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Malte Krüger, Markus de Mareés, Karl-Heinrich Dittmar, Billy Sperlich and Joachim Mester

Purpose:

To examine the effects of a whole-body cryotherapy (WBC) protocol (3 min at –110°C) on acute recovery and key variables of endurance performance during high-intensity intermittent exercise in a thermoneutral environment.

Methods:

Eleven endurance athletes were tested twice in a randomized crossover design in which 5 × 5 min of high-intensity running (HIR) were followed by 1 h of passive rest at ~22°C, including either 3 min of whole-body exposure to –110°C (WBC) or a placebo intervention of 3 min walking (PBO). A ramp-test protocol was performed before HIR (R1) and after the 1-h recovery period (R2). Time to exhaustion (t lim) was measured along with alterations in oxygen content of the vastus lateralis (TSI), oxygen consumption (VO2), capillary blood lactate, heart rate (HR), and rating of perceived exertion (RPE) during submaximal and maximal running.

Results:

The difference in t lim between R1 and R2 was lower in WBC than in PBO (P < .05, effect size d = 1.13). During R2, TSI was higher in WBC during submaximal and maximal running (P < .01, d = 0.68−1.01). In addition, VO2, HR, and RPE were lower at submaximal level of R2 after WBC than in PBO (P = .04 to <.01, d = 0.23−0.83).

Conclusion:

WBC improves acute recovery during high-intensity intermittent exercise in thermoneutral conditions. The improvements might be induced by enhanced oxygenation of the working muscles, as well as a reduction in cardiovascular strain and increased work economy at submaximal intensities.

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Adam Grainger, Paul Comfort and Shane Heffernan

(5°C–15°C), immersion depth (most commonly within thoracic region and total immersion of lower limbs), and duration (CWI = 5–15 min) all differing. 11 Partial body cryotherapy (PBC), which is typically utilized within 24 hours of exercise completion, is another well-used cold exposure recovery

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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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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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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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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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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