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Effects of cryotherapy on muscle damage markers and perception of delayed onset muscle soreness after downhill running: A Pilot study

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Rossato M, et al. Effects of cryotherapy on muscle damage markers and perception of delayed onset muscle soreness after downhill running: A Pilot study. Rev Andal Med Deporte. 2015. http://dx. a b s t r a c t Objective: To investigate the effects of cryotherapy on markers of muscle damage, as well as the perception of muscle soreness caused by eccentric exercise after downhill running. Methods: Ten participants (age = 26 ± 5 year, height = 173 ± 8 cm and body mass = 70 ± 4 kg) performed two running trials on a treadmill tilted –6.6%, separated by one-week period. Cryotherapy (∼15 • C for 30 minutes) was conducted after one of the trials of exercise. Blood samples were analyzed for markers of muscle damage (creatine kinase – CK; lactate dehydrogenase – LDH; calcium – [Ca 2+ ]). Perception of muscle soreness was quantified using an analogical scale of pain. Data were collected before, 24 and 48 h after the trials with and without the use of cryotherapy. Results: Cryotherapy significantly reduced muscle soreness and was able to reestablish homeostasis in CK, LDH and [Ca 2+ ]. Conclusion: Use of cryotherapy after exercise with eccentric contractions was effective to reestablish the level of biochemical markers of muscle damage and reduce muscle soreness and pain perception in subjects submitted to downhill running.
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Please
cite
this
article
in
press
as:
Rossato
M,
et
al.
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study.
Rev
Andal
Med
Deporte.
2015.
http://dx.doi.org/10.1016/j.ramd.2014.07.003
ARTICLE IN PRESS
G Model
RAMD-39;
No.
of
Pages
5
Rev
Andal
Med
Deporte.
2015;xxx(xx):xxx–xxx
www.elsevier.es/ramd
R
e
v
i
s
t
a
A
n
d
a
l
u
z
a
d
e
Medicina
del
Deporte
Original
article
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study
M.
Rossatoa,,
E.
de
Souza
Bezerraa,
D.A.
de
Ceselles
Seixas
da
Silvaa,
T.
Avila
Santanab,
W.
Rafael
Malezamc,
F.P.
Carpesd
aFederal
University
of
Amazonas,
Manaus,
Brazil
bUniversity
Center
North,
Manaus,
Brazil
cFederal
University
of
São
Paulo,
São
Paulo,
Brazil
dLaboratory
of
Neuromechanics,
Federal
University
of
Pampa,
Uruguaiana,
Brazil
a
r
t
i
c
l
e
i
n
f
o
Article
history:
Received
8
November
2013
Accepted
29
July
2014
Available
online
xxx
Keywords:
Inflammation
Post-exercise
recovery
Fatigue
Muscle
damage
a
b
s
t
r
a
c
t
Objective:
To
investigate
the
effects
of
cryotherapy
on
markers
of
muscle
damage,
as
well
as
the
perception
of
muscle
soreness
caused
by
eccentric
exercise
after
downhill
running.
Methods:
Ten
participants
(age
=
26
±
5
year,
height
=
173
±
8
cm
and
body
mass
=
70
±
4
kg)
performed
two
running
trials
on
a
treadmill
tilted
–6.6%,
separated
by
one-week
period.
Cryotherapy
(15 C
for
30
minutes)
was
conducted
after
one
of
the
trials
of
exercise.
Blood
samples
were
analyzed
for
markers
of
muscle
damage
(creatine
kinase
CK;
lactate
dehydrogenase
LDH;
calcium
[Ca2+]).
Perception
of
muscle
soreness
was
quantified
using
an
analogical
scale
of
pain.
Data
were
collected
before,
24
and
48
h
after
the
trials
with
and
without
the
use
of
cryotherapy.
Results:
Cryotherapy
significantly
reduced
muscle
soreness
and
was
able
to
reestablish
homeostasis
in
CK,
LDH
and
[Ca2+].
