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Journal of Sports Sciences
, 1999,
17
, 231± 238
0264± 0414/99
Ó
1999 E & FN Spon
E
V
ects of cold water immersion on the symptoms of
exercise-induced muscle damage
ROGER ESTON* and DANIEL PETERS
School of Sport, Health and Physical Education Sciences, University of Wales, Victoria Drive, Bangor,
Gwynedd LL57 2EN, UK
Accepted 29 March 1998
Cryotherapy is an e
V
ective treatment for acute sports injury to soft tissue, although the e
V
ect of cryotherapy
on exercise-induced muscle damage is unclear. The aim of this study was to assess the e
V
ects of cold water
immersion on the symptoms of exercise-induced muscle damage following strenuous eccentric exercise. After
performing a bout of damage-inducing eccentric exercise (eight sets of
W
ve maximal reciprocal contractions at
0.58 rad ´s
-
1
) of the elbow
X
exors on an isokinetic dynamometer, 15 females aged 22.0
±
2.0 years (mean
±
s
)
were allocated to a control group (no treatment,
n
=
7) or a cryotherapy group (
n
=
8). Subjects in the cryo-
therapy group immersed their exercised arm in cold water (15°C) for 15 min immediately after eccentric exercise
and then every 12 h for 15 min for a total of seven sessions. Muscle tenderness, plasma creatine kinase activity,
relaxed elbow angle, isometric strength and swelling (upper arm circumference) were measured immediately
before and for 3 days after eccentric exercise. Analysis of variance revealed signi
W
cant (
P
< 0.05) main e
V
ects for
time for all variables, with increases in muscle tenderness, creatine kinase activity and upper arm circumference,
and decreases in isometric strength and relaxed elbow angle. There were signi
W
cant interactions (
P
< 0.05) of
group
´
time for relaxed elbow angle and creatine kinase activity. Relaxed elbow angle was greater and creatine
kinase activity lower for the cryotherapy group than the controls on days 2 and 3 following the eccentric exercise.
We conclude that although cold water immersion may reduce muscle sti
V
ness and the amount of post-exercise
damage after strenuous eccentric activity, there appears to be no e
V
ect on the perception of tenderness and
strength loss, which is characteristic after this form of activity.
Keywords
: cold water immersion, cryotherapy, muscle damage.
Introduction
Exercise-induced muscle damage, which commonly
occurs after strenuous eccentric muscle action, consists
of a dull aching pain, sti
V
ness, tenderness and a pro-
longed loss of muscle strength. The symptoms tend to
develop within the
W
rst 24 h post-exercise, peak between
24 and 72 h and then subside after 5± 7 days (Ebbeling
and Clarkson, 1989; Armstrong, 1990; Cleak and
Eston, 1992a; Nosaka and Clarkson, 1995). As eccen-
tric muscle actions are usually associated with a higher
force-to-activation ratio, the `loading pro
W
le’ places a
high stress on the tissues involved and is most likely
a primary factor of muscle damage (Enoka, 1996).
Damage includes disruption of the sarcolemma,
* Author to whom all correspondence should be addressed. e-mail:
r.g.eston@bangor.ac.uk
fragmentation of the sarcoplasmic reticulum, lesions
of the plasma membrane, cytoskeletal damage and
swollen mitochondria (Stauber, 1989; Armstrong,
1990; Friden and Leiber, 1992), although this is re-
stricted to a relatively small proportion of
W
bres within
the a
V
ected muscle.
Additional symptoms of exercise-induced muscle
damage include swelling and a decrease in the range of
motion. Studies on the arm have observed an increase
in volume (Talag, 1973), an increase in circumference
measurements (Friden
et al
., 1988; Hill and Richardson,
1989; Cleak and Eston, 1992b; Howell
et al
., 1993;
Nosaka and Clarkson, 1997) and a decrease in active
and passive range of motion in both
X
exion and exten-
sion of the elbow (Clarkson and Newham, 1994). In
addition, when the arm is hanging in a relaxed position,
the elbow angle is reduced (Cleak and Eston, 1992b;
Clarkson and Newham, 1994; Nosaka and Clarkson,
1997).
