Cryotherapy duration is critical in short-term recovery of athletes: a systematic review

Knee skin temperature response of patients with bilateral patellofemoral syndrome before and after heat and cold stress

Patellofemoral Pain Syndrome is characterized by the presence of pain in the front area of the knee, which occurs when performing common activities such as climbing stairs, and bending the knees, among others. The objective of this research was to evaluate the detection capability of infrared thermography in patients with Patellofemoral Pain Syndrome, in the baseline state, as well as after the application of thermal stress. The investigation was conducted in 48 patients, who were subdivided into four groups (n = 12). Two subgroups were healthy patients and two with Patellofemoral Pain Syndrome. For the diagnosis of the syndrome, a manual evaluation was performed using the Zohlen test and Q angle measurement. Subsequently, cold stress was applied for 10 min to a healthy subgroup and an experimental subgroup. The remaining two subgroups were subjected to heat stress for 15 min. Thermographic images of the lower extremities were acquired at seven time points, at baseline, immediately after application of thermal stress and then every 3 min until 15 min were completed. It was observed that patients presented Patellofemoral Pain Syndrome bilaterally. After statistical analysis, it was found that there were no significant differences in baseline temperature between the groups. However, for heat stress, a higher temperature was observed in the group with Patellofemoral Pain Syndrome (p < 0.05) in the recovery period, and in the case of cold stress, only a lower temperature in the left knee immediately after the application. In conclusion, it is not possible to detect patellofemoral syndrome bilaterally in the baseline state by thermography and neither is it evident in cold stress. However, after heat stress, thermal recovery is lower for the PFPS group, so it would be susceptible to detection.

Enhanced bone healing using local cryostimulation: In vivo rat study

A short-term intense cooling through the skin causes a response of the body. Potentially, it can be used to enhance bone healing. The aim of this study is to evaluate an effectiveness of a bone defect cryostimulation in the Wistar rat model in vivo. Through holes with a diameter of 2.15 mm were formed in the cortical layer of the diaphysis of the hind paws of rats. Further animals were subjected to cryotherapy 1 and 2 times a week (up to 6 weeks). The local average skin surface temperature dropped from 28 to 14 °C. The decrease in temperature in a control point inside the biological tissue was 5.3 °C. Micro CT and histological analyses showed that cryostimulation twice a week is efficient treatment. In this case, there was an acceleration of maturation of the newly formed bone tissue replacing the defect region. In the control, the newly formed immature bone with a large number of osteocytes and vessels was detected. In the experiment, the newly formed bone had a more mature structure with signs of a compact bone (formation of Haversian canals, reduction in the number of osteocytes, appearance of gluing lines). Morphometric analysis has showed a 2-fold decrease of the relative vessels area near the defect region and an increase of 30% in the content of mast cells in the entire bone marrow and especially near the site of osteogenesis. Generally, the complete filling of the critical size defect and almost complete mineralization have been observed. This information is expected to be useful for understanding the effect-exposure correlation of the cryotherapy and in the design of the cryotherapy protocols.

Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis

OBJECTIVE

To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis.

METHODS

Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers.

RESULTS

A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first.

CONCLUSION

Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study

BACKGROUND

This observational research study analyses the uptake of physical therapies treatments in the Polyclinic during the Rio 2016 Olympic Games.

OBJECTIVE

To describe the usage of physical therapies services - physical therapy, osteopath, chiropractic, and sports massage - by athletes and non-athletes and across different sports.

METHODS

The multidisciplinary team of physical therapies recorded treatment modalities, information on provider discipline and reason for attendance, in an Electronic Medical Record system throughout the 32 days of operation of the Olympic Polyclinic. Cold-therapy total immersion ice baths (TIIB) were provided as part of the services, but were reported and analysed separately.

RESULTS

There were 4993 encounters (4038 athletes, 955 non-athlete encounters). 1395 athletes (12.4% of all athletes) and 393 non-athletes sought treatment. For all four provider disciplines, in addition to TIIB, the primary reason for athlete attendance was for recovery (52% of all encounters), followed by injury treatment (30%), and maintenance (16%). Athletes reported "injury" as the main reason for physical therapy (92% of all encounters, 2.8 encounters per athlete), chiropractic (94%, 1.9) and osteopathy (91%, 1.8) visits. Almost all TIIB visits were used for recovery (98% of all TIIB encounters; 2.1 encounters per athlete). Athletes from handball (37% of all handball athletes), followed by judo (22%), and athletics (21%), presented the largest user groups.

CONCLUSION

This Olympic Polyclinic study evaluates the physical therapies' activity, and athlete's reason for use of the multidisciplinary physical therapies team, including total immersion ice bath provision. These results emphasise the importance of a multidisciplinary approach.