Does ice immersion influence ankle joint position sense?

Arm cooling selectively impacts sensorimotor control

The benefits of cold have long been recognized in sport and medicine. However, it also brings costs, which have more rarely been investigated, notably in terms of sensorimotor control. We hypothesized that, in addition to peripheral effects, cold slows down the processing of proprioceptive cues, which has an impact on both feedback and feedforward control. We therefore compared the performances of participants whose right arm had been immersed in either cold water (arm temperature: 14°C) or lukewarm water (arm temperature: 34°C). In experiment 1, we administered a Fitts's pointing task and performed a kinematic analysis to determine whether sensorimotor control processes were affected by the cold. Results revealed 1) modifications in late kinematic parameters, suggesting changes in the use of proprioceptive feedback, and 2) modifications in early kinematic parameters, suggesting changes in action representations and/or feedforward processes. To explore our hypothesis further, we ran a second experiment in which no physical movement was involved, and thus no peripheral effects. Participants were administrated a hand laterality task, known to involve implicit motor imagery and assess the internal representation of the hand. They were shown left- and right-hand images randomly displayed in different orientations in the picture plane and had to identify as quickly and as accurately as possible whether each image was of the left hand or the right hand. Results revealed slower responses and more errors when participants had to mentally rotate the cooled hand in the extreme orientation of 160°, further suggesting the impact of cold on action representations.NEW & NOTEWORTHY We investigated how arm cooling modulates sensorimotor representations and sensorimotor control. Arm cooling induced changes in early kinematic parameters of pointing, suggesting an impact on feedforward processes or hand representation. Arm cooling induced changes in late kinematic parameters of pointing, suggesting an impact on feedback processes. Arm cooling also affected performance on a hand laterality task, suggesting that action representations were modified.

The Effect of Ice on Shoulder Proprioception in Badminton Athletes

This study aims to analyze the influence of the application of cryotherapy on shoulder proprioception in badminton athletes. Thirty federated badminton athletes were included in this study, all of whom belonged to three of the teams currently competing in national competitions (Portugal). Their mean ages were 21.00 ± 5.60 years, and their experience in the modality was 8.40 ± 6.93 years. They practiced in an average of 2.93 ± 1.26 training sessions per week. All of them used their right hand to hold the racket. Each participant's dominant shoulder joint position and force senses were evaluated for four consecutive time points through the isokinetic dynamometer Biodex System 3. The experimental procedure consisted of applying ice for 15 min and the control procedure consisted of no therapeutic intervention. The proprioception outcomes were expressed using the absolute error, relative error, and variable error. All statistical analysis was performed using PASW Statistics 18 software (IBM-SPSS Statistics). There were no statistically significant changes in the joint position and force senses after the intervention, as well as during the subsequent 30 min. We conclude that, after this cryotherapy technique, there is no increased risk of injury associated with a proprioception deficit that prevents athletes from immediately returning to badminton practice.

Effects of calf muscle conditioning upon ankle proprioception

Ankle proprioception is crucial for balance and relies upon accurate input from calf muscle spindles. Spindle input, in turn, depends upon the physiological and mechanical properties of surrounding muscle tissue. Altering these properties could affect ankle proprioception, with potential consequences for balance. Here we determine the effects of prior muscle cooling, stretch and contraction upon performance of a contralateral ankle joint matching task. Participants stood passively leaning against a board oriented 22° rearward from vertical. Their right ankle was rotated to a randomised position between ± 6° plantar/dorsiflexion. The task was to align the left ankle to the same position, without vision. In the first experiment, immediately prior to each testing session, participants either produced a strong calf muscle contraction in a fully plantarflexed (tiptoe) posture or underwent 15° dorsiflexion stretch. Contraction had no effect on task performance, whereas stretch produced a significant bias in ankle placement of 0.89 ± 0.6°, indicating that participants perceived their foot to be more plantarflexed compared to a control condition. In the second experiment, the right lower leg was cooled in iced water (≤ 5°C) for 10 minutes. Cooling increased joint matching error by ~0.4°, through a combination of increased bias and variability. These results confirm that conditioning the triceps surae muscles can alter perception of ankle joint position. Since body movement during quiet stance is in the order of 1°, the magnitude of these changes are relevant for balance.

The Effect of Cryotherapy Application to the Knee Joint on Dynamic Postural Stability

CONTEXT

Decreased postural balance is a primary risk factor for lower-limb injuries. Cryotherapy is commonly utilized by clinicians to provide local analgesia for minor acute knee joint musculoskeletal injuries during breaks in play or at halftime. Its effect on dynamic postural balance remains unclear.

OBJECTIVE

To investigate the acute effects of a 15-minute knee joint cryotherapy application on dynamic postural balance, as assessed primarily via a clinically oriented outcome measure.

