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One session of partial-body cryotherapy (−110 °C) improves muscle damage recovery

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To evaluate the effects of a single session of partial-body cryotherapy (PBC) on muscle recovery, 26 young men performed a muscle-damaging protocol that consisted of five sets of 20 drop jumps with 2-min rest intervals between sets. After the exercise, the PBC group (n = 13) was exposed to 3 min of PBC at −110 °C, and the control group (n = 13) was exposed to 3 min at 21 °C. Anterior thigh muscle thickness, isometric peak torque, and muscle soreness of knee extensors were measured pre, post, 24, 48, 72, and 96 h following exercise. Peak torque did not return to baseline in control group (P < 0.05), whereas the PBC group recovered peak torques 96 h post exercise (P > 0.05). Peak torque was also higher after PBC at 72 and 96 h compared with control group (P < 0.05). Muscle thickness increased after 24 h in the control group (P < 0.05) and was significantly higher compared with the PBC group at 24 and 96 h (P < 0.05). Muscle soreness returned to baseline for the PBC group at 72 h compared with 96 h for controls. These results indicate that PBC after strenuous exercise may enhance recovery from muscle damage.
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One session of partial-body cryotherapy (110 °C) improves
muscle damage recovery
J. B. Ferreira-Junior1,6, M. Bottaro1, A. Vieira1, A. F. Siqueira1, C. A. Vieira1, J. L. Q. Durigan2, E. L. Cadore1,
L. G. M. Coelho3, H. G. Simões4, M. G. Bemben5
1College of Physical Education, University of Brasília, Brasilia, DF, Brazil, 2Physical Therapy Division, University of Brasília,
Brasilia, DF, Brazil, 3Federal Center for Technological Education of Minas Gerais, Divinopolis, MG, Brazil, 4Graduate Program on
Physical Education, Catholic University of Brasilia, Brasilia, DF, Brazil, 5Department of Health and Exercise Science, University of
Oklahoma, Norman, Oklahoma, USA, 6Federal Institute of Triangulo Mineiro, Paracatu, MG, Brazil
Corresponding author: João Batista Ferreira-Junior, PhD, Federal Institute of Triangulo Mineiro, Road MG 188, Km 167, 38600-00
Paracatu, MG, Brazil. Tel: 55 3836798200, Fax: 55 3836798200, E-mail: jbfjunior@gmail.com
Accepted for publication 3 October 2014
To evaluate the effects of a single session of partial-body
cryotherapy (PBC) on muscle recovery, 26 young men
performed a muscle-damaging protocol that consisted of
five sets of 20 drop jumps with 2-min rest intervals
between sets. After the exercise, the PBC group (n=13)
was exposed to 3 min of PBC at 110 °C, and the control
group (n=13) was exposed to 3 min at 21 °C. Anterior
thigh muscle thickness, isometric peak torque, and
muscle soreness of knee extensors were measured pre,
post, 24, 48, 72, and 96 h following exercise. Peak torque
did not return to baseline in control group (P<0.05),
whereas the PBC group recovered peak torques 96 h post
exercise (P>0.05). Peak torque was also higher afterPBC
at 72 and 96 h compared with control group (P<0.05).
Muscle thickness increased after 24 h in the control group
(P<0.05) and was significantly higher compared with the
PBC group at 24 and 96 h (P<0.05). Muscle soreness
returned to baseline for the PBC group at 72 h compared
with 96 h for controls. These results indicate that PBC
after strenuous exercise may enhance recovery from
muscle damage.
Muscular performance may be temporarily impaired by
high-intensity exercise performed during a training
session or competition. The reduction in muscle strength
may be transitory, lasting minutes, hours, or several days
following training or competition (Barnett, 2006).
Longer lasting impairment in muscle strength accompa-
nied by a decrease in range of motion, an increase in
muscle proteins in the blood, inflammatory response,
muscle thickness, and delayed onset muscle soreness is
referred to as exercise-induced muscle damage
(Clarkson & Hubal, 2002; Barnett, 2006; Paulsen et al.,
2012).
Several modalities of recovery have been used to
hasten the recovery period from muscle damage
(Barnett, 2006). Among the most common treatment
strategies used to restore muscle function are massage
(Barnett, 2006; Nelson, 2013), stretching (Barnett, 2006;
Herbert et al., 2011), nonsteroidal anti-inflammatory
drugs (Schoenfeld, 2012), active recovery (Cheung
et al., 2003; Barnett, 2006), compression garments (Hill
et al., 2014), contrast water therapy (Bieuzen et al.,
2013), and cryotherapy (Bleakley et al., 2012; Leeder
et al., 2012), among others (Cheung et al., 2003; Barnett,
2006). A relatively novel modality of cryotherapy is the
whole-body cryotherapy (WBC), which refers to a brief
exposure (2 to 3 min) to extremely cold air (110 to
195 °C) in a temperature-controlled chamber or
cryocabin (Banfi et al., 2010; Hausswirth et al., 2011;
Fonda & Sarabon, 2013). Sessions of partial-body cryo-
therapy (PBC), in which the head is not exposed to cold,
have also been used as a similar modality of WBC
(Hausswirth et al., 2013).
In sports medicine, WBC has been used recently as an
approach to accelerate recovery from muscle damage, to
improve between-training session recovery, and to
prevent overtraining syndrome (Banfi et al., 2010;
Bleakley et al., 2014). It has been reported that the
inflammatory process and muscular enzymes related to
muscle damage were reduced after five sessions of WBC
(Banfi et al., 2009). Hausswirth et al. (2011) observed
that three sessions of WBC hastened muscle damage
recovery after downhill running. On the other hand, two
sessions of WBC (2 h apart) performed 24 h after
muscle-damaging protocol did not improve muscle
recovery (Costello et al., 2012a). Additionally, according
to Fonda and Sarabon (2013), five WBC exposures accel-
erated recovery of peak torque, squat jump start power,
and decreased muscle soreness. However, biochemical
markers, squat, and counter movement jump perfor-
mance were not affected by WBC exposures (Fonda &
Scand J Med Sci Sports 2014: ••: ••–••
doi: 10.1111/sms.12353
© 2014 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd
1
Sarabon, 2013). Therefore, the effects of WBC on muscle
damage recovery are equivocal. These conflicting results
may be due to methodological differences, such as cross-
over vs between-subject design, number of WBC ses-
sions (1 vs 3 vs 5) and the time elapsed between
damaging exercise and WBC (immediately post or 24 h
following WBC muscle-damaging protocol). There is
also ambiguity regarding the optimal treatment protocol
in terms of duration, temperature and sex (Fonda et al.,
2014; Hammond et al., 2014; Selfe et al., 2014). To the
best of our knowledge, there is no study that evaluated the
effects of one session of PBC performed immediately
after damaging exercise on muscle recovery. Using only
one PBC exposure might reduce the cost and time asso-
ciated with multiple treatments, which has currently been
recommended by manufacturers. Thus, this topic
requires further investigation.
