In a previous post I discussed the ongoing debate around post-exercise ice baths and cold-water immersion (CWI) in athletes. The evidence for adults is already nuanced — but when we shift the focus to adolescent athletes, the picture becomes considerably more complex, and the caution warranted becomes considerably greater.

In 2015, together with my colleague Dr Andrew Murray (currently working with the NBA), we published a systematic review and meta-analysis examining the scientific rationale for cold applications in young athletes. The paper — published in Extreme Physiology & Medicine — asked a question that is surprisingly rarely posed: is the evidence base we use to justify ice baths in adult elite athletes in any way transferable to adolescents? The short answer, as you will see, was (and most probably still is) no (but I will let you make your mind up).

Why Adolescents Are Not Small Adults

The foundational assumption underlying most youth recovery practices is a straightforward (and wrong) transfer: if elite adult athletes use ice baths, then junior athletes should too. Coaches and parents, attracted by what they see in professional sport, replicate these practices without questioning the rationale, safety, or developmental implications. This is precisely the problem.

The physiological differences between adolescent and adult athletes are not trivial. Several lines of evidence point to the fact that young athletes are inherently less susceptible to exercise-induced muscle damage than adults — which fundamentally changes the cost-benefit calculation for cold water immersion.

Key finding: Pre-pubertal youths recover faster from high-intensity exercise than adults, partly due to lower relative power outputs, but also because of relatively greater muscle flexibility and compliance — making their muscles structurally less vulnerable to mechanical damage in the first place.

Adolescents have a higher proportion of type I (slow-twitch) muscle fibers, which are less susceptible to eccentric damage. They also show a more pronounced and rapid repeated-bout effect — the protective adaptation that reduces muscle damage from subsequent bouts of the same exercise — which occurs more readily in young males than in adults. Levels of creatine kinase (CK), the blood marker most commonly used to justify recovery interventions, are systematically lower in young athletes performing exercise of the same relative intensity compared to adults, even when body weight is accounted for.

These are not minor footnotes. They mean that the biological “need” for aggressive recovery interventions — however modest in adults — is even smaller in young athletes.

The Muscle Growth Problem

Perhaps the most important concern centres on one of the primary goals of training young athletes: building muscle. The mechanistic pathway from exercise to muscle hypertrophy depends critically on the post-exercise inflammatory cascade. This is not a side-effect to be suppressed — it is the signal.

After intense exercise, the inflammatory response — involving reactive oxygen species, cytokines such as IL-6, neutrophil accumulation and satellite cell activation — drives the remodeling of skeletal muscle tissue. Cold-water immersion blunts this entire cascade. In adult athletes who have already developed their muscular base, this trade-off may occasionally make sense in a competition context (where reducing soreness quickly matters more than maximising adaptation). But in adolescents still in the process of developing their muscular system, suppressing this physiological signal during training periods could directly impede the very adaptations that training is designed to produce.

⚠ Developmental concern

The evidence suggests that regular post-training cold-water immersion during the critical windows of adolescent development may attenuate the muscle remodeling adaptations that are the long-term objective of the training programme. In a population still building foundational physical capacity, this is a significant cost

What Our Review Found

Our systematic search at the time identified 17 articles meeting inclusion criteria for the review, with a further meta-analysis conducted on those studies reporting outcomes amenable to pooling. The evidence base for cold applications in adolescent athletic populations was found to be extremely limited — and the few studies that did exist were methodologically heterogeneous, with small samples, variable protocols and high risk of bias.

The meta-analysis of CWI effects on creatine kinase levels showed a statistically meaningful reduction in CK at 24 and 48 hours post-exercise. However, as our review carefully explains, reduced circulating CK does not straightforwardly equate to better recovery, faster adaptation, or improved performance. It reflects a blunting of the inflammatory marker — and in a young athlete, that blunting may come at the expense of downstream adaptation.

