|Year : 2013 | Volume
| Issue : 2 | Page : 76-81
Effects of cryotherapy on sensation and pinch strength
Bhairavi Bhandari1, Lata Parmar2
1 PG Student, College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Principal, College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
|Date of Web Publication||21-Aug-2018|
Principal, College of Physiotherapy, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat
Source of Support: None, Conflict of Interest: None
Background: Cryotherapy is commonly used in physical therapy with many known benefits; many patients are treated with cryotherapy, but the effects of cryotherapy on sensation and pinch strength are not conclusive. The purpose therefore was to know the effects of cryotherapy on sensation and pinch strength.
Methods: An experimental study, thirty females, aged 18 to 26 years participated. Baseline measurements were taken for sensation and pinch strength. Participants were asked to immerse their hand in 100 of cold water for fifteen minutes; post Cryotherapy measurements of TPD and pinch strength were taken. Aesthesiometer used to measure TPD and pinch gauge hydraulic dynamometer was used to measure pinch strength.
Results: Wilcoxon Signed Ranks Test was used for analysis. The z-scores although negative, TPD sensations for thumb and finger were not statistically different pre and post experiment, p value 0.458 and 0.154 respectively. Pinch strength was reduced after application of Cryotherapy, baseline value for pinch strength was (2.33±0.877) and post experiment (1.95±0.834), p value is 0.02.
Conclusions: TPD not affected; Pinch strength significantly decreased immediately after cryotherapy.
Keywords: Cryotherapy, Sensation, two point discrimination, Pinch strength
|How to cite this article:|
Bhandari B, Parmar L. Effects of cryotherapy on sensation and pinch strength. J Integr Health Sci 2013;1:76-81
| Introduction|| |
Cryotherapy, in the form of cold water immersion and ice packs, has been used for decades as a post-exercise recovery strategy in a variety of sports and physical therapy practices across the world.,,,,, Several factors affect the degree of superficial and deep tissue temperature change accomplished during Cryotherapy e.g., tissue type, depth of the target tissue, temperature gradient between the target tissue and the cooling agent, size of the area being treated, and length of the application. Cold water immersion has also been used before exercise (precooling) or during exercise to improve endurance activities in humid conditions.,
Cryotherapy is routinely used to treat acute and chronic athletic injuries. Effects on cutaneous receptors may provide the benefits derived from cryotherapy administration for both injury management and exercise recovery. Pain modulation associated with altered cutaneous sensation is not fully understood.
It has been suggested that cryotherapy produces decrease in muscle activity which may lead to a higher risk for re-injury when athletes return to competition after treatment. This statement is based on investigations that showed negative effects on: NCV, electromyographic (EMG), joint position sense (proprioception) and medium latency reflex response (increase in delay).
In contrast, other studies have shown no clinically significant effect or even a positive effect of cryotherapy on muscle activity. The effects of Cryotherapy especially on the functions of strength & sensation have been thus controversial. The aim of present study was to identify and analyse effects of Cryotherapy, in normal healthy adults.
To study effect of Cryotherapy on sensation and pinch strength in normal healthy individuals.
Assess the sensation of two point discrimination (TPD) and pinch strength before and after Cryotherapy
| Methods|| |
Study Design: Experimental
Study Population: Normal healthy adults’ (students’) age between 18 to 26 years. Participants were selected using convenient sampling.
Normal healthy adults students (self-reported healthy, non smokers and not on any medication)
- Upper limb dysfunction.
- Any neuro-musculoskeletal disorders.
- History of cold allergy, or frostbites.
- Allergy to cold
- Jamar pinch gauge hydraulic dynamometer
- Thermometer Pen
- Cold water immersion tub
Ethical approval was taken from Institutional Ethical Committee. This was an experimental study wherein participants were recruited from University. Participants were screened, all those meeting the inclusion criteria were explained in detail about the study and those willing to participate in the study were requested for written informed consent.
The participants were assessed pre and post experiment.
- Pinch strength.
- Sensation of TPD
Participant Testing Order
Right side upper limb
Step 1: Baseline sensation of TPD tests as seen in the [Figure 2].
|Figure 2: Shows measurement of sensation of two point discrimination of pad of right index finger.|
Click here to view
For TPD testing, participants were asked to respond with the number (1 or 2) they felt. The tester applied just enough pressure on distal phalanx of thumb and index finger to depress the skin directly below the instrument, and the points contacted the skin at the same time. Each Participant was assessed 3 times with the aesthesiometer. The number of correct responses was the TPD score.