We hypothesized that the physiological responses to
cold exposure from PBC will improve muscle damage
recovery. A logic model regarding the physiological,
neuromuscular, and perceptual rationale for using PBC
has been proposed by Costello et al. (2013). According
to this model, PBC causes a vasoconstriction associated
with decreased core and muscle temperature (Costello
et al., 2012a, b). This vasoconstriction reduces blood
vessels permeability to immune cells and decreases the
inflammatory process (Hausswirth et al., 2011; Pournot
et al., 2011; Ferreira-Junior et al., 2014). This attenua-
tion in the acute inflammatory response could provide a
beneficial role by protecting muscle from secondary
muscle damage, which would result in a decrease in
edema, muscle soreness, and an improvement in muscle
strength (Hausswirth et al., 2011; Pournot et al., 2011;
Ferreira-Junior et al., 2014). Ferreira-Junior et al. (2014)
reported in a mechanistic version that the attenuation in
serum sICAM-1 caused by PBC exposure immediately
following EIMD may be responsible for the decreased
secondary muscle damage. Additionally, hastening mus-
cular recovery is especially important because athletes
are usually required to train or compete at maximal
intensity almost daily. Thus, the aim of this study was to
evaluate the effects of one session of PBC performed
immediately after muscle-damaging protocol on muscle
recovery in physically active young men.
Methods
Subjects
Sample size for both PBC and control groups were determined by
GPower (version 3.1.2; Franz Faul, Universitat Kiel, Germany)
according to Beck (2013). The following design specifications
were taken into account: α=0.05; (1-β)=0.8; effect size f=0.25;
test family =Ftest, and statistical test =analysis of variance
(ANOVA) repeated measures, within-between interaction. The
sample size estimated according to these specifications was 20
subjects. Twenty-six young male university students (20.2 ±2.5
years, weight 71.4 ±9.1 kg and height 174.8 ±7.3 cm) volun-
teered to participate. Inclusion criteria included physically active
subjects involved in moderate physical activity (jogging, agility, or
endurance) for an average of 3 days a week, not performing
resistance training or plyometric exercise at least 3 months prior to
the study. Subjects were informed of the purpose, procedures,
possible discomforts, risks, and benefits of the study prior to
signing the written informed consent form. They were considered
healthy and fit for physical exercise by answering no to all
Physical-Activity Readiness Questionnaire questions (Thomas
et al., 1992). Also, based on Pobdielska et al. (2006), this study
adopted the following exclusion criteria: untreated arterial hyper-
tension, cardiovascular and respiratory diseases, angina, periph-
eral artery occlusive disease, venous thrombosis, urinary tract
diseases, severe anemia, allergy to cold, tumor diseases, viral and
bacterial infections, Raynaud’s syndrome, claustrophobia, or con-
vulsions. The present study was approved by the Institutional
Ethics Committee of the Catholic University of Brasília (Protocol:
71484/2012).
Experimental design
Subjects were randomly placed, using a random number table, in
two groups: PBC and control group (Table 1). Age, weight, height,
skin folds (chest, thigh, and abdomen), peak torque, and muscle
soreness were not significantly different between groups at base-
line (P>0.05); however, anterior thigh muscle thickness was
higher in the PBC group when compared with the control group
(P=0.02; Table 1). Volunteers visited the laboratory on six occa-
sions. The first visit consisted of a familiarization of experimental
procedures and for anthropometric assessment. One week after
familiarization, on visit two, volunteers performed a muscle-
damaging protocol. In order to test the effects of a single session of
PBC performed after damaging exercise on muscle recovery, the
PBC group was exposed to 3 min of PBC at 110 °C 10 min after
Table 1. Physical characteristics and baseline peak torque and muscle soreness of the participants of each experimental group
Physical characteristics Control group (n= 13) PBC group (n= 13) P-value
Age (years) 20.3 ±2.2 20.2 ±2.7 0.88
Weight (kg) 72.1 ±9.9 70.6 ±7.8 0.67
Height (cm) 176.0 ±8.0 173.5 ±5.9 0.38
Thighskin fold (mm) 15 ±913±7 0.56
Chestskin fold (mm) 9 ±58±2 0.63
Abdomenskin fold (mm) 19 ±11 16 ±6 0.45
Anterior thigh muscle thickness (mm) 37.2 ±4.6 41.2 ±3.3* 0.02
Peak torque (N.m) 246.2 ±61.4 261.8 ±36.8 0.46
Muscle soreness (mm) 19 ±14 15 ±14 0.31
*P<0.05, higher than control group.
PBC, partial-body cryotherapy.
Ferreira-Junior et al.
2
completing the muscle-damaging protocol. The control group was
not exposed to PBC 10 min after the damaging exercise. Indirect
markers of muscle damage were evaluated before (pre), immedi-
ately post, 24, 48, 72, and 96 h following the damaging exercise by
measuring always in the same order: anterior thigh muscle thick-
ness, knee extensors isometric peak torque, and knee extensors
muscle soreness. To avoid circadian influences, subjects were
asked to visit the laboratory always at the same time of day.
Volunteers were not allowed to perform any vigorous physical
activities or unaccustomed exercise during the experiment period.
They were also instructed not to take medications or supplements
during the study.
Exercise-induced muscle damage protocol
The muscle-damaging protocol consisted of five sets of 20 drop
jumps from a 0.6 m box with 2-min rest intervals between sets.
After dropping down from the box and landing on the floor, sub-
jects were instructed to perform a maximally explosive vertical
jump upward and then land on the floor. Volunteers were also
instructed to flex their knees to at least at 90° (0° full extension)
during all landings, and to maintain their hands on their hips
during the exercise. Additionally, they received verbal encourage-
ment throughout the exercise. Asimilar muscle-damaging protocol
has been used by other studies (Miyama & Nosaka, 2004;
Howatson et al., 2009; Fonda & Sarabon, 2013).
Recovery modalities
During the PBC exposure (Fig. 1), subjects stood in a head out
cryochamber based on gaseous nitrogen (Kryos Tecnologia, Bra-
sília, Brazil) at 110 °C for 3 min. The temperature and duration
of PBC exposure were based on a study by Costello et al. (2012a,
b). Subjects wore bathing suits, gloves, socks, and shoes with
thermic protection to protect their extremities. The control group
performed a sham treatment control, during which subjects stood
in the cryochamber for 3 min at 21 °C. Thigh temperatures (ante-
rior central area) were measured by an infrared thermometer
(Fluke, 566, China) before and immediately after PBC exposure
and passive recovery. The measurement area was marked with a
pen (Pilot 2 mm, Brazil) before each condition.