Evidence for improvements in perceived soreness, performance markers, or functional recovery in adolescent-specific populations was either absent or inconclusive. Crucially, no studies examined the long-term effects of regular CWI use on muscle development, hormonal milieu, or athletic adaptation in this age group.

The Psychosocial Dimension

There is a dimension of this issue that is rarely discussed: the psychological and social dynamics that surround the use of ice baths in young athletes. Our review highlighted research suggesting that young athletes may endure ice baths not because of genuine physiological need but because of social expectation, peer pressure, or the desire to mimic what they perceive elite adult athletes do. Studies in young individuals have even shown a relationship between feelings of guilt and the ability to endure cold-water immersion — suggesting that some of the “benefit” may be bound up in a kind of ritual discomfort rather than physiology.

The placebo effect is also highly relevant. Research in adults has shown that thermoneutral water immersion produces similar perceived recovery outcomes — suggesting that the expectation of benefit is doing considerable work. Building a culture in youth sport where post-training pain and discomfort are seen as always requiring an intervention could have long-term implications for how young athletes relate to their bodies, their recovery, and their sport.

Figure 1. Schematic diagram of the post-exercise physiological cascade with and without cold-water immersion (CWI), from Murray & Cardinale (2015). The natural inflammatory response (left column) drives satellite cell activation, muscle protein synthesis and long-term adaptation. CWI (right column) blunts this cascade — reducing soreness but potentially impairing the very adaptations that make training effective. This concern is amplified in adolescent athletes whose musculature is still developing.
Abbreviations: ROS = reactive oxygen species; HR = heart rate; Q = cardiac output; IL-6 = interleukin-6; IL-10 = interleukin-10; WBC = white blood cells; CK = creatine kinase; DOMS = delayed onset muscle soreness.

The Evidence at a Glance

What Has Research Shown Since 2015?

A decade on from our review, the broader scientific picture has developed considerably — and rather than softening our concerns, the accumulating evidence from adult and mixed-age populations has, if anything, strengthened them. Here is a summary of the most important threads.

CWI blunts hypertrophy: the evidence has hardened

The most consequential developments since 2015 have come from studies directly examining how regular CWI affects the structural and molecular adaptations to resistance training. Fyfe and colleagues (2019, Journal of Applied Physiology) conducted a rigorous 12-week resistance training study and found that post-exercise CWI attenuated gains in type II muscle fibre cross-sectional area and myonuclear accretion — the very adaptations that underpin long-term strength and power development — without, interestingly, impairing maximal strength as measured by one-repetition maximum tests. The same group demonstrated that these structural blunting effects were paralleled by attenuated molecular markers of skeletal muscle anabolism and increased catabolism, providing a mechanistic explanation consistent with what we had hypothesised.

Roberts et al. (2015) — the landmark study using MRI to directly measure quadriceps muscle mass — found that 12 weeks of post-exercise CWI (10 min at 10°C) resulted in only ~2% increase in quadriceps mass compared to ~15% in the control group. This remains the most striking direct evidence of CWI-induced attenuation of hypertrophy in the literature to date.

A 2021 narrative review by Petersen and Fyfe (Frontiers in Sports and Active Living) synthesised this growing body of mechanistic and longitudinal evidence, concluding that the post-exercise anabolic signalling environment is measurably blunted by CWI, with downstream consequences for satellite cell function and myofibre growth. A 2023 meta-analysis by Grgic (European Journal of Sport Science) extended this to strength outcomes, finding that CWI may also attenuate resistance training-induced strength gains — a more practically alarming finding than the hypertrophy data alone. A further systematic review and meta-analysis published on SportRxiv (2023) — specifically focused on hypertrophy outcomes across eight controlled studies — confirmed meaningful blunting of muscle growth with post-exercise CWI, noting that no published studies to date have included adolescents or older adults in these designs.