Conclusion:
Use
of
cryotherapy
after
exercise
with
eccentric
contractions
was
effective
to
reestablish
the
level
of
biochemical
markers
of
muscle
damage
and
reduce
muscle
soreness
and
pain
perception
in
subjects
submitted
to
downhill
running.
©
2013
Consejería
de
Educación,
Cultura
y
Deporte
de
la
Junta
de
Andalucía.
Published
by
Elsevier
España,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Efectos
de
la
crioterapia
en
los
marcadores
de
da˜
no
muscular
y
en
la
percepción
de
mialgia
de
aparición
tardía
tras
carrera
en
bajada
Palabras
clave:
Inflamación
Recuperación
post-ejercicio
Fatiga
Da˜
no
muscular
r
e
s
u
m
e
n
Objetivo:
Investigar
los
efectos
de
la
crioterapia
en
los
marcadores
de
da˜
no
muscular,
así
como
la
per-
cepción
de
mialgia
causada
por
ejercicio
excéntrico
tras
carrera
en
bajada.
Método:
Diez
participantes
(edad
=
26,0
±
5,0
a˜
nos,
altura
=
173,0
±
8,0
cm
y
masa
corporal
=
70,5
±
4,0
kg)
realizaron
dos
ensayos
de
carrera
en
tapiz
rodante
con
una
inclinación
de
–6.6%,
separados
por
un
periodo
de
una
semana.
Se
llevó
a
cabo
una
sesión
de
crioterapia
(15 C,)
tras
cada
uno
de
los
ensayos.
Se
analizaron
muestras
de
sangre
para
determinar
los
marcadores
de
da˜
no
muscular
(creatín
kinasa–CK;
deshidrogenasa
láctica–DHL;
calcio
-
[Ca2+]).
La
percepción
de
dolor
muscular
fue
cuantificada
usando
una
escala
analógica
de
dolor.
Los
datos
se
tomaron
antes,
24
h
y
48
h
después
de
los
ensayos
con
y
sin
el
uso
de
crioterapia.
Resultados:
La
crioterapia
disminuyó
significantemente
el
dolor
muscular
y
fue
capaz
de
reestablecer
la
homeostasis
en
CK,
DHL
y
[Ca2+].
Corresponding
author.
E-mail
address:
rossato.mateus@gmail.com
(M.
Rossato).
http://dx.doi.org/10.1016/j.ramd.2014.07.003
1888-7546/©
2013
Consejería
de
Educación,
Cultura
y
Deporte
de
la
Junta
de
Andalucía.
Published
by
Elsevier
España,
S.L.U.
This
is
an
open
access
article
under
the
CC
BY-NC-ND
license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Document downloaded from http://www.elsevier.es, day 13/04/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been reviewed, accepted and posted on the Web before copyediting.
Please
cite
this
article
in
press
as:
Rossato
M,
et
al.
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study.
Rev
Andal
Med
Deporte.
2015.
http://dx.doi.org/10.1016/j.ramd.2014.07.003
ARTICLE IN PRESS
G Model
RAMD-39;
No.
of
Pages
5
2
M.
Rossato
et
al.
/
Rev
Andal
Med
Deporte.
2015;xxx(xx):xxx–xxx
Conclusión:
:
El
uso
de
crioterapia
tras
ejercicio
con
contracciones
excéntricas
fue
efectivo
para
reestable-
cer
el
nivel
de
los
marcadores
bioquímicos
de
da˜
no
muscular
y
reducir
la
mialgia
y
la
percepción
de
dolor
en
sujetos
sometidos
a
carrera
en
bajada.
©
2013
Consejería
de
Educación,
Cultura
y
Deporte
de
la
Junta
de
Andalucía.
Publicado
por
Elsevier
España,
S.L.U.