Muscle thickness assessment
Muscle thickness of the anterior thigh was measured by ultraso-
nography using B-Mode ultrasound (Philips-VMI, Ultra Vision
Flip, New York, NY, USA, model BF), and a single technician
evaluated subjects. A water-soluble transmission gel was applied
to the measurement site, and a 7.5-MHz ultrasound probe was
placed on the skin, perpendicular to the tissue interface without
depressing the skin. Subjects were evaluated in supine position,
after resting for 10 min. Muscle thickness of the anterior thigh was
measured at 60% of the distance from the greater trochanter to the
lateral epicondyle and 3 cm lateral to the midline of the anterior
thigh (Chilibeck et al., 2004). Once the technician was satisfied
with the quality of the image, it was frozen on the monitor
(Bemben, 2002). The images were then digitalized and later ana-
lyzed in Image-J software (National Institute of Health, Bethesda,
MD, USA, version 1.37). Muscle thickness was defined as the
distance from the subcutaneous adipose tissue–muscle interface to
the muscle–bone interface (Abe et al., 2000). Additionally, base-
line test/retest reliability coefficient (intraclass correlation coeffi-
cient; ICC) value for anterior thigh muscle thickness was 0.9.
Peak torque assessment
Maximal isometric peak torque of the right knee extensors was
measured by the Biodex System 3 Isokinetic Dynamometer
(Biodex Medical, Inc., Shirley, New York, USA). Subjects were
positioned comfortably on the dynamometer seat with belts fas-
tened across the trunk, pelvis, and thigh to minimize extraneous
body movements, which could affect peak torque and power
values. The lateral epicondyle of the femur was used to align the
knee with the dynamometer’s lever arm. With the participants
positioned on the seat, the following measures were recorded: seat
height, backrest inclination, dynamometer height, and lever arm
length in order to standardize the test position for each participant.
Gravity correction was obtained at full extension by measuring
the torque exerted by the lever arm and the participant’s relaxed
leg. All isokinetic variables were automatically adjusted for
gravity within the Biodex Advantage software. Calibration of
the dynamometer was carried out according to manufacturer’s
specifications.
After having their right leg positioned by the dynamometer at
an angle of 60° (0° represented the full extension), subjects were
asked to cross their arms across the chest and to maximally con-
tract their right knee extensors for 4 s. They had two attempts to
achieve their maximal isometric peak torque. One minute of rest
was given between each attempt. Subjects also received verbal
encouragement throughout the test and all testing procedures were
performed by the same examiner. All procedures were in accor-
dance with Cadore et al. (2012). Moreover, warm-up was not
conducted prior to isometric peak torque assessment because in a
recent study, it was verified that there was no difference between
five types of warm-up protocols and no warm-up protocol on
isokinetic performance (Ferreira-Júnior et al., 2013). Baseline test/
retest reliability coefficient (ICC) value for knee extensors isomet-
ric peak torque was 0.91.
Muscle soreness
Knee extensor muscle soreness was assessed using a 100-mm
visual analog scale with “no soreness” (0 mm) and “severe sore-
ness” (100 mm), respectively (Flores et al., 2011). Subjects rated
their quadriceps soreness during maximal isometric contractions
of the right knee extensors.
Fig. 1. Subject during head out/partial-body cryotherapy
(PBC): 3 min at 110 °C.
Cryotherapy (110 °C) improves muscle recovery
3
Statistical analyses
Data are presented as mean ±standard deviation. The Shapiro–
Wilk test was used to check data for normal distribution. Peak
torque and muscle thickness were analyzed using percent change
from baseline. Considering that the peak torque and muscle thick-
ness data were normally distributed, a two-way [group (PBC and
control) ×time (before, immediately, 24, 48, 72, and 96 h after
damaging exercise)] repeated measures ANOVA was used to
analyze peak torque and muscle thickness. In the case of signifi-
cant differences, a Holm-Sidak post-hoc test was used. The physi-
cal characteristics and baseline peak torque values were evaluated
by using an independent t-test. Given that muscle soreness data did
not present a normal distribution, the nonparametric Mann-
Whitney (between groups) and Friedman (within group) tests were
used to analyze this variable. Significance level was set a priori at
P<0.05. Additionally, the effect size calculation was used to
examine the magnitude of each condition effect. Cohen’s ranges of
0.1, 0.25, and 0.4 were used to define small, medium, and large ƒ
values, respectively, obtained from the following formula (Cohen,
1988; Beck, 2013):
fk
j
k
=
()
=
μμ
j
error
2
1
2
σ
[1]
where μjis the population mean for an individual group, μis the
overall mean, kis the number of groups, and σerror is the within-
group standard deviation.
Results
Knee extensors peak torques are presented in Fig. 2.
There was a significant group-by-time interaction for
peak torque (F=2.3, P=0.049, power =0.44, ƒ=0.26).
Peak torque dropped immediately after damaging exer-
cise with no difference between groups (32.0 ±13.3%
for control group and 28.6 ±11.9% for PBC group,
P=0.46). The PBC group recovered peak torque 96 h
after damaging exercise (P>0.05) while the control
group did not recover peak torque throughout the 96 h
post-testing period (P<0.05). Peak torque was also
higher for the PBC group at 72 (PBC: 238.5 ±50.4 N.m
vs control group: 189.8 ±52.6 N.m) and 96 h
(255.8 ±41.6 N.m vs 207.3 ±56.9 N.m) when com-
pared with the control group (P<0.05).
There was a significant group-by-time interaction for
anterior thigh muscle thickness (F=3.57, P=0.005,
power =0.78, ƒ=0.37). Muscle thickness increased at
24 h in the control group (P<0.001), while it was not
altered in the PBC group throughout the entire 96 h
(P>0.05). Moreover, muscle thickness was higher in
control group at 24 and 96 h after damaging exercise
when compared with the PBC group (P<0.05; Fig. 3).
The PBC group recovered from knee extensor muscle
soreness at 72 h after damaging exercise (χ2=24.53,
P<0.001), while the control group recovered only at
96 h after damaging exercise (χ2=29.36, P<0.001;
Fig. 4). There was no difference in muscle soreness
between groups (P>0.05).
Discussion
The aim of this study was to evaluate the effects of one
session of PBC (3 min at 110 °C) 10 min after damag-
ing exercise on muscle recovery in physically active
young men. The initial hypothesis was confirmed, as the
PBC session resulted in a quicker recovery of muscle
strength and relieved pain 72 h after damaging exercise
with no alteration in muscle thickness. In contrast, the
control group did not recover muscle strength to baseline
values, and recovered muscle thickness to baseline
values and from pain 48 and 96 h after damaging exer-
cise, respectively. Apossible reason for these results may
Time
(
h
)
Normalized isometric peak torque (%)
0
20
40
60
80
100
120
Control
PBC
PrePost24487296
*
*
#
#
*
*
*
***
*
Fig. 2. Mean ±SD percent change from baseline in knee exten-
sors isometric peak torque before (pre), immediately post, and
24–96 h following exercise-induced muscle damage. PBC,
partial-body cryotherapy (110 °C). *P<0.05, lower than pre.
#P<0.05, higher than control group.
