Hydrotherapy with hydrogen-rich water compared with RICE protocol following acute ankle sprain in professional athletes: a randomized non-inferiority pilot trial
Javorac D, Stajer V, Ratgeber L, Olah A, Betlehem J, Acs P, Vukomanovic B, Ostojic SM. · Res Sports Med. 2021;29(6):517-525.
Study at a glance
In eighteen male athletes, both hydrogen ankle baths and standard first aid were followed by improvement over 24 hours. No clear difference between groups was demonstrated. The analysis does not prove equivalence or non-inferiority.
Human
Male professional athletes aged 18–30 with grade I–II acute ankle sprain. Age 23.7 ± 4 years; professional experience 5.9 ± 3.9 years.
Six thirty-minute ankle baths, every four hours in the first 24 hours after injury; first session approximately sixty minutes after injury. Three litres of tap water at 20°C with a magnesium-based HRW Natural Health Products formulation. · Approximately 8 ppm H₂ claimed; concentration change during the thirty-minute bath was not measured.
First 24 hours after injury only.
Within hydrogen, swelling fell 2.1% (95% CI 1.4–2.9, P = 0.0002), versus 1.6% with RICE. Hydrogen range of motion increased 2.4 cm (CI 1.4–3.4, P = 0.0005) and eyes-open balance 18.4 seconds (CI 12.1–24.7, P = 0.0001). Both arms improved several measures. Between-group comparisons were nonsignificant: swelling P = 0.26, rest pain P = 0.12, movement pain P = 0.13, lunge range P = 0.60, eyes-open balance P = 0.06, eyes-closed P = 0.59. CRP, TNF-α and IL-1β interactions P = 0.55, 0.45 and 0.17; hydrogen eyes-closed balance P = 0.08 and IL-1β trend P = 0.07 were not positive findings.
Nine per arm, male athletes, short follow-up, different unblinded procedures, no water-only control, uncertain H₂ retention, multiple endpoints. No durable healing or return-to-sport outcome. Earlier case report PMID 32399209 is cited; individual overlap is not explicitly excluded, so participant counts are not combined.
What kind of evidence is this?
Human
Randomized parallel pilot described by the authors as non-inferiority; blinding and concealment not described. An explicit non-inferiority margin and confidence interval against it were not reported.
Musculoskeletal and pain research
Other forms
Information not yet classified
Some editorial classification fields are still pending. The source-reported outcomes and result are shown below; Hydrogenology does not infer a positive or negative signal from prose automatically.
Methods
Male professional athletes aged 18–30 with grade I–II acute ankle sprain. Age 23.7 ± 4 years; professional experience 5.9 ± 3.9 years.
Eighteen, nine per arm; all completed.
First 24 hours after injury only.
Six thirty-minute ankle baths, every four hours in the first 24 hours after injury; first session approximately sixty minutes after injury. Three litres of tap water at 20°C with a magnesium-based HRW Natural Health Products formulation.
Hydrogen-containing topical water
Approximately 8 ppm H₂ claimed; concentration change during the thirty-minute bath was not measured.
RICE: rest, ice twenty minutes every three hours (eight sessions), elastic compression for 24 hours, elevation above the heart when possible. No ordinary-water bath control; no other interventions.
Outcomes and reported result
Primary: change in ankle swelling by figure-of-eight circumference; pain, range of motion, balance and inflammatory markers.
Within hydrogen, swelling fell 2.1% (95% CI 1.4–2.9, P = 0.0002), versus 1.6% with RICE. Hydrogen range of motion increased 2.4 cm (CI 1.4–3.4, P = 0.0005) and eyes-open balance 18.4 seconds (CI 12.1–24.7, P = 0.0001). Both arms improved several measures. Between-group comparisons were nonsignificant: swelling P = 0.26, rest pain P = 0.12, movement pain P = 0.13, lunge range P = 0.60, eyes-open balance P = 0.06, eyes-closed P = 0.59. CRP, TNF-α and IL-1β interactions P = 0.55, 0.45 and 0.17; hydrogen eyes-closed balance P = 0.08 and IL-1β trend P = 0.07 were not positive findings.
Main-text methods, results, limitations and declarations were reviewed. Source versions, missing information and conflicting findings are stated in this record.
No relevant side effects reported among eighteen participants; questionnaire covered tingling, discoloration, burning, itching and rash, over 24 hours only.
A reported association, difference or mechanism is not automatically a clinical benefit.
Limitations and applicability
Nine per arm, male athletes, short follow-up, different unblinded procedures, no water-only control, uncertain H₂ retention, multiple endpoints. No durable healing or return-to-sport outcome. Earlier case report PMID 32399209 is cited; individual overlap is not explicitly excluded, so participant counts are not combined.
Limited to the population/model and protocol described above. These findings do not provide a treatment, concentration or device recommendation.
Serbian Ministry 175037; Faculty of Sport and Physical Education, Novi Sad; Center for Health, Exercise and Sport Sciences, Belgrade; HRW Natural Health Products Inc.
Authors declare no conflicts and state funders had no role in design, data, interpretation, writing or publication decisions. The commercial provider also funded the trial.
No single-study GRADE certainty rating is assigned. Read how records and evidence assessments are prepared.
Sources and record status
PMID: 33356580 · DOI: 10.1080/15438627.2020.1868468
Complete final Taylor & Francis journal article, Research in Sports Medicine 29(6), 517–525, hosted by Molecular Hydrogen Institute; online publication 27 December 2020.
AI-assisted editorial review of the available main full text, 29 October 2026. No independent clinical or statistical assessment has been performed.
Cover and pages 517–525: Methods; Table 1; Figure 1; Results; Discussion; Disclosure and Funding.
AI-assisted editorial review of the available main full text, 29 October 2026. Complete final Taylor & Francis journal article, Research in Sports Medicine 29(6), 517–525, hosted by Molecular Hydrogen Institute; online publication 27 December 2020.
NCT04167202; ethics ABL11-HRW/2019.
29 October 2026
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