Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial

Abstract

Cryotherapy for post-exercise recovery remains widely used despite the lack of quality evidence. Photobiomodulation therapy (PBMT) studies (with both low-level laser therapy and light-emitting diode therapy) have demonstrated positive scientific evidence to suggest its use. The study aims to evaluate PBMT and cryotherapy as a single or combined treatment on skeletal muscle recovery after eccentric contractions of knee extensors. Fifty healthy male volunteers were recruited and randomized into five groups (PBMT, cryotherapy, cryotherapy + PBMT, PMBT + cryotherapy, or placebo) for a randomized, double-blinded, placebo-controlled trial that evaluated exercise performance (maximum voluntary contraction (MVC)), delayed onset muscle soreness (DOMS), and muscle damage (creatine kinase (CK)). Assessments were performed at baseline; immediately after; and at 1, 24, 48, 72, and 96 h. Comparator treatments was performed 3 min after exercise and repeated at 24, 48, and 72 h. PBMT was applied employing a cordless, portable GameDay device (combination of 905 nm super-pulsed laser and 875- and 640-nm light-emitting diodes (LEDs); manufactured by Multi Radiance Medical, Solon - OH, USA), and cryotherapy by flexible rubber ice packs. PBMT alone was optimal for post-exercise recovery with improved MVC, decreased DOMS, and CK activity (p < 0.05) from 24 to 96 h compared to placebo, cryotherapy, and cryotherapy + PBMT. In the PBMT + cryotherapy group, the effect of PBMT was decreased (p > 0.05) but demonstrated significant improvement in MVC, decreased DOMS, and CK activity (p < 0.05). Cryotherapy as single treatment and cryotherapy + PBMT were similar to placebo (p > 0.05). We conclude that PBMT used as single treatment is the best modality for enhancement of post-exercise restitution, leading to complete recovery to baseline levels from 24 h after high-intensity eccentric contractions.

The Effectiveness of Photobiomodulation Therapy Versus Cryotherapy for Skeletal Muscle Recovery: A Critically Appraised Topic

“…[4][5][6][7][8] There were no studies found in the literature search that supported cryotherapy over PBMT. The PBMT was more effective in preventing increases in CK levels, 4-8 blood lactate, 5 C-reactive protein, 5,7 and inflammation 6,7 after an exercise bout.…”

“…12,25 Muscle damage was noted in the included studies following the exercise protocols. This was demonstrated by an increase of CK, blood lactate, and frequency of necrosis, measured by histological analysis, in placebo treatments, 4,5,8 an ice bag application, 4,8 and coldwater immersion therapy. 5,7 Compared with placebo treated groups, cryotherapy demonstrated no difference in CK 4,5,8 or blood lactate 5 levels at any time points.…”

“…This was demonstrated by an increase of CK, blood lactate, and frequency of necrosis, measured by histological analysis, in placebo treatments, 4,5,8 an ice bag application, 4,8 and coldwater immersion therapy. 5,7 Compared with placebo treated groups, cryotherapy demonstrated no difference in CK 4,5,8 or blood lactate 5 levels at any time points. PBMT protected the muscle against damage in the included studies, with significantly lower levels of muscle damage markers [4][5][6][7][8] ; thus, inflammation markers of c-reactive protein [5][6][7] and leukocyte analysis 6,7 were also lower in groups treated with PBMT.…”

“…• All 5 studies [4][5][6][7][8] supported the use of PBMT rather than cryotherapy as treatment for muscle performance recovery following exercise.…”

“…The selection of studies was based on the following criteria: included a level of evidence rating of 2 or better, investigated a direct comparison between cryotherapy and PBMT application in relation to muscle recovery following strenuous exercise, and compared the effectiveness of the treatments postexercise in terms of muscle performance recovery. [4][5][6][7][8] Implications for Practice, Education, and Future Research…”