Cold-water immersion (CWI) has long been used by athletes participating in endurance exercises to aid in recovery. Although studies have been published examining CWI`s effects, a lack of methodological strength and the use of eccentric protocols to induce muscle damage have limited the clinical applicability of the findings when treating patients after endurance exercise. This critically appraised topic investigated the effects of CWI on delayed onset muscle soreness and markers of recovery in athletes participating in endurance exercise. Articles were limited to peer-reviewed randomized control trials published between 2017 and 2024 that scored a six or higher on the Physiotherapy Evidence Database scale. Four randomized control trials were found that met the criteria. All four articles concluded that CWI does not assist in recovery compared with control groups. An appraisal of good to excellent randomized control trials suggests that CWI does not assist in recovery from delayed onset muscle soreness symptoms or markers of recovery following endurance exercise. However, none of the studies reported adverse effects. Given CWI`s long-standing use in endurance sports, it may remain a preferred recovery strategy among athletes participating in endurance exercise. Clinicians should acknowledge patient preferences while educating them on the lack of evidence supporting CWI`s benefits for endurance exercise recovery.
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