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Belsey J, Gregory R, Paine E, Faulkner J. Skin temperature of the knee was effectively reduced when using a new continuous cold-flow cryocompression device: a randomised controlled crossover trial. Physiotherapy 2024; 123:11-18. [PMID: 38244486 DOI: 10.1016/j.physio.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/07/2023] [Accepted: 12/10/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To determine which temperature settings on a new continuous cold-flow cryocompression device effectively reduce knee skin temperature to 10-15 °C, where pain and swelling are expected to be attenuated. DESIGN Randomised controlled crossover trial. SETTING University laboratory. PARTICIPANTS 32 healthy adult participants recruited (1 dropout) with no contraindications to cryocompressive therapy. INTERVENTION A k-type thermocouple was used to record skin temperature at baseline and every five minutes during a 30-minute cryocompression treatment in a control condition and when using four different device temperature settings (6 °C, 8 °C, 10 °C, and 12 °C) on a continuous cold-flow cryocompression device. Conditions were labelled Control, Con-6, Con-8, Con-10, and Con-12, respectively. MAIN OUTCOME MEASURES Skin temperature change (°C) throughout cryocompression; time taken (mins) to achieve skin temperature < 15 °C; and the difference between final skin temperature and device temperature setting (°C). RESULTS Median (IQR) skin temperature after cryocompression was 32.1 °C (29.3-33.4), 12.8 °C (12.1-14.6), 14.3 °C (13.8-15.7), 16.1 °C (15.2-17.3), and 17.7 °C (16.9-18.9) for the Control condition and Con-6, Con-8, Con-10 and Con-12, respectively. It took 20 min (Con-6) and 25 min (Con-8) for skin temperature to reach < 15 °C. A median (IQR) difference of 6.8 °C (6.1-8.6), 6.3 °C (5.8-7.7), 6.1 °C (5.2-7.3), and 5.7 °C (4.9-6.9) for Con-6, Con-8, Con-10, and Con-12, respectively was observed between device temperature setting and final skin temperature. CONCLUSIONS The device is recommended as it reduced skin temperature to the therapeutic range of 10-15 °C during a 30-minute treatment when using the 6 °C or 8 °C device temperature settings. Future research should determine optimal treatment lengths for cryocompression. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- James Belsey
- University of Winchester, Department of Sport, Health & Community, Sparkford Road, Winchester, United Kingdom.
| | - Ryan Gregory
- University of Winchester, Department of Sport, Health & Community, Sparkford Road, Winchester, United Kingdom
| | - Eloise Paine
- University of Winchester, Department of Sport, Health & Community, Sparkford Road, Winchester, United Kingdom
| | - James Faulkner
- University of Winchester, Department of Sport, Health & Community, Sparkford Road, Winchester, United Kingdom
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Trybulski R, Kużdżał A, Bichowska-Pawęska M, Vovkanych A, Kawczyński A, Biolik G, Muracki J. Immediate Effect of Cryo-Compression Therapy on Biomechanical Properties and Perfusion of Forearm Muscles in Mixed Martial Arts Fighters. J Clin Med 2024; 13:1177. [PMID: 38398489 PMCID: PMC10889478 DOI: 10.3390/jcm13041177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Mixed martial arts (MMA) fighters use their arms and hands for striking with the fists, grappling, and defensive techniques, which puts a high load on the forearms and hand muscles. New methods are needed to decrease the risk of injury and increase the effectiveness of regeneration. This study aimed to assess the effectiveness of cryo-compression (CC) therapy of different times (3 and 6 min) on forearm muscles in MMA fighters by investigating muscle pain, stiffness, tension, elasticity strength, and perfusion. Twenty professional male MMA fighters aged 26.5 ± 4.5 years, with training experience of 10.3 ± 5.0 years, were enrolled on an experimental within-group study design. The participants underwent CC therapy at a temperature of 3 °C and compression of 75 mmHg for 3 min and, in the second session, for 6 min. The investigated parameters were in the following order: (1) perfusion in non-reference units (PU), (2) muscle tone (T-[Hz]), (3) stiffness (S-[N/m]), (4) elasticity (E-[arb]), (5) pressure pain threshold (PPT-[N/cm]), and (6) maximum isometric force (Fmax [kgf]) at two time points: (1) at rest-2 min before CC therapy (pre) and (2) 2 min after CC therapy (post). There were significant differences between 3 and 6 min of CC therapy for PU and T. Meanwhile, F, E, PPT, and S were significantly different when comparing pre- to post-conditions. These results provide evidence that CC therapy is a stimulus that significantly affects parameters characterizing muscle biomechanical properties, pain threshold, strength, and tissue perfusion.
