Inflammation is part of the normal repair process for muscle recuperation and necessary for muscle adaptations. Inhibiting inflammation with ice baths, cryotherapy, and NSAIDS reduces protein synthesis and impairs muscle hypertrophy.



  • Ice baths, cryotherapy, and NSAIDS blunt inflammation and are not conducive to muscle growth.
  • Ice baths can blunt protein synthesis after exercise and reduce testosterone.
  • Heat may be a better alternative than ice and cold water therapy


The inflammation response to exercise is important not only for muscle growth but inhibiting the body’s innate response can lead to hampered muscle growth. Muscle hypertrophy, on the other hand, occurs when the protein synthesis rate exceeds the protein breakdown rate. However, recent evidence suggests that efficient muscle hypertrophy is also attributed to an increased activation of satellite cells, which is triggered by tension overload.

In the most recent edition of Physiological Reports, a comprehensive review titled “Role of macrophages during skeletal muscle regeneration and hypertrophy—Implications for immunomodulatory strategies” provides an overview of current research on inflammation and its impact on muscle growth.

The review focuses on macrophages, a type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. Macrophages are an army of defenders that attack foreign invaders the body does not recognize, but it’s also clear that they may be responsible for muscle growth and repair.

Macrophages are involved in post-injury skeletal muscle regeneration that occurs after resistance exercise, where they are thought to play an important role in the activation of satellite cells. Satellite cells are essential for muscle growth. If you stop or inhibit satellite cell activation, this will inhibit muscle growth.

While scientists are still unraveling the precise mechanisms, the existing research indicates that the accumulation of macrophages might play a crucial role in how macrophages and inflammation contribute to muscle growth. It is important to note that the majority of studies conducted so far have focused on animals. Nevertheless, there are also a few human studies that highlight the significance of macrophages in muscle growth.


Previous animal research illustrates the potential role of macrophages in muscle growth. Back in 2007, DiPasquale and colleagues found that the magnitude of skeletal muscle growth is reduced after the depletion of macrophages induced by drugs that inhibit macrophages. (9) It was also shown that muscle growth is blunted in mice deficient in urokinase-type plasminogen activator (uPA). (10)  uPA deficient mice, this hampers the ability of the mice’s immune system to recruit neutrophils and macrophages. Thus, it seems like macrophages are important for muscle growth.


Few human studies exist regarding macrophages and muscle growth, but the literature is promising. One study found an increase in macrophages after exercise correlated with changes in muscle size and muscle growth factor genes (HGF and IGF-1).(11) A study in older adults found that increased macrophage numbers were found to be positively correlated with muscle growth, satellite cell activation, and capillary density.(12) Overall, macrophages are mobilized into the skeletal muscle in response to resistance training programs in humans, even though the molecular regulators involved in muscle hypertrophy are still to be determined.


 In the past, it was recommended that anti-inflammatory drugs such as NSAIDs and vitamins were beneficial for muscle growth because they reduced inflammation and promoted recuperation. The review article discusses how cooling (i.e., cryotherapy, ice baths, etc.) and the use of NSAIDs has been documented to be counterproductive to muscle growth.

Cold therapy decreases the number of macrophages in various models of muscle damage and delays the shift toward restorative macrophages. (13, 14) NSAIDs and other anti-inflammatory drugs have also been found to reduce muscle growth by inhibiting macrophages.(15) NSAIDs enhance muscle recovery short-term (i.e., 24–48 hours post-exercise) but do not result in long-term functional improvement and can hinder long-term muscle growth.

In contrast to recovery techniques that hinder macrophages, heat therapy and massage seem to increase macrophage activity post-exercise and enhance muscle growth and recovery. (16, 17)

In summary, the review article suggests a growing body of evidence that macrophages and the inflammation response are important for muscle growth. Post-exercise therapies that inhibit the inflammation response, such as cold therapy and NSAIDS, are counterproductive for muscle growth and recuperation.

Conversely, therapies that improve blood flow and macrophage activity, such as heat therapy and massage, are conducive to muscle repair and muscle growth. The authors stated, “Macrophages are at the heart of the regeneration process by interacting with satellite cells and other cell types to restore skeletal muscle structure and function. Growing evidence is also emerging on their role in skeletal muscle hypertrophy.” Rather than completing inhibiting/blunting inflammation post-exercise (i.e., ice therapy/NSAIDS), athletes should seek recovery methods to facilitate the removal of inflammation with techniques such as heat therapy and massage that improve muscle regeneration and muscle growth. (18)


Cryotherapy and ice baths are the rage today for recuperation. Ice baths have been used to reduce inflammation, reduce muscle soreness, and improve recovery post-exercise.[1] Using cold-water therapy is not without drawbacks; some studies have found no benefit in using cold-water immersion post-exercise to reduce muscle soreness.[2,3]

Others have found that cold water immersion long-term (16 weeks) can reduce muscle growth! Subjects performed an intense resistance training protocol and either sat in an ice bath for 10 minutes or performed an active recovery. The investigators found that cold water immersion blunted anabolic signaling pathways and reduced strength and muscle growth. [4,5] Research into the mechanisms responsible for cold water immersion reducing muscle growth after resistance reduces has suggested that ice baths interfere with several important anabolic signaling pathways reducing muscle protein synthesis.

One study discovered that when participants took ice baths after resistance exercise and consumed a post-exercise whey protein and carb shake, it blunted protein synthesis.
The researchers observed that ice baths decreased the muscle’s uptake of amino acids after exercise. Therefore, ice baths hinder the adaptive responses to resistance exercise [6].


In a review of effective recovery modalities, massage, compression garments, and cold-water immersion are the most effective recovery modalities. Massage has the most beneficial effect on muscle soreness and fatigue. Although, to a lesser extent, compression garments and cold-water immersion also have a beneficial effect on both muscle soreness and fatigue.