Step 2: Determine maximal pinch strength,
Each Participant was asked to sit comfortably in a chair in front of tester. Participants were asked to maximally press the bars of the pinch strength dynamometer between the thumb and index finger for 10 seconds, repeat it 3 times, with 1 minute rest between each trial. Participants were instructed to give maximal effort for the entire duration of each of the 3 trials (as seen in [Figure 3].
|Figure 3: Shows measurement of pinch strength with pinch gauge hydraulic dynamometer with thumb pad to index finger pad.|
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Participants underwent a 15-minute ice-bath immersion of the arm from 1inch (2.54 cm) proximal to the medial epicondyle to the distal end of the fingers in the cold immersion tub. The ice bath was at a temperature of 10 degree C at the beginning of testing; it was checked with the thermometer and was allowed to warm as it would in a practical setting in the normal room temperature. The temperature was measured after treatment and adjusted for the next treatment. After treatment, subjects dried their hands with towel, and their sensation tested, and then the pinch strength testing started. Any harmful effects of Cryotherapy were taken care by principal investigator.
Step 4: Post treatment sensation & pinch strength measures.
After 15 minute of Cryotherapy, same outcome measures were repeated and values recorded
| Results|| |
30 female students of age group between 18 to 26 years participated.
Normality Tests- One-Sample Kolmogorov- Smirnov Test was done and as the test showed that data was not normally distributed, nonparametric tests were used for analysis. Wilcoxon Signed Ranks Test used for sensation of thumb and finger and pinch strength pre &post experiment of Cryotherapy
| Discussion|| |
Most of the studies have been done on normal population. Mean age in the present study was 20.97(2.684), all were female. In most of the previous studies age range varied between 19.3 ± 1.2 yr to 25 years. A number of outcome measures have been used to study the effects of cryotherapy viz. the effects of whole body cryotherapy, muscle force reproduction, recovery after muscle damaging exercise, tympanic temperature . Biodex® Balance System to quantify balance. Changes in sensation of pressure, 2-point discrimination, and sub maximal isometric-force production variability viz. handgrip strength due to cryotherapy have also been used.,,,
|Figure 6: Representing sensation of thumb and of finger pre and post Cryotherapy|
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Stefan Schmid et al investigated effect of 20-min knee joint cryotherapy application on electromyographic activity of leg muscles during a single-leg drop jump. Francois Tremblay et al, studied influence of cooling on proprioceptive acuity as reflected in the ability to discriminate weights. One study examined the effects of ice immersion on three functional performance tests. Christopher D. Ingersoll, et al measured three variables following treatment i.e. topagnosis, two-point discrimination, and one-legged balance. Another study experimented to determine if cold water immersion of the arm increases post-immersion handgrip strength.
|Table 2: Comparison of thumb for two point discrimination measurement (thumb)|
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|Table 3: Comparison of finger for two point discrimination measurement (finger)|
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The present study used two point discrimination and pinch strength to assess the effect of cryotherapy on sensation and strength.
The temperatures used for cryotherapy n ranged from, 0-4 degrees,, 1° C17 to 5 degrees C 20 10 degrees,,, 13 degrees  , 15degrees,, 20° C. the duration of immersion has also varied in different studies. The duration of cryotherapy varied from 15 minutes used in one study39 ,20 minutes in number of them,,,,,,, one study however did not try to maintain the temperature thus simulating the clinical protocol and one study used 30 minutes.
Participants in the present study underwent a 15- minute ice-bath immersion of the arm from 1inch proximal to the medial epicondyle to the distal end of the fingers in the cold immersion tub. The ice bath was at a temperature of 10 degree C at the beginning of testing; it was checked with the thermometer and was allowed to warm as it would in a practical setting in the normal room temperature. The temperature was measured after treatment and adjusted for the next treatment.
The present study found the scores of TPD sensation (although z-scores were negative) were not statistically significantly different before and after 10o of cold water immersion, for 15 minute experiment, at baseline value for thumb (0.14±0.052) and index finger (0.13±0.049) post cryotherapy was for thumb (0.13±0.057) and index finger (0.11±0.029) and p value 0.458 for thumb and for finger was 0.154 respectively.
