May 2016: Athletic Training



Content courtesy of the National Swimming Pool Foundation

Aquatic rehabilitation continues to gain popularity in therapy circles because of the tremendous physiological benefits seen when working with patients with musculoskeletal, neurological and cardiopulmonary compromise. But the pool can also be an ideal environment for the individual operating at the top of their physiological game – the athlete. 

One of the most obvious advantages of exercising in the pool is the reduction in stress to muscles, tendons and joints during exercise. Plyometric training has been well-documented in the medical literature to enhance dynamic muscle performances, such as vertical jump height, agility, isometric torque in knee extensors, and balance. However, plyometric training may cause inadvertent muscle soreness and injury when these high intensity exercises are not performed correctly.  Aquatic plyometric training offers a solution to gaining muscle strength while reducing the risks associated with land-based plyometric exercises. The buoyancy of water lowers weight bearing on limbs leading to reduction in exercise-related physical stress.

It is important to note, however, that aquatic versions of exercises do not create identical forces or movement parameters as their land-based counterparts (Dell-Antonio, 2016; Heywood, 2016; Huth, 2016; Louder, 2016; Macaluso, 2016; Ruschel, 2016).

Immersion makes it possible to perform balance training and plyometric-based exercises which would be too challenging or risky on land (Hailu, 2016; Kobak, 2016; Scarneo, 2016; Yousefshahi, 2016). Interestingly, warm water immersion (even without exercise) elicits a very similar cerebrovascular and thermoregulatory adaptation as a period of moderate-intensity exercise training (Bailey, 2016). In addition, resistance training can be performed earlier in the rehab process in the pool and certain circulatory and cardio-respiratory benefits can be protected with water exercises during the down time associated with injuries (Sahu, 2016; Shah, 2016). Even breathing patterns are effected by immersion (Yamashina, 2016).

Immersion in cold water is extensively used as a means of active recovery after exercise in order to prevent delayed onset muscle soreness (Adamczyk, 2016; Aguiar, 2016; Asim, 2016; Castleberry, 2016; Garcia, 2016; Ihsan, 2016; Stephens, 2016; Yeung, 2016). 

Individuals looking for an excellent overview of the importance of using the pool for sports conditioning and rehabilitation of the athlete should look to Torres-Ronda’s 2016 review.  


Adamczyk et al, 2016 

This study was designed to evaluate the effectiveness of ice massage versus cold water immersion on tissue temperature and potential benefit to preventing delayed onset muscle soreness (DOMS) after exercise. Seventy-two hours after exercise, a clear decrease in discomfort was observed in both groups compared to the control group. The two applied treatments have proven to be effective both in utilizing lactate and preventing DOMS. The authors recommend the use of ice when athletes experience localized muscle fatigue and cold water immersion when global or generalized muscle injury or fatigue is present. 

Aguiar et al, 2016 

This study assessed the effectiveness of regular post-exercise cold water immersion on cellular stress response after 4 weeks of high intensity interval training (HIIT). Cold water immersion did not affect exercise performance but was able to increase some markers of cellular stress response and signaling molecules related to mitochondria biogenesis.

Asim et al, 2016 

The aim of this study was to examine effects of cold-water immersion after exercise on power responses of wrestlers. Vertical jump height, ropes climb height, and delayed onset of soreness was measured before and after 24 hours and 48 hours after the wrestling training. Cold-water immersion caused decrements in power loss at each follow-up time in comparison to a thermoneutral immersion.

Bailey et al, 2016 

Warm water immersion has recently been shown to enhance vascular function including the cerebrovascular response to heating. This study was designed to compare the effects of exercise with warm-water immersion training on cerebrovascular and thermoregulatory function. Interestingly, they found that warm water immersion elicits a very similar cerebrovascular, conduit, and thermoregulatory adaptation to a period of moderate-intensity exercise training.

