Water Immersion Therapy in English Premiership Football and Rugby Union: A repeated survey of the 2007/8 and 2018/19 seasons


To optimise athletic training and competitive performance, professional sports clubs use numerous techniques as part of a recovery programme, including water immersion therapy (WIT).

The purpose of this study was to compare the rationale and use of WIT in elite level sports clubs between 2 seasons to determine if it had changed over time.

In 2007/8, 33% of clubs offered players a choice of WIT
compared to 80% in 2018/19.


This was a repeated service evaluation design. All Premiership rugby union and football clubs in England (n=12 rugby union and n=20 football), were surveyed during the 2007/8 and 2018/19 seasons.

A postal questionnaire including eleven questions asked about the use of WIT including: types of immersion, protocols and equipment used, information underpinning use and recovery programme development, aims, option to participate, number of participants, alternative recovery methods and reasons for not participating. The questionnaire was piloted and reminders were sent.

Ethical approval was granted by Manchester Metropolitan University (Ref:6078).


The overall response rates were 81% in 2007/8 and in 2018/19.

Of those who responded, not all clubs used WIT, with 80% in 2007/8 compared with 96% in 2018/19. Contrast and cold WIT were the most popular types used in 2007/8 however; most clubs used cold-water immersion in 2018/19.

No standard protocols stood out for post-match, post-training and during injury rehabilitation. WIT was used more selectively in 2018/19 compared to 2007/8.

In both 2007/8 and 2018/19, research was the largest influence in the decision-making to use WIT and underpinning consideration during programme development. Accelerating recovery was the main aim of WIT in both 2007/8 and 2018/19.

In 2007/8, 33% of clubs offered players a choice of WIT compared to 80% in 2018/19. As a result, on average, fewer players (23%) opted out in 2007/8 compared to 50% in 2018/19.

Dislike was the main reason respondents gave for not participating in 2007/8 and 2018/19.

The use of WIT in English premiership rugby and football has increased between 2007/8 and 2018/9. Despite being influenced by research evidence, there is a wide variety of WIT protocols used in premiership sport. Temperature, depth and duration of cold-water immersion all varied in practice and have changed over time.

The offer of not to participate in WIT has increased over time in line with an increase in choice not to use it, as well as the uptake of alternative recovery modalities. Understanding the changes in rationale and use of WIT over time will help focus on variances in practice, target research and explore good practice.


  • Despite the influence of an evidence base, clinicians design rehabilitation protocols based on professional judgement.
  • More research is needed to guide clinicians to the most effective WIT protocol for recovery.
  • Evidence shows that players' choice is being considered more widely in elite sport to tailor recovery.

Funding acknowledgements

No funding was obtained to carry out this study.

Additional notes

This work was presented at Physiotherapy UK 2019