Este
es
un
artículo
Open
Access
bajo
la
licencia
CC
BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Palavras-chave:
Inflamac¸
ão
Recuperac¸
ão
pós-exercício
Fadiga
Dano
muscular
Efeito
da
imersão
em
agua
gelada
no
dano
muscular
e
dor
tardia
após
a
corrida
de
downhill:
um
estudo
piloto
r
e
s
u
m
o
Introduc¸
ão:
O
dano
muscular
é
frequentemente
observado
em
indivíduos
envolvidos
em
atividades
físicas
que
envolvam
contrac¸
ões
excêntricas.
Nestas
situac¸
ões,
a
crioterapia
é
utilizada
para
reduzir
o
dano
muscular
e
a
sensac¸
ão
de
dor.
No
entanto,
poucos
estudos
investigaram
o
efeito
da
imersão
em
agua
gelada
em
marcadores
de
dano
muscular,
bem
como
a
percepc¸
ão
de
dor
após
exercício
excêntrico.
Método:
Dez
homens
(26,0
±
5,0
anos
de
idade,
173,0
±
8,0
cm
de
estatura,
70,5
±
4,0
kg
de
massa
corpo-
ral).
Os
voluntários
completaram
dois
corridas
(teste
e
controle)
separadas
por
sete
dias,
em
um
percurso
declinado
(–6,6%)
em
esteira.
Em
uma
das
tentativas
realizou-se
imersão
em
água
gelada
(15 C,
30
minutos).
O
dano
muscular
foi
estimado
mediante
os
níveis
sanguíneos
de
(creatina
quinase–CK;
lac-
tato
desidrogenase–LDH
e
cálcio–[Ca2+]).
A
percepc¸
ão
de
dor
muscular
foi
estimada
usando
uma
escala
analógica.
Todas
as
medidas
foram
realizadas
antes,
24
e
48
horas
pós-exercício.
Resultados:
A
imersão
em
agua
gelada
diminuiu
significativamente
a
dor
muscular
e
auxiliou
no
reesta-
belecimento
da
homeostase
da
CH,
LDH
e
Ca2+.
Conclusão:
A
imersão
em
agua
gelada
após
exercício
excêntrico
foi
efetiva
em
reestabelecer
os
níveis
bioquímicos
de
marcadores
musculares
e
diminuiu
a
percepcao
de
dor.
©
2013
Consejería
de
Educación,
Cultura
y
Deporte
de
la
Junta
de
Andalucía.
Publicado
por
Elsevier
España,
S.L.U.
Este
é
um
artigo
Open
Access
sob
a
licença
de
CC
BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Introduction
The
physiological
mechanism
of
the
delayed
onset
muscle
sore-
ness
(DOMS)
after
exercise
is
not
well
elucidated.1The
DOMS
is
more
frequent
and
of
greater
magnitude
after
exercises
with
a
predominance
of
eccentric
contractions.1Among
the
reasons
for
this
association
between
DOMS
and
eccentric
exercise
is
the
fact
that
eccentric
actions
promote
greater
tension
to
the
con-
tractile
apparatus
with
greater
accumulation
of
metabolites
and
structural
damage
in
tissues.1–3 The
structural
damage
to
the
sarcolemma
and
Z
lines
of
sarcomeres
are
often
measured
by
markers
such
as
creatine
kinase
(CK)
and
lactate
dehydrogenase
(LDH).4
DOMS
is
largely
observed
among
sportsmen,
and
it
may
have
deleterious
effects
on
human
performance.5The
performance
degradation
associated
with
DOMS
results
of
mechanisms
such
as
the
loss
of
homeostasis
of
calcium
(Ca2+)6and
local
ele-
vation
of
inflammatory
substances
like
histamine,
kinins
and
prostaglandins.7These
inflammatory
substances
stimulate
pain
receptors
types
III
and
IV.5,7,8 Thus,
the
effect
of
DOMS
on
per-
formance
rely
on
an
increased
sensitivity
to
touch
changing
characteristics
of
skin
sensitivity,
increased
muscle
stiffness
and
reduced
range
of
motion.3,9
Several
strategies
have
been
used
in
order
to
speed
up
recov-
ery
after
exercise
reducing
the
period
and
magnitude
of
DOMS;
some
examples
are
laser
therapy,10 massage,11 contrast
(heat
and
cold
immersion)
and
immersion
cryotherapy;12 this
last
one
is
the
most
popular
due
to
the
low
cost
and
easy
use
by
sportsmen.