Castleberry et al, 2016 

Athletes are consistently pursuing methods to help decrease soreness. The purpose of this study was to evaluate the effects of deep water running (DWR) and cold water immersion (CWI) on perceived muscle soreness and creatine kinase (CK) activity. In this study, neither the DWR nor CWI treatment provided any reduction in CK activity or muscle soreness compared to the control treatment. 

Dell’Antonio et al, 2016 

This study analyzed the effect of water immersion on vertical ground reaction force (GRF) peaks and contact times during the braking, propulsion and landing phases of drop jumps (DJ). The results showed that increasing the level of immersion leads to a decrease in peak force during the braking phase, landing phase as well as in the propulsion phase of the DJ, with the decrease in peak forces between immersions being greater as deeper the immersion level. Increasing the depth of immersion caused an increase in total contact time and in the duration of the braking phase. No differences were found for the duration of the propulsion phase between the conditions.

Garcia et al, 2016 

The researchers in this study evaluated the effectiveness of cold water immersion on recovery of performance (i.e., the ability of repetitively performing a physical test) in rugby players acutely and 12 hours later. Cold water immersion improves 30 second continuous jump performance and total quality recovery and seems to be an easy and practical tool for coaches and players.

Hailu et al, 2016 

The primary purpose of this study was to evaluate the effects of land versus water based fitness program in improving aerobic fitness, muscular strength and speed among young male beginner soccer players. The results indicated that long-term water based performing exercises were better than the land based performing exercises in improving aerobic fitness, muscular strength and speed of beginner soccer players.

Heywood et al, 2016 

Exercises replicating functional activities are commonly used in aquatic rehabilitation although it is not clear how the movement characteristics differ between the two environments. A systematic review was completed in order to compare the biomechanics of gait, closed kinetic chain and plyometric exercise when performed in water and on land. Very large effect sizes showed self-selected speed of walking and vertical ground reaction forces (VGRF) in water were less than on land, however, lower limb range of movement and muscle activity were similar. VGRF in plyometric exercise was lower in water when landing but more similar between the two environments in propulsion. Maximal speed of movement for walking and stationary running was lower in water compared to on land, however was similar in propulsion in plyometric exercise.

Huth et al, 2016 

This study was designed to compare lower extremity running kinematics of female college athletes in an aquatic-based shallow water sprinting environment and in a land-based sprinting environment. The comparisons revealed significant differences in stride rates, stride length, velocity and other variables between land sprinting and aquatic sprinting.

Ihsan et al, 2016 

The use of post-exercise cold water immersion (CWI) is gaining considerable popularity among athletes to minimize fatigue and accelerate post-exercise recovery. The efficacy of CWI for attenuating the secondary effects of exercise induced muscle damage (EIMD) seems dependent on the mode of exercise utilized. For instance, CWI application seems to demonstrate limited recovery benefits when EIMD was induced by single-joint eccentrically biased contractions. In contrast, CWI seems more effective in ameliorating effects of EIMD induced by whole body prolonged endurance/intermittent based exercise modalities.

Kobak et al, 2016 

The purpose of this study was to compare the effects of an aquatic- (W) and land-based (L) plyometric program on balance, vertical jump height, and isokinetic quadriceps and hamstring strength. The study’s results demonstrate that aquatic-based plyometric training can be a valid form of training by producing improvements in balance, force output, and isokinetic strength while concurrently decreasing ground impact forces.

Louder et al, 2016 

Plyometric jumping is a commonly prescribed method of training focused on the development of reactive strength and high-velocity concentric power. The purpose of this study was to quantify acute, biomechanical characteristics of the take-off and flight phase for plyometric movements performed in the water. Results highlight the potential application of aquatic plyometric training as a cross-training tool for improving mechanical power and suggest that water immersion depth and fluid drag play key roles in the specificity of the take-off phase for jumping movements performed in the water.