The mode-dependency distinction: good news for endurance, bad news for strength

One of the more nuanced and practically useful advances in our understanding since 2015 comes from Ihsan, Abbiss and Allan’s 2021 review in Frontiers in Sports and Active Living — pointedly titled “Adaptations to post-exercise cold water immersion: friend, foe, or futile?” Their synthesis of the literature established a now fairly well-accepted mode-dependent picture: CWI appears to have little or no detrimental effect on adaptations to endurance training (and may in some contexts enhance mitochondrial biogenesis via PGC-1α pathways), while consistently impairing adaptations to resistance training. For sports that are primarily endurance-based, this nuance matters. For sports requiring the development of strength, power, and muscle mass — which describes the majority of youth sport contexts — the foe interpretation applies.

A rare study in adolescent swimmers: useful but limited

One of the few studies to directly examine CWI in an adolescent athletic cohort since our review was published by Batista and colleagues in 2024 (European Journal of Applied Physiology). In a randomised crossover design, 20 competitive adolescent swimmers underwent a week-long protocol in which CWI (14°C), thermoneutral water immersion (27°C, acting as placebo), or passive recovery were applied between dry-land resistance training and swimming sessions. The study found no significant differences between conditions for 100m sprint or functional performance, with only trends — not reaching statistical significance — for reduced pain and tiredness with CWI. The authors note that when recovery time between sessions is limited, CWI may help athletes feel ready to perform again, and that possible hypertrophy decrements may be acceptable when strength gains are not the primary training goal. These are reasonable qualifications — but it is equally important to note that a single week is far too short a window to detect any impairment to long-term muscular development, and the study was not designed or powered to address that question.

⚠ The research gap remains

Across all the literature published in the decade since our 2015 review, not a single well-designed longitudinal study has examined the effects of regular CWI use on muscle development, hormonal adaptation, or long-term athletic development in pre- or peri-pubertal athletes. The gap we identified in 2015 remains unfilled. Coaches and practitioners are still extrapolating from adult data — a practice that is physiologically unjustified and potentially counterproductive.

The epigenetic dimension: a new frontier

A 2024/2025 narrative review by Normand-Gravier and colleagues (including researchers at Aspetar, Doha) published in the European Journal of Applied Physiology introduced an additional layer of complexity: the potential epigenetic effects of thermal interventions on skeletal muscle. The review highlights that cold interventions can influence DNA methylation patterns and histone modifications relevant to muscle protein synthesis and satellite cell function — signalling pathways that are particularly active and plastic during adolescent development. While this work is in its early stages and does not yet provide definitive conclusions specifically for young athletes, it adds a further mechanistic dimension to the concern that suppressing post-exercise inflammatory and thermal signalling during developmental years may have consequences that extend beyond the immediate training session.

The placebo narrative has strengthened

Since our 2015 review highlighted the potential role of placebo in mediating the perceived benefits of CWI, further work has continued to support this interpretation. Malta and colleagues’ 2021 meta-analysis in Sports Medicine — examining CWI effects on both strength and endurance adaptations — reinforced that a meaningful portion of the perceived recovery benefit appears to be psychologically mediated. For adolescent athletes who are still developing their relationship with effort, discomfort, and recovery, building a reliance on cold water as a perceived “reset” mechanism carries risks that go well beyond the immediate physiology.

Practical Recommendations

Based on the review’s findings, updated in light of the evidence accumulated since 2015, the following practical positions can be offered for coaches, practitioners and parents working with young athletes:

1. Do not use CWI routinely after training sessions

The training session is precisely the context where the post-exercise inflammatory response should be allowed to run its course. Blunting it systematically — especially during a young athlete’s developmental years — is difficult to justify given the available evidence.

2. In competition, context matters

When an adolescent athlete faces multiple competitive efforts in rapid succession (e.g. tournament heats and finals on the same day), there may be a role for brief cold exposure to reduce perceived soreness and help the athlete feel ready to compete again. Even here, the protocol should be conservative and the evidence understood to be modest.

3. Avoid using CK as a decision-making tool in this population

Circulating CK levels in young athletes are systematically lower than in adults performing comparable exercise. Using elevated CK as a trigger for cold recovery interventions in adolescents is likely to be misleading and to result in unnecessary intervention.