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Affiliation(s)
- Robert Trybulski
- Medical Department Wojciech Korfanty Upper Silesian Academy, 40-659 Katowice, Poland
| | - Adrian Kużdżał
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, 35-959 Rzeszów, Poland;
| | - Marta Bichowska-Pawęska
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Andriy Vovkanych
- Department of Physical Therapy and Ergotherapy, Ivan Boberkyj Lviv State University of Physical Culture, 79007 Lviv, Ukraine;
| | - Adam Kawczyński
- Department of Biomechanics and Sport Engineering, Gdansk University of Physical Education and Sport, 80-336 Gdansk, Poland;
| | - Grzegorz Biolik
- Department of General Surgery, Vascular Surgery, Angiology and Phlebology, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Jarosław Muracki
- Institute of Physical Culture Sciences, Department of Physical Education and Health, University of Szczecin, 70-453 Szczecin, Poland;
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Belsey J, Reid A, Paine E, Faulkner J. A randomised crossover trial of five cryocompression devices' ability to reduce skin temperature of the knee. PLoS One 2024; 19:e0296634. [PMID: 38227605 PMCID: PMC10790989 DOI: 10.1371/journal.pone.0296634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/11/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The application of cold and pressure to the knee is a common part of post-operative rehabilitation. Skin temperature should be reduced to within 10-15 °C to optimise the therapeutic benefits of cryocompression. The purpose of this study was to investigate the ability of five different cryocompression devices to reduce skin temperature to within this therapeutic range. MATERIALS AND METHODS 32 healthy adult participants (mean (SD): age 26.3 (7.9) years; BMI 24.8 (2.7) kg/m2; 20 males) were recruited for this randomised crossover study. Skin temperature was measured 20 mm distal to the patella using a k-type thermocouple every five minutes during a 30-minute treatment with one of five different cryocompression devices (Physiolab S1, GameReady, Cryo/Cuff, VPulse, and a Gel Wrap). Changes in skin temperature over time were compared to baseline within and between conditions. A subjective rating of comfort was also recorded for each device. RESULTS The Physiolab S1 and GameReady devices caused significantly lower skin temperatures compared to the VPulse, Gel Wrap, and Cryo/Cuff after 30 minutes (p<0.05). 87-96% reported a positive comfort rating for the Physiolab S1, VPulse, Cryo/Cuff and Gel Wrap, whereas 53% of participants reported a positive comfort rating for the GameReady. CONCLUSIONS Only the Physiolab S1 and GameReady devices reduced skin temperature of the knee to within the target range of 10-15 °C. The Physiolab S1 was reportedly more comfortable than the GameReady. Clinicians should be aware of the performance differences of different cryocompression devices to understand which is most likely to provide an effective dose of cold therapy to a joint.
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Affiliation(s)
- James Belsey
- School of Sport, Health & Community, Faculty of Health & Wellbeing, University of Winchester, Winchester, Hampshire, United Kingdom
| | - Andrew Reid
- School of Sport, Health & Community, Faculty of Health & Wellbeing, University of Winchester, Winchester, Hampshire, United Kingdom
| | - Eloise Paine
- School of Sport, Health & Community, Faculty of Health & Wellbeing, University of Winchester, Winchester, Hampshire, United Kingdom
| | - James Faulkner
- School of Sport, Health & Community, Faculty of Health & Wellbeing, University of Winchester, Winchester, Hampshire, United Kingdom
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Marinova M, Sundaram A, Holtham K, Ebert JR, Wysocki D, Meyerkort D, Radic R. The role of a cryocompression device following total knee arthroplasty to assist in recovery: a randomised controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:4422-4429. [PMID: 37464101 PMCID: PMC10471706 DOI: 10.1007/s00167-023-07455-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 05/13/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE The study sought to investigate the effectiveness of a cryocompression Game Ready™ (GR) versus usual care protocol (UC) on early post-operative recovery following total knee arthroplasty. METHODS This study prospectively randomised 72 total knee arthroplasties to a 2-week (from day 0) intervention of GR treatment (n = 36, 63.9% females) or UC of ice with static compression (n = 36, 45.7% females). Knee flexion and extension range of motion (ROM), a visual analogue pain scale and limb circumference were documented at day 1, 2 and 14, as well as 6 weeks post-surgery. Medication usage and length of hospital stay were documented. Patient-reported outcome measures (PROMs) included the Knee Injury and Osteoarthritis Outcome Score and a Patient Satisfaction Questionnaire. Statistical analysis using linear mixed modelling and analysis of variance table with Satterthwaite's method were used along with two-tailed t-tests. RESULTS There were no significant group-by-time interactions regarding any of the outcomes. The GR group had 19% lost to follow-up at 2 weeks, while the UC group had 8%. The GR group demonstrated significantly better knee extension ROM at day 1 (p = 0.048) and day 14 (p = 0.007) compared with the UC group. There were no group differences (n.s.) observed in pain, flexion ROM, limb circumference, opioid use or PROMs. Overall, higher pain levels resulted in increased opioid intake (p = 0.002), older patients used significantly less opioids (p < 0.001) and males reported significantly less pain than females (p = 0.048). No adverse effects were observed due to either protocol. CONCLUSION Despite patients gaining significantly more knee extension during the initial two-week intervention period when using GR compared to UC, this effect was likely due to chance. No further significant differences were observed between the groups during or after cession of the intervention. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Mira Marinova
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia.
