I am a bit upset that as physios we seem to be in the business of confusing each other rather than making things clearer. Someone brought evidence on the inefficacies of cold water immersion on DOMS, just one evidence and we are only following suite. what happened to the heirachy of evidence trailing?where consistent evidence from one or two RCTS or systematic reviews maybe?
There are evidences out there suggesting that the same ice water immersion is effective, the only cryotherapy technique investigated in addition is ice massage and that has been proven ineffective.

We need to look at the bigger picture first. DOMS is not a normal acute muscle lesion like a strain.Reasons, it is a readaptive remodelling process hence further injury does not occur with subsequent eccentric exercise rather symptoms go down. secondly, unlike strains, focal myofibrillar disruptions occur but strains often occur along the length of the fibers, thirdly the symptoms of DOMS are independent of each other and occur and resolve at relatively different time scales. It takes about a week for a muscle affected byDOMS to recover but in strains 3weeks. the highest intensity DOMS as shown in the literature takes maybe 2weeks at the most. so therefore even if ice does not work for DOMS it does not mean it should be questioned for classic strain injuries.two different things entirely, dont get it twisted.

Inflammatory indices and myofibrillar indices are very unreliable when used as markers of DOMS muscle damage because they can get cleared from the system easily and individual response is variable. Gender and age have been identified as possible factors predetermining DOMS. So how can you compare the effects of ice or immersion on DOMS with strain injuries?
I left a thread correcting the false notion on ice left by physiomitch in order to bring back the false brain teasers left due to mis information.Before you give judgenment on any paper u should learn to critique and appraise it. That way you make judgements as a true professional not a technician.read the literature on DOMS again not just one paper and get the clearer picture. Read the literature on Ice again and get a clearer picture and stop confusing busy physios who do not have the time to check this evidences themselves.

Please, please, please leave ice alone...or else you will be managing sports people wrongly and causing more damage. If anyone is looking to think laterally, let it be along the lines of what you have been doing that has not worked.then you have basis for argument, its all about making the practice better and more effective.

Vasodilation in acute injury is accompanied by, leaking blood vessel membrane, extravasation of fluid and swelling. True inflammation is needed and it is needed to only ensure that scar is formed. You have been too concerned with vascular responses alone, cell mediated hormonal responses also occur. If inflammation is not controlled, SECONDARY HYPOXIC INJURY WILL OCCUR! plus further damaging the tissues because nearby cells will die(APOPTOSIS) and leak out substances that hurt and kill other cells. inflammation directs fibroblast and macrophage activity and that is
important however excess inflammation leads to too much scar , adhesions and deformity. GET IT! so ice is not only concerned with vessel diameters, there is a bigger picture to see. Please stop confusing people. the body can vasoconstrict on its own and it surely will depending on vessel or area injured which means larger vascular injuries will take time to plug, by that time do u know how much hypoxic starvation of cells could have occurred? you need to control inflammation, ice does not cure, it controls inflammation and is discontinued once inflammation is believed to be appreciably controlled assessed by pain and swelling. GET IT!

the only damage you will get from ice is if u leave it on for too long or the patient finds it hard to tolerate. If you do not use ice in an acute phase and u use the other option heat this is what will happen. vessels that are damaged will further expand leaking out fluid from their membranes and causing more swelling and pain. why would you want to do that to ur patient?

your idea about compensation from the cardivasular system is odd because the only areas the CVS holds priority are the vital organs and brain. hence you have peripheral shut downs and maintenance of core temp in cold situations. If the CVS can do that effectively in a cold weather, do you think a measly 20minutes of local ice to an area not even the sized of the fist would be a problem?think about it logically. If anything at all you should be screening for contracindications e.g vascular diseases, heart conditions etc.
I hope this puts an end to this brain teaser that is seriously backed by either misinformation or pure misinterpretation of good information.