Muscle thickness (%)
0
20
40
60
80
100
120
Control
PBC
Time (h)
Pre Post 24 48 72 96
*##
Fig. 3. Mean ±SD percent change from baseline in anterior
thigh muscle thickness before (pre), immediately post, and
24–96 h following exercise-induced muscle damage. PBC,
partial-body cryotherapy (110 °C). *P<0.05, higher than pre.
#P<0.05, higher than PBC group.
Ferreira-Junior et al.
4
be related to a decrease in core, muscle, and skin tem-
peratures after WBC exposure (Costello et al., 2012a, b).
This thermal response may lead to increased vasocon-
striction, which can cause a reduction in blood vessel
permeability to immune cells and thus decrease the
inflammatory process (Hausswirth et al., 2011; Pournot
et al., 2011; Ferreira-Junior et al., 2014).
Regarding the effects of WBC on inflammatory
process, it has been reported that five sessions of WBC
(30 s at 60 °C and 2 min at 110 °C) in athletes
decreased blood concentrations of muscular enzymes
(creatine kinase and lactate dehydrogenase) and pro-
inflammatory response (prostaglandin E2, adhesion mol-
ecule sICAM-I, interleukin IL-2 and IL-8; Banfi et al.,
2009). Additionally, anti-inflammatory cytokine IL-10
was increased (Banfi et al., 2009). Moreover, Pournot
et al. (2011) evaluated the effect of three sessions of
WBC (3 min at 110 °C) after damaging exercise on the
acute inflammatory response of well-trained runners.
They observed an increase in IL-1ra and a decrease in
IL-1βand C-reactive protein. Thus, according to the
authors, WBC exposure decreased the inflammatory
response via vasoconstriction at the muscular level
caused by drop in muscle temperature. This hypothesis is
supported by Costello et al. (2012a, b), who found a
decrease of 1.6 ±0.6 °C in the vastus lateralis tempera-
ture after WBC session. It was also reported that rectal
temperature decreased 0.3 ±0.2 °C 60 min after WBC
session (Costello et al., 2012a, b). Although muscle tem-
perature was not measured, skin thigh temperature in
the present study dropped from 33.0 ±0.9 °C to
15.7 ±3.9 °C immediately after WBC exposure.
The results reported in the present study are similar to
others that evaluated the effect of WBC on exercise-
induced muscle damage recovery (Hausswirth et al.,
2011; Fonda & Sarabon, 2013).A previous study verified
that three sessions of WBC (3 min at 110 °C) after
muscle-damaging protocol in well-trained runners
improved muscle strength and perceived sensation, and
also decreased muscle pain (Hausswirth et al., 2011).
Additionally, five WBC exposures (3 min at 140 to
190 °C) accelerated recovery of peak torque, squat
jump start power, and decreased muscle soreness in a
different investigation (Fonda & Sarabon, 2013).
Besides the number of WBC exposures, the current
study differs from those cited above (Hausswirth et al.,
2011; Fonda & Sarabon, 2013) in the experimental
design used. The present study used a between-subject
design, whereas the others (Hausswirth et al., 2011;
Fonda & Sarabon, 2013) used a crossover design.
According to Fonda and Sarabon (2013) and
Ferreira-Junior et al. (2014), the major limitation of a
crossover design to evaluate the effects of exercise-
induced muscle damage is that it can be influenced by
the repeated bout effect (Clarkson & Hubal, 2002;
McHugh, 2003). Additionally, a between-subject design
has been considered the gold standard when evaluating
healthcare interventions (Schulz et al., 2010).
On the other hand, using a between-subject design,
Costello et al. (2012a, b) reported that two sessions of
WBC (20 s at 60 °C and 3 min at 110 °C) in healthy
subjects did not hasten muscle strength nor decrease
muscle soreness. The main difference between our study
and Costello et al.’s (2012a, b) study was the timing of
the WBC session. In the current study, the subjects were
exposed 10 min after damaging exercise, while the ses-
sions of WBC was applied 24 h after damaging exercise
in the other study (Costello et al., 2012a, b). Immedi-
ately after damaging exercise, neutrophils and
lymphocytes are mobilized to the injured tissue, and
pro-inflammatory cytokines are produced in muscle by
lymphocytes and monocytes (Clarkson & Hubal, 2002;
Peake et al., 2005; Paulsen et al., 2012). Together, these
substances cause an intramuscular degradation, which
amplify the initial muscle damage (Clarkson & Hubal,
2002; Peake et al., 2005; Paulsen et al., 2012). Thus, it
would make sense to suggest that WBC applied 24 h
after damaging exercise did not avoid or decrease the
secondary muscle damage caused by the acute inflam-
matory process.
As expected, the muscle-damaging protocol used in
the present study caused significant muscle damage,
observed through a reduction of 32.0 ±13.3% in peak
torque, an increase in muscle thickness of 8.5 ±5.1%,
and moderate muscle soreness in the control group. This
muscle damage corroborates the findings from other
studies that used drop jump exercise as a muscle-
damaging protocol (Miyama & Nosaka, 2004; Howatson
et al., 2009).
Methodological considerations
A major limitation of the present study was that core and
quadriceps muscle temperature, muscular enzymes, and
Muscle soreness VAS (mm)
0
20
40
60
80
100 Control
PBC
*
Time
(
h
)
Pre Post 24 48 72 96
**
*
*
**
Fig. 4. Mean ±SD of knee extensors muscle soreness visual
analog scale (VAS) before (pre), immediately post, and 24–96 h
following exercise-induced muscle damage. PBC, partial-body
cryotherapy (110 °C). *P<0.05, higher than pre- within group.
Cryotherapy (110 °C) improves muscle recovery
5
biochemical inflammatory markers were not measured.
Future studies are necessary in order to understand the
WBC effects on muscle inflammatory process caused by
damaging exercise. The current study evaluated only
physically active young men. WBC might be more
accessible to athletes’ population and muscle damage
can also be less profound in this population (Barnett,
2006). In addition, anthropometric characteristics and
sex seem to affect magnitude of skin cooling following
WBC exposure (Hammond et al., 2014). Thus, further
studies on these topics are necessary in order to verify if
WBC can improve muscle recovery after high intense
training or competition in other populations, such as
athletes and women. Moreover, taking into account that
there is ambiguity regarding the optimal treatment pro-
tocol in terms of number of sessions, duration, and tem-
perature (Fonda et al., 2014; Selfe et al., 2014), future
studies should evaluate the effects of these issues on
exercise-induced muscle damage recovery.
Perspectives
The results of the present study showed that a single
session of PBC (3 min at 110 °C) 10 min after
muscle-damaging protocol enhanced muscle recovery
in physically active young men. From a practical stand-
point, PBC might be applied after an intense training
session in order to improve muscle recovery. However,
a question that should be investigated in future studies
is if the same effect would be observed in athletes who
used to experience less profound muscle damaging but
more regularly use WBC. Further studies also need to
evaluate biochemical inflammatory markers, tissue
blood flow, and tissue temperature in order to under-
stand the mechanistic effects of PBC. In addition, find-
ings reported in this study can only be applied when
PBC is administered 10 min after exercise-induced
muscle damage.