4. Educate, do not simply imitate

Coaches and parents should be encouraged to make evidence-based decisions about recovery modalities rather than simply replicating what professional adult athletes do. The professional athlete context — the intensity, the competitive calendar, the physiological maturity — is genuinely different.

5. Prioritise nutrition, sleep and active recovery

These remain the best-supported recovery strategies for any athlete at any age. For adolescents in particular, adequate sleep, appropriate carbohydrate and protein intake, and low-intensity movement are more likely to support both recovery and long-term development than cold water immersion.

Bottom Line

The enthusiasm for ice baths and cold-water immersion in sport has consistently outrun the evidence — and this is especially true when the athletes in question are adolescents. Our 2015 systematic review with Dr Andrew Murray found that the evidence base for CWI in young athletes is sparse, the physiological rationale is weaker than in adults, and the potential for harm to long-term muscle development is a genuine concern that deserves serious attention.

If you work with adolescent athletes, please think carefully before sending them to the ice bath after every training session. The short-term reduction in soreness may feel like a win. The long-term cost to adaptation — and to the culture we build around young athletes’ relationships with their bodies — may be considerably higher. 📄 Read the full review: Murray & Cardinale (2015), Extreme Physiology & Medicine

Key references cited in this post

• Murray A & Cardinale M (2015). Cold applications for recovery in adolescent athletes: a systematic review and meta analysis. Extreme Physiology & Medicine, 4:17. 🔗 https://doi.org/10.1186/s13728-015-0035-8 · PubMed
• Roberts LA, Raastad T, Markworth JF et al. (2015). Post-exercise cold water immersion attenuates acute anabolic signalling and long-term adaptations in muscle to strength training. The Journal of Physiology, 593(18):4285–4301. 🔗 https://doi.org/10.1113/JP270570 · PubMed
• Fyfe JJ, Broatch JR, Trewin AJ et al. (2019). Cold water immersion attenuates anabolic signaling and skeletal muscle fiber hypertrophy, but not strength gain, following whole-body resistance training. Journal of Applied Physiology, 127(5):1403–1418. 🔗 https://doi.org/10.1152/japplphysiol.00127.2019 · PubMed
• Petersen AC & Fyfe JJ (2021). Post-exercise cold water immersion effects on physiological adaptations to resistance training and the underlying mechanisms in skeletal muscle: a narrative review. Frontiers in Sports and Active Living, 3:660291. 🔗 https://doi.org/10.3389/fspor.2021.660291
• Ihsan M, Abbiss CR & Allan R (2021). Adaptations to post-exercise cold water immersion: friend, foe, or futile? Frontiers in Sports and Active Living, 3:714148. 🔗 https://doi.org/10.3389/fspor.2021.714148 · PMC
• Malta ES, Dutra YM, Broatch JR, Bishop DJ & Zagatto AM (2021). The effects of regular cold-water immersion use on training-induced changes in strength and endurance performance: a systematic review with meta-analysis. Sports Medicine, 51(1):161–174. 🔗 https://doi.org/10.1007/s40279-020-01362-0
• Grgic J (2023). Effects of post-exercise cold-water immersion on resistance training-induced gains in muscular strength: a meta-analysis. European Journal of Sport Science, 23(3):372–380. 🔗 https://doi.org/10.1080/17461391.2022.2033851
• Batista NP, de Carvalho FA, Rodrigues CRD et al. (2024). Effects of post-exercise cold-water immersion on performance and perceptive outcomes of competitive adolescent swimmers. European Journal of Applied Physiology, 124(8):2439–2450. 🔗 https://doi.org/10.1007/s00421-024-05462-x · PMC
• Normand-Gravier T, Solsona R, Dablainville V et al. (2025). Effects of thermal interventions on skeletal muscle adaptations and regeneration: perspectives on epigenetics. European Journal of Applied Physiology, 125(2):277–301. 🔗 https://doi.org/10.1007/s00421-024-05642-9 · PMC