- Department of Orthopaedics, Royal Perth Hospital, Perth, WA, Australia.
| | - Abayasankar Sundaram
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
| | - Katie Holtham
- Sports Physiotherapist, Beatty Park Physiotherapy, North Perth, Australia
| | - Jay R Ebert
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, WA, Australia
| | - David Wysocki
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
| | - Daniel Meyerkort
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
| | - Ross Radic
- Perth Orthopaedic and Sports Medicine Research Institute, 31 Outram St, West Perth, WA, 6005, Australia
- Perth Orthopaedic and Sports Medicine Centre, 31 Outram St, West Perth, WA, 6005, Australia
- Division of Surgery, School of Medicine, University of Western Australia, Crawley, WA, Australia
- Department of Orthopaedics, Royal Perth Hospital, Perth, WA, Australia
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Moussa MK, Lefevre N, Valentin E, Meyer A, Grimaud O, Bohu Y, Gerometta A, Khiami F, Hardy A. Dynamic intermittent compression cryotherapy with intravenous nefopam results in faster pain recovery than static compression cryotherapy with oral nefopam: post-anterior cruciate ligament reconstruction. J Exp Orthop 2023; 10:72. [PMID: 37486444 PMCID: PMC10366045 DOI: 10.1186/s40634-023-00639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/18/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE To evaluate the effectiveness of dynamic intermittent compression cryotherapy (DICC) (CryoNov®) with an intravenous nefopam-based pain management protocol (DCIVNPP) in reducing post-operative pain following anterior cruciate ligament reconstruction (ACLR) compared to static compression cryotherapy (SCC) (Igloo®) and oral Nefopam. METHODS This was a retrospective analysis of prospectively collected data including 676 patients who underwent primary ACLR in 2022. Patients were either in the DCIVNPP group or in the SCC (control group), and were matched for age, sex, and Lysholm and Tegner scores (338 per arm). The primary outcome was pain on the visual analogue scale (VAS), analyzed in relation to the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) thresholds for VAS. The secondary outcome was side effects. RESULTS Postoperative pain in the DCIVNPP group was less severe on the VAS than in the control group (p < 0.05). The maximum difference in the VAS between groups was 0.57, which is less than the MCID threshold for VAS. The DCIVNPP group crossed the PASS threshold for VAS on Day 3, sooner than the control group. The side effect profiles were similar in both groups except for higher rates of dizziness and malaise in the DCIVNPP group, and higher rates of abdominal pain in the control group. Most of the side effects decreased over time in both groups, with no significant side effects after Day 3. CONCLUSION DCIVNPP effectively allows for faster pain recovery than in the control group. The difference in side effects between the protocols may be due to mode of administration of nefopam. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mohamad K Moussa
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France.
| | - Nicolas Lefevre
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | - Eugenie Valentin
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | - Alain Meyer
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | - Olivier Grimaud
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | - Yoan Bohu
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | | | - Frederic Khiami
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
| | - Alexandre Hardy
- Department of Sports Surgery, Clinique du Sport, 75005, Paris, France
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Jacobs CC, O'Neil E, Prange T. Efficacy of a commercial dry sleeve cryotherapy system for cooling the equine metacarpus. Vet Surg 2022; 51:1070-1077. [PMID: 35834384 PMCID: PMC9796254 DOI: 10.1111/vsu.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the ability of a commercial cryotherapy system (Game Ready Equine) to cool the metacarpal subcutaneous tissue and the superficial digital flexor tendon (SDFT) in horses. STUDY DESIGN Experimental study. ANIMALS OR SAMPLE POPULATION Six healthy adult horses. METHODS Thermocouples were implanted into the metacarpal subcutaneous tissues and the SDFT of six horses. Two treatments (cryotherapy or cryotherapy with 5-50 mmHg intermittent compression) were randomly assigned to forelimbs and performed for 20 minutes. Temperatures were compared to the target range of 10-19°C and between groups. RESULTS Only one limb in the cryotherapy/compression group reached the target range after cryotherapy. Temperatures did not differ between treatment groups at time 0. Lowest temperatures achieved in the subcutaneous tissue (p = .0043) and SDFT (p = .005) were 4.9 and 7.6°C lower when intermittent compression was applied. Similarly, applying compression induced a maximum change in temperature of approximately 7.0°C in the subcutaneous tissue (p = .014) and 10.2°C in the SDFT (p = .0001). CONCLUSION The cryotherapy system did not cool equine subcutaneous tissue or SDFT to the target temperature range, except in one limb. Combining cryotherapy with intermittent compression did result in lower temperatures and a greater change in temperature of the subcutaneous tissue and SDFT. CLINICAL SIGNIFICANCE When using this cryotherapy system, the addition of intermittent compression should be considered to achieve lower temperatures and potentially greater reduction in inflammation. Further studies are warranted to determine the effect of longer treatment times, higher compression settings, and the optimal temperature for benefits in normal and diseased equine tissues.
