Recovery: Hydrotherapy and Foam Rolling

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In 2017 there was a nice review of the effectiveness of two hydrotherapy techniques, cold water immersion (CWI) and contrast water therapy (CWT), for recovery with team sport athletes. Hundreds of universities and professional organizations have been promoting one or both of these strategies after practice, strength/cardiovascular training, or a competition and now we can better understand if this worth our while. Enjoy.

Inclusion Criteria: “To be included, studies were required to use a physiological stressor associated with team sport. This could include competitive games, simulated competitive games, team training, or combinations of the above. Studies were to include comparison between postexercise recovery modalities associated with hydrotherapy and at least one other group, and examined a time period of no less than 24-hour postphysiological stressor.”

Populations: “Participants were required to be reported as free from injury or illness and further classified as either/or well-trained, athletic, elite/semi-elite, professional/ semiprofessional, and academy/institute team athletes. Studies evaluating untrained, recreational athletes or athletic status not disclosed were excluded.” Of a total of 606 participants, 506 of which were male.

Immersion Methodology: “Studies used a range of times for immersion when applying CWI including a total time immersed of 10 minutes (n = 12), which included 7 studies applying 2 cycles of 5- minute immersions and 1 study applying 5 cycles of 2- minute immersions. Additional immersion times included a single 15-minute immersion (n = 2), 5-minute immersion (n = 7) either as a single 5-minute immersion (n = 3) or 5 cycles of 1-minute immersion (n = 4). Temperatures for cold water ranged between 5 and 158 C with most studies applying cold water between 10 and 128 C (n = 20). Hot/warm water temperatures ranged between 38 and 428 C in most studies (n = 13) applying CWT with immersion times of between 1 and 3 minutes.”

“Data collection time points included baseline, within 1 hour (n = 18), 24 hours (n = 18), 48 hours (n = 8), 72 hours (n = 1), 96 hours (n = 2) and 7 days (n = 3), postexercise stressor. Six studies included other data collection points”

Results by Outcome Measurement:

Counter-Movement Jump: CWI was beneficial for recovery 24 hours post stressor (p = 0.05, CI: 20.004 to 0.578). CWI and CWT were not effective at 1 hour post stressor (1 hour: p = 0.07, CI: 20.004 to 0.863; 24 hours: p = 0.46 CI: 20.227 to 0.498; 48 hours: p = 0.39, CI: 20.191 to 0.489).

Best Sprint Performance: CWI enhanced recovery at 24 hours post stressor (p = 0.02, CI: 20.056 to 0.801). CWI had minimal effect on enhancing recovery at 1, 48, and >90 hours post stressor (1 hour: p = 0.07, CI: 20.039 to 0.873; 48 hours: p = 0.15, CI: 20.159 to 1.068; .90 hours: p = 0.15, CI: 20.093 to 0.591).

Accumulating Sprints: CWI was not effective at 24, 48, and 72 hours post stressor (24 hours: p = 0.29, CI: 20.189 to 0.637; 48 hours: p = 0.44, CI: 20.171 to 0.392; 72 hours: p = 0.07, CI: 20.062 to 1.209). 

Perception of Muscle Soreness: CWI did not enhance perception of muscle soreness at 1, 24, 48, or 72 hours post stressor (1 hour: p = 0.20, CI: 20.192 to 0.920; 24 hours: p = 0.08, CI: 20.092 to 1.936; 48 hours: p = 0.41, CI: 21.632 to 4.011; 72 hours: p = 0.09, CI: 20.121 to 1.555).

Subjective Measures of Fatigue and Effort: CWI did enhance athletes’ perception of fatigue and recovery 72 hours post stressor (p = 0.03, CI: 0.061–1.418). CWT did enhance athletes’ perception of fatigue and recovery 48 hours post stressor (p = 0.04, CI: 0.013–0.942) CWI did NOT enhance athletes’ perception of fatigue and recovery at 24, 48, or 90 hours post stressor points (24 hours: p = 0.44, CI: 20.264 to 0.611; 48 hours: p = 0.28, CI: 20.309 to 1.063; .90 hours: p = 0.16, CI: 20.240 to 1.422) CWT did not enhance perceptions of fatigue and recovery 24 hours or 72 hours following exercise stressor (24 hours: p = 0.59, CI: 20.373 to 0.661; 72 hours: p = 0.08, CI: 20.082 to 1.408).