Macaluso et al, 2016 

In this study, subjects performed arm reaching movements toward visual targets while standing. Targets were presented either close or far from the subjects (requiring in the latter case an additional whole-body displacement). Reaching movements were performed on land or underwater in two different contexts of buoyancy. Results showed that underwater exposure impacted basic movement features, especially movement speed which was reduced.

Ruschel et al, 2016 

Plyometric training in the aquatic environment has been used as way of reducing loads through the action of buoyancy. The aquatic environment can be an alternative when one aims to reduce the load during the drop jump contact; however, the longer duration increasing of contact sub-phases in water at hip immersion may compromise the proper functioning of the stretch-shortening cycle in water.

Sahu et al, 2016 

The objective of this meta-analysis was to observe the trends in the research in reference to the effect of water exercises on the physiology of trained and untrained population and to establish the fact about the water exercise and its responses. The finding of the meta-analysis concluded that water exercises help in the improvement in abilities of the cardio respiratory system and in the reduction of body fat and body mass index.

Scarneo et al, 2016 

Neuromuscular training programs (NTPs) improve landing technique and decrease vertical ground reaction forces (VGRF) resulting in injury risk reduction. This study examined the effects of an aquatic NTP on landing technique immediately and 4-months following the intervention. The researchers found that an aquatic NTP improves landing technique and suggested that the improvements are retained over time. These results show promise of utilizing an aquatic NTP when there is a desire to reduce joint loading, such as early stages of rehabilitation, to improve biomechanics and reduce injury risk.

Shah et al, 2016 

The purpose of this study was to examine the level of pain gets reduced whether by dry-land based concentric-eccentric exercises or by the equivalent type of aquatic exercises in the elite swimmers complaining of chronic shoulder pain. The aquatic concentric-eccentric exercises proved to be efficient for swimmers suffering from swimmer's shoulder condition and early prognosis can be brought with aquatic rehabilitation as compared to the dry-land concentric-eccentric exercises. 

Stephens et al, 2016 

The use of cold water immersion (CWI) for post-exercise recovery has become increasingly prevalent in recent years, however there is a dearth of strong scientific evidence to support the optimization of protocols for performance benefits. This review focuses specifically on why some of the current literature show variability and disparity in the effectiveness of CWI for recovery of athletic performance by examining the body temperature and cardiovascular responses underpinning CWI and how these are related to performance benefits. This review also examined how individual characteristics (such as physique traits), differences in water immersion protocol (depth, duration, temperature) and exercise type (endurance vs maximal) interact with these mechanisms.

Torres-ronda et al, 2016 

This is a review article which highlights the reason aquatic based exercise and recovery protocols are effective. The authors explain why the effects and physical properties of water, such as density, hydrostatic pressure and buoyancy are highly useful resources for training, when used as a counterbalance to gravity, resistance, a compressor and a thermal conductor. Not only does the aquatic medium enable a wider range of activities to be used in a context of low joint impact, but it also constitutes a useful tool in relation to sports rehabilitation, since it allows the athlete to return to training earlier or to continue with high-intensity exercise while ensuring both low joint impact and greater comfort for the individual concerned. Moreover, this medium enables the stimulation of metabolic and neuromuscular systems, followed by their corresponding physiological adaptations allowing both to maintain and improve athletic performance. Hydrotherapy can also play a beneficial role in an athlete's recovery, helping to prevent as well as treat muscle damage and soreness following exercise. 

Yamashina et al, 2016 

The purpose of the present study was to evaluate the effect of water immersion at different water depths on respiratory function and the effect of inspiratory load breathing (ILB) during water immersion at different water depths on respiratory muscle strength evaluated by maximum inspiratory and expiratory pressures. The study demonstrated that forced respiration during deeper water immersion caused greater inspiratory muscle fatigue in healthy young men. 

Yeung et al, 2016 

This study aimed to investigate the effects of cold water immersion on muscle oxygenation and performance during repeated bouts of fatiguing exercise. The results showed that cold water immersion attenuated decreased tissue oxygenation in subsequent exercise performance, the metabolic response to exercise after cold water immersion is worthy of further exploration.

