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Intermittent Pneumatic Compression Technology for Sports Recovery

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Intermittent pneumatic compression (IPC) technologies are widely used in clinical populations to aid the reduction of limb oedema and for the prophylaxis of deep vein thromboses (DVT). IPC application within athletic populations is not however widespread. The main mechanism for the effectiveness of IPC is that it augments venous and arterial blood flow via the periodic inflation of external cuffs. We believe that this may be beneficial to the warmdown activities of athletes. The removal of waste products may help to reduce injury risk and the phenomenon of delayed onset muscle soreness (DOMS). A new implementation of the technology has been developed to test the extent of any potential warm-down effects induced by IPC treatment in athletes. This paper presents a pilot study in which male participants were exposed to IPC following intensive exercise. The specific treatment comprised 60sec inflation and 60sec deflation of a calf-thigh three compartment sequential compression garment (ratio 70∶65∶60mmHg) on each leg. This cycle was implemented by an electric pump with the participants in the partially supine position. The recovery protocol was designed to assess the ability of IPC to reduce the symptoms of delayed onset muscle soreness (DOMS) elicited by a high intensity repeated shuttle run. A 1 hour IPC treatment was implemented in this case. Vertical jump was used to identify any change in performance pre and post trial. Visual analogue scales were used +1, +24 and +48 hours after the tests to assess the presence of DOMS. During these tests, heart rate and blood pressure measurements were recorded.
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Intermittent Pneumatic Compression Technology for
Sports Recovery
Tom Waller
l
,
Mike Caine' and Rhys Morris/
1Sports Technology Research Group, Wolfson School
of
Mechanical and Manufacturing
Engineering, Loughborough University, UK, t.m.waller@lboro.ac.uk
2 Medical Physics and Bioengineemg, University
of
Wales College
of
Medicine, Cardiff, UK
Abstract. Intermittent pneumatic compression (IPC) technologies are widely used in clinical
populations to aid the reduction of limb oedema and for the prophylaxis of deep vein thrombo-
ses (DVT). IPC application within athletic populations is not however widespread. The main
mechanism for the
eff
ectiveness
of
IPC is that it augments venous and arterial blood flow via
the periodic inflation
of
external c
uf
fs. We believe that this may be beneficial to the warm-
down activities
of
athletes. The removal
of
waste products may help to reduce injury risk and
the phenomenon
of
delayed onset muscle soreness (DOMS). A new implementation
of
the
technology has been developed to test the extent
of
any potential warm-down effects induced
by IPC treatment in athletes. This paper presents a pilot study in which male participants were
exposed to IPC following intensive exercise. The specific treatment comprised 60sec inflation
and 60sec deflation
of
a calf-thigh three compartment sequential compression garment (ratio
70:65:60mmHg) on each leg. This cycle was implemented by an electric pump with the par-
ticipants in the partially supine position. The recovery protocol was designed to assess the
ability
of
IPC to reduce the symptoms of delayed onset muscle soreness (DOMS) elicited by a
high intensity repeated shuttle run. A I hour IPC treatment was implemented in this case.
Vertical jump was used to identify any change in performance pre and post trial. Visual ana-
logue scales were used +1, +24 and +48 hours after the tests to assess the presence
of
DOMS.
During these tests, heart rate and blood pressure measurements were recorded.
1 Introduction
Intermittent Pneumatic Compression (lPC) has been used as a mechanical method
of
deep vein thrombosis prophylaxis for a number
of
years. These systems comprise the
pumped inflation and deflation
of
air bladders within cuffs that can cover the foot,
calf or whole leg. The inflation can be applied uniformly or sequentially with a vari-
ety
of
pressures at rapid or moderate rates. The core mechanism for the efficacy
of
these systems is the prevention
of
stasis by augmenting venous and arterial blood
flow (Morris and Woodcock 2002 and 2004). Similarly this technology has been
used for the reduction
of
lymphedema (Pappas and O'Donnell 1992) and to enhance
localised muscle recovery (Wiener, Mizrahi and Verbitsky 2001).
392 Tom Waller, Mike Caine and Rhys Morris
Given these anti-inflammatory and muscle recovery mechanisms it is believed
that IPC may have application in the treatment
of
delayed onset muscle soreness
(DOMS). DOMS is a phenomena often associated with eccentric muscle contractions
whereby damage to muscle fibres from periods
of
exercise causes muscle pain that
can persist for several days. This has disruptive effects upon the training schedules
of
athletes and therefore solutions to reduce the duration
of
soreness are
of
great
benefit.
One such condition that is often associated with the occurrence of DOMS is high
intensity shuttle running (Thompson, Nicholas and Williams 1999). This paper there-
fore describes a pilot study to investigate the influence
of
IPC upon the occurrence
of
DOMS after a period shuttle running.