The
vasoconstriction
of
blood
vessels,
capillaries,
and
lymphatics
supported
by
cryotherapy13 reduces
the
spread
of
fluid
in
the
inter-
stitial
spaces,
thereby
minimizing
inflammation,
pain,
edema,
and
muscular
spasms.14–16
Although
cryotherapy
is
applied
to
reduce
the
DOMS,
changes
in
inflammatory
markers
show
divergent
outcomes.12,17 Ingram
et
al.,12 Bailey
et
al., 17 Eston
and
Peters15 reported
no
change
in
the
concentration
of
CK
after
cryotherapy,
while
Rise
et
al.
observed
reduction
in
the
concentration
of
CK,
myoglobin
and
C-reactive
protein
after
immersion
in
cold
water.
Part
of
the
incongruence
concerning
these
studies
results
from
the
variety
of
methods
used,
such
as
different
water
temperatures,
immersion
time,
intensity
and
type
of
exercise
performed.19
The
influence
of
cryotherapy
on
DOMS
is
evaluated
in
real
sports
context,18 simulations,12,17,20,21 isokinetic
dynamom-
etry
evaluations,15 after
a
series
of
maximum
eccentric
contractions,11,19,22 vertical
jumps
from
a
higher
level24 and
plyometrics.25
Regarding
the
use
of
running
protocols,
Hausswirth
et
al.20 com-
pared
the
effects
of
the
application
of
whole-body
cryotherapy,
infrared
and
passive
recovery
in
a
well-trained
runners
group
on
different
grounds
(flat,
uphill
and
downhill).
These
authors
con-
cluded
that
whole-body
cryotherapy
promotes
faster
recovery
in
comparison
to
other
methods.
However,
it
is
known
that
trained
people
in
modalities
that
require
predominant
eccentric
contrac-
tions
are
more
resistant
to
the
damage
caused
by
these
types
of
contractions,26 which
leads
us
to
question
if
the
application
of
post-
eccentric
exercise
cryotherapy
could
significantly
affect
damage
markers
and
pain
perception
in
physically
active
people.
Never-
theless,
few
studies27 have
sought
a
significant
evaluation
related
to
the
effects
of
application
of
cryotherapy
on
markers
of
muscle
damage
and
muscle
soreness
after
downhill
running
in
people
con-
sidered
to
be
physically
active.
As
a
result
of
the
increasing
number
of
street
racing
fans
and
the
diversity
of
ground
characteristics,
studies
with
this
perspective
are
necessary
since
the
runners
are
exposed
to
situations
of
greater
demand
for
eccentric
contractions.
Thus,
the
objective
of
this
study
was
to
investigate
the
effects
of
application
of
cryotherapy
on
markers
of
muscle
damage,
as
well
as
the
perception
of
muscle
soreness
caused
predominantly
by
eccen-
tric
exercise
after
downhill
running.
Document downloaded from http://www.elsevier.es, day 13/04/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been reviewed, accepted and posted on the Web before copyediting.
Please
cite
this
article
in
press
as:
Rossato
M,
et
al.
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study.
Rev
Andal
Med
Deporte.
2015.
http://dx.doi.org/10.1016/j.ramd.2014.07.003
ARTICLE IN PRESS
G Model
RAMD-39;
No.
of
Pages
5
M.
Rossato
et
al.
/
Rev
Andal
Med
Deporte.
