Effectiveness of air pulsed cryotherapy on delayed onset muscle soreness of elbow flexors following eccentric exercise
More details
Hide details
Department of Physical Therapy, Neuro-Musculoskeletal and Pain Research Unit, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
School of Health Science, University of Brighton, East Sussex, United Kingdom
Peanchai Khamwong   

Department of Physical Therapy Neuro-Musculoskeletal and Pain Research Unit, Faculty of Associated Medical Sciences, Chiang Mai University, 50200 Chiangmai, Thailand. Tel.: +66 539 492 46.
Submission date: 2017-09-19
Acceptance date: 2018-10-28
Online publication date: 2018-03-07
Publication date: 2019-11-17
Pol. Ann. Med. 2018;25(1):103–111
Cryotherapy is widely used in sports to facilitate recovery from exercise-induced muscle damage that often results from strenuous training and/or competition. However, a paucity of evidence exists on the therapeutic values of repeated air pulsed cryotherapy (CRYO) application to suggest its usefulness to clinicians, coaches, sports scientists and athletes in the field of sports and rehabilitation.

This study investigates the effectiveness of CRYO on the recovery from delayed onset of muscle soreness (DOMS) induced by eccentric exercise.

Material and methods:
Thirty-two participants (21.31 ± 1.03 years, height 1.72 ± 0.05 m, BMI 22.15 ± 1.69 kg/cm2) were equally randomized into CRYO group and control group (CONT). DOMS was induced by eccentric contractions of elbow flexors. Visual analogue scale score (VAS), mid arm circumference (MAC), pressure pain threshold (PPT), range of motion of active elbow flexion (ROM-AF), passive elbow flexion (ROM-PF), active elbow extension (ROM-AE), passive elbow extension (ROM-PE) and isometric peak torque of elbow flexors (IPT) were measured at pre-exercise (PRE), immediately, 1, 2, 3, 4, and 7 days post exercise.

Results and discussion:
There were significant interactions effect (group X time) with (P < 0.05) for VAS, MAC, PPT, ROM-PF, ROM-AE, and ROM-PE. Additionally, all outcome measures (except for ROM-AF and IPT) demonstrated a significant improvement (P < 0.05) in DOMS recovery in the CRYO group compared to CONT group.

A 20 minutes (4 session × 5 minutes) session for 5 consecutive days of repeated air pulsed cryotherapy has beneficial effects on the recovery of DOMS on elbow flexors from eccentric exercise.