Biochemical Markers: CWI did NOT enhance creatine kinase clearance 24 hours post stressor (p = 0.06, CI: 20.009 to 0.658).

In summary, there are two primary correlations where hydrotherapy may be beneficial:

  • There may be a neuromuscular benefit to recovery from CWI. This was displayed by the counter-movement jumps and single sprint times. More research should be spent in this window with specificity to events lasting roughly 1-5 seconds, focused highly on the endeavors demanding of the creatine-phosphate system. This may be critical to a power athlete competing in successive days, approximately 24 hours apart.
  • Subjective perceived data remains inconsistent and I remain indifferent.



It seems that there are people on both ends of the spectrum with foam rolling. There are extremists who claim it is critical to mobility and recovery while others consider it a waste of time. This study wanted to examine potential effects foam rolling may have on recovery for elite Spanish soccer players. The conditioning of these athletes is impressive. During a 90 minutes match, time-motion analysis has found that these elite soccer players are covering greater than 6 miles, “…attaining approximately 80–90% of maximal heart rate and 70–80% of maximal oxygen uptake.”

“FR is an emerging recovery method, based on self-myofascial release (33), with several proposed physiological effects, similar to those of massage, that may assist in recovery from fatigue, including the ability to improve arterial function, improving vascular endothelial function, reducing muscle soreness, and decreasing parasympathetic nervous system activity (2).”

Some previous literature has “…shown the effectiveness of FR on recovery reporting reductions in muscle soreness (6,17,25) and performance improvements in sprint (25), jump (17,25), agility (25), muscle activation (17), and passive and dynamic range of motion (17) in comparison with various control conditions.”

Subjects: “Eighteen Spanish professional soccer players volunteered for this study (Mean ± SD; age= 26.6 ± 3.7 years; height= 180.5 ± 4.55 cm; weight = 75.8 ±4.7 kg; body fat percentage= 10.2 ± 0.8; 1RM back squat= 156.7 ± 24.9 kg; VO2 peak= 61.2 ±4.2 ml-1 kg-1 min-1).”

Methods: “This study used a 2-group, randomized controlled trial design, including 2 experimental sessions, to compare the effects of 2 posttraining recovery modalities on anaerobic performance, flexibility, and subjective ratings 24 hours after a training session.” The tests performed were a counter-movement jump, 5m sprint, 10m sprint, T-test, sit and reach, and perception of soreness. During the study, nutrition was controlled, as well as total workload of both groups to mitigate any disadvantages in muscle damage. The protocol for the foam rolling group began approximately 3 minutes after the training session, rolling “…at a cadence of 50 beats per minute (25). The five exercises covered the gluteals, hamstrings, quadriceps, adductors, and plantarflexors “…on both the right and left legs for two 45-s bouts each with a 15-s rest (25).” The passive group remained seated during this time.


CMJ decreased in both groups 24 hours after training (P=0.461).

No statistical significant differences in 5m or 10m sprint times (P =0.109 and P = 0.200, respectively).

The foam rolling group had less decrements in the T-test than the passive group (ES=1.06).

Sit and Reach displayed “…no significant main effects of time (P = 0.162) and group (P = 0.424) and no significant time × group interactions (P = 0.070).”

Lastly, foam rolling had a large effect on both perceived recovery measures “…TQR (ES = 1.08) and VAS (ES = 1.02) in comparison to passive recovery group at 24 h post-training.”

Two primary findings from this study:

  • No significant differences elicited by foam rolling for counter-movement jump, 5m and 10m sprints, and sit and reach tests.
  • Immediate foam rolling was effective in reducing decrements in T-test time and mitigating perceived levels of soreness/muscle pain. It could be true that neuromuscular coordination, in this case multi-directional agility, is influenced by foam rolling to a small degree. More likely, foam rolling may allow for a decreased muscular tone following a session- which would allow an athlete to feel more supple. 

 The reoccurring theme in the current literature in based on improvements in self-reported DOMS. “Previous studies in healthy physically active males (17) and physically active resistance-trained males (25) have shown foam-rolling exercises can reduce the subjective perceived delayed onset of muscle soreness measured by pressure pain thresholds and a visual analogue scale.”

“In summary, results of the current study indicate post-training foam rolling exercises may help in restoring muscle soreness, player’s perception of recovery, and agility on the following day in professional soccer players.”


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