Microvascular Perfusion and Intramuscular Temperature of the Calf during Cooling

Selkow, Noelle M.; Day, Carly; Liu, Zhenqi; Hart, Joseph M.; Hertel, Jay; Saliba, Susan A.

doi:10.1249/mss.0b013e31823bced9

Cited by 23 publications

(21 citation statements)

References 45 publications

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“…Intramuscular temperature 1 to 2 cm below adipose tissue has been reported to decrease 7°C to 8°C using CIB 14,15,19 but only 5°C 17 using CWI, after conventional treatment times of 20 to 30 minutes. Additionally, a recent study examining blood flow during cryotherapy treatments 22 concluded that the previously recommended treatment times 19 to achieve a 7°C change in intramuscular temperature may not be sufficient to reduce blood flow and achieve desired physiological effects.…”

Section: T T Resultsmentioning

confidence: 99%

“…These treatment times, to achieve a 7°C decrease in intramuscular temperature, were 12 minutes for patients with 0-to 10-mm adipose tissue, 30 minutes for patients with 11-to 20-mm adipose tissue, 40 minutes for patients with 21-to 30-mm adipose tissue, and 60 minutes for patients with 31-to 40-mm adipose tissue. Recently, Selkow et al 22 examined microvascular blood flow with ice-bag treatments using these treatment-time recommendations, and reported that intramuscular blood flow did not decrease below baseline levels immediately after ice-bag treatment, despite an intramuscular temperature decrease of 7°C.…”

Section: Discussionmentioning

confidence: 99%

“…14,17,22 Similarly, our intervention parameters were chosen based on common previously reported parameters. 10,17 Water temperature during immersion was monitored and kept consistently at 12°C, but ice-bag temperature was not monitored throughout treatment.…”

Section: Discussionmentioning

confidence: 99%

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Intramuscular Temperature Changes During and After 2 Different Cryotherapy Interventions in Healthy Individuals

Rupp¹,

Herman²,

Hertel³

et al. 2012

J Orthop Sports Phys Ther

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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...

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Section: T T Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intramuscular Temperature Changes During and After 2 Different Cryotherapy Interventions in Healthy Individuals

Rupp¹,

Herman²,

Hertel³

et al. 2012

J Orthop Sports Phys Ther

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“…The sample size was estimated at 24 participants using the minimal detectable change for blood flow, which is 0.026 dB/s, when power equals 0.80 and α is set at P = .05. 19 We had slightly fewer participants in this study than estimated, which was a limitation. Due to time constraints in the university hospital, we were not able to collect data on a larger sample.…”

Section: Participantsmentioning

confidence: 95%

Microvascular Perfusion Increases After Eccentric Exercise of the Gastrocnemius

Selkow

Herman

Liu

et al. 2013

Journal of Ultrasound in Medicine

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epeated contractions of skeletal muscle, as in exercise, have been shown to increase local blood flow. [1][2][3][4][5][6][7][8] This increase in blood flow is proportional to the metabolic demands of the muscle tissue being exercised. 9 Metabolic demand changes depending on the type of exercise performed. Eccentric contractions produce more force with less metabolic demand than concentric or isometric contractions. 10 It is unclear, however, whether this difference in metabolic demand alters circulatory responses in muscle as seen with concentric-eccentric and isometric contractions. During eccentric contractions, the breakdown of adenosine triphosphate is slowed, resulting in lower requirements for energy 11,12 and oxygen consumption to rarely elevate from rest. 13,14 Several studies have examined the effect of isometric or concentriceccentric contractions on blood flow. 2-8 However, eccentric-only Noelle M. Selkow, PhD, ATC, Daniel C. Herman, MD, PhD, Zhenqi Liu, MD, Jay Hertel, PhD, ATC, Joseph M. Hart, PhD, ATC, Susan A. Saliba, PhD, MPT, ATC Received July 13, 2012, ORIGINAL RESEARCHObjectives-The purpose of this study was to assess microvascular perfusion immediately after eccentric exercise using contrast-enhanced sonography.Methods-An intravenous catheter was placed in the antecubital vein of the arm contralateral to the leg being tested for the delivery of microbubbles to 18 healthy volunteers (mean age ± SD, 22.2 ± 2.2 years; height, 166.0 ± 11.9 cm; weight, 69.4 ± 25.0 kg). Eccentric exercises were performed unilaterally in a randomized leg. Calf-lowering repetitions off a raised step were performed to the beat of a metronome over 3 seconds in the sequence of 50 repetitions, 5 minutes of rest, and 50 repetitions. Microvascular perfusion (blood volume, blood flow, and blood flow velocity) was measured before and immediately after exercise using replenishment kinetics.Results-Blood volume and flow both significantly increased after exercise (P < .001). Baseline measurements were 5.88 ± 1.33 dB and 2.34 ± 0.41 dB/s and increased to 12.20 ± 3.31 dB and 4.52 ± 1.05 dB/s, respectively. There was a significant decrease in blood flow velocity (P = .035) after exercise (0.38 ± 0.03 s -1 ) from baseline (0.41 ± 0.06 s -1 ).Conclusions-Circulatory responses were altered after eccentric exercise, which may be due to the metabolic demand placed on the body. On the basis of this finding, eccentric exercise may be used as a model to assess the effect modalities have on the circulatory system after an elevated state of microvascular perfusion is reached.