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Affiliation(s)
- Carrie C. Jacobs
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Erin O'Neil
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth CarolinaUSA
| | - Timo Prange
- Department of Clinical SciencesCollege of Veterinary Medicine, North Carolina State UniversityRaleighNorth CarolinaUSA
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Yang JH, Hwang KT, Lee MK, Jo S, Cho E, Lee JK. Comparison of a Cryopneumatic Compression Device and Ice Packs for Cryotherapy Following Anterior Cruciate Ligament Reconstruction. Clin Orthop Surg 2022; 15:234-240. [PMID: 37008961 PMCID: PMC10060780 DOI: 10.4055/cios21246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of the current study was to evaluate and compare the effectiveness of a cryopneumatic compression device with that of standard ice packs following arthroscopic anterior cruciate ligament (ACL) reconstruction, with a primary focus on early postoperative pain. Methods Participants were divided into two groups: cryopneumatic compression device group (CC group) and standard ice pack group (IP group). Patients in the CC Group (28 patients) received a cryopneumatic compression device (CTC-7, Daesung Maref) treatment, while patients in the IP group (28 patients) received standard ice pack cryotherapy postoperatively. All cryotherapy was applied three times (every 8 hours) per day for 20 minutes until discharge (postoperative day 7). Pain scores were assessed preoperatively and at 4, 7, and 14 days after surgery, and the primary outcome for analysis was pain at postoperative day 4 assessed using a visual analog scale (VAS). Other variables were opioid and rescue medication use, knee and thigh circumferences, postoperative drainage, and joint effusion quantified by a three-dimensional magnetic resonance imaging (MRI) reconstruction model. Results The mean pain VAS score and difference in VAS relative to the preoperative measurements for postoperative day 4 were significantly lower in the CC group than in the IP group (p = 0.001 and p = 0.007, respectively). The sum of postoperative drainage and effusion quantified by MRI showed a significant reduction of postoperative effusion in the CC group compared to the IP group (p = 0.015). The average total rescue medication consumption was comparable between the two groups. Circumferential measurements at days 7 and 14 postoperatively relative to those at day 4 (index day) demonstrated no significant differences between the groups. Conclusions Compared to standard ice packs, application of cryopneumatic compression was associated with a significant reduction in VAS pain scores and joint effusion during the early postoperative period following ACL reconstruction.
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Affiliation(s)
- Jae-Hyuk Yang
- Department of Orthopaedic Surgery, Hanyang University Guri Hospital, Guri, Korea
| | - Kyu-Tae Hwang
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Myoung Keun Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Sungsin Jo
- Hanyang University Institute for Rheumatology Research, Hanyang University, Seoul, Korea
| | | | - Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, Korea
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Alexander J, Selfe J, Greenhalgh O, Rhodes D. Cryotherapy and compression in sports injury management: a scoping review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims For the management of sports injury, cryotherapy is commonly applied, yet modalities differ extensively in application including levels of compression. The aim of this study was to provide a comprehensive review of the current position in the literature on contemporary cryo-compression applications for musculoskeletal sports injury management. Methods A total of eight databases were searched: Sport Discus, Science Direct, CINHAL, Scopus, PubMed, Cochrane, ProQuest and MEDLINE. Publications were restricted to 30 years and had to be in the English language. Medical subject headings, free-text words, and limiting descriptors for concepts related to cryotherapy and compression for sports injury were applied. Inclusion criteria determined at least one modality of cryotherapy treatment applied simultaneous to compression or as a comparison, relevant to sports injury management. Modalities included cryo-compressive devices and gel/ice packs, in association with concomitant compression. Male, female, healthy and injured participants were included. Two reviewers independently selected eligible articles, resulting in 22 studies meeting the inclusion criteria following full-text appraisal. Results Inconsistent methodologies, low sample sizes and variability in outcome measures provided uncertainty over optimum protocols. A lack of previous understanding in the protocols in the available literature for isolated cryotherapy/compression applications prevents understanding of the therapeutic benefits of combined cryo-compression. No definitive agreement behind optimal cryo-compression applications were identified collectively from studies other than the consensus that compression aids the magnitude of cooling. Conclusions Although compression appears a useful adjunct to cooling modalities for the management of sports injury, no definitive agreement on optimum compression concurrent with cooling protocols were drawn from the studies. This was because of several methodological gaps in reporting throughout studies, highlighting a lack of studies that represent applications of compression and cryotherapy within a sporting context or applied nature within the available research.