DESIGN

Experimental study.

SETTING

University biomechanics laboratory.

PATIENTS OR PARTICIPANTS

A total of 28 elite-level college male field-sport athletes.

INTERVENTION

Participants were tested on the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test both before and after a 15-minute knee joint cryotherapy application.

MAIN OUTCOME MEASURE(S)

Normalized reach distances, 3-dimensional knee joint kinematics, sagittal plane hip and ankle joint kinematics, as well as fractal dimension of the center-of-pressure path during the performance of the anterior, posteromedial, and posterolateral reach directions of the Star Excursion Balance Test.

RESULTS

There was a statistically significant decrease in reach distance scores achieved on anterior, posteromedial, and posterolateral directions of the Star Excursion Balance Test from precryotherapy to postcryotherapy (P < .05). None of the decreases in reach distance scores exceeded the reported smallest detectable difference values. No significant differences were observed in hip, knee, or ankle joint kinematics (P > .05). No significant change in fractal dimension was observed for any reach direction following cryotherapy application (P > .05).

CONCLUSIONS

The results of the present study indicate that dynamic postural balance is unlikely to be adversely affected immediately following cryotherapy application to the knee joint.

Comparison of the effects of standard and intermittent cryoimmersion on stability, pain threshold and tolerance in the ankle region in healthy individuals

Abstract Introduction: Cryotherapy is a technique that involves the application of low temperatures in the treatment of acute injuries, with ice being the simplest and oldest therapeutic modality for this. Objective: To compare two different cold water immersion protocols (standard and intermittent) on the ankle region of healthy volunteers, we analyzed changes in static postural stability, threshold, and pain tolerance immediately after application. Method: This is a quasi-experimental study, controlled clinical trial, and non-probabilistic sampling. The total sample consisted of 40 male patients aged 18 to 30 years. Two different cold water immersion protocols (standard and intermittent) were compared for their effects on pain threshold, tolerance, and static postural stability. Results: There were no significant differences between the groups with regards to the stabilometric variables after the application of both protocols (p > 0.05). There was a significant difference in the threshold and tolerance of the two groups after the application of cold water immersion (p < 0.05); however, there were no significant differences between the groups (p > 0.05). Conclusion: Both cold water immersion protocols proved to be safe for static postural balance, without showing deficits in stabilometric variables. Regarding the analgesic effect, both were effective and significantly increased the threshold and tolerance of ankle pain after cryoimmersion, without any differences between groups. Thus, intermittent 10-minute cold water immersion is sufficient to generate the same analgesic effect as the standard 20-minute pattern, with no change in static postural stability.

Cryotherapy Reduces Muscle Spasticity But Does Not Affect Proprioception in Ischemic Stroke: A Randomized Sham-Controlled Crossover Study

OBJECTIVE

The aim of the study was to evaluate the immediate effects of cryotherapy (using an ice pack) on ankle joint position sense and the degree of spasticity after chronic hemiparetic stroke.

DESIGN

We used a sham-controlled crossover design. Sixteen chronic hemiparetic patients were randomly assigned to two groups: (1) those who received cryotherapy followed by a control intervention 15 days later (cryotherapy group) and (2) those who received the control intervention followed by cryotherapy 15 days later (control intervention group). Ankle joint position sense was measured on the paretic side using a Biodex Multi-joint System 3 dynamometer before and after 20 mins of either application on the calf muscles. Lower absolute error scores were calculated for data analyses and were used to determine joint position sense. The degree of spasticity of the plantar flexor muscles was scored according to the Modified Ashworth Scale.

RESULTS

Sixteen patients completed the crossover experiment; however, data analysis was successfully conducted in 15 participants. Cryotherapy reduced the degree of spasticity of the plantar flexor muscles without altering ankle joint position sense.

CONCLUSIONS

Cryotherapy (using an ice pack) may reduce plantar flexor spasticity without influencing proprioception.

The Effects of Cryotherapy on Knee Joint Position Sense and Force Production Sense in Healthy Individuals

The proprioceptive information received from mechanoreceptors is potentially responsible for controlling the joint position and force differentiation. However, it is unknown whether cryotherapy influences this complex mechanism. Previously reported results are not universally conclusive and sometimes even contradictory. The main objective of this study was to investigate the impact of local cryotherapy on knee joint position sense (JPS) and force production sense (FPS). The study group consisted of 55 healthy participants (age: 21 ± 2 years, body height: 171.2 ± 9 cm, body mass: 63.3 ± 12 kg, BMI: 21.5 ± 2.6). Local cooling was achieved with the use of gel-packs cooled to -2 ± 2.5°C and applied simultaneously over the knee joint and the quadriceps femoris muscle for 20 minutes. JPS and FPS were evaluated using the Biodex System 4 Pro apparatus. Repeated measures analysis of variance (ANOVA) did not show any statistically significant changes of the JPS and FPS under application of cryotherapy for all analyzed variables: the JPS’s absolute error (p = 0.976), its relative error (p = 0.295), and its variable error (p = 0.489); the FPS’s absolute error (p = 0.688), its relative error (p = 0.193), and its variable error (p = 0.123). The results indicate that local cooling does not affect proprioceptive acuity of the healthy knee joint. They also suggest that local limited cooling before physical activity at low velocity did not present health or injury risk in this particular study group.