The authors thank all the people who participated in the study and as well as the support staff in the physiotherapy department for their assistance in completion of this research.
None declared.
Cheung K, Hume P, Maxwell L. Delayed onset muscle soreness: treatment strategies and performance factors. Sports Med.2003;33(2):145–164.
Tee JC, Bosch AN, Lambert MI. Metabolic consequences of exercise-induced muscle damage. Sports Med. 2007;37(10):827–836.
Andersen LL, Jay K, Andersen CH, et al. Acute effects of massage or active exercise in relieving muscle soreness: randomized controlled trial. J Strength Cond Res. 2013;27(12):3352–3359.
Close GL, Ashton T, McArdle A, Maclaren DP. The emerging role of free radicals in delayed onset muscle soreness and contraction-induced muscle injury. Comp Biochem Physiol A Mol Integr Physiol. 2005;142(3):257–266.
Nosaka K, Newton M, Sacco P. Delayed-onset muscle soreness does not reflect the magnitude of eccentric exercise-induced muscle damage. Scand J Med Sci Sports. 2002;12(6): 337–346.
Clarkson PM, Hubal MJ. Exercise-induced muscle damage in humans. Am J Phys Med Rehabil. 2002;81(11 Suppl):S52–S69.
Glasgow PD, Ferris R, Bleakley CM. Cold water immersion in the management of delayed-onset muscle soreness: is dose important? A randomised controlled trial. Phys Ther Sport. 2014;15(4):228–233.
Olsen O, Sjøhaug M, van Beekvelt M, Mork PJ. The effect of warm-up and cool-down exercise on delayed onset muscle soreness in the quadriceps muscle: a randomized controlled trial. J Hum Kinet. 2012;35:59–68.
Khamwong P, Pirunsan U, Paungmali A. A prophylactic effect of proprioceptive neuromuscular facilitation (PNF) stretching on symptoms of muscle damage induced by eccentric exercise of the wrist extensors. J Bodyw Mov Ther. 2011;15(4):507–516.
Curtis D, Fallows S, Morris M, McMakin C. The efficacy of frequency specific microcurrent therapy on delayed onset muscle soreness. J Bodyw Mov Ther. 2010;14(3):272–279.
Khamwong P, Pirunsan U, Nosaka K, Paungmali A. Prophylactic effect of hot pack on symptoms of eccentric exercise-induced muscle damage of the wrist extensors. Eur J Appl Physiol. 2012;12(5):443–453.
Jakeman JR, Macrae R, Eston R. A single 10-min bout of cold-water immersion therapy after strenuous plyometric exercise has no beneficial effect on recovery from the symptoms of exercise-induced muscle damage. Ergonomics. 2009;52(4):456–460.
Torres R, Ribeiro F, Alberto Duarte J, Cabri JM. Evidence of the physiotherapeutic interventions used currently after exercise-induced muscle damage:systematic review and meta-analysis. Phys Ther Sport. 2012;13(2):101–114.
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.
Cameron MH. Physical Agents in Rehabilitation: From research to practice. 4 ed. Philadelphia, Pennsylvania: W.B. Saunders company; 2013.
Gregson W, Black MA, Jones H, et al. Influence of cold water immersion on limb and cutaneous blood flow at rest. Am J Sports Med. 2011;39(6):1316–1323.
Leeder J, Gissane C, van Someren K, Gregson W, Howatson G. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med. 2012;46(4):233–240.
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. 2012;(2):CD008262.
Oakley ET, Pardeiro RB, Powell JW, Millar AL. The effects of multiple daily applications of ice to the hamstrings on biochemical measures, signs, and symptoms associated with exercise-induced muscle damage. J Strength Cond Res. 2013;27(10):2743–2751.
Ingram J, Dawson B, Goodman C, Wallman K, Beilby J. Effect of water immersion methods on post-exercise recovery from simulated team sport exercise. J Sci Med Sport. 2009;12(3):417–421.
Eston R, Peters D. Effects of cold water immersion on the symptoms of exercise-induced muscle damage. J Sports Sci. 1999.17(3):231–238.
Bailey DM, Erith SJ, Griffin PJ, et al. Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running. J Sports Sci. 2007;25(11):1163–1170.
Guilhem G, Hug F, Couturier A, et al. Effects of air-pulsed cryotherapy on neuromuscular recovery subsequent to exercise-induced muscle damage. Am J Sports Med. 2013;41 (8):1942–1951.
Goodall S, Howatson G. The effects of multiple cold water immersions on indices of muscle damage. J Sports Sci Med. 2008;7(2):235–241.
Howatson G, Goodall S, van Someren KA. The influence of cold water immersions on adaptation following a single bout of damaging exercise. Eur J Appl Physiol. 2009;105(4):615–621.
Hausswirth C, Louis J, Bieuzen F, et al. Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners. PLoS One. 2011;6(12):e27749.
Knight KL, Han KM, Rubley MA, Brucker JB. Comparison of tissue cooling and numbness during application of cryo5 air cooling, crushed ice packs, ice massage, and ice water immersion. J Athletic Train. 2002;36:S103.
Bleakley CM, Hopkins JT. Is it possible to achieve optimal levels of tissue cooling in cryotherapy? Phys Ther Rev. 2010;15(4):344–350.
Paungmali A, Joseph LH, Sitilertpisan P, Pirunsan U, Uthaikhup S. Lumbopelvic Core Stabilization Exercise and Pain Modulation among Individuals with Chronic Nonspecific Low Back Pain. Pain Pract. 2017;17(8):1008–1014.
Khamwong P, Paungmali A, Pirunsan U, Joseph L. Prophylactic Effects of Sauna on Delayed-Onset Muscle Soreness of the Wrist Extensors. Asian J Sports Med. 2015;6(2) e25549.
Zainuddin Z, Newton M, Sacco P, Nosaka K. Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. J Athl Train. 2005;40(3):174–180.
Lau WY, Blazevich AJ, Newton MJ, Wu SS, Nosaka K. Assessment of Muscle Pain Induced by Elbow-Flexor Eccentric Exercise. J Athl Train. 2015;50(11):1140–1148.
Nosaka K, Newton M, Sacco P. Muscle damage and soreness after endurance exercise of the elbow flexors. Med Sci Sports Exerc. 2002;34(6):920–927.
Vickers AJ. Comparison of an ordinal and a continuous outcome measure of muscle soreness. Int J Technol Assess Health Care. 1999;15(14):709–716.
Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R. Ice-water immersion and delayed-onset muscle soreness:a randomised controlled trial. Br J Sports Med. 2007;41(6):392–397.
Howatson G, Gaze D, van Someren KA. The efficacy of ice massage in the treatment of exercise-induced muscle damage. Scand J Med Sci Sports. 2005;15(6):416–422.
Paddon-Jones DJ, Quigley BM. Effect of cryotherapy on muscle soreness and strength following eccentric exercise. Int J Sports Med. 1997;18(8):588–593.
Lau WY, Nosaka K. Effect of vibration treatment on symptoms associated with eccentric exercise-induced muscle damage. Am J Phys Med Rehabil. 2011;90(8):648–657.
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007;41(6):365–369.
Clarkson PM, Sayers SP. Etiology of exercise-induced muscle damage. Can J Appl Physiol. 1999;24(3):234–248.
Howatson G, Van Someren KA. Ice massage. Effects on exercise-induced muscle damage. J Sports Med Phys Fitness. 2003;43(4):500–505.
Hohenauer E, Taeymans J, Baeyens JP, Clarys P, Clijsen R. The Effect of Post-Exercise Cryotherapy on Recovery Characteristics: A Systematic Review and Meta-Analysis. PloS One. 2015;10(9):e0139028.