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Affiliation(s)
- Jill Alexander
- Sport, Nutrition and Clinical Sciences, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - James Selfe
- Health, Psychology and Communities, Manchester Metropolitan University, Manchester, UK
| | - Olivia Greenhalgh
- Health, Psychology and Communities, Manchester Metropolitan University, Manchester, UK
| | - David Rhodes
- Institute of Coaching and Performance (ICaP), School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
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Alexander J, Jeffery J, Rhodes D. Recovery profiles of eccentric hamstring strength in response to cooling and compression. J Bodyw Mov Ther 2021; 27:9-15. [PMID: 34391318 DOI: 10.1016/j.jbmt.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/23/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The effectiveness of different forms of cryotherapy and combined compression (cryo-compression) commonly used in sport to enhance recovery following exercise are not fully understood. Therefore, the exploration of protocols that use contemporary cryo-compression is warranted. The purpose of the study was to investigate the effectiveness of using a cryo-compression device to recover hamstrings eccentric strength following a fatiguing exercise. METHODS Eighteen healthy male adult footballers were randomly allocated to receive cryo-compression or rest following a lower limb fatiguing protocol. Cryo-compression was applied for 15-min, target temperature of 10 °C, and high intermittent pressure (5-75 mm Hg) using the Game Ready® device. Rest consisted of 15-min in a prone position on a plinth. To induce hamstring fatigue, participants performed the Yo-Yo intermittent fatigue test (IFT). Skin surface temperature (Tsk) and hamstring eccentric strength measures were taken at three time points; pre-IFT, immediately post-fatigue test (IPFT), and immediately post-intervention (IPI) (rest or Game Ready®). Participants returned one week later and performed the Yo-Yo IFT again and were exposed to the opposite intervention and data collection. RESULTS Significant decreases in Tsk over the posterior thigh were reported for all timepoints compared to pre cryo-compression temperatures (p=<0.05). Overall data displayed no significant main effects for timepoint or condition for PT or AvT (p=<0.05). There was no timepoint × condition interaction for PT or AvT (p=<0.05). Collapse of the data by condition (CC/R) demonstrated no significant effect for time for PT or AvT (p=>0.05). CONCLUSIONS No significant changes in HES occurred after exposure to cryo-compression or rest applied immediately following the Yo-Yo IFT. Further investigations to maximise beneficial application of contemporary cryo-compression applications in sport are required. Multiple measures of performance over rewarming periods, within competitive training schedules after sport-specific training are required to develop optimal cooling protocols for recovery.
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Affiliation(s)
- J Alexander
- Sport, Nutrition and Clinical Sciences, School of Sport & Health Sciences, University of Central Lancashire, Preston, UK.
| | - J Jeffery
- Everton Football Club, Finch Farm, Merseyside, UK
| | - D Rhodes
- Institute of Coaching and Performance (ICaP), School of Sport & Health Sciences, University of Central Lancashire, Preston, UK
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Leegwater NC, van der Meer SM, Sierevelt IN, Spruijt H, Nolte PA. Continuous-flow cryocompression therapy penetrates to bone level in hip fracture patients in a numerical simulation. J Orthop Surg Res 2019; 14:49. [PMID: 30764844 PMCID: PMC6376712 DOI: 10.1186/s13018-019-1081-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/31/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The aim of this study was to define deep tissue temperature during cryotherapy in postoperative hip fracture patients, by using measured skin temperature as input parameter for a simple numerical model. Second, an association was investigated between pain and tissue temperature distribution, to assess cryotherapy-induced analgesia of soft tissue-derived pain. METHODS Data from 35 participants in an ongoing trial was used. In three subjects who consented on optional measurements, skin temperature was measured in 3 days during and after cryotherapy. A simple numerical model was developed to calculate tissue temperature distribution during cryotherapy. RESULTS Inter and intrasubject skin temperature displayed high variation: trochanter 11-27 °C, mid-femur 11-24 °C, distal femur 10-16 °C. Predicted temperatures decreased to 20 °C at 1 cm, 26 °C at 2 cm, and 30 °C at 3 cm tissue depth. Smallest soft tissue layer was measured at the trochanter; 42% had less than 30 mm and 21% had less than 20 mm. Numeric rating scale pain varied (mean = 2.14; SD = 1.92), and no association was found between pain and decrease in temperature (r = 0.064; p = 0.204). CONCLUSIONS Cryotherapy was predicted to reduce temperature up to 3 cm; in cachectic patients, this reaches the bone, where it might have implications for bone tissue healing when treated for a prolonged period of time. Cryotherapy-induced analgesia is likely to originate from skin analgesia rather than analgesia of muscle or bone-derived pain.