Key words: Recovery modality, peak torque, muscle
thickness, muscle soreness.
Acknowledgement
The study was partially funded by CAPES-Brazil.
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Cryotherapy (110 °C) improves muscle recovery
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... Muscle damage also directly interferes with the sensation of muscle pain in the days after exercise [17], an effect known as delayed-onset muscle soreness (DOMS), which also presents a peak variation between 24-48 hours post-exercise [18][19][20]. The increase in serum [CK] concentration and DOMS are indirect markers of muscle damage [21][22][23], and can be considered easy to assess and have useful practical application, since they make it possible to estimate muscle damage without the need for muscle biopsy techniques after exercise, which are costly and invasive to the subject. ...
... The DOMS assessment took place 24 and 48 hours after exercise, subsequently measured by [CK]. The level of muscle pain perceived in the quadriceps was assessed from the sensation of pain in an eccentric action (movement of squatting slowly until approximately a 90º angle of knee flexion and returning to the initial position) [20,25,26]. The volunteer indicated which level of muscle pain he was feeling from a visual analog scale with a score from 0 to 10, with 0 being nothing; 2 discomfort; 4 irritating; 6 horrible; 8 terrible and; 10 agonizing [12]. ...
... The eccentric exercise used in the present study was effective in inducing muscle damage, with an increase [CK] in the days following its performance (Table I), an effect also demonstrated by Miyama and Nosaka [16]. In addition, Ferreira-Junior et al. [20] identified that the referred plyometric jumping protocol was able to induce muscle damage resulting in increased perception of muscle pain in the days after exercise. ...
... Muscle damage also directly interferes with the sensation of muscle pain in the days after exercise [17], an effect known as delayed-onset muscle soreness (DOMS), which also presents a peak variation between 24-48 hours post-exercise [18][19][20]. The increase in serum [CK] concentration and DOMS are indirect markers of muscle damage [21][22][23], and can be considered easy to assess and have useful practical application, since they make it possible to estimate muscle damage without the need for muscle biopsy techniques after exercise, which are costly and invasive to the subject. ...
... The DOMS assessment took place 24 and 48 hours after exercise, subsequently measured by [CK]. The level of muscle pain perceived in the quadriceps was assessed from the sensation of pain in an eccentric action (movement of squatting slowly until approximately a 90º angle of knee flexion and returning to the initial position) [20,25,26]. The volunteer indicated which level of muscle pain he was feeling from a visual analog scale with a score from 0 to 10, with 0 being nothing; 2 discomfort; 4 irritating; 6 horrible; 8 terrible and; 10 agonizing [12]. ...
... The eccentric exercise used in the present study was effective in inducing muscle damage, with an increase [CK] in the days following its performance (Table I), an effect also demonstrated by Miyama and Nosaka [16]. In addition, Ferreira-Junior et al. [20] identified that the referred plyometric jumping protocol was able to induce muscle damage resulting in increased perception of muscle pain in the days after exercise. ...
Article
Full-text available
Introdução: O alongamento estático é comumente utilizado como parte da rotina de preparação para o exercício físico, no entanto ainda é controversa a sua influência sobre a inibição e ou redução dos danos musculares ocasionados pelo exercício excêntrico. Objetivo: Analisar o efeito do uso de um protocolo de alongamento estático com duração de 5 min (5 x 60 s) pré-exercício na resposta da concentração de creatina quinase ([CK]) e dor muscular de início tardio (DMIT) 24 e 48 horas após exercício de saltos pliométricos. Métodos: Trata-se de um estudo quase-experimental contrabalanceado de medidas repetidas e a amostra foi composta por 10 voluntários saudáveis que foram submetidos a duas sessões experimentais: 1) sem alongamento prévio ao exercício (controle) e; 2) com alongamento estático prévio ao exercício (alongamento estático). Em ambas as sessões os participantes foram submetidos a um exercício de saltos pliométricos para indução de dano muscular. Previamente às sessões experimentais e 24 e 48 horas pós-exercício foi mensurada a [CK], bem como a DMIT 24 e 48 horas pós-exercício. Resultados: Não houve diferença significativa para [CK] e DMIT quando comparadas as sessões experimentais, controle e alongamento estático, (p > 0,05). Além disso, ambas obtiveram pico da [CK] 24 horas pós-exercício, e a DMIT foi classificada como irritante para ambas as sessões. Conclusão: O protocolo de alongamento estático com duração de cinco minutos (5 x 60s) prévio ao exercício de saltos pliométricos não minimizou ou inibiu os danos musculares associados às ações excêntricas avaliadas pela [CK] e DMIT.
... The studies used different protocols that included cold water immersion techniques, ice packs, ice massage, and ice compression for cryotherapy. Thus, in 18 studies (Abaïdia et al., 2017;Adamczyk et al., 2016;Ascensão et al., 2011;Denegar & Perrin, 1992;Doungkulsa et al., 2018;Elias et al., 2012;Ferreira-Junior et al., 2015;Fonseca et al., 2016;Glasgow et al., 2014;Leeder et al., 2015;Machado et al., 2017;Malmir et al., 2017;Marquet et al., 2015;Pointon et al., 2011;Selkow et al., 2015;Siqueira et al., 2018;Vaile et al., 2008;Wiewelhove et al., 2018) significant effects were described, while14 studies showed no effects (Behringer et al., 2018;de Paiva et al., 2016;Guilhem et al., 2013;Hassan, 2011;Howatson et al., 2005Howatson et al., , 2008Howatson & Van Someren, 2003;Isabell et al., 1992;Jajtner et al., 2015;Johar et al., 2012;Micheletti et al., 2019;Paddon-Jones & Quigley, 1997;Sellwood et al., 2007;Tseng et al., 2013). ...