How does cryotherapy effect ankle proprioception in healthy individuals?

Objectives To investigate how a 15-min cryotherapy intervention effects proprioception by measuring joint positional sense (JPS) and static single legged balance. Design Repeated measures design. Setting Laboratory. Participants Eighteen healthy university sports team students (11 males, 7 females) aged between 20 and 21 years old. Main outcome measures Participants were treated with 15 min of Aircast Cryo-cuff. The subject's skin temperature was measured before and immediately after 15 min of cryotherapy treatment. Ankle active joint positional sense (A-JPS) and passive joint positional sense (P-JPS) were measured at pre-test, immediately post-test, and 5 min post-test. Static balance was measured by centre of pressure (CoP) mean path length, medial-lateral (ML) CoP mean deviation, and anterior-posterior (AP) CoP mean deviation and mean time-to-boundary (TtB) minima for AP and ML directions. Results No significant differences were found for the variables of JPS and static single balance testing after 15 min of cryotherapy treatment. However, mean differences for CoP mean path length and ML mean deviation were shown to improve following cryotherapy treatment, results not previously found in the literature. Conclusion Results suggest that 15 min of Cryo-cuff treatment does not significantly affect proprioception. Although the effect of cryotherapy on proprioception depends on cooling modality used, time frame applied, and joint applied to.

Effects of wearing ankle weight on knee joint repositioning sense in the elderly

[Purpose] To investigate the effects of different ankle weights on knee joint repositioning sense in elderly individuals. [Subjects and Methods] Twenty-one subjects were divided for assessment as follows: young (20–30 years, n=10) and elderly (60–70 years, n=11). Knee joint repositioning error was measured by asking the subjects to reposition the target angle of their knee joints while wearing different ankle weights (0%, 0.5%, 1%, and 1.5%) in an open kinetic chain. The Hawk Digital System (60 Hz; Motion Analysis, Santa Rosa, CA, USA) was used to measure knee joint repositioning error. Differences in knee joint repositioning error between the young and elderly groups according to ankle weight load were examined by using two-way mixed repeated-measures analysis of variance. [Results] The knee joint repositioning error was lower with than without ankle weights in both groups. The error value was lowest with the 1.0% weight, though not significantly. Knee joint repositioning error was significantly higher in the elderly under all the ankle weight conditions. [Conclusion] Knee joint repositioning sense can be improved in elderly individuals by wearing proper ankle weights. However, weights that are too heavy might disturb knee joint positioning sense.

An exploratory study into the effects of a 20 minute crushed ice application on knee joint position sense during a small knee bend

OBJECTIVES

The effect of cryotherapy on joint positioning presents conflicting debates as to whether individuals are at an increased risk of injury when returning to play or activity immediately following cryotherapy application at the knee. The aim of this study was to investigate whether a 20 min application of crushed ice at the knee immediately affects knee joint position sense during a small knee bend.

DESIGN

Pre- and post-intervention.

SETTING

University movement analysis laboratory.

PARTICIPANTS

Eleven healthy male participants.

MAIN OUTCOME MEASURES

Kinematics of the knee were measured during a weight bearing functional task pre and post cryotherapy intervention using three-dimensional motion analysis (Qualisys Medical AB Gothenburg, Sweden). Tissue cooling was measured via a digital thermometer at the knee.

RESULTS

Results demonstrated significant reductions in the ability to accurately replicate knee joint positioning in both sagittal (P = .035) and coronal (P = .011) planes during the descent phase of a small knee bend following cryotherapy.

CONCLUSION

In conclusion a 20 min application of crushed ice to the knee has an adverse effect on knee joint repositioning. Team doctors, clinicians, therapists and athletes should consider these findings when deciding to return an athlete to functional weight bearing tasks immediately following ice application at the knee, due to the potential increase risk of injury.