2015;xxx(xx):xxx–xxx
3
Method
Subjects
This
study
included
10
male
volunteer
subjects,
healthy
and
sedentary
(26
±
5
years
of
age,
173
±
8
cm
height
and
70
±
4
kg
body
weight).
This
set
of
subjects
is
similar
to
the
ones
that
underwent
cryotherapy
in
other
studies
(Eston
and
Peters15 n
=
8,
Ascensão
et
al.18 n
=
10,
and
Santos
et
al.28 n
=
9).
Subjects
who
have
partici-
pated
on
this
study
were
informed
about
the
goals
and
methods
of
the
study
and
subsequently
signed
a
consent
form
in
accordance
with
the
local
ethics
committee.
Subjects
who
reported
muscu-
loskeletal
problems
were
excluded.
Procedures
The
subjects
underwent
two
bouts
of
exercise
with
a
predom-
inance
of
eccentric
action
(PEA)
with
one
week
interval
between
bouts.
In
the
end
of
one
session,
randomly,
a
treatment
with
cryotherapy
was
applied.
The
perception
of
pain
and
markers
of
muscle
damage
were
measured
immediately
before,
24
and
48
h
after
the
PEA.
The
subjects
were
instructed
to
avoid
intense
exercise
and
maintain
normal
diet
during
the
previous
days
to
the
testing.
All
tests
were
performed
in
the
afternoon,
with
a
room
temperature
of
24 C.
The
PEA
was
performed
on
a
treadmill,
with
a
negative
slope
of
6.6%,
similar
to
the
one
used
by
Malm
et
al.29 The
protocol
started
with
a
five-minute
warm
up
walk
(with
no
slope)
at
5
km/h.
After
warming
up,
the
treadmill
was
declined
and
subjects
ran
for
25
min
at
8
km/h.
After
the
PEA,
the
subjects
walked
for
five
min
at
5
km/h
with
no
slope
in
order
to
calm
down.
The
application
of
cryotherapy
was
immediately
performed
after
the
end
of
one
of
the
two
sessions
of
PEA.
Cryotherapy
was
applied
through
the
immersion
of
the
lower
limbs
into
cold
water
(15
±
1C)25 for
30
min.
During
this
period,
the
subjects
remained
standing
and
had
both
legs
submerged
up
to
the
iliac
crest
height.
A
thermometer
was
used
to
check
the
temperature,
which
was
regulated
by
the
addition
of
ice
throughout
the
session.
The
perception
of
DOMS
was
assessed
by
a
visual
analog
scale
of
pain
from
0
to
10
points,18 in
which
zero
indicates
no
pain
and
ten
indicates
severe
pain.
Initially
the
subjects
indicated
the
general
feeling
of
pain,
and
then
reported
the
perception
by
muscle
groups
of
the
lower
limbs,
which
are
ankle
dorsal
and
plantar
flexors
and
knee
flexors
and
extensors.
Samples
of
10
ml
of
venous
blood
were
collected,
centrifuged
and
analyzed
by
spectrophotometry
before
exercise,
24
and
48
h
after
the
application
of
cryotherapy.
Blood
tests
allowed
the
analy-
sis
of
the
enzymes
lactate
dehydrogenase
(LDH)
and
creatine
kinase
(CK)
using
commercial
kits
(Labtest
Diagnóstica,
Lagoa
Santa,
MG,
Brazil).
These
enzymes
are
among
those
indicated
for
monitoring
muscle
injuries.4
Analysis
of
data
The
data
were
tested
using
Shapiro–Wilk
for
normality,
fol-
lowed
by
Mauchly’s
test
of
sphericity.
In
order
to
check
the
effect
of
350
300
250
200
150
100
50
0
0h 24h
48h
CK (IU/I)
Without cryotherapy
With cryotherapy
Fig.
1.
