Comparison of Cryotherapy Performed With Ice or Gel and Superficial Skin Cooling of Older Women: A Randomized, Crossover, Clinical Trial.

BACKGROUND AND PURPOSE: Cryotherapy is an affordable and popular treatment of soft tissue injuries, which can reduce inflammation and pain. Studies have specifically addressed young adults and athletes, and these findings have been extended to older adults in clinical practice. Aging is associated with changes in the skin, including collagen degradation, decreased fat layer thickness, and reduced blood flow, which can alter the skin response to stress. Because of age-related changes, there are concerns about the direct use of ice on the skin of older individuals. Skin injuries were also observed after cryotherapy. This study aimed to assess the most effective and safe cryotherapy for superficial skin cooling among older women. METHODS: Eighteen older women were enrolled in this blinded, randomized, crossover, clinical trial. The mean values (SD) of their age, height, and weight were 70.0 years (6.0), 156.0 cm (9.1), and 72.8 kg (19.5), respectively. The participants underwent cryotherapy using bagged ice, bagged ice plus a wet towel, or gel pack for 20 minutes. The surface temperature of the skin was measured at the end of a 20-minute cryotherapy session using an infrared thermometer. Repeated-measures analysis of variance was conducted to analyze the effect of cryotherapy modalities and time, as well as the interaction between these 2 factors. The secondary outcome was the presence of cryotherapy-induced lesions. RESULTS AND DISCUSSION: Cryotherapy modalities had significant effects on superficial skin temperature (P = .001). Time points after application also had an effect (P = .0001), and no interaction was observed between cryotherapy modalities and time points (P = .051). Bonferroni post hoc evaluation showed that bagged ice (P = .008) and gel (P = .007) were more effective in decreasing the superficial skin temperature than bagged ice plus wet towel. No difference was observed between bagged ice and gel (P = .32). Three of the 18 patients experienced adverse effects with the gel pack. CONCLUSION: This study of older women found that ice and gel cooled the skin more effectively than ice wrapped in towels. However, the gel pack had some adverse effects. Therefore, bagged ice is recommended for cryotherapy in older women.

Intra and interrater reliability for lower limb flexibility assessment using photogrammetry.

INTRODUCTION: Photogrammetry represents an advancement in the flexibility evaluation, and although it was highly explored for postural assessment, there is a scarcity of studies analyzing lower limb angular measurements using it. The purpose of this study is to verify the reliability of intrarater and interrarater photogrammetry in assessing lower limb flexibility. METHODS: This was a randomized cross-sectional observational study with test-retest design and a two-day interval. Thirty healthy, physically active adults were included. Three novice raters assessed the participants through flexibility tests of iliopsoas, hamstring, quadriceps and gastrocnemius on two occasions, and independently analyzed the captured images to establish reliability. Intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were calculated. RESULTS: Intrarater reliability was excellent for iliopsoas (ICC = 0.96; SEM = 1.4; MDC = 3.8), hamstring (ICC = 0.99; SEM = 1.1; MDC = 3.1), quadriceps (ICC = 0.99; SEM = 0.8; MDC = 2.3) and gastrocnemius (ICC = 0.98; SEM = 0.9; MDC = 2.5). Interrater reliability was excellent for iliopsoas (ICC = 0.94; SEM = 1.7; MDC = 4.6) and gastrocnemius (ICC = 0.91; SEM = 2.1; MDC = 5.8), but good for hamstring (ICC = 0.90; SEM = 2.8; MDC = 7.9) and quadriceps (ICC = 0.85; SEM = 3.0; MDC = 8.3). CONCLUSIONS: The excellent intrarater and good to excellent interrater reliability suggest that photogrammetry assessment of lower limb flexibility by novice raters is reliable. However, clinicians should consider the higher threshold of range of motion change necessary to outweigh measurement error due to interrater variability.

Hold-relax PNF is more effective than unilateral lumbar mobilization on increasing hamstring flexibility: A randomized clinical trial.

BACKGROUND: Although lumbar mobilization (LM) and proprioceptive neuromuscular facilitation (PNF) are used to increase flexibility in clinical practice, remains unclear which technic is the most effective. This study aims to verify and compare the immediate effect of unilateral LM and hold-relax PNF on hamstring flexibility. METHOD: A randomized, blinded, crossover trial carried out in university research laboratory. Thirty healthy young adults were randomly allocated to three groups, each group receive unilateral, central posterior-anterior LM grade III to the L4 joint, hold-relax PNF and control intervention in a different order with 48 h of washout period. Hamstring flexibility was measured using photogrammetry before and immediately after intervention through range of motion (ROM) change in the Straight Leg Raise Test. T-tests were used to compare ROM within groups, and ANOVA repeated measure followed by Bonferroni post-hoc tests was used for between groups comparison. RESULTS: Two participants were lost to follow-up, leaving 28 for analysis (21.6 ± 2.2 years-old). LM increased 4.5° (95% CI 2.3-6.5°, p = 0.001, d = 0.29) on the straight leg raise test and PNF increased 10.0° (95% CI 7.7-12.2°, p = 0.001, d = 0.7). No statistically significant increase was observed on the control group (p = 0.151, d = 0.08). Further, the technique used significantly influenced ROM (p = 0.001, η²p = 0.37). On the between group analysis, PNF was better than LM (p = 0.005) and control (p = 0.001), whereas LM was no better than the control for hamstring flexibility (p = 0.68). CONCLUSIONS: Although hold-relax PNF and unilateral LM techniques increased ROM, hold-relax PNF was more effective on increasing hamstring flexibility.