Yousefshahi et al, 2016 

This study was done to evaluate the impact of an aquatic physical balance training course. Their findings showed that aquatic balance training is temporarily is a good alternative for physical exercise in individuals who do not have the ability to perform physical balance exercises due to rest or those who have any nervous-skeletal damage that make such exercises too difficult on land.


Adamczyk, J. G., Krasowska, I., Boguszewski, D., & Reaburn, P. (2016). The use of thermal imaging to assess the effectiveness of ice massage and cold-water immersion as methods for supporting post-exercise recovery. Journal of Thermal Biology, 60, 20–25. doi:10.1016/j.jtherbio.2016.05.006

Aguiar, P. F., Magalhães, S. M., Fonseca, I. A. T., da Costa Santos, V. B., de Matos, M. A., Peixoto, M. F. D., … Amorim, F. T. (2016). Post-exercise cold water immersion does not alter high intensity interval training-induced exercise performance and Hsp72 responses, but enhances mitochondrial markers. Cell Stress & Chaperones, Epub ahead of print. doi:10.1007/s12192-016-0704-6

Asim Cengiz, & Mehmet Settar Kocak. (2016). Effects of water immersion on the recovery of upper and lower body anaerobic power following a wrestling session. International Journal of Human Sciences, 13(1), 1402–. Retrieved from

Bailey, T., Cable, N., Miller, G., Sprung, V., Low, D., & Jones, H. (2016). Repeated Warm Water Immersion Induces Similar Cerebrovascular Adaptations to 8 Weeks of Moderate-Intensity Exercise Training in Females. International Journal of Sports Medicine, Epub ahead of print. doi:10.1055/s-0042-106899

Castleberry, T. J., BenEzra, V., Deemer, S., Niemann, T., & Foreman, J. (2015). The Effects of Deep Water Running and Cold Water Immersion on Muscle Soreness. International Journal of Exercise Science: Conference Proceedings, 2(7). Retrieved from

Dell’Antonio, E., Ruschel, C., de Brito Fontana, H., Haupenthal, A., Pereira, S. M., & Roesler, H. (2016). Effect Of Immersion On Ground Reaction Force And Contact Time During Drop Jump Exercise. The Journal of Strength & Conditioning Research, Epub Ahead of Print. doi:10.1519/JSC.0000000000001446

Garcia, C. A., da Mota, G. R., & Marocolo, M. (2016). Cold Water Immersion is Acutely Detrimental but Increases Performance Post-12 h in Rugby Players. International Journal of Sports Medicine, Epub ahead of print. doi:10.1055/s-0035-1565200

Hailu, E., Rani, S., & Deyou, M. (2016, February 24). Effects of land versus water based fitness program in improving aerobic fitness, muscular strength and speed among young male beginner soccer players. Turkish Journal of Kinesiology. Epub ahead of print Retrieved from

Heywood, S., McClelland, J., Geigle, P., Rahmann, A., & Clark, R. (2016). Spatiotemporal, kinematic, force and muscle activation outcomes during gait and functional exercise in water compared to on land: A systematic review. Gait & Posture, 48, 120–130. doi:10.1016/j.gaitpost.2016.04.033

Huth, L., Schmidt, E., & G Killgore. (2015). Kinematic Differences between Land and Shallow-water Sprinting. International Journal of Exercise Science: Conference Proceedings, 8(3). Retrieved from

Ihsan, M., Watson, G., & Abbiss, C. R. (2016). What are the Physiological Mechanisms for Post-Exercise Cold Water Immersion in the Recovery from Prolonged Endurance and Intermittent Exercise? Sports Medicine (Auckland, N.Z.), Epub ahead of print. doi:10.1007/s40279-016-0483-3