2 Methods
Nine healthy male participants mean SD (age 25.2±I.72yrs, height 184.8±9.94m,
body mass 87±10.46kg, body fat 14.9±3.61% and
V0
2max
of
53.1±2.69ml·kg-
1
·min-
1
)
attended the High Performance Athletics Centre at Loughborough University on four
separate occasions.
It was requested that participants did not consume any food for 2
hours prior to arriving and refrained from alcohol, caffeine and rigorous exercise for
at least 24 hours prior to the tests.
The first of these sessions was a test to estimate maximal oxygen uptake
(V0
2max
) .
This was done using a progressive shuttle run (Ramsbottom, Brewer and
Williams 1988) and permitted the grouping
of
participants during a modified
Loughborough Intermittent Shuttle Test (LIST, Nicholas, Nuttall and Williams 2000)
tailored to exacerbate delayed onset muscle soreness. All participants were also ha-
bituated with the segmented bladder, Intermittent Pneumatic Compression
(IPe)
and
vertical jump equipment (Jump Meter, Just Jump). Body mass and composition were
measured using a set of electronic scales (BF Scales, Tanita) and a 4 site skinfold
calliper method (Jackson and Pollock 1985) respectively.
Each participant was then assigned to a group (n> I) comprising others with simi-
lar progressive shuttle run scores for completion
of
the following tailored LIST test:
12 x 20m at jogging speed (4 x 3 sequential bouts interspersed with the
sprint)
12 x 20m at maximal running speed (sprint) (4 x 3 sequential bouts inter-
spersed with the jog)
18 x 20m at walking pace
Repeat (approximately 12 times, equivalent l hr total duration)
The shuttle runs were repeated on three separate occasions by each participant (at
least 3 days apart) and preceded a treatment session that comprised either: a rest for
one hour; a one hour low-pressure IPC treatment (20:15:10mmHg) or; a one hour
high-pressure IPC treatment (70:65:60mmHg) . All treatments were carried out in the
partially supine position and the order
of
application was randomized.
Body mass, vertical jump and
calf
/ thigh circumference were recorded prior to
and immediately following the completed treatment session. Heart rate was recorded
lntennittent
Pneumatic
Compression
Technology
forSports
Recovery
393
during the tests (Polar Team System, Polar Electro). A vital signs monitor (Smart-
signs Assist, Huntleigh Healthcare) was used to record heart rate and blood pressure
during the treatment sessions . Following completion
of
the sessions, participants
completed a soreness diagram (Fig. I) with the aid
of
a 10 point scale with anchors
ranging from I (Not sore) to 10 (Very, very sore). Participants were prompted to rate
their perceived level
of
soreness and identify the location by marking the diagram
accordingly. This was repeated without supervision +24 and +48 hours post-testing.
Not Sore
A Little Sore
Quite Sore
6
7
8
Very Sore
10
Very. Very Sore
Fig. 1.
Soreness
diagram
and
accompanying
visual
analogue
scale
Repeated measures t-tests were used to investigate any differences in data be-
tween the high pressure, low pressure and no pressure treatments . Significance was
taken at p
<O
.05. All results are presented as mean values ± 1 standard deviation.
3 Results
3.1 Shuttle Session
Consistent heart rate plots were recorded by all subjects across each
of
the shuttle
run sessions. The heart rates observed during all trials ranged from a minimum
of
118.9±12.3bpm to a maximum
of
I81.8±9.lbpm. These heart traces were also used
to check consistency
of
the shuttle run sets and sprint component durations . The
plots show that both the set and sprints were consistent for all subjects with 6.8±O.7
and 3.0±O.3min for the set and sprint times respectively.
3.2 Treatment Session
Over the hour
of
treatment, hart rate gradually approached resting values from ele-
vated rates immediately post-shuttle run. During this time both the high and low
394 Tom Waller, Mike Caine and Rhys Morris
pressure treatments produced significantly lower mean heart rate values than the no
treatment condition (83±6.9 and 82.4±9.1 vs. 87.3±8.1bpm respectively) . Inciden-
tally the high and low pressure treatments were not significantly different. Diastolic
blood pressure was also significantly higher without any leg compression (76±2.4 vs.
7I.7±2.0 and 7I.5±1.9mmHg for the high and low pressure treatments respectively).
As per the heart rate plots, there was no significant difference between high and low
pressures .
3.3 Performance Measures
There was no significant or consistent change in the measured calfand thigh circum-
ferences. Vertical jump performance was reduced on all occasions however the mag-
nitude
of
the reduction was smaller following high and low pressure
IPe
treatments .