ANÁLISE DO DESEMPENHO FÍSICO E DO EQUILÍBRIO SOB INFLUÊNCIA DA CRIOTERAPIA EM ATLETAS DE FUTSAL

Introdução Crioterapia é a aplicação de modalidades de frio com temperatura de 0ºC a 18,3ºC, podendo interferir no desempenho físico e equilíbrio, dependendo da capacidade do indivíduo em manter a estabilização, direcionar padrões de movimentos, controlar a postura e posição articular. Objetivo Avaliar o desempenho físico, a frequência cardíaca e o equilíbrio estático com olhos abertos, em atletas de futsal (futebol de salão), antes e depois da crioimersão nos membros inferiores. Métodos Trinta e dois indivíduos do gênero masculino participaram do estudo, distribuídos aleatoriamente em dois grupos: (A) grupo controle, imersão em água a 24°C por 10 min; (B) grupo intervenção, crioimersão em água com gelo a 10°C por 10 min. Os voluntários realizavam a avaliação do equilíbrio no baropodômetro, em seguida corriam em linha reta e em ziguezague por 100 m, entravam na crioimersão, terminando com uma nova avaliação. Foram analisados o desempenho físico, através dos tempos das corridas, a frequência cardíaca, por meio de um frequencímetro e o equilíbrio, através da baropodometria e estabilometria em apoio bipodal de olhos abertos. Resultados O desempenho físico foi alterado após a crioimersão quando das análises intra e intergrupos. A frequência cardíaca apresentou diferença ao comparar-se antes e após a crio, porém sem diferenças em comparação ao controle. O equilíbrio não foi alterado após a crioimersão e nem em comparação com o grupo controle. Conclusão A crioimersão prejudicou o desempenho físico, quando a atividade foi imediatamente após a mesma, sendo desta forma o gelo não aconselhável quando se deseja desempenho na atividade desportiva. Porém não apresentou interferência na frequência cardíaca e no equilíbrio de atletas de futsal, que podem não ter sido alterados devido ao tempo da crioimersão.

Dynamic Postural-Stability Deficits After Cryotherapy to the Ankle Joint

CONTEXT

Decreased postural stability is a primary risk factor for lower limb musculoskeletal injuries. During athletic competitions, cryotherapy may be applied during short breaks in play or during half-time; however, its effects on postural stability remain unclear.

OBJECTIVE

To investigate the acute effects of a 15-minute ankle-joint cryotherapy application on dynamic postural stability.

DESIGN

Controlled laboratory study.

SETTING

University biomechanics laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 29 elite-level collegiate male field-sport athletes (age = 20.8 ± 1.12 years, height = 1.80 ± 0.06 m, mass = 81.89 ± 8.59 kg) participated.

INTERVENTION(S)

Participants were tested on the anterior (ANT), posterolateral (PL), and posteromedial (PM) reach directions of the Star Excursion Balance Test before and after a 15-minute ankle-joint cryotherapy application.

MAIN OUTCOME MEASURE(S)

Normalized reach distances; sagittal-plane kinematics of the hip, knee, and ankle joints; and associated mean velocity of the center-of-pressure path during performance of the ANT, PL, and PM reach directions of the Star Excursion Balance Test.

RESULTS

We observed a decrease in reach-distance scores for the ANT, PL, and PM reach directions from precryotherapy to postcryotherapy (P < .05). No differences were observed in hip-, knee-, or ankle-joint sagittal-plane kinematics (P > .05). We noted a decrease in mean velocity of the center-of-pressure path from precryotherapy to postcryotherapy (P < .05) in all reach directions.

CONCLUSIONS

Dynamic postural stability was adversely affected immediately after cryotherapy to the ankle joint.

Lower limb ice application alters ground reaction force during gait initiation

BACKGROUND:

Cryotherapy is a widely used technique in physical therapy clinics and sports. However, the effects of cryotherapy on dynamic neuromuscular control are incompletely explained.

OBJECTIVES:

To evaluate the effects of cryotherapy applied to the calf, ankle and sole of the foot in healthy young adults on ground reaction forces during gait initiation.

METHOD:

This study evaluated the gait initiation forces, maximum propulsion, braking forces and impulses of 21 women volunteers through a force platform, which provided maximum and minimum ground reaction force values. To assess the effects of cooling, the task - gait initiation - was performed before ice application, immediately after and 30 minutes after removal of the ice pack. Ice was randomly applied on separate days to the calf, ankle and sole of the foot of the participants.

RESULTS:

It was demonstrated that ice application for 30 minutes to the sole of the foot and calf resulted in significant changes in the vertical force variables, which returned to their pre-application values 30 minutes after the removal of the ice pack. Ice application to the ankle only reduced propulsion impulse.

CONCLUSIONS:

These results suggest that although caution is necessary when performing activities that require good gait control, the application of ice to the ankle, sole of the foot or calf in 30-minute intervals may be safe even preceding such activities.