232
Eston and Peters
Several studies have been undertaken to
W
nd ways
to alleviate and treat the symptoms of exercise-induced
muscle damage (see Cleak and Eston, 1992a, for a
review). One such treatment modality, common to the
treatment of acute sports injury, involves cryotherapy
(ice or cold therapy). However, the e
V
ectiveness of
this treatment is unclear due to limited research and
the variations in treatment modality, frequency of
application and duration of treatment.
The response of soft tissue to various forms of
cryotherapy and temperatures of application in both
humans and animals has been reviewed comprehen-
sively by Meeusen and Lievens (1986). A major cause
of in
X
ammation after acute muscle injury is an increase
in capillary permeability, which in conjunction with
an increase in extracellular protein concentration and
vasodilation, results in oedema (Schoberth, 1980).
This response varies directly with tissue temperature
(Janssen and Waaler, 1967). A decrease in tissue tem-
perature results in a reduction in nerve conduction
velocity and activity of the muscle spindle. This
decreases the stretch re
X
ex response and spasticity of
muscle, which reduces the pain± spasm cycle and con-
tributes to the relief of pain (Meussen and Lievens,
1986). Thus, when cryotherapy is applied at an appro-
priate frequency, duration and temperature to injured
muscle, it reduces the in
X
ammatory response and
alleviates spasm and pain after muscle injury (Meeusen
and Lievens, 1986).
In the
W
rst published study to investigate the e
V
ects of
heat and cold therapy, in conjunction with stretching
exercise, on the symptoms of exercise-induced muscle
damage, Prentice (1982) observed that a combination
of cold treatment and stretching was most e
V
ective.
However, more recent research has observed that
cryotherapy has a negligible e
V
ect. Yackzan
et al
. (1984)
applied ice therapy in three separate groups (immediate,
after 24 h or after 48 h) after strenuous eccentric
exercise of the elbow
X
exors. They reported no dif-
ferences in the joint range of motion and concluded
that cryotherapy was not e
V
ective for reducing the
symptoms of exercise-induced muscle damage. How-
ever, it is possible that the single cold application treat-
ment was insu
Y
cient to in
X
uence the mechanisms
responsible for reducing the joint angle in their study. In
a similar study, Isabell
et al
. (1992) assessed the e
V
ects
of ice-massage alone, ice-massage with exercise and
exercise alone on range of motion of the elbow
X
exors
after damaging exercise in three separate groups. No
di
V
erences in range of motion were observed between
the three groups. Braun and Clarkson (1989) also
observed that cold treatment applied before and during
damaging exercise of the elbow
X
exors did not a
V
ect
the relaxed arm angle. It is possible that the lack of
agreement between studies may be attributable to the
nature of the cryotherapy procedure (ice application or
ice-massage) and the timing of the applications.
Another application technique, mostly used in
research settings because of the ability to control the
temperature, is immersion in cold water. However, as far
as we are aware, this form of cryotherapy has not been
used in human studies to assess the e
V
ects on muscle
damage resulting from exercise. The aim of this study
was to assess the e
V
ects of cold water immersion on the
signs and symptoms of exercise-induced muscle damage
after a strenuous bout of eccentric exercise.
Methods
Fifteen female student volunteers (mean age 22.0
±
2.0 years) at the University of Wales, Bangor, provided
informed consent to participate in the study. After
a bout of eccentric exercise on the elbow
X
exors of
the dominant arm, the participants were allocated at
random to either a cryotherapy treatment group or a
control group. The symptoms of exercise-induced
muscle damage were then compared to baseline values
over a period of 3 days.
The bout of damage-inducing exercise
The bout of eccentric exercise consisted of eight sets
of
W
ve maximal contractions (eccentric and concentric)
at 0.58 rad ´s
-
1
with 60 s rest between each set on
an isokinetic dynamometer (Kincom
TM
, Chattanooga,
Bicester, UK). This was similar to other muscle
damage-inducing protocols (Nosaka and Clarkson,
1995; Gulick
et al
., 1996).
