Reference/Citation: Bleakley CM, Costello JT, Glasgow PD. Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Sports Med. 2012; 42(1):69-87.Clinical Question: Does local tissue cooling affect immediate functional performance outcomes in a sport situation?Data Sources: Studies were identified by searching MED-LINE, the Cochrane Central Register of Controlled Trials, and EMBASE, each from the earliest available record through April 2011. Combinations of 18 medical subheadings or key words were used to complete the search.Study Selection: This systematic review included only randomized controlled trials and crossover studies published in English that examined human participants who were treated with a local cooling intervention. At least 1 functional performance outcome that was measured before and after a cooling intervention had to be reported. Excluded were studies using whole-body cryotherapy or cold-water immersion above the waist and studies that measured strength or force production during evoked muscle contraction.Data Extraction: Data were extracted by 2 authors using a customized form to evaluate relevant data on study design, eligibility criteria, detailed characteristics of cooling protocols, comparisons, and outcome measures. Disagreement was resolved by consensus or third-party adjudication. To perform an intent-to-treat analysis when possible, data were extracted according to the original allocation groups, and losses to followup were noted. The review authors were not blinded to the study author, institution, or journal. For each study, mean differences or standardized mean differences and 95% confidence intervals were calculated for continuous outcomes using RevMan (version 5.1; The Nordic Cochrane Centre, Copenhagen, Denmark). Treatment effects were based on between-groups comparisons (cryotherapy versus control) using postintervention outcomes or within-group comparisons (precryotherapy versus postcryotherapy). If continuous data were missing standard deviations, other statistics including confidence intervals, standard error, t values, P values, or F values were used to calculate the standard deviation. The Cochrane risk-of-bias tool was used to assess the methodologic quality of included studies. Each study was evaluated for sequence generation, allocation concealment, assessor blinding, and incomplete outcome data. Studies were graded as low or high based on the criteria met, but the risk of bias across the studies was consistently high, so meaningful subgroup classifications were not possible. Differences in study quality and intervention details, including duration of cryotherapy interventions and time periods after intervention before follow-up, were potential sources of bias and considered for a subgroup analysis.Main Results: Using the search criteria, the authors originally identified 1449 studies. Of these, after title and abstract review, 99 studies were deemed potentially relevant and kept for further analys...
There were decreases in muscle activation in the anterior deltoid between previously injured and healthy people, as well as in the lower trapezius, in previously injured subjects. Understanding the source of muscle-activation deficits can help clinicians focus rehabilitation exercises on specific muscles.
ryotherapy is commonly administered to relieve musculoskeletal pain for both acute and chronic injuries. 1 Although cold application is often used for inflammation, recent research evidence suggests that the primary benefit of cryotherapy treatment may be decreased pain that results from changes in skin sensation. 2 The beneficial effects of cold on joint function also appear to relate to a sensory effect. 3 Cryotherapy alters cutaneous sensory input to the central nervous system through various mechanisms, including decreased receptor sensitivity, 4 decreased receptor-firing rate, 4 decreased nerve conduction velocity, 5 increased action potential latency, 6 and by providing a counter-irritation effect. 7 Cold treatments are often described as producing a series of sequential sensations, such as cold, burning, aching, and numbness, 8 which may relate to the mechanism of pain modulation.There are numerous methods for therapeutic application of cold, including ice packs, ice massage, and context: Alterations in skin sensations may be responsible for pain reduction provided by cryotherapy, but the exact physiological mechanism is unknown. objective: To investigate perceptions of skin sensations associated with different modes of cryotherapy administration and skin temperature at the point of perceived numbness. Design: Repeated measures. participants: 30 healthy subjects (12 Male, 18 Female, Age = 21.1±1.9 years). interventions: Crushed ice bag, ice massage, and cold water immersion. main outcome measures: Perceptions of sensations during each mode of cryotherapy administration were derived from a Modified McGill Pain Questionnaire. Skin temperature was recorded when numbness was reported for each treatment. results: Participants experienced sensations that included cold, tight, tingling, stinging, and numb. Ice massage sensations transitioned rapidly from cold to numb, whereas cold water immersion and ice bag treatments produced altered sensations for longer duration. Ice massage decreased skin temperature significantly more than the other two modes of cryotherapy administration. conclusions: Ice massage may be the best mode of cryotherapy administration for achievement of anaesthesia as rapidly as possible, whereas cold water immersion and ice bag application may be better for attainment of pain reduction associated with noxious stimulation of skin receptors.
Context:Recommended treatment duration for cryotherapy varies, but the primary therapeutic benefit may be related to the amount of time required for changes in cutaneous sensation.Objective:To determine the amount of time required to induce numbness for three different modes of cryotherapy administration, and the amount of time that numbness persists after treatment.Design:Repeated measures.Participants:30 healthy adults (12 males, 18 females, age = 21.1 ± 1.9 years).Interventions:Crushed ice bag, ice massage, and cold water immersion.Main Outcome Measures:Time required to induce numbness and the amount of time numbness remained after removal of each mode of cryotherapy.Results:Ice massage and cold water immersion produced numbness significantly faster than the crushed ice. There were no significant differences in terms of numbness duration.Conclusions:Changes in cutaneous sensation can be achieved in a relatively short amount of time (6–12 minutes) with ice massage and cold water immersion. The duration of the treatment effect did not differ among the three modes of cryotherapy administration.
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