The effects of cryotherapy on proprioception system

Proprioception plays an important role in the complex mechanism of joint control. Contemporary sport activities impose extremely high physical demands on athletes. Winter sports are played in areas with excessively low temperatures. Moreover, many athletes are subjected to treatments that involve local lowering of the body temperature before, during, and after physical activity. This work reviews the current knowledge regarding the influence of local cryotherapy on the proprioception system. The reviewed literature identified several tests that evaluate different aspects of proprioception. There is no universally agreed protocol, or clear set of criteria for test conditions. The outcomes of different tests and assessments of cryotherapy procedures using different cold modalities are poorly correlated. In general, the published results on the mechanism of cryotherapy effects on proprioception are not uniquely conclusive and are frequently contradictory. Additional high-quality research is required to explicitly answer the following questions: (1) whether local cryotherapy influences all aspects of proprioception; (2) whether the current methods of evaluation are adequate for the exploration of the relationship between cryotherapy and proprioception; and (3) whether the application of local cryotherapy is safe for athletes regarding proprioception. The review clearly showed that there is no comprehensive model relating cryotherapy and proprioception.

Effects of cold water immersion on lower extremity joint biomechanics during running

The purpose of this study was to identify the influence of cryotherapy on lower extremity running biomechanics. Twenty-six healthy male volunteers were randomised into two intervention groups: cold water (cold water at ~11°C) or tepid water (tepid water at ~26°C). They were required to run at 4.0 ± 0.2 m · s(-1) before and after they underwent water immersion for 20 min. Differences between pre- and post-intervention were used to compare the influence of water intervention during running. Peak joint angles, peak joint moments, peak ground reaction forces (GRF) and contact time (CT) were calculated using three-dimensional gait analysis. Independent t-tests were applied with a significant alpha level set at 0.05. Decreased peak propulsive and vertical GRF, decreased plantarflexion moments, increased hip flexion angle and longer CT were observed following cold water immersion. Although cold water immersion (cryotherapy) affected the running movement, none of the alterations have been related to running biomechanical patterns associated with injuries. Therefore, our results indicated that cold water immersion appears safe prior to running activities.

On the effect of thermal agents in the response of the brachial biceps at different contraction levels

The objective of this study was to assess electromyographic features of the brachial biceps muscle after the application of cryotherapy and short-wave diathermy. Sixty healthy volunteers participated in the study and were equally divided into three groups: cryotherapy - application of ice packs for 30 min; short-wave diathermy for 20 min; and control. The thermal agents were applied to the anterior and posterior regions of the non-dominant arm. The electromyographic (EMG) signal from the brachial biceps was recorded before and after the application of thermal agents during flexion of the elbow joint at 25%, 50%, 75% of a maximum voluntary isometric contraction defined at least two days before the actual experiments (MVICbl). The volunteers also were asked to execute a free MVIC before and after the application of the thermal agents (MVIC free). A linear regression model with mixed effects (random and fixed) was used. Intra-group analysis showed a reduction in root mean square (RMS) at MVIC free, with no change in the median frequency of the EMG signal at any contraction level for the short-wave diathermy group. An increase on RMS values and a decrease on median frequencies were found after the application of cryotherapy for all contraction levels. The results imply that cryotherapy plays an important role on changing neuromuscular responses at various levels of muscle contraction. Therapists should be aware of that and carefully consider its use prior to activities in which neuromuscular precision is required.

The effect of cryotherapy on the normal ankle joint position sense

Purpose

To determine whether a fifteen-minute water immersion treatment affects the normal ankle joint position sense (JPS) at the middle range of dorsiflexion and plantar flexion actively and passively.

Methods

Thirty healthy female volunteers aged between 18 and 30 years were treated by a 15-minute cryotherapy (6 ± 1°C). The subject's skin temperature over antromedial aspect of dominant ankle was measured by the Mayomed device before, immediate and 15 minutes after water immersion. Ankle JPS was tested trough the pedal goniometer at 3 stages similar to the skin temperature. ANOVA (α = 0.05) was performed on each of variables using SPSS 19.0 software.

Results

Skin temperature was seen to decrease after water immersion but subjects did not return to pre-test skin temperature after 15 minutes (P<0.001). The research found no significant difference in JPS at middle range of dorsiflexion and plantar flexion actively and passively before and after cryotherapy.

Conclusion

These findings suggest that 15-minute water immersion at 6°C dose not significantly alter the middle range of plantar flexion/ dorsiflexion JPS at the ankle and is not deleterious to JPS.