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Affiliation(s)
- Nick C. Leegwater
- 0000 0004 0568 6419grid.416219.9Department of Orthopedics, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Sander M. van der Meer
- 0000 0004 0568 6419grid.416219.9Department of Clinical Physics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Inger N. Sierevelt
- 0000 0004 0568 6419grid.416219.9Department of Orthopedics, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
| | - Hugo Spruijt
- 0000 0004 0568 6419grid.416219.9Department of Clinical Physics, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Peter A. Nolte
- 0000 0004 0568 6419grid.416219.9Department of Orthopedics, Spaarne Gasthuis, Spaarnepoort 1, 2134 TM Hoofddorp, The Netherlands
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Effectiveness of Salted Ice Bag Versus Cryocompression on Decreasing Intramuscular and Skin Temperature. J Sport Rehabil 2019; 28:120-125. [PMID: 29035620 DOI: 10.1123/jsr.2017-0173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Rest, ice, compression, and elevation are commonly recommended immediately after injury. Traditionally, ice bag (IB) with elastic wrap compression has been utilized; however, recently intermittent cryocompression units are being used. Limited research has evaluated tissue temperature decreases with intermittent cryocompression units. OBJECTIVE Evaluate magnitude of muscle and skin cooling. DESIGN Repeated-measures counterbalanced study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve healthy college-aged participants (4 males and 8 females; age = 23.08 [1.93] y; height = 171.66 [9.47] cm; mass = 73.67 [13.46] kg; subcutaneous thickness = 0.90 [0.35] cm) without compromised circulation or injury. INTERVENTION(S) Salted IB, GameReady (GR), and PowerPlay-ice bag (PP-ice) were applied to the posterior aspect of the nondominant calf for 30 minutes; participants underwent each treatment in counterbalanced order. MAIN OUTCOME MEASURE(S) Muscle temperature measured via 21-gauge catheter thermocouple; skin temperature measured via a surface thermocouple. Temperatures were recorded at baseline and during a 30-minute treatment. Correlations were evaluated between muscle and skin temperatures. RESULTS Nonsignificant treatment × time interaction and nonsignificant main effect of treatment for intramuscular cooling. Mean Decrease From Baseline: IB, 6.4°C (±2.8); GR, 5.4°C (±1.1); PP-ice, 4.8°C (±2.8). Nonsignificant treatment × time interaction for skin cooling (F20,200 = 1.440, P = .65, ηp2=.346 , and observed β = 0.773), but significant main effect for treatment (F10,100 = 5.279, P = .03, ηp2=.883 , and observed β = 1.00). Mean Decrease From Baseline: IB, 17.0°C; GR, 16.4°C; PP-ice, 14.6°C. No significant correlation between intramuscular and skin temperatures in any condition at any time point. No significant correlation between adipose tissue thickness and maximum temperature decrease with any modality. CONCLUSIONS Salted IB with elastic wrap compression, GR, and PP-ice produced equivalent intramuscular temperature decreases during the treatment period.
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Examination of Intramuscular and Skin Temperature Decreases Produced by the PowerPlay Intermittent Compression Cryotherapy. J Sport Rehabil 2018; 27:244-248. [PMID: 28422604 DOI: 10.1123/jsr.2016-0244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Previous research has found ice bags are more effective at lowering intramuscular temperature than gel packs. Recent studies have evaluated intramuscular temperature cooling decreases with ice bag versus Game Ready and with the PowerPlay system wetted ice bag inserts; however, intramuscular temperature decreases elicited by PowerPlay with the standard frozen gel pack inserts have not been examined. OBJECTIVE Evaluate the rate and magnitude of cooling using PowerPlay with frozen gel pack (PP-gel) option, PowerPlay with wetted ice bag (PP-ice) option, and control (no treatment) on skin and intramuscular temperature (2 cm subadipose). DESIGN Repeated-measures counterbalanced study. SETTING University research laboratory. PATIENTS OR OTHER PARTICIPANTS Twelve healthy college-aged participants (4 men and 8 women; age = 23.08 (1.93) y, height = 171.66 (9.47) cm, mass = 73.67 (13.46) kg, and subcutaneous thickness = 0.90 (0.35) cm). INTERVENTION(S) PowerPlay (70 mm Hg) with either wetted ice bag or frozen gel pack was applied to posterior aspect of nondominant calf for 30 minutes; control lay prone for 30 minutes. Participants underwent each treatment in counterbalanced order (minimum 4 d, maximum 10 d between). MAIN OUTCOME MEASURE(S) Muscle temperature was measured via 21-gauge catheter thermocouple (IT-21; Physitemp Instruments, Inc). Skin temperature was measured via surface thermocouple (SST-1; Physitemp Instruments, Inc). RESULTS Significant treatment-by-time interaction for muscle cooling (F10,80 = 11.262, P = .01, [Formula: see text], observed β = 0.905) was observed. PP-ice cooled faster than both PP-gel and control from minutes 12 to 30 (all Ps < .05); PP-gel cooled faster than control from minutes 18 to 30 (all Ps < .05). Mean decreases from baseline: PP-ice = 4.8°C (2.8°C), PP-gel = 2.3°C (0.8°C), and control = 1.1°C (0.4°C). Significant treatment-by-time interaction for skin cooling (F10,80 = 23.920, P = .001, [Formula: see text], observed β = 0.998) was observed. PP-ice cooled faster than both PP-gel and control from minutes 6 to 30 (all Ps < .05); PP-gel cooled faster than control from minutes 12 to 30 (all Ps < .05). Mean decreases from baseline: PP-ice = 14.6°C (4.8°C), PP-gel = 4.0°C (0.9°C), and control = 1.0°C (1.0°C). CONCLUSIONS PP-ice produces clinically and statistically greater muscle and skin cooling compared with PP-gel and control.