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“…Skeletal muscle perfusion can be measured without factoring in skin perfusion. Cryotherapy and eccentric exercise have been examined with CEUS in isolation, 3,7 but the effect of cryotherapy on inflammation caused by eccentric contractions has not been studied.…”

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Blood Flow After Exercise-Induced Muscle Damage

Selkow

Herman

Liu

et al. 2015

Journal of Athletic Training

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Context:The most common modality used to address acute inflammation is cryotherapy. Whereas pain decreases with cryotherapy, evidence that changes occur in perfusion of skeletal muscle is limited. We do not know whether ice attenuates the increases in perfusion associated with acute inflammation.Objective: To examine the effects of repeated applications of ice bags on perfusion of the gastrocnemius muscle after an eccentric exercise protocol.Design: Controlled laboratory study. Setting: Laboratory.Patients or Other Participants: Eighteen healthy participants (3 men, 15 women; age ¼ 22.2 6 2.2 years, height ¼ 166.0 6 11.9 cm, mass ¼ 69.4 6 25.0 kg).Intervention(s): To induce eccentric muscle damage, participants performed 100 unilateral heel-lowering exercises off a step to the beat of a metronome. A randomized intervention (cryotherapy, sham, control) was applied to the exercised lower extremity immediately after the protocol and again at 10, 24, and 34 hours after the protocol.Main Outcome Measure(s): Baseline perfusion measurements (blood volume, blood flow, and blood flow velocity) were taken using contrast-enhanced ultrasound of the exercised leg.Perfusion was reassessed after the first intervention and 48 hours after the protocol as percentage change scores. Pain was measured with a visual analog scale at baseline and at 10, 24, 34, and 48 hours after the protocol. Separate repeatedmeasures analyses of variance were used to assess each dependent variable.Results: We found no interactions among interventions for microvascular perfusion. Blood volume and blood flow, however, increased in all conditions at 48 hours after exercise (P , .001), and blood flow velocity decreased postintervention from baseline (P ¼ .041). We found a time-by-intervention interaction for pain (P ¼ .009). Visual analog scale scores were lower for the cryotherapy group than for the control group at 34 and 48 hours after exercise.Conclusions: Whereas eccentric muscle damage resulted in increased blood flow, ice did not decrease muscle perfusion 48 hours after exercise. Therefore, ice does not seem to decrease muscle perfusion when blood flow is elevated, as it would be during inflammation.

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Microvascular Perfusion and Intramuscular Temperature of the Calf during Cooling

Cited by 23 publications

References 45 publications

Intramuscular Temperature Changes During and After 2 Different Cryotherapy Interventions in Healthy Individuals

Intramuscular Temperature Changes During and After 2 Different Cryotherapy Interventions in Healthy Individuals

Microvascular Perfusion Increases After Eccentric Exercise of the Gastrocnemius

Blood Flow After Exercise-Induced Muscle Damage

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