... The methodological evaluation of the quality of the studies has yielded an average of 4.7 points on the PEDro scale. Sixteen studies were considered "high quality" (Aaron et al., 2017;Aytar et al., 2008;Chang et al., 2019;Craig et al., 1999b;de Paiva et al., 2016;Ferreira-Junior et al., 2015;Fleckenstein et al., 2016Fleckenstein et al., , 2017 R.L. Nahon, J.S. Silva A. Monteiro de Magalhães Neto Physical Therapy in Sport 52 (2021) 1e12 et al., 2002;Mikesky & Hayden, 2005;Selkow et al., 2015;Sellwood et al., 2007;Vinck et al., 2006); 42 studies were considered "moderate quality" (Adamczyk et al., 2016;Andersen et al., 2013;Butterfield et al., 1997;Changa et al., 2020;Craig et al., 1996b;Curtis et al., 2010;Doungkulsa et al., 2018;Elias et al., 2012;Glasgow et al., 2014;Guilhem et al., 2013;Hart et al., 2005;Hasson et al., 1990;Hazar Kanik et al., 2019;Hoffman et al., 2016;Howatson et al., 2008;Jayaraman et al., 2004;Jeon et al., 2015;Johar et al., 2012;Kirmizigil et al., 2019;Kong et al., 2018;Law & Herbert, 2007;Leeder et al., 2015;Macdonald et al., 2014;Machado et al., 2017;Malmir et al., 2017;McLoughlin et al., 2004;Micheletti et al., 2019;Naderi et al., 2020;Paddon-Jones & Quigley, 1997;Rey et al., 2012;Rocha et al., 2012;Romero-Moraleda et al., 2019;Siqueira et al., 2018;Smith et al., 1994;Tourville et al., 2006;Wang et al., 2006;Weber et al., 1994;Wiewelhove et al., 2018;Xie et al., 2018;Zebrowska et al., 2019;Zhang et al., 2000) and 63 studies were considered "low quality" (Akinci et al., 2020;Behringer et al., 2018;Boobphachart et al., 2017;Carling et al., 1995;Ferguson et al., 2014;Haksever et al., 2016;Hill et al., 2017;Imtiyaz et al., 2014;Jakeman et al., 2010aJakeman et al., , 2010bKraemer et al., 2001;Lau & Nosaka, 2011;Northey et al., 2016;Ozmen et al., 2017;Pearcey et al., 2015;Prill et al., 2019;Rhea et al., 2009;Timon et al., 2016;Vaile et al., 2007Vaile et al., , 2008Visconti et al., 2020;Wheeler & Jacobson, 2013) , (Ascensão et al., 2011;Hassan, 2011;Hilbert et al., 2003;Howatson & Van Someren, 2003;Jajtner et al., 2015;Kargarfard et al., 2016;Lightfoot et al., 1997;Marquet et al., 2015;Micklewright, 2009;Tiidus & Shoemaker, 1995;Torres et al., 2013;Weber et al., 1994;Wessel & Wan, 1994;Xiong et al., 2009;Zainuddin et al., 2005) , (Abaïdia et al., 2017;Barlas et al., 2000;Cardoso et al., 2020;Craig et al., 1996aCraig et al., , 1999aHowatson et al., 2005;Itoh et al., 2008;Mankovsky-Arnold et al., 2013;Minder et al., 2002;Parker & Madden, 2014;Petrofsky et al., 2012;Plaskett et al., 1999;Shankar et al., 2006;Taylor et al., 2015;Tseng et al., 2013;Tufano et al., 2012;Vanderthommen et al., 2007;Zainuddin et al., 2006) (See details in Appendix 3). The overall analysis results showed that there was "low quality evidence" (according to GRADE classification). ...
Article
Objective To evaluate the impact of interventions on pain associated with DOMS. Data sources PubMed, EMBASE, PEDro, Cochrane, and Scielo databases were searched, from the oldest records until May/2020. Search terms used included combinations of keywords related to “DOMS” and “intervention therapy”. Eligibility criteria Healthy participants (no restrictions were applied, e.g., age, sex, and exercise level). To be included, studies should be: 1) Randomized clinical trial; 2) Having induced muscle damage and subsequently measuring the level of pain; 3) To have applied therapeutic interventions (nonpharmacological or nutritional) and compare with a control group that received no intervention; and 4) The first application of the intervention had to occur immediately after muscle damage had been induced. Results One hundred and twenty-one studies were included. The results revealed that the contrast techniques (p = 0,002 I² = 60 %), cryotherapy (p = 0,002 I² = 100 %), phototherapy (p = 0,0001 I² = 95 %), vibration (p = 0,004 I² = 96 %), ultrasound (p = 0,02 I² = 97 %), massage (p < 0,00001 I² = 94 %), active exercise (p = 0,0004 I² = 93 %) and compression (p = 0,002 I² = 93 %) have a better positive effect than the control in the management of DOMS. Conclusion Low quality evidence suggests that contrast, cryotherapy, phototherapy, vibration, ultrasound, massage, and active exercise have beneficial effects in the management of DOMS-related pain.
... muscle soreness and muscle damage) [15][16][17]. As Ferreira-Junior et al. [7] reported, after one session of partial body cryotherapy, muscle thickness and soreness returned to baseline faster (group with cryotherapy) compared to the control groups. W-BC also improves acute recovery during high-intensity intermittent exercise in thermoneutral conditions. ...
Article
Whole-body cryostimulation (W-BC) is commonly used following exercise to accelerate recovery or as a form of therapy to prevent and cure sports injuries. This study aimed to investigate the effect of a series of 24 W-BC sessions on morphological and rheological blood indicators in physically active men. Eighteen physically active men participated in the study (mean age 22.1 ± 0.07). They were divided into two groups depending on their self-reported levels of physical activity: moderate or high physical activity. The participants completed a total of 24 W-BC sessions every second day, over a span of two months. Blood was collected at baseline, immediately after and 24 h after the first treatment, before and after the 12th treatment, before, immediately after, and 24 h after the 24th treatment, and one, two, three, and four weeks after the 24th treatment. Rheological and morphological indicators of blood were examined. The number of leukocytes was decreased in the moderate activity group (p < 0.05) but not in the high intensity group, following the first W-BC session. There were no significant changes in elongation index (EI) at a shear stress of 2.19–31.04 (Pa) in both groups as well as at the following values: aggregation index (AI), the half time (T½) and the amplitude of aggregation (AMP) in both studied groups. Differences between the first and the 12th or the 24th session became apparent in some morphological indices in one or both groups. Changes in the morphological properties were not observed after the first exposure but became evident following repeated W-BC sessions.
... The debate on whether WBC is effective in reducing muscle soreness has been highlighted previously Costello et al., 2015) and by the discrepant findings between studies demonstrating benefits (e.g. Fonda & Sarabon, 2013;Wilson et al., 2018) versus studies that have not Ferreira-Junior et al., 2015). The variety of EIMD protocols utilised in WBC studies makes it difficult to draw definitive comparisons and conclusions regarding the impact of WBC on muscle soreness. ...