Cryotherapy
The cryotherapy group submerged their exercised arm
(ensuring that the origins and insertions of the biceps
were fully submerged) into a plastic tub of water for
15 min (Meeusen and Lievens, 1986). The water
was maintained at the recommended temperature of
15
±
1
°
C (by adding ice cubes, cold or hot water,
previously practised in a pilot study) to elicit a drop in
intramuscular temperature of about 7± 10
°
C (Meeusen
and Lievens, 1986). This treatment was applied
immediately post-exercise and every 12 h thereafter for
a duration of 3 days in accordance with the suggested
clinical applications of cryotherapy (Kellet, 1986).
Measurements of exercise-induced muscle damage
The criterion measures were plasma creatine kinase
activity, isometric strength of the elbow
X
exors, relaxed
arm angle, local muscle tenderness and upper arm
Cryotherapy and exercise-induced muscle damage
233
circumference. These measurements were recorded
immediately before the damage-inducing exercise and
then every 24 h thereafter for a duration of 3 days.
For the treatment group, the measurements were per-
formed immediately before the cryotherapy session to
avoid the initial anaesthetic e
V
ects induced by cold
application.
Creatine kinase activity.
Plasma creatine kinase activity
was determined from a
W
ngertip blood sample. A warm
W
ngertip was cleaned with a sterile alcohol swab and
allowed to dry. Capillary puncture was made with
an Autoclix lancette and a sample of whole blood
(32
m
l) was pipetted from a capillary tube onto the test
strip and analysed for creatine kinase activity using a
colorometric assay procedure (Re
X
otron, Boehringer
Mannheim, Lewes, UK). This system uses a plasma
separation principle which is incorporated in the
reagent carrier on the test strip. Samples with creatine
kinase activity in excess of 2000 IU ´ l
-
1
were diluted
with equal parts of distilled water according to the
manufacturer’s instructions.
Isometric strength
. After a brief warm-up and practice
of two to three maximal repetitions, the subject per-
formed two maximal isometric contractions of the
elbow
X
exors in the standing position with the elbow
X
exed at an angle of 2.36 rad. All subjects were given
standardized instructions to exert as great a force as
possible against the lever arm of the dynamometer. The
force was displayed on the computer monitor in real
time for feedback and motivation purposes. The average
of these two scores was recorded.
Relaxed arm angle
. The subjects stood with their hands
and arms down by their sides in the anatomical position.
The exercised arm was fully
X
exed and then actively
extended into a relaxed resting position. The angle was
recorded using a transparent goniometer (Baseline
TM
,
Physiomed, Cheshire, UK). This is an indirect method
of measuring muscle sti
V
ness and soft tissue shortening
that has been used previously (Cleak and Eston, 1992b;
Nosaka and Clarkson, 1995, 1997).
Muscle tenderness.
Muscle tenderness was measured
with the subject in the sitting position and with the
exercised arm in a relaxed position with the upper
arm exposed. A computer-mediated algometer was
used (Biokinetics, Bangor, UK), which is described
elsewhere (Edwards
et al
., 1996). A cylindrical metal
probe with a
X
at head diameter of 10 mm was attached
to the load cell of the algometer and was pushed into the
same mid-belly site of the biceps. Accurate placement of
the probe was assured by a pen mark at the mid-belly
site. The subject was asked to press the hand-held
response button when they felt the sensation change
from discomfort to pain (Edwards
et al
., 1996). The
reading from the algometer was then deducted from
the ceiling value of 40 N and this was taken to be the
tenderness value. This procedure was
W
rst used by
Newham
et al
. (1983) and has been used successfully in
similar studies (Cleak and Eston, 1992b; Eston
et al
.,
1996). The mean score of three trials was recorded as
the subject’ s tenderness score.
Swelling: Upper arm circumference.
An anthropometric
tape measure was used to determine the upper arm
circumference at the mid-belly of the biceps at the level
of the pen mark. The mean of three measurements was
recorded.
Treatment of data
Comparisons between the treatment and control group
were analysed by a mixed-model, two-factor (group
vs
time) analysis of variance, using the SPSS (6.1)
statistical software package. Creatine kinase values were
converted to natural log values to satisfy the assump-
tions of homogeneity of variance necessary for the
analysis. The assumptions of homogeneity of covariance
were tested by the Mauchly sphericity test. Where this
was signi
W
cant, as in the case of the creatine kinase data,
the Greenhouse-Geisser epsilon was used to adjust
the degrees of freedom to increase the critical value
of the
F
-ratio. Tukey
post-hoc
tests were applied to
determine between-mean di
V
erences if the analysis of
variance revealed a signi
W
cant main e
V
ect for time or
interaction of group
´
time.
