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Kyung-Min Kim, Christopher D. Ingersoll and Jay Hertel

Context:

Focal ankle-joint cooling (FAJC) has been shown to increase Hoffmann (H) reflex amplitudes of select leg muscles while subjects lie prone, but it is unknown whether the neurophysiological cooling effects persist in standing.

Objective:

To assess the effects of FAJC on H-reflexes of the soleus and fibularis longus during 3 body positions (prone, bipedal, and unipedal stances) in individuals with and without chronic ankle instability (CAI).

Design:

Crossover.

Setting:

Laboratory.

Participants:

15 young adults with CAI (9 male, 6 female) and 15 healthy controls.

Intervention:

All subjects received both FAJC and sham treatments on separate days in a randomized order. FAJC was accomplished by applying a 1.5-L plastic bag filled with crushed ice to the ankle for 20 min. Sham treatment involved room-temperature candy corn.

Main Outcome Measures:

Maximum amplitudes of H-reflexes and motor (M) waves were recorded while subjects lay prone and then stood in quiet bipedal and unipedal stances before and immediately after each treatment. Primary outcome measures were Hmax:Mmax ratios for the soleus and fibularis longus. Three-factor (group × treatment condition × time) repeated-measures ANOVAs and Fisher LSD tests were performed for statistical analyses.

Results:

Significant interactions of treatment condition by time for prone Hmax:Mmax ratios were found in the soleus (P = .001) and fibularis longus (P = .003). In both muscles, prone Hmax:Mmax ratios moderately increased after FAJC but not after sham treatment. The CAI and healthy groups responded similarly to FAJC. In contrast, there were no significant interactions or main effects in the bipedal and unipedal stances in either muscle (P > .05).

Conclusions:

FAJC moderately increased H-reflex amplitudes of the soleus and fibularis longus while subjects were prone but not during bipedal or unipedal standing. These results were not different between groups with and without CAI.

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Robert Topp, Lee Winchester, Amber M. Mink, Jeremiah S. Kaufman and Dean E. Jacks

Context:

Soft-tissue injuries are commonly treated with ice or menthol gels. Few studies have compared the effects of these treatments on blood flow and muscle strength.

Objective:

To compare blood flow and muscle strength in the forearm after an application of ice or menthol gel or no treatment.

Design:

Repeated-measures design in which blood-flow and muscle-strength data were collected from subjects under 3 treatment conditions.

Setting:

Exercise physiology laboratory.

Participants:

17 healthy adults with no impediment to the blood flow or strength in their right arm, recruited through word of mouth.

Intervention:

Three separate treatment conditions were randomly applied topically to the right forearm: no treatment, 0.5 kg of ice, or 3.5 mL of 3.5% menthol gel. To avoid injury ice was only applied for 20 min.

Main Outcome Measures:

At each data-collection session blood flow (mL/min) of the right radial artery was determined at baseline before any treatment and then at 5, 10, 15, and 20 min after treatment using Doppler ultrasound. Muscle strength was assessed as maximum isokinetic flexion and extension of the wrist at 30°/s 20, 25, and 30 min after treatment.

Results:

The menthol gel reduced (−42%, P < .05) blood flow in the radial artery 5 min after application but not at 10, 15, or 20 min after application. Ice reduced (−48%, P < .05) blood flow in the radial artery only after 20 min of application. After 15 min of the control condition blood flow increased (83%, P < .05) from baseline measures. After the removal of ice, wrist-extension strength did not increase per repeated strength assessment as it did during the control condition (9−11%, P < .05) and menthol-gel intervention (8%, P < .05).

Conclusions:

Menthol has a fast-acting, short-lived effect of reducing blood flow. Ice reduces blood flow after a prolonged duration. Muscle strength appears to be inhibited after ice application.

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Shona L. Halson, Marc J. Quod, David T. Martin, Andrew S. Gardner, Tammie R. Ebert and Paul B. Laursen

Cold water immersion (CWI) has become a popular means of enhancing recovery from various forms of exercise. However, there is minimal scientific information on the physiological effects of CWI following cycling in the heat.

Purpose:

To examine the safety and acute thermoregulatory, cardiovascular, metabolic, endocrine, and inflammatory responses to CWI following cycling in the heat.

Methods:

Eleven male endurance trained cyclists completed two simulated ~40-min time trials at 34.3 ± 1.1°C. All subjects completed both a CWI trial (11.5°C for 60 s repeated three times) and a control condition (CONT; passive recovery in 24.2 ± 1.8°C) in a randomized cross-over design. Capillary blood samples were assayed for lactate, glucose, pH, and blood gases. Venous blood samples were assayed for catecholamines, cortisol, testosterone, creatine kinase, C-reactive protein, IL-6, and IGF-1 on 7 of the 11 subjects. Heart rate (HR), rectal (Tre), and skin temperatures (Tsk) were measured throughout recovery.

Results:

CWI elicited a significantly lower HR (CWI: Δ116 ± 9 bpm vs. CONT: Δ106 ± 4 bpm; P = .02), Tre (CWI: Δ1.99 ± 0.50°C vs. CONT: Δ1.49 ± 0.50°C; P = .01) and Tsk. However, all other measures were not significantly different between conditions. All participants subjectively reported enhanced sensations of recovery following CWI.