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Leegwater NC, Bloemers FW, de Korte N, Heetveld MJ, Kalisvaart KJ, Schönhuth CP, Pijnenburg BACM, Burger BJ, Ponsen KJ, Maier AB, van Royen BJ, Nolte PA. Postoperative continuous-flow cryocompression therapy in the acute recovery phase of hip fracture surgery-A randomized controlled clinical trial. Injury 2017; 48:2754-2761. [PMID: 29079365 DOI: 10.1016/j.injury.2017.10.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The acute recovery phase after hip fracture surgery is often complicated by severe pain, postoperative blood loss with subsequent transfusion, and delirium. Prevalent comorbidity in hip fracture patients limit the use of opioid-based analgesic therapies, yielding a high risk for inferior pain treatment. Postoperative cryotherapy is suggested to provide an analgesic effect, and to reduce postoperative blood loss. In this prospective, open-label, parallel, multicentre, randomized controlled, clinical trial, we aimed to determine the efficacy of continuous-flow cryocompression therapy (CFCT) in the acute recovery phase after hip fracture surgery. METHODS Patients with an intra or extracapsular hip fracture scheduled for surgery were included. Subjects were allocated to receive postoperative CFCT or usual care. The primary endpoint was numeric rating scale (NRS) pain the first 72 postoperative hours. Secondly, analgesic use; postoperative haemoglobin change and transfusion incidence; functional outcome; length of stay; delirium incidence; location of rehabilitation; patient-reported health outcome; complications and feasibility were assessed. RESULTS Sixty-one subjects in the control group, and 64 subjects in the CFCT group were analysed. Within the CFCT group, post treatment NRS pain declined 0.31 (p=0.07) at 24h, 0.28 (p=0.07) at 48h, and 0.47 (p=0.002) at 72h relative to pre treatment NRS pain. Sensitivity analysis at 72h showed that NRS pain was 0.92 lower in the CFCT group when compared to the control group (1.50 vs. 2.42; p=0.03). Postoperative analgesic use was comparable between groups. Between postoperative day one and three haemoglobin declined 0.29mmol/l in the CFCT group and 0.51mmol/l in controls (p=0.06), and transfusion incidence was comparable. The timed up and go test and length of stay were also comparable between both groups. Complications, amongst delirium and cryotherapy-related adverse events were not statistically significantly different. Discharge locations did not differ between groups. At outpatient follow-up subjects did not differ in patient-reported health outcome scores. Subjects rated CFCT satisfaction with an average of 7.1 out of 10 points. CONCLUSIONS No evidence was recorded to suggest that CFCT has an added value in the acute recovery phase after hip fracture surgery. If patients complete the CFCT treatment schedule, a mild analgesic effect is observed at 72h.
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Affiliation(s)
- Nick C Leegwater
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands.
| | - Frank W Bloemers
- Department of Surgery, Section of Traumasurgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Niels de Korte
- Department of Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | | | - Kees J Kalisvaart
- Department of Geriatrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Casper P Schönhuth
- Department of Orthopaedics, Admiraal De Ruyter Ziekenhuis, Goes, The Netherlands
| | - Bas A C M Pijnenburg
- Department of Orthopaedics, Acibadem International Medical Center, Amsterdam, The Netherlands
| | - Bart J Burger
- Department of Orthopaedics, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Kornelis J Ponsen
- Department of Surgery, Section of Traumasurgery, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University, Amsterdam, The Netherlands; Department of Medicine and Aged Care, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Barend J van Royen
- Department of Orthopaedics, VU University Medical Centre, Amsterdam, The Netherlands
| | - Peter A Nolte
- Department of Orthopaedics, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Leegwater NC, Bakker AD, Hogervorst JMA, Nolte PA, Klein-Nulend J. Hypothermia reduces VEGF-165 expression, but not osteogenic differentiation of human adipose stem cells under hypoxia. PLoS One 2017; 12:e0171492. [PMID: 28166273 PMCID: PMC5293214 DOI: 10.1371/journal.pone.0171492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/20/2017] [Indexed: 01/01/2023] Open
Abstract
Cryotherapy is successfully used in the clinic to reduce pain and inflammation after musculoskeletal damage, and might prevent secondary tissue damage under the prevalent hypoxic conditions. Whether cryotherapy reduces mesenchymal stem cell (MSC) number and differentiation under hypoxic conditions, causing impaired callus formation is unknown. We aimed to determine whether hypothermia modulates proliferation, apoptosis, nitric oxide production, VEGF gene and protein expression, and osteogenic/chondrogenic differentiation of human MSCs under hypoxia. Human adipose MSCs were cultured under hypoxia (37°C, 1% O2), hypothermia and hypoxia (30°C, 1% O2), or control conditions (37°C, 20% O2). Total DNA, protein, nitric oxide production, alkaline phosphatase activity, gene expression, and VEGF protein concentration were measured up to day 8. Hypoxia enhanced KI67 expression at day 4. The combination of hypothermia and hypoxia further enhanced KI67 gene expression compared to hypoxia alone, but was unable to prevent the 1.2-fold reduction in DNA amount caused by hypoxia at day 4. Addition of hypothermia to hypoxic cells did not alter the effect of hypoxia alone on BAX-to-BCL-2 ratio, alkaline phosphatase activity, gene expression of SOX9, COL1, or osteocalcin, or nitric oxide production. Hypothermia decreased the stimulating effect of hypoxia on VEGF-165 gene expression by 6-fold at day 4 and by 2-fold at day 8. Hypothermia also decreased VEGF protein expression under hypoxia by 2.9-fold at day 8. In conclusion, hypothermia decreased VEGF-165 gene and protein expression, but did not affect differentiation, or apoptosis of MSCs cultured under hypoxia. These in vitro results implicate that hypothermia treatment in vivo, applied to alleviate pain and inflammation, is not likely to harm early stages of callus formation.