Mack D. Rubley et al (2003) concluded that sensation of pressure decreased after cryotherapy, whereas 2-point discrimination was unaltered. This was also similarly reported by Christopher D. Ingersoll et al who concluded that there were no significant differences detected in topagnosis, and one-legged balance suggesting that therapeutic applications of heat and cold did not affect sensory perception.
The fact that TPD was not affected, may be because of the highly sensitive receptors located in the digits of the hand. Meissner corpuscles and Merkel disks are located in the fingers in large numbers and have relatively small receptive fields, approximately 2 to 4 mm in diameter. The large number of receptors in close proximity may account for the ability of the receptors to distinguish such a small difference in distance, 2 mm. Again the clinical significance of these findings is that cryotherapy does not affect TPD.
Jenna K. Cataldi reported that ice massage and cold water immersion produced numbness significantly faster than the crushed ice. Changes in cutaneous sensation can be achieved in a relatively short amount of time (6–12 minutes) with ice massage and cold water immersion. Castello et al  also indicated no detrimental effects (in terms of proprioceptive acuity) of using whole body cryotherapy before exercise, despite a significant reduction in Tympanic Temperature.
Conflicting results regarding the effects of cold on strength have been reported. Reports of several authors state that cold causes reduced dexterity and sensitivity in the hand and fingers explaining that decrease in manual dexterity could be due to the effect of cold on nerve conduction velocity, proprioception, or muscular function. Nerve conduction velocity in efferent and afferent fibers decreases linearly with decreases in nerve tissue temperature. The perception of the stimulus may be altered as afferent pathways are slowed down because of decreased temperature9. Additionally, when in intramuscular tissue temperature reduces, the neuronal discharge and sensitivity of the muscle spindles are impeded, even if stimulation from the muscle spindle activates the reflex arc, the neuronal message for increased muscle excitability may be inhibited due to a significant decrease in the motor end plate’s potential.
The strength in the present study was studied immediately following the Cryotherapy and demonstrated significant reduction in pinch strength, p value 0.02 [Table 4]b.
Carl G. Mattacola et al reported isokinetic plantar flexor strength significantly reduced (p < 0.01), immediately after Cold Water Submersion. Other authors, studied the effects of arm immersion in cold water at 10 C for 30 minute on handgrip strength and concluded that Grip strength significantly decreased as a consequence of immersion of the forearm. No increases in post-immersion strength were observed.
Mack D. Rubley et al reported increase in variability (decreased precision) and targeting error (decreased accuracy); however, this could be due to fatigue which they did not measure. This fatigue according to them may be the result of a depletion of muscle adenosine triphosphate when greater demand is placed on the muscles for longer periods oftime.
Stefan Schmid, et al summarized that, 20 min of knee joint cooling tended to decrease the average EMG activity of the lower extremity musculature during a plyometric exercise. It has been suggested that a diminished proprioception, induced by the cryotherapy application, could have resulted in a modification of the central program and thus in a decrease of the pre-landing and braking phase muscle activity during a plyometric exercise. This may lead to a reduced storage of elastic energy in the tendinous tissue during the eccentric phase and thus to a decrease in performance during the push-off phase. The results lent support to the suggestion that cryotherapy during sporting events may play a role in enhancing risk for re-injury.
Matthew Douglas et al suggested that cryotherapy to the ankle had a negative effect on the medio-lateral (ML) component of dynamic balance following ice water immersion. Immediate return to play following cryotherapy application is cautioned given the decreased dynamic ML balance and potential for increased injury risk.
António Ascensão et al, reported that 10 min cold water immersion at 10°C immediately after a one-off soccer match reduced muscle damage and discomfort, possibly contributing to a faster recovery of neuromuscular function, suggesting cryotherapy is effective in reducing some biochemical, functional, and perceptual markers of muscle damage.
The conclusion of application of cold (ice immersion10° C), for 15 minutes in the present study are as follows:
- Two point discrimination was not affected by cryotherapy
- Pinch strength was significantly decreased immediately after cryotherapy.
Thus, cryotherapy has been seen to have both beneficial and deleterious effects and therefore need to be used but not without caution.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4]