Results
The results for both the treatment group and the control
group are shown in Table 1.
Relaxed arm angle
The control group had a signi
W
cantly lower relaxed
arm angle than the cryotherapy group (mean
±
s
:
2.56
±
0.21
vs
2.78
±
0.08 rad;
F
1,14
=
5.99,
P
< 0.05).
There was also a main e
V
ect for time (
F
3,39
=
12.98,
P
< 0.001). The relaxed arm angle decreased from
2.82
±
0.09 rad at baseline to 2.67
±
0.16, 2.63
±
0.14
and 2.60
±
0.15 rad on days 1, 2 and 3, respectively.
There was also a group
´
time interaction (
F
3,39
=
4.46,
P
< 0.01) (Fig. 1). There was a larger decrease in
relaxed arm angle for the control group, which was
still 13% lower than baseline and 14% lower than the
cryotherapy group on day 3.
234
Eston and Peters
Table 1
Criterion measures across both groups (mean
±
s
)
Variable Baseline 24 h 48 h 72 h
Ln CK (IU ´ l
2
1
)
Cryotherapy
Control
4.57
±
0.53
4.65
±
0.34
4.97
±
0.65
4.78
±
0.43
4.81
±
0.61
5.50
±
1.36
4.72
±
0.55
5.99
±
1.69
Isometric strength
Cryotherapy
Control
101.6
±
34.2
100.4
±
32.8
78.3
±
21.4
73.0
±
29.0
92.5
±
31.2
81.3
±
42.1
112.3
±
27.2
86.4
±
45.3
Relaxed arm angle (rad)
Cryotherapy
Control
2.86
±
0.11
2.75
±
0.06
2.75
±
0.08
2.59
±
0.25
2.74
±
0.05
2.49
±
0.25
2.78
±
0.06
2.40
±
0.27
Upper arm circumference (cm)
Cryotherapy
Control
26.7
±
2.3
29.8
±
2.2
27.3
±
2.2
30.2
±
2.4
27.3
±
2.1
30.4
±
2.4
27.1
±
2.2
30.4
±
2.7
Tenderness (N)
Cryotherapy
Control
15.1
±
9.4
15.7
±
6.1
22.6
±
7.3
26.9
±
3.9
24.9
±
6.4
26.7
±
5.6
22.1
±
5.4
21.9
±
6.9
Abbreviation
: CK
=
creatine kinase activity.
Figure 1
Relaxed arm angle of the cryotherapy group (s ) and the control group (h ) immediately before and 3 days after
strenuous eccentric exercise of the elbow
X
exors (mean
±
s
xÅ
). The values for the control group were 13% lower than baseline
values and 14% lower than for the cryotherapy group by day 3 (
P
< 0.05).
Swelling: Upper arm circumference
There was a signi
W
cant main e
V
ect for time (
F
3,39
=
11.16,
P
< 0.01).
Post-hoc
tests revealed that upper arm
circumference increased from 28.2
±
2.7 cm at baseline
to 28.7
±
2.7 cm and 28.6
±
2.9 cm on days 2 and 3,
respectively. However, there was no signi
W
cant inter-
action of group
´
time.
Creatine kinase activity
There was a signi
W
cant main e
V
ect for time (
F
1.3, 16.5
=
4.51,
P
< 0.05). Tukey
post-hoc
tests indicated that, by
day 3, the creatine kinase log values were signi
W
cantly
higher than pre-test values (5.31
±
1.34
vs
4.60
±
0.44
IU ´l
-
1
). There was also a signi
W
cant group
´
time inter-
action (
F
1.3, 16.5
=
4.47,
P
< 0.05) (Fig. 2). Tukey tests
Cryotherapy and exercise-induced muscle damage
235
Figure 2
Natural log values for plasma creatine kinase activity of the cryotherapy group (s ) and the control group
(h ) immediately before and 3 days after strenuous eccentric exercise of the elbow
X
exors (mean
±
s
xÅ
). The values for the control
group were higher than baseline values and the values for the cryotherapy group by day 3 (
P
< 0.05).
revealed that although there was no di
V
erence in
creatine kinase activity on days 0 and 1 between the two
groups, by days 2 and 3 the values in the control group
were signi
W
cantly higher, with the highest value for
this group being recorded on day 3. Creatine kinase
activity in the treatment group did not change sig-
ni
W
cantly across time.
