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1.
Accelerated Muscle Recovery in Baseball Pitchers Using Phase Change Material Cooling.
Mullaney, MJ, McHugh, MP, Kwiecien, SY, Ioviero, N, Fink, A, Howatson, G
Medicine and science in sports and exercise. 2021;(1):228-235
Abstract
PURPOSE The purpose of this study was to document recovery after a pitching performance and determine whether prolonged postgame phase change material (PCM) cooling of the shoulder and forearm accelerates recovery. METHODS Strength, soreness, and serum creatine kinase (CK) activity were assessed before and on the 2 d after pitching performances in 16 college pitchers. Pitchers were randomized to receive either postgame PCM cooling packs on the shoulder and forearm or no cooling (control). PCM packs were applied inside compression shirts and delivered cooling at a constant temperature of 15°C for 3 h. Strength was assessed for shoulder internal rotation (IR), external rotation (ER), empty can (EC) test, and grip. RESULTS Total pitch count was 60 ± 16 for 23 PCM cooling games and 62 ± 17 for 24 control games (P = 0.679). On the days after pitching, IR strength (P = 0.006) and grip strength (P = 0.036) were higher in the PCM cooling group versus control. One day after pitching, IR strength was 95% ± 14% of baseline with PCM cooling versus 83% ± 13% for control (P = 0.008, effect size d = 0.91) and 107% ± 9% versus 95% ± 10% for grip strength (P = 0.022, effect size d = 1.29). There was a trend for greater ER strength with PCM cooling (P = 0.091, effect size d = 0.51). The EC strength was not impaired after pitching (P = 0.147) and was therefore unaffected by PCM cooling (P = 0.168). Elevations in soreness and CK were not different between treatments (treatment-time CK P = 0.139, shoulder soreness P = 0.885, forearm soreness P = 0.206). CONCLUSION This is one of the first studies to document impairments in muscle function on the days after baseball pitching, and the first study showing a novel cryotherapy intervention that accelerates recovery of muscle function in baseball pitchers after a game.
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Abdominal Ice after Laparoscopic Hysterectomy: A Randomized Controlled Trial.
Cope, AG, Wetzstein, MM, Mara, KC, Laughlin-Tommaso, SK, Warner, NS, Burnett, TL
Journal of minimally invasive gynecology. 2021;(2):342-350.e2
Abstract
STUDY OBJECTIVE To assess the impact of abdominal ice packs on opioid use and pain control after laparoscopic hysterectomy DESIGN Randomized controlled trial. SETTING Academic tertiary care medical center. PATIENTS Total of 142 adult women undergoing laparoscopic (either conventional or robotic) hysterectomy were randomized to control (n = 69) or intervention (n = 73). Exclusion criteria included preoperative opioid use, planned intensive care unit admission or same-day discharge, an incision ≥4 cm, and regional anesthesia use. INTERVENTIONS Subjects in the intervention group had a large ice pack placed directly on the lower abdomen before leaving the operating room. The ice pack was maintained continuously for 12 hours postoperation, as desired thereafter until discharge, and continued use encouraged after discharge for up to 48 hours. MEASUREMENTS AND MAIN RESULTS Total opioids administered postoperatively, while inpatient and after dismissal, were assessed in morphine milligram equivalents. Postoperative pain, as well as analgesia acceptability and side effects, were assessed using validated measures: Brief Pain Inventory and Overall Benefit of Analgesia Score. Median morphine milligram equivalent was lower in the intervention group than the controls from inpatient stay on the floor to completion of opioid use as an outpatient (22.5 vs 26.2) but was not statistically significant (p = .79). There was no significant difference between the groups in Brief Pain Inventory assessment of postoperative pain severity (p = .80) or pain interference (p = .36) or Overall Benefit of Analgesia Score total score (p = .88). Most patients in the intervention group were very satisfied with ice pack use (n = 51, 79.7%) and very likely to recommend it to friends or family (n = 54, 83.1%). There were no adverse events related to ice pack use. CONCLUSION There was no significant difference in postoperative opioid use or pain assessment with ice pack use after laparoscopic hysterectomy. However, most of the subjects expressed high satisfaction specific to ice pack use and would recommend its use to others, suggesting potential desirability as adjunct therapy in postoperative pain control.