Concentration
of
the
creatine
kinase
(CK)
in
the
pre-PEA
(preconditions
to
the
exercise
with
predominance
of
eccentric
action,
0
h),
24
h
and
48
h
after
PEA
conditions.
*
Indicates
significant
differences
(p
<
0.05)
for
pre-PEA
(0
h)
and
48
h.
cryotherapy
and
time
after
treatment,
as
well
as
their
interactions,
a
linear
mixed
model
of
2
factors
(with
and
without
cryotherapy;
0
h,
24
h
or
48
h)
was
used
with
Bonferroni
adjustment
for
multiple
comparisons.
When
there
was
cryotherapy
effect,
the
comparisons
were
made
employing
Student’s
t
test
for
paired
samples;
when
there
was
effect
on
the
different
durations
of
the
treatment,
com-
parisons
were
made
using
the
analysis
of
variance
for
repeated
measurements
ANOVA.
The
significance
level
of
0.05
was
used
for
all
analysis
using
a
commercial
statistical
package
(SPSS
version
13.0).
Results
The
subjects
reported
no
DOMS
before
starting
the
PEA
proto-
cols.
The
culmination
of
the
induction
protocol
to
DOMS
without
the
subsequent
application
of
cryotherapy
caused
DOMS
in
70%
of
the
subjects.
The
application
of
cryotherapy
significantly
reduced
(p
<
0.05)
values
of
DOMS
compared
to
the
situation
without
cryotherapy;
no
differences
were
observed
concerning
the
previ-
ous
situation
(Table
1).
In
the
situation
without
cryotherapy,
DOMS
increased
significantly
after
24
and
48
h
compared
to
the
previous
situation;
the
highest
values
occurred
24
h
after
the
PEA.
Reports
of
DOMS
in
different
muscle
groups
showed
a
preva-
lence
of
the
knee
extensors
of
71.4%
opposite
to
the
57.1%
of
the
knee
flexors;
and
a
predominance
of
the
ankle
dorsal
flexors
of
57.1%,
opposite
to
the
28.5%
of
the
ankle
plantar
flexors.
The
general
DOMS
reports
indicated
only
the
knee
extensor
muscles.
Regarding
markers
of
muscle
damage,
the
plasma
concentration
of
CK
in
both
situations
was
higher
after
24
h,
but
it
was
only
a
sig-
nificant
change
in
the
situation
without
cryotherapy
(Fig.
1).
Plasma
concentrations
of
LDH
during
the
recovery
period,
regardless
of
the
treatment,
did
not
change
significantly
(Fig.
2).
The
concentrations
Table
1
Scores
for
pain
scale,
expressed
as
mean
±
standard
deviation
for
the
group
of
subjects
in
the
conditions
with
and
without
the
application
of
cryotherapy.
Without
cryotherapy
With
cryotherapy
Pre
24
h
48
h
Pre
24
h
48
h
Pain
scale
0
6.2
±
2.4*,# 5.3
±
2.6*,# 0
2
0
*Statistically
significant
difference
(p
<
0.05)
compared
to
the
group
with
cryotherapy.
#Statistically
significant
difference
(p
<
0.05)
compared
to
Pre.
Document downloaded from http://www.elsevier.es, day 13/04/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been reviewed, accepted and posted on the Web before copyediting.
Please
cite
this
article
in
press
as:
Rossato
M,
et
al.
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study.
Rev
Andal
Med
Deporte.
2015.
http://dx.doi.org/10.1016/j.ramd.2014.07.003
ARTICLE IN PRESS
G Model
RAMD-39;
No.
of
Pages
5
4
M.
Rossato
et
al.
/
Rev
Andal
Med
Deporte.
2015;xxx(xx):xxx–xxx
350
300
250
200
150
100
50
0h 24h
48h
LDH (IU/I)
Without cryotherapy
With cryotherapy
0
Fig.
2.