Strength
The isometric strength values for the subjects in
this study are similar to those of a previous study
that used similar subjects and methods (Nosaka and
Clarkson, 1997). There was a signi
W
cant main e
V
ect
for time on strength (
F
3,39
=
2.87,
P
< 0.05). Strength
was lower than the baseline value at day 1 (76.1
±
29.6
vs
101
±
32.2 N), returning to baseline values by
days 2 and 3. There was no signi
W
cant group
´
time
interaction.
Muscle tenderness
There was a signi
W
cant main e
V
ect for time on muscle
tenderness (
F
3,39
=
16.55,
P
< 0.001). Tenderness values
were signi
W
cantly higher than baseline values on day
1 (24.3
±
5.7
vs
15.4
±
7.8 N) and remained above
baseline values on day 2 (25.4
±
6.0 N) and day 3
(22.0
±
6.1 N). There was no signi
W
cant interaction of
group
´
time on tenderness.
Discussion
The results of this study are in line with those of previ-
ous studies that examined the temporal characteristics
of exercise-induced muscle damage on the upper arm
musculature (Newham
et al
., 1983; Yackzan
et al
.,
1984; Newham and Jones, 1985; Friden
et al
., 1988;
Nosaka
et al
., 1991; Cleak and Eston, 1992b; Howell
et al
., 1993; Nosaka and Clarkson, 1997). However, the
most interesting
W
ndings are revealed by the group
´
time interactions on two of the dependent variables ±
namely, relaxed arm angle and creatine kinase activity.
The overall decrease in relaxed arm angle in the con-
trol group by day 3 (0.35 rad) was very similar (0.38
rad) to that observed by Cleak and Eston (1992b), but
greater than (0.21 rad) that observed by Nosaka and
Clarkson (1997), who used a faster eccentric speed to
induce muscle damage (1.05
vs
0.58 rad ´s
-
1
). Several
investigators have speculated that the cause of muscle
shortening may be an abnormal increase of calcium ions
in the muscle cell (Armstrong, 1984; Newham
et al
.,
1985; Clarkson and Tremblay, 1988; Ebbeling and
Clarkson, 1989; Nosaka
et al
., 1991), which has been
attributed to a defect in the sarcoplasmic reticulum
after damaging exercise. Increased intracellular levels of
calcium have been observed in the muscles of horses
subjected to high-intensity exercise (Byrd, 1992).
The results provide support that cryotherapy may
reduce the extent to which the muscle and connective
tissue unit becomes shortened after strenuous eccentric
exercise. This is indicated by the signi
W
cant group
´
236
Eston and Peters
time interaction for the relaxed arm angle measurement.
It can be seen from Fig. 1 that the cryotherapy group
experienced less of a decrease in relaxed arm angle
(increased range of motion) than the control group.
Studies on humans and animals have shown that
local cooling a
V
ects the motor neuron pool, the muscle
spindle and its a
V
erents, the skin a
V
erents, the myo-
neural junction and the extrafusal
W
bres of the muscle
(see Meeusen and Lievens, 1986, for a review). The
progressive fall in conduction velocity of the motor and
sensory nerves exposed to cold application is in propor-
tion to the temperature of the tissues, and continues
until the nervous tissue temperature decreases to 10± -
15
°
C (Fox, 1961). The rate of
W
ring from muscle spin-
dle a
V
erents decreases when the whole muscle is cooled.
This e
V
ect is immediate and results in a reduction in
spasticity.
Our results lend some support to a previous study
(Prentice, 1982), which examined the use of heat and
cold therapy in conjunction with stretching to deter-
mine what combination would elicit the greatest
amounts of relaxation within muscles that were in a
state of exercise-induced damage. Electromyographic
activity indicated that the application of cold followed
by stretching was the most successful combination.