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Effectiveness and safety of a thermal insulating coverage on the top of the cryo-cabin during a partial-body cryostimulation.
De Nardi, M, Silvani, S, Facheris, C, Pagnoncelli, M, Bisio, A, Faelli, E, La Torre, A, Ruggeri, P, Codella, R
Journal of thermal biology. 2021;:102901
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Abstract
Partial Body Cryostimulation (PBC) consists of exposing minimally dressed participants to very cold air, in a specially designed cabin (cryo-cabin), for a short period of time. In recent years, cryo-cabins have been launched with a coverage to limit thermo-dispersion, however a validation study is lacking. The aim of this study was to compare thermal responses after a PBC protocol in an open cryo-cabin or into a cryo-cabin closed at the top with a polyurethane-made lid. Eighteen young male adults completed the two 150 s PBC sessions in a cross-over fashion. Temperature of the inner cabin and thermal responses were measured prior and 1, 5, 10, 20 min after completing each PBC session. When covered, cryo-cabins maintained a lower temperature in the front with respect to the back. There was a significant interaction regarding coverage*time*position with a main effect of coverage. Body surfaces were significantly colder under covered condition compared to open PBC. Subjects perceived a greater thermal discomfort during a covered PBC rather than during an open condition. For the first time, the use of a coverage placed on the top of the cabin was demonstrated to maintain lower temperatures of the inner environment and the users' skin with respect to a standard PBC. This evidence indicates that practitioners and clinicians making use of PBC can successfully and safely cover cryo-cabins with an insulating lid so to improve the effectiveness of their treatments.
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Cool Crosslinking: Riboflavin at 4°C for Pain Management After Crosslinking for Keratoconus Patients, A Randomized Clinical Trial.
Toro-Giraldo, L, Morales Flores, N, Santana-Cruz, O, Ramirez-Miranda, A, Navas, A, Olivo-Payne, A, Lichtinger, A, Jimenez-Corona, A, Graue-Hernández, EO
Cornea. 2021;(1):1-4
Abstract
PURPOSE To explore corneal cooling as a method of pain management in corneal-accelerated collagen cross-linking. METHODS This was a prospective and interventional randomized clinical trial registered in the National Institutes of Health Clinical Trials through the identifier NCT030760770. The research was conducted at the Institute of Ophthalmology "Conde de Valenciana." A total of 98 patients were randomly assigned to one of the following 2 groups: cold riboflavin (4°C) group or control group (riboflavin at room temperature). The inclusion criteria were patients of any sex, older than 18 years of age with keratoconus diagnosis who needed management with cross-linking in both eyes because of the evidence of progression. The exclusion criteria were patients who had cross-linking without epithelial debridement, unilateral cross-linking, or any other ocular pathologies besides keratoconus and any cognitive incapacity that would make the understanding of the pain test difficult. The main outcome measures were pain, tearing, photophobia, foreign body sensation, and irritation. RESULTS At 2 hours post-op, pain in the case and control groups was 3.80 ± 3.00 and 8.08 ± 2.21 (P < 0.05), tearing was 1.56 ± 1.96 and 8.29 ± 2.42 (P < 0.05), photophobia was 5.44 ± 3.57 and 7.83 ± 2.64 (P < 0.05), foreign body sensation was 2.20 ± 2.78 and 6.54 ± 2.73 (P < 0.05), and irritation was 3.48 ± 2.98 and 6.79 ± 3.00 (P < 0.05), respectively. A statistical significant difference was maintained in pain values on day 1 (2.79 ± 3.09 and 4.91 ± 3.27 [P < 0.05]), 2 (2.54 ± 2.41 and 4.00 ± 2.43 [P < 0.05]), and 4 (0.45 ± 0.76 and 1.22 ± 1.67 [P < 0.05]). CONCLUSIONS This study demonstrated that pain and associated symptoms decreased significantly in the riboflavin 4°C group.
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Comparing the effect of acupressure with or without ice in LI-4 point on labour pain and anxiety levels during labour: a randomised controlled trial.
