspeople.

Meditation in an athletic setting

So, as always, let’s look into the research to see whether some of these big claims are true. Is meditating going to make us better at our sports? Perhaps it depends on our sport of choice. More stress-based sports such as golf might benefit more from a calmer mind, as those athletes consider and execute shots, compared to the more chaotic goings on of a rugby field. This might be where our meditation style should be considered. Focused attention meditation (FAM) requires the individual to focus on a specific action or object, such as their breathing. This can help to eliminate distractions and aid skills like sinking a crucial putt. The other type of meditation we’ll consider is open monitoring meditation (OMM). This is much more suited to more open sports as it allows focus on all internal and external input before decisions can be made. This type of meditation weakens the focus on the task, as there is so much else going on, but can be more appropriate in these more open type sports.

But does meditation actually work? Well, the evidence in closed sports (sports performed in a stable or largely predictable environmental setting, such as archery, golf, or field events like throwing the javelin) is pretty strong. Following an extended period of integrating meditation into normal training, golfers have been found to improve their performance across a season. It is thought this happens by identifying the right things to focus on.

This may not be surprising though given the kind of sport it is and the benefits of remaining calm, relaxed and focused on the task. The good news is that in a soccer task where meditation was used twice a week for six weeks, shooting performance improved here too. The exact mechanism of these performance benefits are uncertain though it likely shows how meditation can play a part in the toolkit of improved sports performance.

Another potential mechanism behind the successes of meditation is the ability to achieve a state of ‘flow’. Flow is that feeling where you’re ‘in the zone’ and not needing to think about the task at hand. You’ve likely heard sportspeople talk about it in interviews after exceptional performances, though often you and even them don’t know that it’s happened: “Yeah, to be honest I can’t really remember too much of the match!”; “That final set was all a bit of a blur!”; “Looking back on the race now I couldn’t even really tell you that much about it!”. This would be flow. It can manifest as a loss of concept of time, reduction in self-consciousness, a focus on the present and a sense of effortlessness in your endeavours. If only we could bottle it! But it seems meditation can help us find it easier to achieve. This is also backed up by the research and linked to decreases in pessimism.

This sadly isn’t something we can likely tap into in one session though. It seems that at least three weeks seems to be around the point where performance benefits begin to manifest. This isn’t to say there will be no performance benefits at all or no other kind of benefits. Here we come back to two themes that seem to be a running trend in sports science topics – ‘it’s individual’ and ‘the placebo effect’. We need to remember that scientific studies use what we call a sample. This means that maybe 10, 20 or 50 individuals are used in a study to allow the outcomes to be expressed as if they are likely for the whole population. That is why the average response across the whole sample is reported. Some people will respond better, some worse. The bigger the sample the better, as it’s more representative of the population as a whole. You might be one of the good responders and it might only take a week for you to benefit from meditation. On the other hand, you might be a bad responder and it might be longer before you feel a benefit.

The other ever present is the potential for the placebo effect to impact our performance – the placebo effect is real too, there is no doubt about it. If you feel you’re getting a benefit from a practice then you are! And you should keep doing it. If that’s the case for meditation for you then great. At least you can do it for free! Meditative techniques such as focusing on your breathing will also certainly have an effect on your state of calm. This might not directly help you to sink the championship-winning free throw, but it certainly won’t hurt.

Meditation techniques

So, if we think this might be something we’d like to trial, how do we actually go about doing it? If you want some help, there are plenty of apps out there that can help to lead you through it but really it doesn’t have to be too complicated. If you want to keep it simple then you can sit somewhere quiet (you don’t need to be cross-legged!) and concentrate on your breathing. The reason behind using your breathing as an anchor is that thinking of nothing (which is often what people think of as the aim of meditation) is very hard! In fact, even focusing on your breathing is hard. So perhaps start with just three minutes and gradually build it up towards the 20 minute mark.

It’s also recommended by many to do it first thing in the morning – pre-emails, pre-coffee, pre-teeth brushing. This allows you to hopefully focus before your brain starts being pulled all over the place! There are many meditation techniques, and I would advise you perhaps to trial a few to see what you feel most comfortable with.

