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Temporal dynamics of muscle strength recovery following acute Cold-Water Immersion: A Systematic Review and Meta-Analysis

anatomy-and-physiology
kinesiology
biomechanics
sports-injury
sports-medicine

Abstract

Objective: This study aimed to investigate the time-dependent effects of a single bout of acute cold-water immersion (CWI) on the recovery of post-exercise maximal muscle strength, explosive power, biochemical markers of muscle damage, and subjective pain, with the specific goal of determining the optimal temporal window for its practical application.
Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane Library, and Embase databases for studies published from inception to September 1, 2025. Randomized controlled trials (RCTs) comparing a single bout of acute CWI with passive recovery regarding their effects on post-exercise strength recovery in healthy individuals were included. Methodological quality and risk of bias were assessed using the PEDro scale and the RoB 2 tool, respectively. Statistical analysis was performed using Stata-MP 18.0 software.
Results: Twenty-two high-quality studies were included. Compared with passive recovery, CWI significantly reduced overall CK levels (g = -0.29, 95% CI: -0.45 to -0.12, p < 0.01) and DOMS (g = -0.49, 95% CI: -0.82 to -0.15, p < 0.01). While no overall effect was found for MVIC or CMJ, CMJ recovery exhibited significant time-dependence (p < 0.01), characterized by performance inhibition at 0 h (g = -0.66, 95% CI: -1.14 to -0.18, p = 0.01) that resolved by 24 h. Peak efficacy occurred at 24 h for CK reduction (g = -0.49, 95% CI: -0.79 to -0.19, p < 0.01) and at 0 h for analgesia (g = -0.49, 95% CI: -0.82 to -0.15, p < 0.05). Sensitivity analyses and bias assessments confirmed these findings were robust.
Conclusion: A single acute CWI exhibits a clear time-dependent effect on post-exercise muscle recovery. CWI temporarily inhibits explosive power performance at 0 hours post-exercise while producing a significant analgesic effect. At 24 hours, the effects on muscle damage (CK) and muscle soreness (VAS) are relatively consistent. By 48-72 hours, these effects tend to diminish. Therefore, CWI is suitable for short-term recovery strategies aimed at “next-day recovery” but is not recommended for situations requiring immediate recovery of explosive power.
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