It was proposed that cold application reduced the level
of electrical activity of the muscle spindle by increasing
the threshold stimulus for
W
ring and decreasing the
a
V
erent
W
ring rate. However, the results are not in
line with those of previous studies (Yackzan
et al
.,
1984; Braun and Clarkson, 1989; Isabell
et al
., 1992)
that examined the e
V
ects of cold therapy on muscle
spasticity following exercise-induced muscle damage.
This may be a result of the variation in timing and
nature of cold applications.
These factors may also explain why our results di
V
er
from those of Isabell
et al
. (1992), who observed that
cryotherapy, applied after damaging eccentric exercise,
had no e
V
ect on plasma creatine kinase activity.
Although the overall mean values (the main e
V
ect for
group) indicated that creatine kinase activity increased
above baseline values on days 2 and 3, this e
V
ect appears
to be a phenomenon of the group
´
time interaction.
It can be seen from Fig. 2 that creatine kinase activity
continued to increase in the control group, whereas
in the cryotherapy group there was no increase above
baseline values.
It is unclear what mechanism can account for the
di
V
erence in creatine kinase activity between the two
groups after the bout of damaging exercise. Several lines
of explanation might be proposed: there was a reduced
e
Z
ux of creatine kinase from the muscle into the
lymphatic system, a reduction in the amount of post-
exercise damage as a result of cold application in
the treatment group, or an increase in creatine kinase
clearance rates in the treatment group. We believe the
last of these explanations not to be plausible, as this
would depend on an enhanced blood
X
ow that might
increase e
Z
ux of creatine kinase from the muscle. The
cold water immersion technique used here was designed
to constrict the capillaries, reduce capillary permeability
and reduce blood
X
ow to the damaged muscle.
It is possible that the di
V
erence in creatine kinase
response between the two groups may be associated
with the e
V
ect of cryotherapy on the permeability of
the blood and lymph vessels. As indicated earlier, one
of the major aspects of the in
X
ammatory response
resulting from muscle injury is the increase in the per-
meability of the vessel wall, which, in combination with
an augmented extravascular and extracellular protein
concentration, results in oedema formation (Schoberth,
1980). As creatine kinase di
V
uses into the lymph vessel,
it is possible that a reduced permeability of the vessel
walls induced by the cold treatment reduced the rate of
creatine kinase e
Z
ux from the muscle. It is also possible
that the cold treatment reduced lymph
X
ow, as this is
directly a
V
ected by factors which a
V
ect the permeability
of the capillary (Byrne and Levy, 1993). It has been
shown experimentally that cooling the intestinal tissue
of dogs
in vivo
to 4.5
°
C reduces lymph
X
ow to about
33% of baseline levels (Ackerman, 1975).
A further explanation may be that the rate of post-
exercise damage to the muscle tissue was reduced by
the cold treatment, which may have resulted in less
creatine kinase e
Z
ux in the cryotherapy group. It is
worth noting that the intramuscular cooling e
V
ect is
maintained for several hours after removal of the surface
cooling (Meeusen and Lievens, 1986). However, if
this was the case, then we might expect the statistical
analysis to reveal a signi
W
cant group
´
time interaction
on strength. Thus, it is somewhat di
Y
cult to substanti-
ate this hypothesis, as both groups experienced a similar
amount of strength loss after 24 h. However, it is inter-
esting to note that the return of strength to baseline
levels was faster in the cryotherapy group (111%
vs
86%
of baseline values by day 3), although this di
V
erence was
not statistically signi
W
cant.
As previously indicated, there were signi
W
cant incre-
ments in the amount of swelling experienced by both
groups throughout the 72 h of measurements. This is
attributed to an in
X
ammatory response that involves
movement of
X
uid, plasma proteins and leukocytes into
the damaged tissues (Smith, 1991). The time-course of
swelling was similar for both groups.
As both relaxed arm angle and upper arm circum-
ference demonstrated a main e
V
ect for time in this study,
we considered it appropriate to assess the relation-
ship between the relaxed arm angle and the amount of
swelling, particularly as swelling may be a contributing
factor to sti
V
ness of the muscle (Clarkson and Newham,
Cryotherapy and exercise-induced muscle damage
237
1994). The relationship was analysed across the four
separate days for both groups (i.e. 60 paired compar-
isons). Pearson product± moment correlation analysis
revealed a highly signi
W
cant
r
-value of
-
0.54 (
P
<
0.001). Thus, in this study, swelling of the upper arm
was inversely associated with the relaxed arm angle.