Mirzaee, F, Hasaroeih, FE, Mirzaee, M, Ghazanfarpour, M
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology. 2021;(3):395-400
Abstract
The aim of this study was to assess the effect of acupressure with or without ice on reducing pain and anxiety during labour. The anxiety level of mothers was measured before and after study using Spielberger Inventory along with the labour pain. To improve the strength of this study, a meta-analysis was conducted on the effect of acupressure in point LI-4 on anxiety during labour. Ninety women in labour were randomly divided into three groups: acupressure with ice, acupressure without ice and the control group. The result suggested that women receiving both acupressure with ice (p = .005) or without ice (p < .001) experienced less labour pain in comparison with the control group. Also, the labour pain severity in acupressure without ice was lower than the group with ice (p < .001). Acupressure with (p = 1) or without (p = .09) ice was not significantly different from the control group in terms of the anxiety level. However, women in the group of acupressure without ice experienced less anxiety in comparison with acupressure with ice (p = .04). The difference in pain severity before and after treatment with acupressure with (RCI = 2.86) or without ice (RCI = 5.54) was clinically significant. The intervention was not clinically meaningful in terms of anxiety.Impact statementWhat is already known on this subject? Previous trials have exhibited that acupressure with/without ice reduced pain and anxiety during labour.What do the results of this subject add? The results of this research was consistent with previous studies, suggesting that acupressure, with or without ice, is more effective than the control group regarding labour pain. However, the group of acupressure with ice was not different from the control group with respect to the anxiety level.What are the implications of these findings for clinical practice and/or further research? In light of advantages, such as growing preference of women, researcher and health care providers for physiological delivery coupled with its safety and simplicity, it can be used as an effective technique to manage labour pain. Further studies are required to assess the effect of acupressure at L4 on the anxiety level.
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Prolonging the duration of cooling does not enhance recovery following a marathon.
Kwiecien, SY, McHugh, MP, Hicks, KM, Keane, KM, Howatson, G
Scandinavian journal of medicine & science in sports. 2021;(1):21-29
Abstract
Runners commonly utilize cryotherapy as part of their recovery strategy. Cryotherapy has been ineffective in mitigating signs and symptoms of muscle damage following marathon running and is limited by its duration of application. Phase change material (PCM) packs can prolong the duration of cooling. This study aimed to test the efficacy of prolonging the duration of cooling using PCM on perceptual recovery, neuromuscular function, and blood markers following a marathon run. Thirty participants completed a marathon run and were randomized to receive three hours of 15°C PCM treatment covering the quadriceps or recover without an intervention (control). Quadriceps soreness, strength, countermovement jump (CMJ) height, creatine kinase (CK), and high sensitivity C-reactive protein (hsCRP) were recorded at baseline, 24, 48, and 72 hours after the marathon. Following the marathon, strength decreased in both groups (P < .0001), with no difference between groups. Compared to baseline, strength was reduced 24 (P = .004) and 48 hours after the marathon (P = .008) in the control group, but only 24 hours (P = .028) in the PCM group. Soreness increased (P < .0001) and CMJ height decreased (P < .0001) in both groups, with no difference between groups. Compared to baseline, CMJ height was not reduced on any days in the PCM group but was reduced in the control group 24 (P < .0001) and 48 hours (P = .003) after the marathon. CK and hsCRP increased in both groups (P < .0001). Although the marathon run induced significant muscle damage, prolonging the duration of cooling using PCM did not accelerate the resolution of any dependent variables.
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Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate.
Smith, BM, Draper, DO, Hyldahl, RD, Rigby, JH
Journal of sport rehabilitation. 2020;(4):538-544
Abstract
CONTEXT Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. OBJECTIVE To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. DESIGN Controlled laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). INTERVENTION(S): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. MAIN OUTCOME MEASURE(S): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. RESULTS There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) μg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. CONCLUSIONS Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.
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Males benefit more from cold water immersion during repeated handgrip contractions than females despite similar oxygen kinetics.
Baláš, J, Kodejška, J, Krupková, D, Giles, D
The journal of physiological sciences : JPS. 2020;(1):13
Abstract
The purpose of the present study was to assess the effect of different water immersion temperatures on handgrip performance and haemodynamic changes in the forearm flexors of males and females. Twenty-nine rock-climbers performed three repeated intermittent handgrip contractions to failure with 20 min recovery on three separate laboratory visits. For each visit, a randomly assigned recovery strategy was applied: cold water immersion (CWI) at 8 °C (CW8), 15 °C (CW15) or passive recovery (PAS). While handgrip performance significantly decreased in the subsequent trials for the PAS (p < 0.05), there was a significant increase in time to failure for the second and third trial for CW15 and in the second trial for CW8; males having greater performance improvement (44%) after CW15 than females (26%). The results indicate that CW15 was a more tolerable and effective recovery strategy than CW8 and the same CWI protocol may lead to different recovery in males and females.