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Affiliation(s)
- Nick C. Leegwater
- Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Astrid D. Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Jolanda M. A. Hogervorst
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
| | - Peter A. Nolte
- Department of Orthopaedics, Spaarne Hospital, Hoofddorp, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, MOVE Research Institute Amsterdam, Amsterdam, The Netherlands
- * E-mail:
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Khoshnevis S, Craik NK, Matthew Brothers R, Diller KR. Cryotherapy-Induced Persistent Vasoconstriction After Cutaneous Cooling: Hysteresis Between Skin Temperature and Blood Perfusion. J Biomech Eng 2016; 138:4032126. [PMID: 26632263 DOI: 10.1115/1.4032126] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 12/13/2022]
Abstract
The goal of this study was to investigate the persistence of cold-induced vasoconstriction following cessation of active skin-surface cooling. This study demonstrates a hysteresis effect that develops between skin temperature and blood perfusion during the cooling and subsequent rewarming period. An Arctic Ice cryotherapy unit (CTU) was applied to the knee region of six healthy subjects for 60 min of active cooling followed by 120 min of passive rewarming. Multiple laser Doppler flowmetry perfusion probes were used to measure skin blood flow (expressed as cutaneous vascular conductance (CVC)). Skin surface cooling produced a significant reduction in CVC (P < 0.001) that persisted throughout the duration of the rewarming period. In addition, there was a hysteresis effect between CVC and skin temperature during the cooling and subsequent rewarming cycle (P < 0.01). Mixed model regression (MMR) showed a significant difference in the slopes of the CVC-skin temperature curves during cooling and rewarming (P < 0.001). Piecewise regression was used to investigate the temperature thresholds for acceleration of CVC during the cooling and rewarming periods. The two thresholds were shown to be significantly different (P = 0.003). The results show that localized cooling causes significant vasoconstriction that continues beyond the active cooling period despite skin temperatures returning toward baseline values. The significant and persistent reduction in skin perfusion may contribute to nonfreezing cold injury (NFCI) associated with cryotherapy.
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Mooventhan A, Nivethitha L. Effects of ice massage of the head and spine on heart rate variability in healthy volunteers. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2016; 14:306-10. [PMID: 27417177 DOI: 10.1016/s2095-4964(16)60266-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Ice massage (IM) is one of the treatment procedures used in hydrotherapy. Though its various physiological/therapeutic effects have been reported, effects of IM of the head and spine on heart rate variability (HRV) have not been studied. Thus, this study evaluated the effects of IM of the head and spine on HRV in healthy volunteers. METHODS Thirty subjects were randomly divided into 3 sessions: (1) IM, (2) tap water massage (TWM) and (3) prone rest (PR). Heart rate (HR) and HRV were assessed before and after each intervention session. RESULTS A significant increase in the mean of the intervals between adjacent QRS complexes or the instantaneous HR (RRI), square root of mean of sum of squares of differences between adjacent normal to normal (NN) intervals (RMSSD), number of interval differences of successive NN intervals greater than 50 milliseconds (NN50), proportion derived by dividing NN50 by total number of NN intervals along with significant reduction in HR after IM session; significant increase in RRI along with significant reduction in HR after TWM, and a significant increase only in RMSSD after PR were observed. However, there was no significant difference between the sessions. CONCLUSION Results of this study suggest that 20 min of IM of the head and spine is effective in reducing HR and improving HRV through vagal dominance in healthy volunteers.
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Affiliation(s)
- A Mooventhan
- Sri Dharmasthala Manjunatheshwara College of Naturopathy and Yogic Sciences and Hospital, Ujire-574240, Karnataka, India
| | - L Nivethitha
- Swami Vivekananda Yoga Anusandhana Samsthana University, Bengaluru-560019, Karnataka, India
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