Influence of cryotherapy on balance and joint position sense in healthy subjects: randomized clinical trial.
Lins, Caio Alano de Almeida; Macedo, Liane de Brito; Silveira, Renata Augusta Gomes; Borges, Daniel Tezoni; Brasileiro, Jamilson Simões
Background: Cryotherapy has been widely used in clinical practice, particularly for the treatment of acute injuries to soft tissues and various joints. However, since decrease in temperature can results in reduced nerve conduction velocity and proprioception, it can therefore be assumed that cryotherapy, applied before exercise, can result in a greater predisposition of the joints to lesion. Thus, the objective of this study was to evaluate the influence of cryotherapy on balance and knee joint position sense (JPS). Methods: We conducted a randomized single-blinded clinical trial, with thirty volunteers of both genders (age: 23.3 ± 2.5 years; BMI: 22.2 ± 2.1 Kg/m2), who were randomly distributed into two groups with 15 subjects in each: control group - 20 minutes at rest; and experimental group - application of cryotherapy on the knee of the dominant lower limb, for 20 minutes. All subjects were submitted to the assessment of the balance, by means of computerized baropodometry and the JPS of the knee of the dominant lower limb (DLL) using an electrogoniometer, both open kinetic chain (OKC) and closed kinetic chain (CKC), before and after the interventions. Statistical analysis was performed using SPSS 20.0 software. Kolmogorov-Smirnov test was used to check the data normality and two-way ANOVA to verify intra and inter-group differences. The study was approved by the local Research and Ethics Committee (Approval no. 099/10) Results: There was a difference on the JPS assessed in OKC in the experimental group (p= 0.03). There was no alteration in the balance and the JPS with CKC, in none of the groups tested (p > 0.05). Conclusion: Cryotherapy when applied on knee did not affect balance or the JPS with CKC of the knee, although alteration was observed in OKC. We therefore conclude that application of cryotherapy before exercises do not posses increased risk of myoarticular injuries, since the most of these activities is performed in CKC.
1. Janwantanakul P. The effect of quantity of ice and size of contact area on ice pack/ skin interface temperature. Physiother. 2009;95:120-5.
2. Rupp KA, Herman DC, Hertel J, Saliba SA. Intramuscular temperature changes during and after 2 different cryotherapy interventions in healthy individuals. J Orthop Sports Phys Ther. 2012;42(8):731-7.
3. Ferreira-Junior JB, Bottaro M, Loenneke JP, Vieira A, Vieira CA, Bemben MG. Could whole-body cryotherapy (below −100°C) improve muscle recovery from muscle damage? Front. Physiol. 2014;5: 247.
4. Fonda B, Sarabon N. Effects of whole-body cryotherapy on recovery after ham- string damaging exercise: a crossover study. Scand. J. Med. Sci. Sports. 2013;23: 270–8.
5. Pastre CM, Bastos FN, Netto Junior J, Vanderlei LCM, Hoshi RA. Métodos de recuperação pós-exercício: uma revisão sistemática. Rev Bras Med Esporte. 2009;15(2):138-144.
6. Vaile J, Halson S, Gill N, Dawson B. Effect of hydrotherapy on the signs and symptoms of delayed onset muscle soreness. Eur J Appl Physiol. 2008;102(4):447–455.
7. Costello JT, Donnelly AE. Cryotherapy and joint position sense in healthy participants: A systematic review. J Athl Train. 2010;45(3):306–316.
8. Muaidi QI, Nicholson LL, Refshauge KM. Proprioceptive acuity in active rotation movements in healthy knees. Arch Phys Med Rehabil. 2007;89(2):371–6.
9. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sports Med. 2004;32(1):251–261.
10. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J. The effects of core proprioception on knee injury: a prospective biomechanical-epidemiological study. Am J Sports Med. 2007;35(3):368–373.
11. Wassinger CA, Myers JB, Gatti JM, Conley KM, Lephart SM. Proprioception and throwing accuracy in the dominant shoulder after cryotherapy. J Athl Train. 2007;42(1):84–9.
12. Ribeiro F, Mota J, Oliveira J. Effect of exercise-induced fatigue on position sense of the knee in the elderly. Eur J Appl Physiol. 2007;99:379–385.
13. Dover G, Powers ME. Reliability of joint position sense and force-reproduction measures during internal and external rotation of the shoulder. J Athl Train. 2003;38(4):304–310.
14. Bennell K, Wee E, Crossley K, Stillman B, Hodges P. Effects of experimentally induced anterior knee pain on knee joint position sense in healthy individuals. J Orthop Res. 2005;23(1):46–53.
15. Hansen MS, Dieckmann B, Jensen K, Jakobsen BW. The reliability of balance tests performedon the kinesthetic ability trainer (KAT 2000). Knee Surg Sports Traumatol, Arthrosc. 2000;8:180–5.
16. Janwantanakul P, Magarey ME, Jones MA, Dansie BR. Variation in shoulder position sense at mid and extreme range of motion. Arch Phys Med Rehabil. 2001;82:840–4.
17. Bishop PA, Jones E, Woods AK. Recovery from training: a brief review. J. Strength Cond. Res. 2008;22:1015–1024.
18. Uchio Y, Ochi M, Fujihara A, Adachi N, Iwasa J, Sakai Y. Cryotherapy influences joint laxity and position sense of the healthy knee joint. Arch Phys Med Rehabil. 2003;84:131-5.
19. Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. J Sports Med. 2007;41:365–9.
20. Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther. 2010;90:581-591.
21. Oliveira R, Ribeiro F, Oliveira J. Cryotherapy impairs knee joint position sense. Int J Sports Med. 2010;31(3):198–201.
22. Pincivero DM, Gandaio GB, Ito, Y. Gender-specific knee extensor torque, flexor torque, and muscle fatigue responses during maximal effort contractions. Eur J Appl Physiol. 2003;89:134–141.
23. Ageberg E, Roberts D, Holmström E, Fridén T. Balance in Single-Limb Stance in Patients With Anterior Cruciate Ligament Injury: Relation to Knee Laxity, Proprioception Muscle Strength, and Subjective Function. Am J Sports Med. 2005;33:1528-1535.
24. Surenkok O, Aytarb A, Tüzün EH, Akman MN. Cryotherapy impairs knee joint position sense and balance. Isokinet and Exerc Sci. 2008;16:69–73.
25. Reid G, Babes A, Pluteanu F. A cold and menthol-activated current in rate dorsal root ganglion neurones: properties and role in cold transduction. J Physiol. 2002;545:595–614.
26. Proske U, Wise AK, Gregory JE. The role of muscle receptors in the detection of movements. Progres Neurobiol. 2000;60:85-96.
27. Herrington L. Knee-Joint Position Sense: The relationship between open and closed kinetic chain tests. J Sport Rehabil. 2005;14:356-362.
28. Miniello S, Dover G, Powers M, Tillman M, Wikstrom E. Lower leg cold immersion does not impair dynamic stability in healthy women. J Sport Rehabil. 2005;14:234-247.