This randomized, controlled, laboratory study was designed to examine the effect of cold water immersion (CWI) as a recovery modality on repeat performance on the yo-yo intermittent recovery test (YIRT), a widely accepted tool for the evaluation of physical performance in soccer, separated by 48 hours. Twenty-two healthy Division I collegiate soccer players (13 men and 9 women; age, 19.8 ± 1.1 years; height, 174.0 ± 9.0 cm; mass, 72.1 ± 9.1 kg) volunteered as participants during the noncompetitive season. The YIRT was used to induce volitional fatigue and was administered at baseline and again 48 hours later. Athletes progressively increased sprint speed between markers set 20 m apart until pace was failed. Countermovement vertical jump (CMVJ) was used to assess anaerobic power and was measured before YIRT, immediately post-YIRT, and 24 and 48 hours post-YIRT. A 10-cm horizontal visual analog scale was administered immediately, 24 hours and 48 hours post-YIRT to assess perceived fatigue (PF) in the legs. Participants were randomly placed into the CWI or control group. The CWI condition consisted of immersion to the umbilicus in a 12°C pool for 15 minutes, whereas the control group sat quietly for 15 minutes. There were no significant differences between intervention conditions on YIRT performance (control, 4,900 ± 884 m; CWI, 5,288 ± 1,000 m; p = 0.35) or PF (control, 9.4 ± 0.5 cm; CWI, 9.3 ± 0.6 cm; p = 0.65) at 48 hours post-YIRT. There was a main time effect for CMVJ over 48 hours, but no group differences (pre-YIRT, 64.6 ± 11.0 cm; post-YIRT, 66.4 ± 10.9 cm; 24 hours post-YIRT, 63.4 ± 9.9 cm; 48 hours post-YIRT, 63.1 ± 9.4 cm; p = 0.02). This study demonstrated that in collegiate soccer players, CWI performed immediately and 24 hours after induced volitional fatigue did not affect subsequent physical performance estimates.
Cryotherapy is a commonly used treatment modality in acute musculoskeletal trauma and pain. Physiological changes occur both during and after cryotherapy treatment. Some of these changes are well reported in the literature, such as control of secondary hypoxic injury and edema, 16 decreased skin 12,13 and muscle 5,15,17 temperature, decreased nerve conduction velocity, 1,8 increased pain threshold and tolerance, 1 and reduced pain. 3,24Cryotherapy can be applied in various forms, but crushed-ice bags (CIB) and cold-water immersion (CWI) are frequently used in sports medicine. These 2 modalities have different levels of efficacy in inducing physiologic changes. When compared to CIB, CWI has been shown to be more effective in reducing nerve conduction parameters after a 15-minute cooling treatment 8 and maintaining the reductions in sensory nerve conduction parameters during rewarming. 7 In a study by Myrer et al, 17 both CIB and CWI decreased intramuscular temperature after a 20-minute treatment, and there was no difference in immediate posttreatment temperature between the modalities. But in the same study, during the 30-minute posttreatment monitoring period, intramuscular temperature increased 2°C after the ice bag was removed, whereas intramuscular temperature continued to decrease nearly 2°C after CWI was removed. 17In clinical practice, the same cryotherapy modalities can be applied in multiple ways. Ice bags can be applied with flexible plastic wrap, elastic wrap, or without compression. CWI can be applied at various depths and temperatures, with typical immersion T T STUDY DESIGN: Crossover. T T OBJECTIVES:To compare the time required to decrease intramuscular temperature 8°C below baseline temperature, and to compare intramuscular temperature 90 minutes posttreatment, between 2 cryotherapy modalities. T T BACKGROUND:Cryotherapy is used to treat pain from muscle injuries. Cooler intramuscular temperatures may reduce cellular metabolism and secondary hypoxic injury to attenuate acute injury response, specifically the rate of chemical mediator activity. Modalities that decrease intramuscular temperature quickly may be beneficial in the treatment of muscle injuries. T T METHODS:Eighteen healthy subjects received 2 cryotherapy conditions, crushed-ice bag (CIB) and cold-water immersion (CWI), in a randomly allocated order, separated by 72 hours. Each condition was applied until intramuscular temperature decreased 8°C below baseline. Intramuscular temperature was monitored in the gastrocnemius, 1 cm below subcutaneous adipose tissue. The primary outcome was time to decrease intramuscular temperature 8°C below baseline. A secondary outcome was intramuscular temperature at the end of a 90-minute rewarming period. Paired t tests were used to examine outcomes. T T RESULTS:Time to reach an 8°C reduction in intramuscular temperature was not significantly different between CIB and CWI (mean difference, 2.6 minutes; 95% confidence interval: -3.10, 8.30). Intramuscular temperature remained significantly colder 90 minute...
Neither the long nor the short treatment decreased skin sensation compared with sham conditions. All interventions resulted in decreased skin sensation when comparing baseline SWM scores to all posttreatment scores. Phonophoresis with lidocaine did not result in an enhanced anaesthetic effect on human subjects.
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