Thesis
Full-text available
Whilst Whole Body Cryotherapy (WBC) has become an emerging tool for sport and exercise recovery, its overall efficacy remains contentious. This thesis addressed a variety of issues concerning the practice. Firstly, the impact of single WBC interventions for treating exercise-induced muscle damage (EIMD) is unclear. Secondly, the influence of inter-individual factors on WBC outcomes post-exercise remains an under-investigated area. Therefore the first main study explored the effects of age and body fat content on responses to WBC following downhill running, a commonly utilised eccentric exercise model for inducing muscle damage. WBC participants underwent cryotherapy (3 minutes, −120°C) one hour post- downhill run and control (CON) participants passively recovered (20°C). Despite the presence of EIMD, WBC significantly blunted (p=0.04) the decrease in muscle torque 24 hours after the downhill run. This response was significantly influenced by age, with young participants (<40 years) retaining their muscle strength more than older participants (≥45 years). WBC may therefore attenuate EIMD and benefit muscle strength recovery following eccentrically biased exercise, particularly for young males. A subsequent downhill run study investigated the influence of WBC timing post-exercise, a factor that could clarify optimal treatment usage. An additional objective was to compare the effects of WBC with cold water immersions (CWI) since the verdict regarding which cold modality is superior for recovery remains an on-going area of controversy. It was revealed that WBC 4 hours post-exercise was ineffective in treating EIMD markers, so applying WBC within one hour after exercise may be preferable to delaying by several hours. However, WBC was no more effective than CWI, meaning that the cost vs. reward implications of WBC treatments would need further reviewing. Finally, the implications of repetitive WBC during training programmes require further evaluation due to the possibility of repetitive cold interfering with long term adaptations. The final study investigated the impact of two weekly WBC treatments on adaptations to a 6 week strength and endurance training programme. It was found that WBC participants significantly improved their muscle strength comparatively to the CON group. However WBC did not improve their jump height (p=0.23) in contrast to the CON group (p=0.01). In conclusion, repetitive WBC does not appear to blunt strength training adaptations, although there may be an interference effect in the development of explosive power.
... Despite the demonstrated anti-inflammatory potential of WBC (Ziemann et al., 2012;Ferreira-Junior et al., 2014), the long term consequences of mitigating inflammation could be detrimental due to continual dampening of the adaptive responses. It is acknowledged that inflammation post-exercise is a means through which muscles can repair and regenerate (Fatourous and Jamurtas, 2016), thereby facilitating training adaptations. ...
Article
Full-text available
Despite its potential merit in sport and exercise recovery, the implications of repetitive Whole Body Cryotherapy (WBC) during training programmes require further review due to the possibility of repetitive cold interfering with long term adaptations. This study investigated the impact of two weekly 3 min WBC sessions (30 s at −60 • C, 150 s at −120 • C) on adaptations to a 6 week strength and endurance training programme. Sixteen male participants (mean ± SD age 33.4 ± 9.8 years, body mass 82.3 ± 9.8 kg) randomly allocated into WBC (n = 7) and non-cryotherapy control (CON, n=9) groups completed the programme consisting of two weekly strength and plyometric training sessions and two weekly 30 min runs (70% VO 2 max). Participants were assessed for body fat, VO2 max, muscle torque, three repetition maximum barbell squat and countermovement jump height before and after the programme. Resistance and running intensities were progressed after 3 weeks. Participants in both groups significantly improved muscle torque (WBC: 277.1 ± 63.2 Nm vs. 318.1 ± 83.4 Nm, p < 0.01, d = 0.56; CON: 244.6 ± 50.6 Nm vs. 268.0 ± 71.8 Nm, p = 0.05, d = 0.38) and barbell squat (WBC: 86.4 ± 19.5 kg vs. 98.9 ± 15.2 kg, p = 0.03, d = 0.69; CON: 91.1 ± 28.7 kg vs. 106.1 ± 30.0 kg, p<0.01, d=0.51) following the 6 week programme. For the CON group, there was also a significant reduction in body fat percentage (p = 0.01) and significant increase in jump height (p = 0.01). There was no significant increase in VO2 max for either group (both p > 0.2). There was no difference between WBC and CON for responses in muscle torque, 3RM barbell squat and body fat, however WBC participants did not increase their jump height (p = 0.23). Repetitive WBC does not appear to blunt adaptations to a concurrent training programme, although there may be an interference effect in the development of explosive power. Sports practitioners can cautiously apply repetitive WBC to support recovery post-exercise without undue concern on athletes' fitness gains or long term performance, particularly throughout training phases focused more on general strength development than explosive power.
... 4 The PBC exposes users to temperatures of −110°C to −150°C for 1 to 3 minutes using extremely cold, dry air 4 to improve acute recovery from high-intensity bouts of exercise and muscle damage. 5 Whole-body cryotherapy (WBC), a similar cold exposure method, was also shown to elicit changes in hormonal concentrations in elite athletes with testosterone elevated for up to 24 hours, 6 and maintained salivary α-amylase concentration compared with decreases in a control (CON) condition. 7 The rise in salivary α-amylase reflects activation of the autonomic nervous system that has potential performance benefits. ...
Article
Full-text available
Purpose: This study evaluated the effect of partial-body cryotherapy (PBC) exposure 1, 2, or 3 hours before maximal-effort jump performance, salivary enzyme concentration, perceived readiness, and well-being. Methods: Male team-sport players (N = 27; 24.2 [3.6] y; 91.5 [13.2] kg) were exposed to a blinded bout of PBC (-135°C [6°C]) and control (-59°C [17°C]) either 1, 2, or 3 hours prior to countermovement jumps. Passive saliva samples were collected to determine α-amylase concentration. Self-reported performance readiness and well-being questionnaires were completed using a 1-5 Likert scale. Results: Differences in the change in mean countermovement jump velocity and absolute power between PBC and control were unclear at 1 hour (+1.9% [5.3%], P = .149; +0.7% [10.6%], P = .919; mean difference [90% confidence limits]), 2 hours (+3.3% [2.7%], P = .196; +7.8% [7.4%], P = .169), and 3 hours postexposure (+3.1% [3.3%], P = .467; +0.7% [4.8%], P = .327). Salivary α-amylase concentration was elevated 15 minutes postexposure in the 1-hour (+61% [14%], P = .008) and 2-hour groups (+55% [12%], P = .013). The increase in self-reported performance readiness was higher after PBC (+2.4 [1.2] units, P = .046) in the 2-hour group and by 1.4 (1.1) units (P = .023) after 3 hours. Mental fatigue was favorably decreased 2 hours after PBC exposure (+0.5 [0.1], P = .041). Conclusions: An acute exposure of PBC elicits potentially favorable but unclear changes in countermovement jump performance. The PBC enhances salivary α-amylase concentration and perceived performance readiness, reduces mental fatigue, and could be useful in sport-specific training or competitions.
... Specifically, attention should be given to female basketball players with a lower body mass index as they seem to be more sensitive to cold, which could potentially affect compliance with cryotherapy. Several studies have incorporated similar temperatures (− 110 °C) and exposure times (3 min) and have shown decreased muscle soreness [69] and enhanced eccentric muscle performance recovery [60]. ...
Article
Full-text available
Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players’ recovery for training and competition throughout the season.
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This study explored whether anthropometric measures influence magnitude of skin cooling following exposure to whole body cryotherapy (WBC). Height, weight, body fat percentage, and lean mass were measured in 18 male and 14 female participants. Body surface area, body surface area to mass ratio, body mass index, fat-free mass index, and fat mass index were calculated. Thermal images were captured before and after WBC (-60°C for 30 seconds, -110°C for 2 minutes). Skin temperature was measured at the chest, arm, thigh, and calf. Mean skin temperature before and after WBC and change in mean skin temperature (ΔT sk) were calculated. ΔT sk was significantly greater in females (12.07 ± 1.55°C) than males (10.12 ± 1.86°C; t(30) = -3.09, P = .004). A significant relationship was observed between body fat percentage and ΔT sk in the combined dataset (P = .002, r = .516) and between fat-free mass index and ΔT sk in males (P = .005, r = .622). No other significant associations were found. Skin response of individuals to WBC appears to depend upon anthropometric variables and sex, with individuals with a higher adiposity cooling more than thinner individuals. Effects of sex and anthompometrics should be considered when designing WBC research or treatment protocols.
