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Susan Miniello, Geoffrey Dover, Michael Powers, Mark Tillman and Erik Wikstrom

Context:

Previous studies have suggested that cryotherapy affects neuromuscu-lar function and therefore might impair dynamic stability. If cryotherapy affects dynamic stability, clinicians might alter their decisions regarding returning athletes to play immediately after treatment.

Objective:

To assess the effects of lower leg cold immersion on muscle activity and dynamic stability of the lower extremity.

Design:

Within-subject time-series design with 1 pretest and 2 posttests.

Setting:

A climate-controlled biomechanics laboratory.

Participants:

17 healthy women.

Interventions:

20-minute cold-water immersion.

Main Outcome Measures:

Preparatory and reactive electromyographic activity of the tibialis anterior and peroneus longus and time to stabilization after a jump landing.

Results:

Preparatory activity of the tibialis anterior increased after treatment, whereas preparatory and reactive peroneus longus activity decreased. Both returned to baseline after a 5-minute recovery. Time to stabilization did not change.

Conclusions:

Lower leg cold-immersion therapy does not impair dynamic stability in healthy women during a jump-landing task. Return to participation after a cryotherapy treatment is not contraindicated for healthy athletes.

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Andrew G Jameson, Stephen J Kinzey and Jeffrey S Hallam

Context:

Cryotherapy is commonly used in the care of acute and chronic injuries. It decreases pain, reduces swelling, and causes vasoconstriction of blood vessels. Its detrimental effects on motor activity might predispose physically active individuals to further injury.

Objective:

To examine the effects of cryotherapy on vertical-ground-reaction-force (VGRF) during a 2-legged landing from a 2-legged targeted vertical jump.

Design:

2 × 4 MANOVA with repeated measures.

Setting:

Biomechanics laboratory.

Participants:

10 men, means: 22.40 ± 1.26 years, 76.01 ± 26.95 kg, 182.88 ± 6.88 cm.

Intervention:

VGRF during landing from a targeted vertical jump (90% of maximum) was measured before and after four 20-minute cryotherapy treatments.

Results:

There were no significant differences in VGRF as a result of cryotherapy.

Conclusion:

Under the constraints of this study there is no evidence that returning to activity immediately after cryotherapy predisposes an athlete to injury because of a change in VGRF.

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Bonnie L. Van Lunen, Clayton Carroll, Kristen Gratias and Doug Straley

Context:

Rehabilitation.

Objective:

To determine the effects of a 20-min ice treatment on pain tolerance and peak torque.

Design:

A 2 × 2 × 6 factorial with repeated measures on 1 factor.

Setting:

Outpatient rehabilitation clinic.

Participants:

20 men and 15 women.

Intervention:

The participants were randomly assigned to an experimental (ice bag) or control (no ice bag) group.

Main Outcome Measures:

Peak electrical-stimulation output intensity (ESOI) was recorded in mV, and isokinetic peak torque (IPT), in N · m, every 4 min for 20 min.

Results:

ESOI and IPT increased over time. ESOI for the experimental condition was greater than for the control and within the experimental condition at 12, 16, and 20 min. No other differences were found for the IPT measures. There were no differences for ESOI and IPT between genders.

Conclusions:

Cryotherapy enables patients to tolerate greater output intensities but does not result in increased peak torque

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Mack D. Rubley, William R. Holcomb and Mark A. Guadagnoli

Context:

Cryotherapy is initially uncomfortable, but habituation is thought to occur during treatment.

Objective:

To examine pain habituation to ice-bath immersion over 5 consecutive days.

Design:

Mean Borg ratings were analyzed by ANOVA.

Setting:

Athletic training laboratory.

Intervention:

Ankle immersion in a 1 °C ice bath for 20 min.

Participants:

28 healthy individuals.

Main Outcome Measure:

Level of discomfort was rated at immersion; during treatment at 1, 3, 5, 8, 11, 14, 17, and 20 min; and 1 min posttreatment.

Results:

Analysis revealed significant main effects for day and time and a Day × Time interaction. Day 1 had higher pain ratings than days 4 and 5. From min 1 to 11 there was a progressive decline in pain rating; after that there was no significant decline.

Conclusions:

Discomfort was greatest during the first 5 min, and perception of discomfort at initial immersion was consistent across 5 days. In addition, after 3 days of treatments habituation occurred. Taken together, this suggests that treatment habituation is not the result of change in receptor sensitivity.

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Eric J. Hunter, Jennifer Ostrowski, Matthew Donahue, Caitlyn Crowley and Valerie Herzog

Context:

Many researchers have investigated the effectiveness of different cryotherapy agents at decreasing intramuscular tissue temperatures. However, no one has looked at the effectiveness of adding salt to an ice bag.

Objective:

To compare the cooling effectiveness of different ice bags (wetted, salted cubed, and salted crushed) on cutaneous and intramuscular temperatures.

Design:

Repeated-measures counterbalanced design.

Setting:

University research laboratory.

Participants:

24 healthy participants (13 men, 11 women; age 22.46 ± 2.33 y, height 173.25 ± 9.78 cm, mass 74.51 ± 17.32 kg, subcutaneous thickness 0.63 ± 0.27 cm) with no lower-leg injuries, vascular diseases, sensitivity to cold, compromised circulation, or chronic use of NSAIDs.

Interventions:

Ice bags made of wetted ice (2000 mL ice and 300 mL water), salted cubed ice (intervention A; 2000 mL of cubed ice and 1/2 tablespoon of salt), and salted crushed ice (intervention B; 2000 mL of crushed ice and 1/2 tablespoon of salt) were applied to the posterior gastrocnemius for 30 min. Each participant received all conditions with at least 4 d between treatments.