Take-home points on sports meditation

It feels a lot of my blogs aren’t able to provide strong evidence to back up the use of the technology or practice we’re discussing. It seems today though that we are on sturdier ground – there is good evidence that meditation can play a role in helping athletes achieve a better state of mind when they’re competing. This translates well across a variety of sport types to lead to improved performance. Will it work for everyone? Of course not – not much does, but I would certainly recommend giving it a go. Just keep in mind you likely need a decent level of commitment to it as potentially you’ll feel little benefit initially.

But for a technique that can be practised very cheaply, with low time commitments and no physical effort, what are the downsides? Perhaps there’s a reason it’s been around for thousands of years!

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Dr. Tom Brownlee

Tom is an assistant professor in applied sports sciences and has worked with elite sports for over 10 years. Previous roles include working as a sports scientist at Liverpool F.C., where he completed his Ph.D., and working across a number of other sports. He is passionate about physiology, coach communication, and high-performance strategy and systems.

Tom graduated with a BSc in 2011 before undertaking an MSc at Loughborough University. He has published 25 academic papers on strength and conditioning, nutrition, and youth development in Sports Medicine, the Journal of Strength & Conditioning Research, and others. Tom also now supervises a number of his own Ph.D. students around the world embedded within sporting organisations.

More content by Tom

The post Sports meditation: Can it make a difference to your performance? appeared first on Science for Sport.

Yoga provides many recovery benefits from both physiological and psychological stress, which can correlate to improved athletic performance.

By Will Ambler
Last updated: March 24th, 2025
3 min read

• Some stress is required for athletes to achieve their optimum performance, but it’s a balancing act – too little stress and athletes become bored but if stress becomes too high, they can experience anxiety.
• Yoga provides many recovery benefits from both physiological and psychological stress which correlates to improved athletic performance.
• Athletes should complete two 30-minute yoga sessions per week to maximise their recovery.

Yoga for recovery: Why you should ponder it as an option

Stress is often perceived as inherently bad for athletic performance. It has been cited to be one of the main contributors to feelings of anxiety, depression, and even physiological  issues like cardiovascular disease. Despite technological and medical advancements, stress can be difficult to recognise, manage, and can negatively impact performance.

Despite the negative impact of stress, Yerkes and Dodson (1908) explained not all stress is bad. In fact, some stress is required for athletes to achieve their optimum performance. Commonly referred to as the inverted-U theory of stress, the researchers’ work dictates that performance increases with physiological or mental arousal, but only to a point. Too little stress and athletes become bored, but if stress becomes too high, then the very same athletes can experience acute anxiety or unhappiness, says a leading performance coach.

“Stress and recovery need to be strategically implemented to elicit increases in athletic performance … where lots of coaches struggle today is that they do not emphasise the importance of recovery, or lack the recovery modalities to accurately address both physical and mental stress,” said Paige Schober, assistant athletic performance coach at the University of California, during her Science for Sport Presentation titled ‘Recovery Yoga for High Performing Athletes’.

Athletes commonly experience the following, if stressed:
Physical stress

• Muscle damage
• Fatigue
• Sleep disturbances
• Testosterone imbalances

Psychological stress

• Burnout
• Staleness
• Depression
• Mental health issues

How yoga can mitigate stress

There is a high correlation between the variables studied in physiological and psychological stress accumulation and the benefits of yoga, Schober said.

“If done correctly, yoga can play a key role in maintaining and improving the physical and mental health of athletes whilst also developing athletic performance through improved recovery,” said Schober.

Yoga helps by improving an athlete’s mindfulness, breathing, movement, relaxation response, and psychological resilience. Schober explained that together, this leads to favourable on- and off-field performance improvements including but not limited to:
Physiological benefits of yoga

• Decreased soreness
• Increased pain tolerance
• Improved sleep
• Increased immune function

Psychological benefits of yoga

• Decreased self-reported stress
• Increased energy
• Increased self-reported recovery
• Decreased depression levels

Yoga prescription for athletes

Schober outlined some best practises for how to prescribe yoga effectively for athletes:

• Athletes should complete two 30-minute yoga sessions per week to maximise their recovery.
• An additional 60-minute session is recommended if the athlete’s time schedule accommodates.
• Teach a prolonged exhale technique to take control of breathing during yoga practice.
• With reference to movements, start with a simple, accessible posture to target mobility and flexibility needs.
• Allow your athletes to become more resilient by progressively challenging and overloading through different yoga examples.
• The greatest influencer for athlete buy-in is word of mouth from other athletes who have attended, so be sure to share testimonials from similar other athletes.