One of the consequences of increased water within
the extracellular matrix (e.g. connective tissue) is
increased pressure on pain receptors in muscle tissue
(Stauber, 1989). As the time-course of swelling was
similar in both groups, this may account for the similar
increases in tenderness measurements across time. Peak
tenderness occurred at around 48 h post-exercise,
which is in line with previous studies (Ebbeling and
Clarkson, 1989; Cleak and Eston, 1992b; Eston
et al
.,
1996). Nevertheless, the relaxed elbow angle and
creatine kinase activity values provide evidence of less
damage in the cryotherapy group, which might logically
be expected to be associated with reduced levels of
tenderness in this group. It is possible that the apparent
similarity in tenderness measurements between the two
groups may, in part, be attributable to the method of
assessing tenderness in this study at the mid-belly site
only. Muscle tenderness is more pronounced at the
musculotendinous junction after damaging eccentric
exercise (Cleak and Eston, 1992b; Clarkson and
Newham, 1994; Eston
et al
., 1994; Baker
et al
., 1997).
Selection of the method was based on observations
in our laboratory (Baker
et al
., 1997). Here, tenderness
was measured at nine sites on the quadriceps femoris
before and after eccentric exercise. Tenderness at sites
on the mid-belly of the muscle were less variable than at
the proximal and distal musculotendinous junctions.
Although our
W
ndings generally contradict previous
observations (Yackzan
et al
., 1984; Isabell
et al
., 1992;
Gulick
et al
., 1996), it is possible that the repeated
treatments applied in this study, which followed
clinically prescribed procedures, might provide a valu-
able insight into the e
V
ects that cryotherapy may have
on some of the functional consequences of exercise-
induced muscle damage. This disagreement may be
due to the variation in application methods, application
time and temperature of the methods used. The form
of cryotherapy used in this study was essentially dif-
ferent from that in previous studies, which used direct
application of ice, an ice pack or ice-massage on the
skin. Immersion in cold water allows for the possibility
of greater temperature control. Also, it may not be quite
as uncomfortable for the subject.
On a cautionary note, research has shown that limb
blood
X
ow is decreased by immersion in water baths of
temperatures between 42 and 14
°
C, but that it increases
at temperatures below 10
°
C (see Meeusen and Lievens,
1986, for a review). A decrease in tissue temperature
below 25
°
C for lengthy periods dilates the muscle vessels.
Excessive cryotherapy therefore has an adverse e
V
ect
owing to the increased haemorrhage and in
X
ammatory
response (Barcroft and Edholm, 1943; Kellet, 1986;
Meeusen and Lievens, 1986). In a recent study, histo-
logical evidence from the muscle tissue of rats indicated
that cryotherapy treatment exacerbated damage to the
myo
W
brils (as measured by electron microscopy) after
intense exercise (Fu
et al
., 1997). There is evidence,
therefore, to suggest that whatever form cryotherapy
takes, recommended guidelines must be followed.
In conclusion, although the
W
ndings from this study
lend some support to the repeated application of cryo-
therapy after strenuous eccentric exercise, further re-
search using cryotherapy procedures is recommended.
It appears that this form of cryotherapy decreases the
degree of shortening of the muscle or the connective
tissue after eccentric exercise. Evidence is also presented
to indicate a possible reduction in damage to the muscle
tissue. This may reduce the possibility of re-rupture and
may allow earlier mobilization of the muscle, which is
an important aspect in the healing of muscle injuries
(Hurme
et al
., 1993). However, despite the apparent
e
V
ects of cryotherapy on exercise-induced muscle
damage, it does not appear to alter the normal temporal
pattern of tenderness, swelling and strength loss.
Acknowledgements
We thank Ron Maughan, Priscilla Clarkson, Mike Gleeson
and the anonymous referees for their helpful comments. We
also thank Declan Connolly for his advice in the early stages of
the project.
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