Cold modalities (e.g., cryotherapy and cold-water immersion) and massage elicit the greatest effects on reducing muscle damage markers.[7] Inflammation is part of the normal healing process; cryotherapy, cold water immersion, and ibuprofen block the normal inflammation process and reduce muscle growth. Non-steroidal anti-inflammatory drugs (NSAIDs) and anti-inflammatories blunt the adaptation responses for muscle growth to occur. Research has shown that taking ibuprofen and other NSAIDS can reduce muscle protein synthesis and muscle growth.[8] Stay away from NSAIDs like the plague if you are trying to gain muscle.

In sum, inflammation is part of the normal repair process for muscle recuperation and is necessary for muscle adaptations. Inhibiting inflammation with ice baths, cryotherapy, and NSAIDS reduces protein synthesis and impairs muscle hypertrophy.


  • Ice baths, cryotherapy, and NSAIDS are not conducive to muscle growth.


1.     Chris Bleakley et al., “Cold-Water Immersion (Cryotherapy) for Preventing and Treating Muscle Soreness after Exercise,” The Cochrane Database of Systematic Reviews, no. 2 (February 15, 2012): CD008262.

2.     Pinto, J., Rocha, P., & Torres, R. (2020). Cold-Water Immersion Has No Effect on Muscle Stiffness After Exercise-Induced Muscle Damage. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 30(6), 533–538.

3.     Jonathan M. Peake et al., “The Effects of Cold Water Immersion and Active Recovery on Inflammation and Cell Stress Responses in Human Skeletal Muscle after Resistance Exercise,” The Journal of Physiology 595, no. 3 (February 1, 2017): 695–711.

4.     Llion A. Roberts et al., “Post-Exercise Cold Water Immersion Attenuates Acute Anabolic Signalling and Long-Term Adaptations in Muscle to Strength Training,” The Journal of Physiology 593, no. 18 (2015): 4285–4301.

5.     Jackson J. Fyfe et al., “Cold Water Immersion Attenuates Anabolic Signaling and Skeletal Muscle Fiber Hypertrophy, but Not Strength Gain, Following Whole-Body Resistance Training,” Journal of Applied Physiology (Bethesda, Md.: 1985) 127, no. 5 (November 1, 2019): 1403–18.

6.     Fuchs, C., Kouw, I., Churchward-Venne, T., Smeets, J., Senden, J., van Marken Lichtenbelt, W., et al. (2020). Postexercise cooling impairs muscle protein synthesis rates in recreational athletes. J. Physiol. 598, 755–772.

7.     Olivier Dupuy et al., “An Evidence-Based Approach for Choosing Post-Exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis,” Frontiers in Physiology 9 (2018): 403.


8.     Tommy R. Lundberg and Glyn Howatson, “Analgesic and Anti-Inflammatory Drugs in Sports: Implications for Exercise Performance and Training Adaptations,” Scandinavian Journal of Medicine & Science in Sports 28, no. 11 (November 2018): 2252–62.

9.         DiPasquale DM, Cheng M, Billich W, Huang SA, Rooijen Nv, Hornberger TA, et al. Urokinase-type plasminogen activator and macrophages are required for skeletal muscle hypertrophy in mice. American Journal of Physiology-Cell Physiology. 2007;293(4):C1278-C85.

10.         Bryer SC, Fantuzzi G, Van Rooijen N, Koh TJ. Urokinase-Type Plasminogen Activator Plays Essential Roles in Macrophage Chemotaxis and Skeletal Muscle Regeneration. The Journal of Immunology. 2008;180(2):1179-88.

11.         Walton RG, Kosmac K, Mula J, Fry CS, Peck BD, Groshong JS, et al. Human skeletal muscle macrophages increase following cycle training and are associated with adaptations that may facilitate growth. Scientific Reports. 2019;9(1):969.

12.         Peck BD, Murach KA, Walton RG, Simmons AJ, Long DE, Kosmac K, et al. A muscle cell-macrophage axis involving matrix metalloproteinase 14 facilitates extracellular matrix remodeling with mechanical loading. The FASEB Journal. 2022;36(2):e22155.

13.         Miyakawa M, Kawashima M, Haba D, Sugiyama M, Taniguchi K, Arakawa T. Inhibition of the migration of MCP-1 positive cells by icing applied soon after crush injury to rat skeletal muscle. Acta Histochemica. 2020;122(3):151511.

14.         Kawashima M, Kawanishi N, Tominaga T, Suzuki K, Miyazaki A, Nagata I, et al. Icing after eccentric contraction-induced muscle damage perturbs the disappearance of necrotic muscle fibers and phenotypic dynamics of macrophages in mice. Journal of Applied Physiology. 2021;130(5):1410-20.


15.         Lapointe BM, Frenette J, Côté CH. Lengthening contraction-induced inflammation is linked to secondary damage but devoid of neutrophil invasion. J Appl Physiol (1985). 2002;92(5):1995-2004.

16.         Takeuchi K, Hatade T, Wakamiya S, Fujita N, Arakawa T, Miki A. Heat stress promotes skeletal muscle regeneration after crush injury in rats. Acta Histochemica. 2014;116(2):327-34.

17.         Ballotta V, Driessen-Mol A, Bouten CVC, Baaijens FPT. Strain-dependent modulation of macrophage polarization within scaffolds. Biomaterials. 2014;35(18):4919-28.

18.       Bernard C, Zavoriti A, Pucelle Q, Chazaud B, Gondin J. Role of macrophages during skeletal muscle regeneration and hypertrophy-Implications for immunomodulatory strategies. Physiol Rep. 2022;10(19):e15480.

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