Page 70 - JSOM Winter 2022

FR treatment, and the posttest was administered immediately FIGURE 2 Postulated synergistic effects of flotation therapy.
after the FR treatment. Reported objective measures (e.g., ac- THERMAL CHEMICAL MECHANICAL
curacy, precision) statistically improved (p = .01) after 40 min- EFFECTS EFFECTS EFFECTS
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utes of FR. Similar studies are yet to be conducted to assess Warm Water MgSO Whole Body
the effects of FR on performance in sports in which success Immersion (Epsom salt) Immersion
depends on bursts of strength or speed, rapidity of reactions, • Improved • Improved healing • Increased blood
or the ability to make rapid changes of motion or attention. immunity time circulation
Therefore, additional FR research is warranted in events that • Reduced pain • Increased mental • Increased cell
relaxation
oxygenation
• Reduced
emphasize power or speed, such as sprints and field sports. 29 inflammation • Increased physical • Improved
relaxation cardiovsacular
The prospective benefits of FR as a performance-enhancing functioning
recovery tool for the Special Forces community are encourag-
ing. However, FR studies of elite athletes comparable to SOs are well known. A limited number of researchers have reported
remain sparse, and most have been performed under labora- the transdermal absorption of magnesium sulfate through the
tory conditions rather than in the field. We were able to locate skin during FR, although many of the studies lacked adequate
only two published studies on the effects of FR on recovery and statistical power and had weak experimental designs and lack
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performance in competitive athletes. Driller and Argus found of peer review. One proposed entry point for magnesium sul-
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small to moderate improvements in mood states and perceived fate is through the hair follicles, but these represent only 0.1%
muscle soreness in elite athletes (e.g., basketball, cycling, foot- to 1% of the total surface area of the skin. Currently, evidence
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ball, rowing, rugby, swimming) exposed to FR. Broderick et al. is scarce regarding the magnitude of the contribution of mag-
found small to moderate effects of FR on sleep, physical fatigue, nesium sulfate effects during an FR session, especially in the
salivary cortisol levels, perceived muscle soreness, and several management of pain, improved sleep, anxiety, depression, and
physical performance measures in a sample of 19 trained male stress, as well as the precise mechanisms associated with these
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athletes (e.g., basketball, football, rugby). Currently, empirical improvements. Therefore, exploration is warranted regarding
evidence is insufficient to fully support the use of FR in elite the role of magnesium sulfate in FR and its precise mechanism
military and athletic populations, although a large percentage of action.
of elite competitive athletes anecdotally recommend the routine
use of FR for performance enhancement and recovery. 30 The precise mechanisms of action contributing to the reported
physical and mental benefits of FR therapy remain elusive.
SOs are routinely exposed to prolonged physically and psy- However, the associated synergistic benefits of FR may be
chologically demanding training developments and missions attributed to the following: (1) thermal effects, (2) chemical
that may result in marked alterations in body composition and effects, and (3) mechanical effects (Figure 2). These effects
endocrine function and degradations in physical and mental are analogous to what is reported in the scientific literature
performance. 16,17,23 Research is needed to determine whether regarding the medicinal effects of thermal waters, known as
FR can enhance recovery from these demands, thereby restor- balneology or balneotherapy. 31-34 Future investigators should
ing optimal performance and health. If found to be effective, focus their efforts on this domain to pinpoint the specific
the impact of a holistic recovery tool such as this may provide mechanisms of actions of FR.
wide-ranging value to Special Forces operations, including im-
proving the overall health of SOs, thus sustaining the longevity Conclusion
of their careers or reducing downstream healthcare costs.
It is understood that SOs suffer from high workloads, chron-
ic-overuse musculoskeletal injuries, and various other inter-
Postulated Mechanisms of Action
related health disorders. 15,16,30 FR may serve as an effective
Collectively, researchers have reported that the lack of sensory recovery technique in ameliorating musculoskeletal pain,
stimulation involved in FR therapy reduces the arousal of the modulating blood biomarkers (e.g., testosterone, cortisol), and
stress response system by eliciting the RR, which is associated improving sleep. 21,32,33
with the parasympathetic nervous system (control of relax-
ation and repose responses). 7,8,10–12 The critical components The potential effects of FR on improving sleep duration and
of the stress response system include the sympathetic nervous quality could serve as the single impetus toward improving an
3,9
system (SNS; control of fight/flight responses) and HPA. We array of physiological and psychological parameters in SOs.
hypothesize that the reported mechanisms of actions of FR Second, performance is widely viewed by many SOs as para-
are likely synergistic (Figure 2), resulting in the dampening of mount toward meeting yearly performance standards. Future
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the HPA and SNS activity. Interestingly, the metabolite of investigators should consider the short and long-term effects of
norepinephrine degradation, 3-methoxy-4-hydroxyphenyleth- FR on physical performance parameters (e.g., marksmanship,
yleneglycol, has also been reported to significantly diminish improved reaction time) in select groups of SOs. The mecha-
following several FR sessions, suggesting a lowered arousal nisms of actions associated with these improvements have not
response of the SNS. The purported mechanisms of action been delineated in the literature and, therefore, deserve thor-
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linked to these changes are unknown and deserve further ough investigation. Research on the efficacy of FR has been pri-
investigation. marily conducted on untrained healthy adults and recreational
and competitive athletes within a controlled laboratory envi-
Beyond the effects on the RR, another proposed mechanism of ronment. Research is needed to determine the effects of FR in
action for FR is related to magnesium sulfate. During FR, the more specialized populations, such as SOs. Effective dose and
individual floats in a high-concentration solution of Epsom frequency also need to be determined. The efficacy of FR in
salt (magnesium sulfate). The benefits of magnesium sulfate such populations has been supported only anecdotally. Finally,

68 | JSOM Volume 22, Edition 4 / Winter 2022