The high pressure treatment produced a significantly smaller mean reduction than
both the low pressure treatment and no treatment (1.9±1.4 vs. 4.4±3.8 and 5.9±3.4cm
respectively).
00
· 1.0
E
-2.0
~
.). 0
<-
-1 0
:l)
"
"
·1.0
..c:
"
,;::
-60
:l)
-7.0
~
·
1'1.
0
·q.o
-10.0
T~tOI
T~tO:!
~
--
'--,--
Test
Fig. 2. Reduction in vertical jump performance (*significant, p
<O
.05)
3.4 Soreness Measures
Mean perceived soreness measured at the shins, calves, quadriceps and hamstrings
was significantly reduced by high and low pressure
IPe
treatment +1 hour (2.1±1.2,
3±1.l c.f. 4±1.5), +24 hours (1.3±O.2,
2±O.8
c.f. 3±1) and +48 hours (O.6±0.2,
1.1±0.3 c.f. 1
.9±O
.7) compared to no treatment after the shuttle runs. In each case the
low pressure treatment produced significantly lower ratings than after no treatment,
and the high pressure treatment produced significantly lower ratings than both the
low pressure treatment and no treatment.
Intermittent Pneumatic Compression Technology for Sports Recovery 395
= l
;;
::
. .
:I)
=
'E J
I hour
2
~
hOOD
Tine:after treatment
48 houn
Fig. 3. Mean soreness rating for shin, calf, quadriceps and hamstring (*significant, p<O.05)
4 Discussion
Analysis
of
the shuttle run heart rate data shows that good consistency was main-
tained throughout the trials in terms
of
duration and effort
of
each shuttle component.
The relative changes in the remaining data can therefore be considered reliable.
During the IPC treatment session, heart rate and blood pressure were both lower
compared to the no treatment condition.
It is interesting to note however that both the
low and high pressure values are similar. This could suggest that only a low pressure
is necessary to reduce cardiac work, however, further inspection
of
the equipment
highlights a more likely explanation. The low pressure IPC pump applied pressure to
both legs simultaneously whereas the high pressure pump compressed each leg in
tum. This may have resulted in a lower net effect with the leg under high pressure
and the leg receiving no pressure forming a lower equilibrium comparable to the
lower pressure treatment. This factor does not seem to have had an effect on the
performance and soreness data.
The vertical jump results clearly show a benefit
of
IPC given the reduction in the
performance deficit. This improvement is greatest and reaches significance with the
high pressure treatment suggesting that IPC is capable
of
maintaining performance
levels even after high intensity work. The mechanism for this benefit may be ex-
plained by the soreness data given that the lowest soreness values were recorded
following the high pressure IPC treatment. This reduced soreness may have permit-
ted a more pain free muscle activation in the final vertical jump manoeuvre. Interest-
ingly there is also a reduction in soreness with the lower pressure treatment. This
suggests that there may be other mechanisms contributing to the reduced soreness
such as the thermal insulation or supportive benefits. In addition to this it is clear that
this treatment could be optimised. The pressures applied were in accordance with the
manufacturer's instructions and chosen to produce a magnitude
of
effect in blood
396 Tom Waller, Mike Caine and Rhys Morris
dynamics. A program
of
optimisation may be required to better understand the bene-
fits of increasing pressure and perhaps the application
ofheat
or cold.
We had expected to see some increase in
calf
or thigh circumference brought on
by fluid collecting in the limbs during treatment. We hypothesized that the IPC
treatment would abate this swelling. The data suggests however that there is no
change. This could be due to insufficient muscle damage taking place, however, it is
more likely that the results are due to postural differences. The first measurement
was taken on arrival at the test session on a cold muscle whereas the second meas-
urement was taken immediately following I hour in the supine position.
It may
therefore have been more appropriate to take a third measurement between the com-
pletion
of
the shuttle run and prior to the treatment session.
5 Conclusion
This study has shown that IPC provides benefits in terms
of
abating performance
reduction following high intensity exercise and reduces soreness shortly after exer-
cise as well as 48 hours later. This favourably suggests that athletes undertaking IPC
as part
of
their training regime should be able to increase their training volume with a
reduced risk
of
discomfort and injury. Further investigations will be useful in opti-
mising the technology thus increasing the magnitude of these effects.
Acknowledgements
The authors would like to thank Huntleigh Healthcare for supporting the project and
supplying the IPC equipment and garments.
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... Since 1930s Intermittent Pneumatic Compression (IPC) has been widely used to exert a mechanical action on limbs, for a number of applications like improving blood circulation in lower limbs [1], preventing deep vein thrombosis [2][3][4], treatment of lymphedema [5], and sports recovery [6], [7]. ...