Tissue heating in different short wave diathermy methods: A systematic review and narrative synthesis.

OBJECTIVE: To assess the change in temperature caused by different short wave diathermy (SWD) methods of application in different healthy tissues. DATA SOURCES: The Cochrane Central Register of Controlled Trials, MEDLINE, Science Direct, CINAHL, SciELO, PEDro, ClinicalTrials.gov, Brazilian Registry of Clinical Trials and the World Health Organization ICTRP were searched (1990-April 2020). METHODS: Randomized, quasi-randomized, and single-arm controlled trials assessing temperature change after SWD application in healthy adults were included. Group analysis was done according to SWD mode and where temperature was collected, risk of bias was assessed using the Cochrane tool and the quality of evidence using GRADE. A narrative synthesis was conducted since methodological homogeneity was not sufficient to undertake a meta-analysis. RESULTS: Eleven studies were included, reporting data of 240 subjects. Regarding skin temperature change, the application that increased temperature the most was under the electrode using continuous SWD on coplanar arrangement of capacitive technique (7.9 [1.76] °C), coplanar arrangement also had the slowest temperature decay, and the lowest temperature found was through a low dose application of pulsed SWD (0.34 [0.69] °C). Regarding muscle temperature change, the application that increased temperature the most was using the inductive technique of pulsed SWD (4.58 [0.87] °C), this technique also had the slowest temperature decay, and the lowest temperature found was through ReBound shortwave diathermy (2.31 [0.87] °C). CONCLUSION: SWD efficacy depends on setting choices. This review provides a detailed description of SWD methods of application and a quantitative data set of resulting temperature change.

Coplanar arrangement of shortwave diathermy is the most effective in skin temperature change: A randomized crossover trial.

INTRODUCTION: Continuous shortwave diathermy (CSWD) efficacy relies on change in temperature, which had been evaluated previously. However, the studies are not comparable enough, consequently the primary goal of this study was to analyze which SWD capacitive technique arrangement is the most effective in skin temperature change. METHOD: A randomized, single-blinded crossover trial conducted in a university research laboratory. Twenty young healthy male subjects were randomly allocated using a website to receive 20 min of CSWD application to the anterior aspect of the thigh through coplanar, contraplanar and longitudinal arrangement. Skin temperature was collected under the proximal electrode and at the thigh center over 25 min after electrodes removal, using an infrared thermography camera. RESULTS: There were two losses to follow up, remaining 18 subjects for analysis (age = 21.4 ± 2.09 years, BMI = 23.6 ± 2.46 kg/m2). Under the electrode all arrangements achieved vigorous heating (coplanar = 7.9 ± 1.76 °C; contraplanar = 6.52 ± 2.68 °C; longitudinal = 7.46 ± 1.8 °C) immediately after electrodes removal and temperature decreased with a similar rate across arrangements. At the thigh center, coplanar arrangement achieved mild heating (1-2 °C) until 17 min after electrodes removal; meanwhile, the other arrangements did not increase temperature sufficiently for post intervention therapeutic effects. No unintended effect was detected. CONCLUSIONS: Coplanar arrangement increased skin temperature the most, heated the greatest area, and had the slowest temperature decay. If the body part accommodates any of the capacitive technique arrangements, coplanar should be used to treat superficial tissues.

Volume of water added to crushed ice affects the efficacy of cryotherapy: a randomised, single-blind, crossover trial.

OBJECTIVE: To compare the effects of different cryotherapeutic preparations. DESIGN: Randomised, single-blind, crossover trial. SETTING: University laboratory. PARTICIPANTS: Sixteen healthy women. INTERVENTIONS: Participants were randomised to receive three cryotherapeutic preparations: pure ice (500g), watered ice (500g of ice in 500ml of water) and wetted ice (500g of ice in 50ml of water). MAIN OUTCOME MEASURES: The primary outcome was skin surface temperature after cryotherapy, measured at the central point of application, and the minimum temperature of the region of interest (ROI). The secondary outcome was the surface area cooled to <13.6°C, which is the recommended temperature to achieve therapeutic effects. RESULTS: After application of ice, mean skin surface temperature at the central point was 4.6 [standard deviation (SD) 1.9] °C for the pure ice preparation, 4.9 (SD 2.5) °C for the wetted ice preparation, and 9.6 (SD 1.8) °C for the watered ice preparation. When compared with the watered ice preparation, this represented a mean difference (MD) of 5.0°C for the pure ice preparation [95% confidence interval (CI) 4.0 to 6.0; P<0.001] and an MD of 4.7°C for the wetted ice preparation (95% CI 2.5 to 6.8; P<0.001). The minimum temperatures in the ROI were also lower for the pure ice preparation 3.0 (SD 0.9) °C and the wetted ice preparation 2.8 (SD 0.6) °C than the watered ice preparation 7.9 (SD 1.5) °C. This represented an MD of 4.8°C for the pure ice preparation (95% CI 4.0 to 5.7; P<0.001) and 5.1°C for the wetted ice preparation (95% CI 4.0 to 6.2; P<0.001]. CONCLUSIONS: Application of pure ice or wetted ice led to a greater decrease in skin surface temperature compared with watered ice. For clinical purposes, combining equal parts of water and ice could decrease this effect. CLINICAL TRIAL REGISTRATION NUMBER: Clinicaltrials.gov (NCT03414346).