Effects of cold water immersion on knee joint position sense in healthy volunteers

The purpose of this study was to determine the effects of cryotherapy, in the form of cold water immersion, on knee joint position sense. Fourteen healthy volunteers, with no previous knee injury or pre-existing clinical condition, participated in this randomized cross-over trial. The intervention consisted of a 30-min immersion, to the level of the umbilicus, in either cold (14 ± 1 °C) or tepid water (28 ± 1 °C). Approximately one week later, in a randomized fashion, the volunteers completed the remaining immersion. Active ipsilateral limb repositioning sense of the right knee was measured, using weight-bearing and non-weight-bearing assessments, employing video-recorded 3D motion analysis. These assessments were conducted immediately before and after a cold and tepid water immersion. No significant differences were found between treatments for the absolute (P = 0.29), relative (P = 0.21) or variable error (P = 0.86). The average effect size of the outcome measures was modest (range -0.49 to 0.9) and all the associated 95% confidence intervals for these effect sizes crossed zero. These results indicate that there is no evidence of an enhanced risk of injury, following a return to sporting activity, after cold water immersion.

Effects of whole-body cryotherapy (-110 °C) on proprioception and indices of muscle damage

The purpose of this study was to investigate the effects of whole-body cryotherapy (WBC) on proprioceptive function, muscle force recovery following eccentric muscle contractions and tympanic temperature (T(TY) ). Thirty-six subjects were randomly assigned to a group receiving two 3-min treatments of -110 ± 3 °C or 15 ± 3 °C. Knee joint position sense (JPS), maximal voluntary isometric contraction (MVIC) of the knee extensors, force proprioception and T(TY) were recorded before, immediately after the exposure and again 15 min later. A convenience sample of 18 subjects also underwent an eccentric exercise protocol on their contralateral left leg 24 h before exposure. MVIC (left knee), peak power output (PPO) during a repeated sprint on a cycle ergometer and muscles soreness were measured pre-, 24, 48 and 72h post-treatment. WBC reduced T(TY) , by 0.3 °C, when compared with the control group (P<0.001). However, JPS, MVIC or force proprioception was not affected. Similarly, WBC did not effect MVIC, PPO or muscle soreness following eccentric exercise. WBC, administered 24 h after eccentric exercise, is ineffective in alleviating muscle soreness or enhancing muscle force recovery. The results of this study also indicate no increased risk of proprioceptive-related injury following WBC.

Cryotherapy and joint position sense in healthy participants: a systematic review

OBJECTIVE

To (1) search the English-language literature for original research addressing the effect of cryotherapy on joint position sense (JPS) and (2) make recommendations regarding how soon healthy athletes can safely return to participation after cryotherapy.

DATA SOURCES

We performed an exhaustive search for original research using the AMED, CINAHL, MEDLINE, and SportDiscus databases from 1973 to 2009 to gather information on cryotherapy and JPS. Key words used were cryotherapy and proprioception, cryotherapy and joint position sense, cryotherapy, and proprioception.

STUDY SELECTION

The inclusion criteria were (1) the literature was written in English, (2) participants were human, (3) an outcome measure included JPS, (4) participants were healthy, and (5) participants were tested immediately after a cryotherapy application to a joint.

DATA EXTRACTION

The means and SDs of the JPS outcome measures were extracted and used to estimate the effect size (Cohen d) and associated 95% confidence intervals for comparisons of JPS before and after a cryotherapy treatment. The numbers, ages, and sexes of participants in all 7 selected studies were also extracted.

DATA SYNTHESIS

The JPS was assessed in 3 joints: ankle (n = 2), knee (n = 3), and shoulder (n = 2). The average effect size for the 7 included studies was modest, with effect sizes ranging from -0.08 to 1.17, with a positive number representing an increase in JPS error. The average methodologic score of the included studies was 5.4/10 (range, 5-6) on the Physiotherapy Evidence Database scale.

CONCLUSIONS

Limited and equivocal evidence is available to address the effect of cryotherapy on proprioception in the form of JPS. Until further evidence is provided, clinicians should be cautious when returning individuals to tasks requiring components of proprioceptive input immediately after a cryotherapy treatment.

Effect of knee joint cooling on the electromyographic activity of lower extremity muscles during a plyometric exercise

During sporting events, injured athletes often return to competition after icing because of the reduction in pain. Although some controversy exists, several studies suggest that cryotherapy causes a decrease in muscle activity, which may lead to a higher risk of injury upon return to play. The purpose of this study was to investigate the effect of a 20-min knee joint cryotherapy application on the electromyographic activity of leg muscles during a single-leg drop jump in twenty healthy subjects, randomly assigned to an experimental and a control group. After the pre-tests, a crushed-ice bag was applied to the knee joint of the experimental group subjects for 20 min, while the control group subjects rested for 20 min. All subjects were retested immediately after this period and retested again after another 20 min of rest. Average electromyographic activity and ground contact time were calculated for the pre- and post-test sessions. Decreases in electromyographic activity of the lower extremity musculature were found in pre-activation, eccentric (braking), and concentric (push-off) phases immediately after the icing, and after 20 min of rest. The results lend support to the suggestion that cryotherapy during sporting events may place the individuals in a vulnerable position.