... 1 3.0·10 6 3.5·10 6 4.0·10 6 4.5·10 6 5.0·10 6 5.5·10 6 6.0·10 6 6.5·10 6 The Table I reports the maximum values of bladder pressure p i calculated by the model for given combinations of K M and d 0 . The Fig. 5 shows the experimental recording of the air pressure in the corresponding bladder; the maximum pressure value is around 45300 Pa. ...
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Intermittent Pneumatic Compression devices are widely used for various therapies concerning the cardio-circulatory or lymphatic system, and also for performance recovery in sports activity. The development and setup of such devices are mainly based on empirical procedures, while few researches adopt an engineering approach based on mathematical modeling and identification. In this approach, the most critical point is the definition of parameters concerning the human-machine interaction. This paper proposes an original and simple method to identify such parameters, which allows to describe in effective way the main dynamic characteristics, fundamental for a correct design and control of the device.
... One efficient mechanism of recovery enhancement is augmented venous return and arterial blood flow, which can be achieved by intermittent pneumatic compression (IPC) therapy [11]. Within the athletic population, IPC is used to enhance localized muscle recovery [12]; its anti-inflammatory and muscle recovery mechanisms had application in the treatment of delayed onset of muscle soreness [13] and are efficient in removing blood lactate [13,14]. One study shows that the IPC is an effective tool in changing the HRR and frequencydomain measures of HRV after short-term sub-maximal exercise compared with passive recovery [15]. ...
... One efficient mechanism of recovery enhancement is augmented venous return and arterial blood flow, which can be achieved by intermittent pneumatic compression (IPC) therapy [11]. Within the athletic population, IPC is used to enhance localized muscle recovery [12]; its anti-inflammatory and muscle recovery mechanisms had application in the treatment of delayed onset of muscle soreness [13] and are efficient in removing blood lactate [13,14]. One study shows that the IPC is an effective tool in changing the HRR and frequencydomain measures of HRV after short-term sub-maximal exercise compared with passive recovery [15]. ...
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Purpose The present study aimed to investigate the effect of intermittent pneumatic compression (IPC) and active recovery on heart rate recovery (HRR), heart rate variability (HRV), blood pressure (BP) and rate of perceived exertion (RPE) after sub-maximal aerobic exercise in collegiate soccer players. Methods Fifteen male collegiate soccer players aged between 18 and 25 years were recruited in this cross-over study design with two groups (IPC and Active recovery group). Subjects were performed with an incremental treadmill test at sub-maximal intensity followed by 15 min of recovery methods (IPC or active recovery). After sub-maximal exercise testing, heart rate recovery at the first minute (HRR1) and second minute (HRR2) were observed. Heart rate, HRV, BP and RPE measures were taken before the exercise and 25 min of post-sub-maximal exercise. Results HRR1 and HRR2 showed a significant difference between IPC and active recovery (p < 0.001). Time-domain and frequency-domain measures of HRV showed only significant time effect (p ≤ 0.04), whereas group effect and time × group interaction were found to be non-significant. There was a significant time effect (p = 0.04), group effect (p = 0.003) and time × group interaction (p = 0.01) for systolic BP, while diastolic BP only showed a significant time effect (p = 0.02). There was a significant time effect (p < 0.001) and time × group interaction (p = 0.001) for RPE. Conclusion IPC is a better recovery tool in terms of HRR, BP and RPE than active recovery while no such difference was found in the time- and frequency-domain measures of HRV.
... Apesar do seu uso ser consensual na área médica, o seu histórico recente no mundo desportivo torna-a um método controverso. Tal deve-se a fatores de várias ordens:5 • O tipo de protocolo aplicado -existem várias formas de aplicar a CPI: a) de forma sequencial (em que as câmaras de ar enchem de baixo para cima, mantendo a pressão nas inferiores; b) peristáltico (as câmaras de ar enchem e esvaziam de baixo para cima), c) contínuo (pressão cíclica em todas as câmaras de ar simultaneamente) revfisiodesp.pt/artigos/compressao-pneumatica-intermitente/ ...
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... Similarly, Waller et al. 5 made a pilot study aiming to demonstrate that IPC devices may be beneficial to the warm-down activities of athletes. They compared two different treatments with low pressure (20:15:10 mmHg) and high pressure (70:65:60 mmHg) and concluded that 'athletes undertaking IPC as part of their training regime should be able to increase their training volume with a reduced risk of discomfort and injury'. ...
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An automatic pneumatic system designed to investigate the physiological effects induced by limb compressions, able to apply customizable pressure patterns in the physiologic range (0–200 msmHg), is here presented. A mathematical model, simulating the whole pneutronic system and its interaction with the limb is described. The model is validated by means of experimental tests. An on-going study aiming to investigate the role of different factors in the development of post compression hyperemia is presented.
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