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Will Ambler

More content by Will

The post Recovery yoga: how it can help athletes manage stress and improve performance appeared first on Science for Sport.

DOMS is the soreness we get in our muscles caused by micro-traumas, and the chemical processes associated with going above and beyond. But is it dangerous, and how can you avoid or minimise it?

By Dr. Tom Brownlee
Last updated: March 17th, 2025
9 min read

Delayed onset muscle soreness (DOMS): A brief introduction

We all know the feeling. For me, it’s when I attempt to reintroduce squatting into my program. For a lot of the soccer players I’ve worked with over the years, it was the first day back after their off-season when the grounds are hard and they have to start running again. For you, it might be your first five-a-side soccer session in a while and you have to mark someone who’s a little too quick for you, and you’re running around more than a kid on Christmas morning. I’m talking about muscle soreness. And to get all scientific on you I’m talking delayed onset muscle soreness, or DOMS.

You may have heard the term before, and if not, as I say you’ve almost certainly felt it. As its first initial suggests, typically you don’t feel it during the activity, or even straight after. No. This silent assassin typically strikes while we’re asleep and it’s when we wake up and hobble out of bed the next day that we feel the full effects!
Typically, it presents itself as pretty serious muscle ache localised around an area that you used the previous day, such as the glutes and hamstrings following a squat session. The duration of this soreness can be three or four days even in extreme cases. So, what’s going on here? Are we working too hard, and this is our body’s way of saying that it’s damaged? Or is this a necessary evil to make us stronger and if so, what can we do to reduce its severity and duration? Or shouldn’t we be looking to dampen it at all? That’s a lot of questions. So, let’s find out what’s going on.

For those of us who have ever taken 10 minutes to get down the stairs the day after a tough session, this is for you.

Defining DOMS

As the name suggests, this is a muscular soreness that occurs after a specific event. That event in our case is likely to be a bout of exercise. But physiologically, what’s going on in the muscle, why does it happen and why doesn’t it happen to us every time we train?
Let’s start off with some basic muscle physiology. If we were to look at skeletal muscle under a microscope (as opposed to cardiac or smooth muscle, which aren’t involved in moving our bodies), we would see a chequerboard of cells nicely, neatly arranged. When we move, those cells contract or squeeze together – think about when you flex your biceps muscle. You can see it getting shorter when it contracts – that is the result of those cells contracting. After a period of exercise, that neat, ordered microscope image would look quite different. Now we would see a much messier pattern as the cells have become disrupted and damaged. Here, damaged is the correct word but may sound more serious than we need it to – every time we exercise, ideally we are looking for progressive overload. That is to say that what we’re asking our body to do is ever so slightly beyond our current ability. If we don’t do that when we train, then our body has no reason to adapt and become stronger (in the case of weight training). That’s not to say that every session needs to get harder and harder – rest is still important, and we need to periodise our work on a session-by-session, week-by-week and month-by-month basis.

But back to the microscope. So, after our session we would see that damage, or micro-trauma, as it’s known. And it’s a good thing – it’s bringing da gainz! These micro-traumas aren’t solely responsible for DOMS though – in fact you can have DOMS with no trauma, but generally they do factor into the explanation.

As well as the trauma, another factor that can lead to DOMS is some of the chemical changes in our muscle caused by the exercise bout. We’re not talking about lactic acid here though, which is often accused of being a contributor to DOMS. We won’t go too much further into the science here but we’re talking about an increase in hydrogen ions that occur when we exercise. This metabolic stress plays an important role in our recovery as it leads to inflammation. Inflammation has quite a bad reputation but is also very important in aiding recovery and adaptation. These chemicals and inflammation are picked up by nerve endings that tell our brain that something hurts. Our brain is kind enough to then let us know this! Much like inflammation, DOMS is part of the important cycle of repair and growth and as we’ll discuss later we should consider carefully whether we want to eliminate it or not.

Will any training type lead to DOMS?

To some degree, any training type can elicit DOMS if we do enough of it. Some types of exercise will bring about greater DOMS than others though. Eccentric training is the big culprit here. Eccentric training is where our muscles are lengthening under tension. A good example of this might be if you are at the top of a pull-up position and you lower yourself to the start position as slowly as you can. Here it is still your latissimus dorsi (lats) and biceps taking the majority of the work, but this is being done in a lengthening fashion. Again, think of the shape of your biceps muscle during this effort – it’s becoming longer as you go down but it’s doing a lot of work. This is an eccentric contraction and it’s great at producing micro-trauma and subsequently, DOMS.