Conclusion:

CWI did not result in hypothermia and can be considered safe following high intensity cycling in the heat, using the above protocol. CWI significantly reduced heart rate and core temperature; however, all other metabolic and endocrine markers were not affected by CWI.

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Haydee G. Galvan, Amanda J. Tritsch, Richard Tandy and Mack D. Rubley

Context:

Ice-bath temperatures range from 1 to 15ºC; the pain response during treatment might be temperature specific.

Objective:

To determine levels of perceived pain during ice-bath immersion at distinct temperatures.

Design:

2 (sex) × 3 (temperature) × 9 (treatment time).

Setting:

Athletic training research laboratory.

Participants:

32 healthy subjects.

Intervention:

Ankle immersion in 1, 10, and 15°C ice baths for 20 minutes.

Main Outcome Measures:

Discomfort measured by the Borg scale of perceived pain at immersion for 1, 2, 4, 6, 8, 10, 15, and 20 minutes.

Results:

The magnitude of pain felt depended on treatment temperature (F 18,522 = 11.65, P < .0001). Pain ratings were 43% higher for 1ºC than 10ºC and 70% higher than 15ºC, and ratings at 10ºC were 46% higher than at 15ºC.

Conclusions:

Pain depends on treatment temperature. Patients might report inconsistent pain ratings with varying temperature.

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Wigand Poppendieck, Oliver Faude, Melissa Wegmann and Tim Meyer

Purpose:

Cooling after exercise has been investigated as a method to improve recovery during intensive training or competition periods. As many studies have included untrained subjects, the transfer of those results to trained athletes is questionable.

Methods:

Therefore, the authors conducted a literature search and located 21 peer-reviewed randomized controlled trials addressing the effects of cooling on performance recovery in trained athletes.

Results:

For all studies, the effect of cooling on performance was determined and effect sizes (Hedges’ g) were calculated. Regarding performance measurement, the largest average effect size was found for sprint performance (2.6%, g = 0.69), while for endurance parameters (2.6%, g = 0.19), jump (3.0%, g = 0.15), and strength (1.8%, g = 0.10), effect sizes were smaller. The effects were most pronounced when performance was evaluated 96 h after exercise (4.3%, g = 1.03). Regarding the exercise used to induce fatigue, effects after endurance training (2.4%, g = 0.35) were larger than after strength-based exercise (2.4%, g = 0.11). Cold-water immersion (2.9%, g = 0.34) and cryogenic chambers (3.8%, g = 0.25) seem to be more beneficial with respect to performance than cooling packs (−1.4%, g= −0.07). For cold-water application, whole-body immersion (5.1%, g = 0.62) was significantly more effective than immersing only the legs or arms (1.1%, g = 0.10).

Conclusions:

In summary, the average effects of cooling on recovery of trained athletes were rather small (2.4%, g = 0.28). However, under appropriate conditions (whole-body cooling, recovery from sprint exercise), postexercise cooling seems to have positive effects that are large enough to be relevant for competitive athletes.

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J. Ty Hopkins and Christopher D. Ingersoll

Objectives:

To define the concept of arthrogenic muscle inhibition (AMI), to discuss its implications in the rehabilitation of joint injury, to discuss the neurophysiologic events that lead to AMI, to evaluate the methods available to measure AM1 and the models that might be implemented to examine AMI, and to review therapeutic interventions that might reduce AMI.

Data Sources:

The databases MEDLINE, SPORTDiscus, and CIHNAL were searched with the terms reflex inhibition, joint mechanoreceptor, Ib interneuron, Hoffmann reflex, effusion, and joint injury. The remaining citations were collected from references of similar papers.

Conclusions:

AMI is a limiting factor in the rehabilitation of joint injury. It results in atrophy and deficiencies in strength and increases the susceptibility to further injury. A therapeutic intervention that results in decreased inhibition, allowing for active exercise, would lead to faster and more complete recovery.

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Jeffrey R. Doeringer, Megan Colas, Corey Peacock and Dustin R. Gatens

likelihood that microscopic tears in the muscle tissue, which cause inflammation, will then lead to delayed onset muscle soreness. 4 Cryotherapy has been consistently used for relief of these symptoms, including pain associated with musculoskeletal injuries. 1 The physiological response to cryotherapy is

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Robert Vallandingham, Zachary Winkelmann, Lindsey Eberman and Kenneth Games

recommendations, clinicians should deploy a myriad of tasks, as outlined in Table  1 . 6 Table 1 Recommendations Set Forth in the Position Statement Treatment Recommendations Other Interventions Return-to-Play Considerations Cryotherapy Range of motion Patient-reported outcome measures (PROMs) Compression

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Mitchell Naughton, Joanna Miller and Gary J. Slater

on modulating aspects of primary ultrastructural damage and/or the secondary inflammation response (Figure  1 ) to assist recovery. Strategies identified to improve aspects of recovery following EIMD include cryotherapy modalities, 10 , 35 hydrotherapies, 36 , 37 compression garments, 38 and

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Kyle Southall, Matt Price and Courtney Wisler

which had not improved with conservative treatment, the athlete was diagnosed with MLL characterized by a space created between the fascia layers that allows an increase in superficial swelling caused by a shearing blunt force to the area. The team physician suggested continuation of cryotherapy and