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Should ice application be replaced with neurocryostimulation for the treatment of acute lateral ankle sprains? A randomized clinical trial.
Tittley, J, Hébert, LJ, Roy, JS
Journal of foot and ankle research. 2020;(1):69
Abstract
STUDY DESIGN Single-blind parallel group randomized clinical trial. OBJECTIVES To compare the effects of neurocryostimulation (NCS) with those of traditional ice application on functional recovery, pain, edema and ankle dorsiflexion range of motion (ROM) in individuals receiving physiotherapy treatments for acute lateral ankle sprains (LAS). BACKGROUND Ankle sprain is a very common injury and its management is often costly, with important short- and long-term impacts on individuals and society. As new methods of therapy using cold (cryotherapy) are emerging for the treatment of musculoskeletal conditions, little evidence exists to support their use. NCS, which provokes a rapid cooling of the skin with the liberation of pressured CO2, is a method believed to accelerate the resorption of edema and recovery in the case of traumatic injuries. METHODS Forty-one participants with acute LAS were randomly assigned either to a group that received in-clinic physiotherapy treatments and NCS (experimental NCS group, n = 20), or to a group that received the same in-clinic physiotherapy treatments and traditional ice application (comparison ice group, n = 21). Primary (Lower Extremity Functional Scale - LEFS) and secondary (visual analog scale for pain intensity at rest and during usual activities in the last 48 h, Figure of Eight measurement of edema, and weight bearing lunge for ankle dorsiflexion range of motion) outcomes were evaluated at baseline (T0), after one week (T1), two weeks (T2), four weeks (T4) and finally, after six weeks (T6). The effects of interventions were assessed using two-way ANOVA-type Nonparametric Analysis for Longitudinal Data (nparLD). RESULTS No significant group-time interaction or group effect was observed for all outcomes (0.995 ≥ p ≥ 0.057) following the intervention. Large time effects were however observed for all outcomes (p < 0.0001). CONCLUSION Results suggest that neurocryostimulation is no more effective than traditional ice application in improving functional recovery, pain, edema, and ankle dorsiflexion ROM during the first six weeks of physiotherapy treatments in individuals with acute LAS. LEVEL OF EVIDENCE Therapy, level 1b. TRIAL REGISTRATION ClinicalTrials.gov , NCT02945618 . Registered 23 October 2016 - Retrospectively registered (25 participants recruited prior to registration, 17 participants after).
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Vibration Versus Ice to Reduce Cosmetic Botulinum Toxin Injection Pain-A Randomized Controlled Trial.
Chorney, SR, Villwock, JA, Suryadevara, AC
Ear, nose, & throat journal. 2019;(6):351-355
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Abstract
Botulinum toxin is the most commonly performed facial cosmetic procedure and pain at the injection site is a frequent patient concern. While various topical interventions have been described for analgesia, there have not been any studies comparing different techniques. We compared the use of a vibratory stimulus, ice pack application, and no intervention on injection site pain for cosmetic botulinum toxin injection. A prospective-, randomized-, individual-controlled study was conducted using a visual analog scale to assess pain. Patients received bilateral glabellar injections, with randomization into unilateral vibration, unilateral ice application, or vibration and ice on either side. We analyzed 88 injections on 22 patients. Mean visual analog scores were 26.5 (standard deviation [SD]: 23.1) among injections with vibration, 24.4 (SD: 22.9) with ice, and 29.4 (SD: 27.1) without analgesia. There was no significant difference in pain scale scores with the use of vibration, ice, or no topical anesthesia (P = .737). Further, pain scale scores did not differ significantly between medial and lateral injections nor did patients have a reduction in pain on either side of the forehead regardless of which method was used. While there may be a role for topical interventions to improve injection site analgesia, we maintain that consistently proper technique plays a greater role in improving patient tolerance. Future studies will continue to investigate the role of topical anesthesia in cosmetic facial injections and address patient-specific factors contributing to discomfort.