Concentration
of
the
lactate
dehydrogenase
(LDH)
in
the
pre-PEA
(precondi-
tions
to
the
exercise
with
predominance
of
eccentric
action,
0
h),
24
and
48
h
after
exercise.
There
were
no
statistically
significant
differences.
of
blood
calcium
[Ca2+]
were
significantly
higher
in
the
situation
without
cryotherapy
when
compared
0
h
and
48
h
(Fig.
3).
Discussion
This
study
has
investigated
the
effects
of
cryotherapy
on
markers
of
damage
and
muscle
soreness
caused
by
exercise
pre-
dominantly
eccentric
in
downhill
running.
The
results
showed
that
the
treatment
with
ice
immediately
after
the
PEA
is
able
to
reduce
and
minimize
DOMS
effects
caused
by
muscle
damage
and
that
14
12
10
8
6
4
2
0
0h 24h
48h
Ca++ (IU/I)
Without cryotherapy
With cryotherapy
Fig.
3.
Concentration
of
calcium
[Ca2+]
in
the
pre-PEA
(preconditions
to
the
exercise
with
predominance
of
eccentric
action,
0
h),
24
h
and
48
h
after
exercise.
*
Indicates
significant
differences
(p
<
0.05)
compared
to
pre-PEA
(0
h).
some
mechanisms
associated
with
inflammation
appear
to
be
the
major
determinants
of
DOMS
in
sedentary
subjects.
The
inflammatory
process
caused
by
damage
to
the
muscle
tissue
increases
the
concentration
of
pro-inflammatory
chemical
mediators
that
stimulate
pain
receptors.5,7 Although
the
mech-
anisms
are
not
yet
fully
elucidated,
it
is
widely
accepted
that
cryotherapy
has
an
analgesic
effect.
The
ice
seems
to
decrease
the
ability
of
sensory
transmission
and
thus
reduces
acetyl-
choline
release
influencing
the
pain
threshold.19 Yet,
according
to
these
authors,
another
possible
benefit
of
cryotherapy
would
be
the
change
in
hydrostatic
pressure
on
the
body,
which
could
be
associated
with
a
reduction
in
edema
and
pain
in
the
mus-
cle.
When
cryotherapy
is
used,
the
values
found
after
24
and
48
h
PEA
did
not
differ
from
the
preconditions.
This
demonstrates
that
the
application
of
cryotherapy
maintains
homeostasis
in
CK
levels
after
PEA.
It
is
speculated
that
cryotherapy
may
reduce
membrane
permeability
and
thus
reduce
the
flow
of
CK
into
the
interstitium.15
However,
the
results
found
in
the
literature
are
not
conclu-
sive
regarding
the
effects
of
cryotherapy
on
CK.
The
differences
among
the
studies
that
concern
the
effectiveness
of
cryotherapy
on
DOMS
depend
on
the
type
of
exercise
and
immersion
time.
Ascensão
et
al.18 observed
that,
after
a
soccer
match,
players
treated
with
cryotherapy
(10 C)
for
10
min
decreased
the
concentrations
of
CK
after
24
and
48
h
compared
to
the
control
situation
(35 C).
Ingram
et
al.12 using
the
same
temperature
but
with
2
×
5
min
immersions
separated
by
2.5
min,
reported
no
significant
differ-
ences
in
the
concentrations
of
CK
in
a
group
of
11
athletes.
Goodall
and
Howatson24 induce
DOMS
through
jumps
on
downhill
and
used
cryotherapy
(10 C)
right
after
the
exercise,
24
and
48
h
later.
The
results
indicated
higher
concentration
of
CK
after
intervention
with
cryotherapy.
According
to
some
researchers,
CK
shows
great
variability
among
individuals,
entailing
considerable
heterogeneity
between
subjects.30,31
After
PEA
downhill
running,
LDH
showed
no
significant
changes
caused
by
cryotherapy.