The effect of immersion cryotherapy on medial-lateral postural sway variability in individuals with a lateral ankle sprain

BACKGROUND AND PURPOSE

Postural stability has been shown to be impaired after a lateral ankle sprain (LAS) and after immersion cryotherapy in healthy ankles. This study was performed to determine the effects of cryotherapy on postural stability after LAS.

METHOD

A single-session, repeated measures design was used. Fifteen 18- to 29-year-old males (mean age 21.33 +/- 3.54, height 71.23 +/- 2.50 cm, mass 170.33 +/- 19.77 kg) with relatively recent grade I LAS volunteered. Medial-lateral postural sway variability was assessed during single-leg barefoot stance using a Bertec force platform. Sway was tested before cryotherapy ('Pre'), immediately after 20 minutes of lower-leg immersion cryotherapy ('Post(0)'), and 10 and 20 minutes after cryotherapy ('Post(10)' and 'Post(20)'). Both legs were tested (individually) before cryotherapy; the involved leg was tested alone after cryotherapy. The uninvolved leg served as a control.

RESULTS

Postural sway variability of the involved le was significantly greater than the uninvolved le before cryotherapy (p = 0.001). Postural sway variability of the involved leg was also significantly greater than the uninvolved LE during Post(0) (p = 0.000), Post(10) (p = 0.000) and Post(20) testing (p = 0.003) with the largest increase in sway variability occurring at Post(0).

CONCLUSIONS

Medial-lateral postural sway variability was greater after LAS. This effect was augmented by immersion cryotherapy.

Intra-articular temperatures of the knee in sports - an in-vivo study of jogging and alpine skiing

BACKGROUND

Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature.

METHODS

In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19 degrees C room temperature and skiing in a ski resort at -3 degrees C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test.

RESULTS

Median intra-articular temperatures increased from 31.4 degrees C before activity by 2.1 degrees C, 4 degrees C, 5.8 degrees C and 6.1 degrees C after 15, 30, 45 and 60 min of jogging (all p < or = 0.05). Median intra-articular temperatures dropped from 32.2 degrees C before activity by 0.5 degrees C, 1.9 degrees C, 3.6 degrees C and 1.1 degrees C after 15, 30, 45 and 60 min of skiing (all n.s.). After 60 minutes of skiing (jogging), the median intra-articular temperature was 19.6% (8.7%) higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups.

CONCLUSION

This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

The PRICE study (Protection Rest Ice Compression Elevation): design of a randomised controlled trial comparing standard versus cryokinetic ice applications in the management of acute ankle sprain [ISRCTN13903946]

BACKGROUND

Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities employed in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established. Intermittent ice applications are thought to exert a significant analgesic effect. This could facilitate earlier therapeutic exercise after injury, potentially allowing for a quicker return to activity. The primary aim of the forthcoming study is therefore to examine the safety and effectiveness of combining intermittent ice applications with periods of therapeutic exercise in the first week after an acute ankle sprain.

METHODS/DESIGN

The study is a randomised controlled trial. 120 subjects with an acute grade I or grade II ankle sprain will be recruited from Accident & Emergency and a University based Sports Injury Clinic. Subjects will be randomised under strict double-blind conditions to either a standard cryotherapy (intermittent ice applications with compression) or cryokinetic treatment group (intermittent ice applications with compression and therapeutic exercise). After the first week, treatment will be standardised across groups. Assessor blinding will be maintained throughout the trial. Primary outcome will be function, assessed using the Lower Extremity Functional Scale (LEFS). Additional outcomes will include pain (10 cm Visual Analogue Scale), swelling (modified figure-of-eight method) and activity levels (activPALtrade mark physical activity monitor, PAL Technologies, Glasgow, UK). Diagnostic Ultrasound (Episcan-1-200 high frequency ultrasound scanning system, Longport International Ltd, PA) will also be used to assess the degree of soft tissue injury. After baseline assessment subjects will be followed up at 1, 2, 3 & 4 weeks post injury. All data will be analysed using repeated measures analysis of co-variance (ANCOVA).

DISCUSSION

This paper describes the rationale and design of a randomised controlled trial which will examine the effectiveness of two different cryotherapy protocols in the early management of acute ankle sprain.

TRIAL REGISTRATION

ISRCTN13903946.