To this point, we’ve mainly focused on how resistance training causes DOMS, but that isn’t always the case. You may have also experienced DOMS when you’ve upped your mileage when running or another kind of aerobic activity. This is our clue that really it’s the novelness of an activity, coupled with a relatively high intensity, that causes DOMS rather than specifically its type. In fact, going back to eccentric contractions briefly, when aerobically exercising, you may have experienced bad DOMS from a period of running downhill. This is due to the braking forces going through our legs in each step to stop us gaining too much momentum and cartwheeling off to the bottom.

What to do once you’ve got DOMS

Something I’ve been asked a fair few times is “should I not train again while I have DOMS?”. Keeping in mind we now know this soreness is in part linked to micro-traumas and it is part of a recovery process, then there is certainly logic to this question. Well, DOMS will reduce your ability for the muscle to produce full force, which obviously can lead to reduced abilities when we train. It doesn’t seem to worsen the muscle damage though, so when making your decision to train or not you should consider how important it is that you do so. By this I mean, if you’re a recreational athlete who can take an extra day’s rest before coming back firing on all cylinders, then I would do so. For those who really feel they need to get back to it, or perhaps are into their second (or third!!) day of DOMS, you can do so knowing you won’t be causing further issues.

Is there anything we can do to avoid or reduce DOMS?

Now we have a bit of an understanding as to what is causing DOMS, what are the best ways to avoid it? Well, the easiest way, as you may have guessed, is to ramp up our exercise stimuli more slowly. This allows more time for the body to become familiar with the demands we’re trying to place on it. Sometimes we get a little carried away though, and perhaps remember what we could squat eight weeks ago when we last tried – we might take it down by a little, but likely not enough, and then we’re waddling like Donald and Daffy for a week! 
But let’s imagine that we’ve already got this soreness – what can we do? Foam rolling might help, if you can stand the pain of doing it. It’s something you can do yourself and is relatively cheap.

If you are fortunate enough to be able to utilise massage therapy, then there is some positive suggestion that it can help relieve the pain of DOMS. This may be due to increased blood flow to the area rather than by reducing offending metabolites, but the exact mechanism is unclear. The same cannot be said for cryotherapy though, sadly, which pours (ice) cold water on some of the reasoning around cold-water immersion helping reduce muscular inflammation.

On the whole it seems that although there are a few ways of quickening the process, in the case of speeding up the DOMS timeline, time really is a healer. We just have to let our body work through it in the time it requires.

Should we want to speed up recovery from DOMS?

But as I planted the seed earlier, even with these little tips, do we want to get rid of DOMS? For example, despite cold-water immersion being unlikely to reduce inflammation, many will testify that it makes them feel less sore. But if it’s part of recovery and adaptation, surely that soreness is a good thing, or at least a necessary evil? Well, really that depends why we are training and why we might want to get rid of it. If this is our first session of pre-season and we’re looking to adapt and get fitter for what’s to come, then it stands to reason that perhaps we just need to suck it up and get through it. If we have DOMS from our Olympic 100m quarter-final and we have a semi-final and hopefully final tomorrow, then we probably want to try our best to dampen it down!! Here though we must remember that we are far more likely to experience DOMS when we are unaccustomed to the training stimuli. If you’ve made it to an Olympic quarter-final then I’d hope you’ve got enough work in the tank not to cause DOMS in the first place, but you get the idea! 
It’s also important to keep in mind that having DOMS is not the marker of a successful session. In fact, as you get more in the swing of your training you’ll probably experience it less and less. And that’s a good thing. Although DOMS isn’t to be feared, it is relatively painful and it can impact your ability to train, which can lead to reduced motivation. So, get past it, plan your training accordingly and enjoy.

Take home points

So, there you have it. If you didn’t know the name, you had likely experienced the muscular pain following an increase in training load, especially if it was your first effort for a while. DOMS is the soreness we get in our muscles caused by micro-traumas, and the chemical processes associated with going above and beyond a little too over-zealously. It’ll pass, it isn’t dangerous and if you’re really desperate you can actually still do some training while you have it, though lowering the intensity in the form of a recovery-type session is probably your best bet.

