Cryotherapy: Recovery or Performance?
If you played competitive baseball, you know the feeling of achiness in your throwing shoulder and elbow a day after a start on the bump. If you are so interested as to why you are feeling this soreness, check out one of my previous posts.
There is a TON of research on how we can increase on-field performance for the baseball player. It is overwhelming. However, sometimes we forget about how we should recover from our last start.
If we do not properly take care of our arm before, during, and after a start, our arm will metaphorically “yell” at us for not taking care of it.
It is also well known that throwing-induced injuries are on the rise across multiple populations. No matter whatever the cause may be, this brings us back to the importance of recovery strategies to delay fatigue and reduce our risk of injury.
With that being said, I think post-game arm care may be the most important aspect of recovery for the baseball pitcher.
This article will focus on why cryotherapy may be a modality to help you facilitate the recovery process and increase your performance.
Cryo: cooling. The cooling effect on the body has been used mostly as a recovery agent in research. Until recent, cryotherapy is showing to be a potential aid in performance as well.
Most pitchers rest between innings and throw on a jacket to keep their body temperature elevated. Not to say that we shouldn’t do so, but some research is shedding light on using cold therapy modalities in the recovery process for activities like pitching.
Cryotherapy has been shown to reduce overuse symptoms of pain, swelling, and inflammation. Interestingly, cold therapy has also shown to increase muscle activation, maintain repeated performance, and improve sprinting performance (according to a few studies).
Linking cryotherapy and baseball performance is very new. One study found that cryotherapy reduced the amount of muscle soreness and increased throwing velocity without affecting accuracy. Although, this particular study did not control for pitch count, so the subjects may not have thrown enough pitches to get that physiological response.
However, there is not enough research on using cryotherapy to delay muscle soreness. My guess is that there are multiple factors that cannot be controlled. A good amount of protein and carbohydrate, light-intensity activity, and a full night of sleep is your best bet.
Cryotherapy performed with light-intensity exercise, to date, are the preferred methods for minimizing shoulder strength loss. However, these findings that I am mentioning are not specific to the violent nature of throwing a baseball.
8 trained amateur baseball pitchers were used in this study. The first thing that comes to mind when reading that sentence is that the effect size (overall strength) of the study will not be big enough to make a valid claim. However, the results of this study are still important.
The pitchers were asked to throw a fastball from the mound every 20 seconds, with 12 pitches being recorded each inning. Pitchers threw a total of 5 simulated innings since this is the amount that you need in a 9-inning game to record a “win”. Therefore, total volume of pitches was controlled (60).
6 minutes of rest were given between simulated innings to replicate real-life scenarios.
Pitch velocity was used with a radar gun, which was not previously mentioned in other studies to be reliable. The average pitch speed was recorded for each inning as well as over 5 innings.
Once the pitchers were familiarized with the protocol, they were randomly selected to either the experimental (cryotherapy) or the control group (no cryotherapy).
The pitchers in the experimental group used ice bag cooling of the shoulder and forearm of the throwing arm.
Prior to, between, and after each inning, pitchers were asked to give their perceived recovery status (PRS) on a scale from 0-10: 10 being fully recovered, 0 being not recovered at all.
The Borg RPE scale was also used to assess physical exertion. The scale runs from 6-20: 6 indicating no exertion, and 20 indicating maximal exertion. Pitchers recorded their RPE at the end of each inning.
During the study, there were 2 experimental trials that were separated by 5-7 days, the usual split for a major-league baseball player.
The results of this study are rather interesting. First, there was no statistical difference between groups in the first inning. These data should not alarm you because since both groups were basically equal in throwing velocity in the first inning, all pitchers were well rested and it would be easier to track changes over the course of the 5 innings.
With that being said, if one group already threw harder than the other, then this would be a limitation.
Second, over the course of all 5 innings, the experimental group had a higher throwing velocity than the control. Interestingly, the experimental group had significantly higher throwing velocities in the 4th and 5th innings.
Rather than just looking between groups, it is also important to look within-groups. Just by looking at the numbers in the chart above, you can see that the experimental group barely lost ANY velocity over the course of 5 innings of work. Without the PRS data, I can already see that these pitchers were well recovered between innings.
For the control group, although velocity showed a decrease every inning, this is not alarming because this is normal. A decrease in throwing velocity indicates fatigue, which a pitcher will accumulate by the 5th inning or so.
The experimental group significantly improved their recovery between innings and had a 35% reduction in perceived exertion in comparison to the control group.
The Borg RPE scale (6-20) has been used for detecting intensity levels for aerobic activity. Although pitching is not an aerobic activity, the findings are still interesting (to learn more, click here).
While comparing these results to another previous study, intermittent cryotherapy resulted in an increased total work in a simulated game (26% more pitches). However, further research is needed to generalize these results.
Although throwing volume over a game can increase, we know that total throwing volume is one of the risk factors for overuse injuries, and the effects of cryotherapy and the reduction of overuse injuries are still unknown.
As previously mentioned, the cryotherapy may have aided in the attenuation of throwing velocity loss due to its pain-relieving effects.
Discussion: What Does This Mean for You?
This research does give us some information on a modality that can facilitate a quicker recovery process. In the game of baseball, the pitcher usually wants to keep the arm “warm” between innings to stay loose.
Now we know that applying ice therapy to the throwing shoulder between innings does not have any negative effects on performance.
But, don’t some studies say that icing actually makes recovery worse? Yes, there are some studies, so that is why this study is pretty interesting. Although throwing velocity did not go up a ton (about 1.5 miles per hour), it still raises some eyebrows.
So, why/how does cryotherapy work?
As we apply ice to the skin, blood vessels vasoconstrict (get smaller in diameter) and eventually cool the muscle temperature to decrease the rate of metabolism. This helps to break the “pain-spasm” cycle.
I think that using ice should be looked at as a recovery method rather than a tool that will “enhance” your performance.
What else can be used with ice? Well, light-intensity exercise seems to work too, but I like the Marc Pro device.
In brief, the Marc Pro uses electrical impulses that allow your muscles to involuntarily contract. It’s not to be thought of as electrical stimulation therapy, but the inherent nature of the device allows blood flow to be flushed in and out of the muscles being contracted to allow for a quicker recovery process.
If you want to do more research on this device, visit their website.
To keep it “cool”, I would advise throwers to intermittently use ice, regular light-intensity activity, adequate nutrition, and a good night sleep!
Jarad Vollkommer, CSCS
Bishop, S.H., Herron, R.L., Ryan, G.A., Katica, C.P., and Bishop, P.A. (2016). The effect of intermittent arm and shoulder cooling on baseball pitching velocity. Journal of Strength and Conditioning Research 30(4), 1027-1032.