Main Outcome Measure:

Cutaneous and intramuscular (2 cm plus adipose thickness) temperatures of nondominant gastrocnemius were measured during a 10-min baseline period, a 30-min treatment period, and a 45-min rewarming period.

Results:

Differences from baseline were observed for all treatments. The wetted-ice and salted-cubed-ice bags produced significantly lower intramuscular temperatures than the salted-crushed-ice bag. Wetted-ice bags produced the greatest temperature change for cutaneous tissues.

Conclusions:

Wetted- and salted-cubed-ice bags were equally effective at decreasing intramuscular temperature at 2 cm subadipose. Clinical practicality may favor salted-ice bags over wetted-ice bags.

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Jennifer Ostrowski, Angelina Purchio, Maria Beck and JoLynn Leisinger

Cryotherapy is one of the most commonly utilized modalities during immediate care of athletic injuries and is often included as part of RICE (rest, ice, compression, and elevation); however, evidence supporting these components as a whole or individually is inconclusive. 1 Physiologic effects of

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Justin H. Rigby and Shaylene B. Dye

A variety of cryotherapy systems may be used to cool tissues immediately after an injury. The purpose our study was to examine the effect of a 30-min application of various cryotherapy devices on skin temperatures and compression. A crossover-designed study performed in a university research laboratory was conducted. Each treatment condition was applied to the lateral ankle for 30 min on different days. HyperIce’s colder temperatures over the lateral ankle (p < .0001) would make it the treatment choice for immediate care of ankle lateral ligament injuries, but is limited due its size for larger injuries.

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Jenna K. Cataldi, Kimberly A. Pritchard, Joseph M. Hart and Susan A. Saliba

Context:

Recommended treatment duration for cryotherapy varies, but the primary therapeutic benefit may be related to the amount of time required for changes in cutaneous sensation.

Objective:

To determine the amount of time required to induce numbness for three different modes of cryotherapy administration, and the amount of time that numbness persists after treatment.

Design:

Repeated measures.

Participants:

30 healthy adults (12 males, 18 females, age = 21.1 ± 1.9 years).

Interventions:

Crushed ice bag, ice massage, and cold water immersion.

Main Outcome Measures:

Time required to induce numbness and the amount of time numbness remained after removal of each mode of cryotherapy.

Results:

Ice massage and cold water immersion produced numbness significantly faster than the crushed ice. There were no significant differences in terms of numbness duration.

Conclusions:

Changes in cutaneous sensation can be achieved in a relatively short amount of time (6–12 minutes) with ice massage and cold water immersion. The duration of the treatment effect did not differ among the three modes of cryotherapy administration.

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Rui Torres, Filipa Silva, Vera Pedrosa, João Ferreira and Alexandre Lopes

Context:

Cryotherapy, a common intervention used by clinicians, poses several benefits in managing acute injuries. However, cooling muscle tissue can interfere with muscular properties and the sensory-motor system.

Objective:

The aim of this study was to analyze the influence of cryotherapy with a crushed-ice pack on shoulder proprioception concerning joint position sense, force sense, the threshold for detecting passive movement, and maximal force production.

Design:

A randomized, double-blind controlled trial.

Participants:

48 healthy women aged 22.6 ± 0.4 y with a mean body mass index of 22.8 ±0.37 kg/m2 and a percentage of body fat of 15.4 ± 1.5%.

Methods:

In the experimental group, a crushed-ice pack was applied to the shoulder for 15 min, whereas participants in the control group applied a sandbag at skin temperature, also for 15 min. An isokinetic dynamometer was used to assess maximal voluntary contraction, force sense, joint position sense, and the threshold for detecting passive movement.

Results:

Paired sample t tests revealed that maximal voluntary isometric contraction decreased significantly after cryotherapy (P ≤ .001), or approximately 10% of the reduction found in both muscular groups assessed. Shoulder position sense (P < .001) and the threshold for detecting passive movement (P = .01 and P = .01 for lateral and medial shoulder rotator muscles, respectively) also suffered significant impairment. Nevertheless, no significant differences emerged in force sense at 20% and 50% of maximal force reproduction (P = .41 and P = .10 for lateral rotator muscles at 20% and 50%, respectively; and P = .20 and P = .09 for medial rotator muscles at 20% and 50%, respectively).

Conclusion:

Applying a crushed-ice pack to the shoulder for 15 min negatively affected muscle strength and impaired shoulder proprioception by decreasing joint position sense and the threshold for detecting passive movement.

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Hailey N. Love, Kimberly A. Pritchard, Joseph M. Hart and Susan A. Saliba

Context:

Alterations in skin sensations may be responsible for pain reduction provided by cryotherapy, but the exact physiological mechanism is unknown.

Objective:

To investigate perceptions of skin sensations associated with different modes of cryotherapy administration and skin temperature at the point of perceived numbness.

Design:

Repeated measures.

Participants:

30 healthy subjects (12 Male, 18 Female, Age = 21.1±1.9 years).

Interventions:

Crushed ice bag, ice massage, and cold water immersion.

Main Outcome Measures:

Perceptions of sensations during each mode of cryotherapy administration were derived from a Modified McGill Pain Questionnaire. Skin temperature was recorded when numbness was reported for each treatment.

Results:

Participants experienced sensations that included cold, tight, tingling, stinging, and numb. Ice massage sensations transitioned rapidly from cold to numb, whereas cold water immersion and ice bag treatments produced altered sensations for longer duration. Ice massage decreased skin temperature significantly more than the other two modes of cryotherapy administration.

Conclusions:

Ice massage may be the best mode of cryotherapy administration for achievement of anaesthesia as rapidly as possible, whereas cold water immersion and ice bag application may be better for attainment of pain reduction associated with noxious stimulation of skin receptors.