Although
LDH
is
used
to
assess
muscle
damage,4few
studies
have
evaluated
the
effects
of
cryother-
apy
on
its
behavior.
The
effects
of
acute
intervention
(first
hour)
and
subacute
(24–168
h)
use
of
cryotherapy
were
analyzed
and
reported
that
LDH
was
not
affected
significantly
by
the
applica-
tion
of
cryotherapy,
and
that
major
changes
were
noticeable
only
96
h
after
the
harmful
stimulus.22 Vaile
et
al.23 who
analyzed
dif-
ferent
hydrotherapy
strategies
for
the
recovery
of
muscle
injuries,
also
reported
no
differences
in
the
concentrations
of
LDH,
even
after
72
h.
In
the
present
study
the
concentrations
of
LDH
were
checked
48
h
after
the
PEA,
so
we
would
expect
that
significant
increases
were
not
noticeable
and/or
cryotherapy
does
not
cause
many
effects
on
this
marker.
This
suggests
that
some
blood
markers
can
be
used
for
evaluations
of
cryotherapy
in
acute
post-exercise
recovery,
while
others
seem
to
be
more
sensitive
to
medium
and
long
term
changes.
Cryotherapy
was
effective
in
reducing
the
levels
of
calcium
ion
48
h
after
the
PEA.
This
can
be
explained
by
the
function
of
cryother-
apy
in
reducing
the
plasma
membrane
permeability.15 The
damage
caused
by
PEA
results
in
an
increasing
intracellular
calcium
concen-
tration.
It
would
be
associated
with
the
stimulation
of
the
autogenic
phase,
increasing
the
action
of
proteases
and
phospholipases,
with
subsequent
myofibrillar
degradation
especially
desmine
and
cell,
thus
triggering
an
inflammatory
process.5This
increased
pressure
also
causes
tissue
edema,
which
activate
pain
receptors
thereby
increasing
the
feeling
of
discomfort
associated
with
DOMS.19 The
ratio
of
intra-
and
extracellular
calcium
with
the
mechanism
of
skeletal
muscle
apoptosis
can
lead
to
reduction
in
muscle
power,
and
the
more
releasing
of
inflammatory
markers
and
DOMS,
the
more
muscle
undergoes
apoptosis
thus
reducing
the
number
of
myocytes
chronically.32
Document downloaded from http://www.elsevier.es, day 13/04/2015. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. This early online article has been reviewed, accepted and posted on the Web before copyediting.
Please
cite
this
article
in
press
as:
Rossato
M,
et
al.
Effects
of
cryotherapy
on
muscle
damage
markers
and
perception
of
delayed
onset
muscle
soreness
after
downhill
running:
A
Pilot
study.
Rev
Andal
Med
Deporte.
2015.
http://dx.doi.org/10.1016/j.ramd.2014.07.003
ARTICLE IN PRESS
G Model
RAMD-39;
No.
of
Pages
5
M.
Rossato
et
al.
/
Rev
Andal
Med
Deporte.
2015;xxx(xx):xxx–xxx
5
Our
main
conclusion
is
that
cryotherapy
after
exercise
is
a
perti-
nent
strategy
to
reduce
DOMS
and
also
markers
of
muscle
damage
for
street
racers
who
perform
their
training
on
slopes.
Among
the
limitations
of
this
study
we
can
mention
the
small
number
of
sub-
jects,
and
the
fact
that
improvements
in
the
perception
of
pain
reported
by
the
subjects
after
treatment
cannot
be
compared
to
a
placebo
situation.
Our
results
suggest
that
the
use
of
cryotherapy
by
immersion
for
30
min
at
15 C
immediately
after
the
practice
of
PEA
reduces
the
DOMS
of
the
lower
limbs,
while
maintaining
the
homeostasis
of
some
markers
of
muscle
damage,
such
as
CK
and
serum
calcium.
Conflict
of
interests
The
authors
agree
that
there
is
no
conflict
of
interests
about
this
study.
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