Therapeutic cooling: no effect on hamstring reflexes and knee stability

PURPOSE

Stretch reflexes contribute to joint stiffness, but the effects of therapeutic cooling on these reflexes are unknown. Therapeutic cooling is frequently used in knee rehabilitation, for instance, after rupture of the anterior cruciate ligament. Cooling a joint can affect nerve conduction velocity and the function of sensory organs. Such changes in neuromuscular coupling could reduce knee stability and increase the risk of knee injury. The aim of the present study was to evaluate whether there are negative effects of knee cooling on the hamstring short and medium latency reflex responses or on the anterior tibia trajectory after mechanically induced tibia translation.

METHODS

In 15 healthy volunteers, the latency and size of short latency and medium latency reflex responses of hamstring muscles were assessed before and after 20 min of cold therapy of the knee joint as applied in rehabilitation. Reflex responses were evoked by a mechanically induced posterior-anterior tibia translation during standing. Reflexes were recorded by surface electromyography. The distance of anterior tibia motion and its velocity were assessed by potentiometric position transducer.

RESULTS

Local cold therapy of the knee did not alter the latency or the size of short or medium latency responses. Also, the extent and the velocity of tibia translation were unchanged after knee cooling.

CONCLUSION

Cold therapy does not seem to adversely influence the spinal reflexes of the hamstrings induced by anterior tibia translation. As neuromuscular coupling was not significantly affected, the cold therapy, as performed in the present study, is not likely to increase the risk of knee injury.

Single-Leg Landing Strategy after Knee-Joint Cryotherapy

Context:

Despite recent findings regarding lower extremity function after cryotherapy, little is known of the neuromuscular, kinetic, and kinematic changes that might occur during functional tasks.

Objective:

To evaluate changes in ground-reaction forces, muscle activity, and knee-joint flexion during single-leg landings after 20-minute knee-joint cryotherapy.

Design:

1 × 4 repeated-measures, time-series design.

Setting:

Research laboratory.

Patients or Other Participants:

20 healthy male and female subjects.

Intervention:

Subjects performed 5 single-leg landings before, immediately after, and 15 and 30 minutes after knee-joint cryo-therapy.

Main Outcome Measures:

Ground-reaction force, knee-joint flexion, and muscle activity of the gastrocnemius, hamstrings, quadriceps, and gluteus medius.

Results:

Cryotherapy did not significantly (P> .05) change maximum knee-joint flexion, vertical ground-reaction force, or average muscle activity during a single-leg landing.

Conclusion:

Knee-joint cryotherapy might not place the lower extremity at risk for injury during landing.

Lower Leg Cold Immersion Does Not Impair Dynamic Stability in Healthy Women

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.

Cryotherapy does not impair shoulder joint position sense11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated

OBJECTIVE

To determine the effects of a cryotherapy treatment on shoulder proprioception.

DESIGN

Crossover design with repeated measures.

SETTING

University athletic training and sports medicine research laboratory.

PARTICIPANTS

Thirty healthy subjects (15 women, 15 men).

INTERVENTION

A 30-minute cryotherapy treatment.

MAIN OUTCOME MEASURES

Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception.

RESULTS

Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application.

CONCLUSIONS

Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

The relationship between intramuscular temperature, skin temperature, and adipose thickness during cryotherapy and rewarming

OBJECTIVE

To describe the relationships among muscle temperature, skin temperature, room temperature, body core temperature, time, and subcutaneous adipose thickness during cryotherapy and rewarming.

DESIGN

A multiple linear regression with 5 independent variables (skin temperature, body core temperature, subcutaneous adipose thickness, room temperature, time) predicting intramuscular (IM) temperature.

SETTING

A sports injury research laboratory.

PARTICIPANTS

Fifteen volunteers with thigh skinfold measurements smaller than 40 mm.

INTERVENTIONS

Thirty-minute cryotherapy treatment (ice bag) followed by a 120-minute rewarming period.

MAIN OUTCOME MEASURES

The relationship between skin and IM temperature was described, and an equation predicting IM temperature by using room temperature, skin temperature, body core temperature, time, and adipose thickness was developed.

RESULTS

Pearson's correlations between each predictor variable of IM temperature during cryotherapy were skin temperature, r = .46; skinfold, r = .37; time, r = -.59; core temperature, r =.21; and room temperature, r = -.47. During rewarming, the correlations were skin temperature, r = .71; skinfold, r = .27; time, r = .76; core temperature, r = - .05; and room temperature, r = - .21. A multiple regression equation (R(2) = .76) was developed to predict IM temperature during cryotherapy. A separate equation (R(2) =.81) was developed to predict muscle temperatures during rewarming.

CONCLUSIONS

During and after ice application, no single predictor adequately explained the change in IM temperature. Skin surface temperature was a weak predictor of IM temperature during cryotherapy and should not be used as the sole dependent measure in cryotherapy efficacy studies.