Self-massage such as foam rolling or seeing a massage therapist is likely to make it feel a little bit better, but you can be safe in the knowledge that it’ll pass. It’s all about building things up, and in time you’ll be doing way more than you were able to before, and all without a duck waddle in sight!

[optin-monster slug=”nhpxak0baeqvjdeila6a”]

Dr. Tom Brownlee

Tom is an assistant professor in applied sports sciences and has worked with elite sports for over 10 years. Previous roles include working as a sports scientist at Liverpool F.C., where he completed his Ph.D., and working across a number of other sports. He is passionate about physiology, coach communication, and high-performance strategy and systems.

Tom graduated with a BSc in 2011 before undertaking an MSc at Loughborough University. He has published 25 academic papers on strength and conditioning, nutrition, and youth development in Sports Medicine, the Journal of Strength & Conditioning Research, and others. Tom also now supervises a number of his own Ph.D. students around the world embedded within sporting organisations.

More content by Tom

The post Delayed onset muscle soreness (DOMS): What is it, and how can it be minimised? appeared first on Science for Sport.

In episode 83 of the Science for Sport podcast, one of the world’s leading sport performance scientists reveals the truth behind one of the most used recovery methods: ice and cold water exposure.

By Matt Solomon
Last updated: March 17th, 2025
2 min read

Ice baths and cold water recovery: Are they worth the pain?

Recovery from sport is absolutely crucial if you or your athletes want to perform optimally. Unfortunately, there are a plethora of useless contraptions on the market designed to relieve you of your money, and ultimately prevent you from recovering fully before your next big game.

In episode 83 of the Science for Sport podcast, Dr. Robin Thorpe, sport performance scientist and coach, gives you the truth behind one of the world’s most used recovery methods: cold and warm water exposure.

Have you ever sat in an ice bath, freezing your family jewels off, wondering why you even bother with this nonsense? I have, and frankly, I still had massive muscle aches the next day. If this sounds familiar there is some good news: ice baths do actually work. The bad news is, it probably didn’t need to be that cold!
Never again waste time shivering yourself into icy submission – instead heed the advice of Thorpe, who provides the exact knowledge you need to recover fully before your next big game.

Thorpe frames the conversation by suggesting there are a range of complicated methods and gizmos which the literature doesn’t support.

“When you look at the literature, a lot of these interventions and tools have been used for years and years and years. From a physiological perspective, they actually don’t do a lot,” Thorpe said.

How long and how cold do you have to go?

In fact, the former Manchester United sport scientist points out the majority of these interventions probably only provide a placebo effect.

“The main thing it seems to be is there’s a perception of improved recovery, which we know could be attributed to athlete belief effects or the placebo phenomenon.”
So what does work? Well, Thorpe’s research includes in-depth investigations into how athletes can recover faster using hot or cold baths. These methods are backed by science.

“There’s decent literature that suggests the optimal dose-response from cold water, across the research, is going to be around 10 to 12 minutes,” Thorpe said.

Ok, so you have to endure at least 10 minutes of cold to enhance the recovery process, but just how cold does it need to be?
“I think 10 to 12 minutes between eight and 12 degrees Celsius is going to be, I think, a good starting point for anyone working with athletes or for athletes themselves,” Thorpe said.

This sounds pretty attainable, right? Well, according to the good doctor, you can bin off all the icy goodness, and instead you could just fill your bath from the cold tap.

“People historically have been going out and buying absolutely tons of ice at a supermarket, they could just get a pretty decent ratio by just running the cold tap,” Thorpe said.

What about warm water before training?

So there you have it, those super chilled ice baths which turn you into a human penguin might have been missing the mark, you could have just gotten away with a 10-minute dip using the cold tap.

Thorpe goes on to discuss great details on how to use warm water before training, and how he used cold and warm water immersion in an English Premier League setting. So if you need to take your recovery game up a notch, just hit the link below!
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Matt Solomon

Matt is a strength and conditioning coach at Team NL (Dutch Olympic Team). He was also the Lead Academy Sports Scientist/Strength and Conditioning coach at Al Shabab Al Arabi FC. For Science for Sport, Matt works as the group manager for the Coaches Club and is the host of the Science for Sport Podcast.

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