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Whole-body cryotherapy (WBC) involves short exposures to air temperatures below -100°C. WBC is increasingly accessible to athletes, and is purported to enhance recovery after exercise and facilitate rehabilitation postinjury. Our objective was to review the efficacy and effectiveness of WBC using empirical evidence from controlled trials. We found ten relevant reports; the majority were based on small numbers of active athletes aged less than 35 years. Although WBC produces a large temperature gradient for tissue cooling, the relatively poor thermal conductivity of air prevents significant subcutaneous and core body cooling. There is weak evidence from controlled studies that WBC enhances antioxidant capacity and parasympathetic reactivation, and alters inflammatory pathways relevant to sports recovery. A series of small randomized studies found WBC offers improvements in subjective recovery and muscle soreness following metabolic or mechanical overload, but little benefit towards functional recovery. There is evidence from one study only that WBC may assist rehabilitation for adhesive capsulitis of the shoulder. There were no adverse events associated with WBC; however, studies did not seem to undertake active surveillance of predefined adverse events. Until further research is available, athletes should remain cognizant that less expensive modes of cryotherapy, such as local ice-pack application or cold-water immersion, offer comparable physiological and clinical effects to WBC.
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Whole body cryotherapy (WBC) is the therapeutic application of extreme cold air for a short duration. Minimal evidence is available for determining optimal exposure time. To explore whether the length of WBC exposure induces differential changes in inflammatory markers, tissue oxygenation, skin and core temperature, thermal sensation and comfort. This study was a randomised cross over design with participants acting as their own control. Fourteen male professional first team super league rugby players were exposed to 1, 2, and 3 minutes of WBC at -135°C. Testing took place the day after a competitive league fixture, each exposure separated by seven days. No significant changes were found in the inflammatory cytokine interleukin six. Significant reductions (p<0.05) in deoxyhaemoglobin for gastrocnemius and vastus lateralis were found. In vastus lateralis significant reductions (p<0.05) in oxyhaemoglobin and tissue oxygenation index (p<0.05) were demonstrated. Significant reductions (p<0.05) in skin temperature were recorded. No significant changes were recorded in core temperature. Significant reductions (p<0.05) in thermal sensation and comfort were recorded. Three brief exposures to WBC separated by 1 week are not sufficient to induce physiological changes in IL-6 or core temperature. There are however significant changes in tissue oxyhaemoglobin, deoxyhaemoglobin, tissue oxygenation index, skin temperature and thermal sensation. We conclude that a 2 minute WBC exposure was the optimum exposure length at temperatures of -135°C and could be applied as the basis for future studies.
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Aim: The optimal warm-up protocol for isokinetic strength performance assessment remains unclear. Therefore, the purpose of this study was to analyze the effects of different warm-up routines on strength production in young adults. Methods: Fifteen healthy young men (24.8±3.5 years) were exposed to five different isokinetic warm-up protocols. Isokinetic strength was assessed after each protocol at 60°.s-1. The warm-up protocols were: (1) submaximal, 10 submaximal consecutive repetitions (50% of maximum effort) at 60°.s-1; (2) intermittent, one set of 10 maximal intermittent contractions (30 s between contractions) at 60°.s-1; (3) 180, 10 maximal consecutive repetitions at 180°.s-1; (4) 300, 10 maximal consecutive repetitions at 300°.s-1 and (5) control session (no warm-up). Results: Peak torque was greater (P<0.05) after the intermittent (295.3±53.2 N.m) when compared to 300 (267.5±47.3 N.m) and 180 (275.2±48.6 N.m) warm-up protocols. Also, peak torque was higher (P<0.05) in the control (285.4±48.7 N.m) protocol when compared to 300. Load range was greater (P<0.05) in both no warm-up (121.5±3.5 ms) and intermittent (121.6±2.4 ms) protocols when compared to 300 (118.4±6.7 ms) and submaximum (117.7±5.5 ms) warm-up protocols. Power did not differ among protocols (P=0.31). Conclusion: Warm-up is not necessary before isokinetic tests, however, for those subjects that believe in physiological benefits of warm-up, the intermittent protocol could be an interesting strategy. In addition, subjects should avoid warm-up using velocities higher than the testing velocity.
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Delayed onset muscle soreness (DOMS) is a familiar experience for the elite or novice athlete. Symptoms can range from muscle tenderness to severe debilitating pain. The mechanisms, treatment strategies, and impact on athletic performance remain uncertain, despite the high incidence of DOMS. DOMS is most prevalent at the beginning of the sporting season when athletes are returning to training following a period of reduced activity. DOMS is also common when athletes are first introduced to certain types of activities regardless of the time of year. Eccentric activities induce micro-injury at a greater frequency and severity than other types of muscle actions. The intensity and duration of exercise are also important factors in DOMS onset. Up to six hypothesised theories have been proposed for the mechanism of DOMS, namely: lactic acid, muscle spasm, connective tissue damage, muscle damage, inflammation and the enzyme efflux theories. However, an integration of two or more theories is likely to explain muscle soreness. DOMS can affect athletic performance by causing a reduction in joint range of motion, shock attenuation and peak torque. Alterations in muscle sequencing and recruitment patterns may also occur, causing unaccustomed stress to be placed on muscle ligaments and tendons. These compensatory mechanisms may increase the risk of further injury if a premature return to sport is attempted. A number of treatment strategies have been introduced to help alleviate the severity of DOMS and to restore the maximal function of the muscles as rapidly as possible. Nonsteroidal anti-inflammatory drugs have demonstrated dosage-dependent effects that may also be influenced by the time of administration. Similarly, massage has shown varying results that may be attributed to the time of massage application and the type of massage technique used. Cryotherapy, stretching, homeopathy, ultrasound and electrical current modalities have demonstrated no effect on the alleviation of muscle soreness or other DOMS symptoms. Exercise is the most effective means of alleviating pain during DOMS, however the analgesic effect is also temporary. Athletes who must train on a daily basis should be encouraged to reduce the intensity and duration of exercise for 1–2 days following intense DOMS-inducing exercise. Alternatively, exercises targeting less affected body parts should be encouraged in order to allow the most affected muscle groups to recover. Eccentric exercises or novel activities should be introduced progressively over a period of 1 or 2 weeks at the beginning of, or during, the sporting season in order to reduce the level of physical impairment and/or training disruption. There are still many unanswered questions relating to DOMS, and many potential areas for future research.