Kobak, M.S., Rebold, M.J., Desalva, R., & Otterstetter, R. (2015). A Comparison of Aquatic-vs. Land-Based Plyometrics on Various Performance Variables. International Journal of Exercise Science, 8(2), 134–144. Retrieved from

Louder, T. J., Searle, C. J., & Bressel, E. (2016). Mechanical parameters and flight phase characteristics in aquatic plyometric jumping. Sports Biomechanics / International Society of Biomechanics in Sports, 1–15. doi:10.1080/14763141.2016.1162840

Macaluso, T., Bourdin, C., Buloup, F., Mille, M.-L., Sainton, P., Sarlegna, F. R., … Bringoux, L. (2016). Kinematic features of whole-body reaching movements underwater: Neutral buoyancy effects. Neuroscience, Epub Ahead of Print. doi:10.1016/j.neuroscience.2016.04.014

Marinho-Buzelli, A. R., Barela, A. M., Barela, J. A., Celestino, M. L., Popovic, M. R., & Verrie, M. (2016). The Influence of the Aquatic Environment on Gait Initiation: A Pilot Study. Motor Control, Epub ahead of print. doi:10.1123/mc.2015-0091

Ruschel, C., Dell’Antonio, E., Fontana, H. de B., Haupenthal, A., Hubert, M., Pereira, S. M., & Roesler, H. (2016, March 16). Biomechanical analysis of the contact phase in drop jumps performed in water and on dry land. Brazilian Journal of Kinanthropometry and Human Performance. Epub ahead of print. Retrieved from

Sahu, M., & Sharma, K. (2016). Physiological Responses of Water Training on Athletes: A MetaAnalysis. Journal of Physical Education Research, 3(1), 64–72. Retrieved from

Scarneo, S. E., Root, H. J., Martinez, J. C., Denegar, C., Casa, D. J., Mazerolle, S. M., … DiStefano, L. J. (2016). Landing Technique Improvements after an Aquatic-Based Neuromuscular Training Program in Physically Active Females. Journal of Sport Rehabilitation. Epub ahead of print. doi:10-1123/jsr.2015-0052

Shah, P. K., & Koley, S. (2016). Swimmer’s Shoulder in Athletes: Comparison between Efficacy of Aquatic versus Dry-land Concentric-Eccentric Exercises. Human Biology Review, 5(52), 168–175. Retrieved from

Stephens, J. M., Halson, S., Miller, J., Slater, G. J., & Askew, C. D. (2016). Cold Water Immersion for Athletic Recovery: One Size Does Not Fit All. International Journal of Sports Physiology and Performance, Epub ahead of print. doi:10.1123/ijspp.2016-0095

Torres-Ronda, L., & Del Alcázar, X. S. I. (2014). The Properties of Water and their Applications for Training. Journal of Human Kinetics, 44, 237–48. doi:10.2478/hukin-2014-0129

Yamashina, Y., Yokoyama, H., Naghavi, N., Hirasawa, Y., Takeda, R., Ota, A., … Okazaki, K. (2016). Forced respiration during the deeper water immersion causes the greater inspiratory muscle fatigue in healthy young men. Journal of Physical Therapy Science, 28(2), 412–418. doi:10.1589/jpts.28.412

Yeung, S. S., Ting, K. H., Hon, M., Fung, N. Y., Choi, M. M., Cheng, J. C., & Yeung, E. W. (2016). Effects of Cold Water Immersion on Muscle Oxygenation During Repeated Bouts of Fatiguing Exercise: A Randomized Controlled Study. Medicine, 95(1), e2455. doi:10.1097/MD.0000000000002455

Yousefshahi, M. & Parsaei, N. (2016). The Impact of an Aquatic Physical Balance Training Course On the Static Balance of Novice Damaged Athletes. International Journal of Biology, Pharmacy and Allied Sciences, 5(1), 398–408. Retrieved from IJBPAS 2016 JAN SPCL 1119.pdf