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Examining effects of acute cryotherapy on muscle force and perception of soreness

Amanda Al-Sheikh,Amanda Braitsch,Yesenia Castillo,Ramon Contreras,
Johnnie Durbin, Moenique Parris
Exercise Physiology
Summer 2015

ABSTRACT
Background: Delayed onset muscle soreness (DOMS) is caused by micro traumas to
muscles during high force eccentric contraction. Ice water immersion submersion has been

implemented in athletic and clinical settings to help prevent soreness (Crystal, 2013). Aim: This
study aims to determine whether ice water immersion post-resistance training will elicit greater
recovery response in comparison to bicycle cool down (BCD). Methods: Subjects included 6
males and 2 females who exercised > 2 days/wk. Subjects completed 5 repetitions of knee
flexion and extension of dominant leg on an isokinetic dynamometer (BioDex) to establish
baseline torque. 1RM was determined on leg press (LP) and extension machine (LEM). Subjects
performed 4 sets of 10 repetitions at 70% 1RM on LP and EM, 5 forced eccentric contractions on
EM, and 4 sets of lunges. 10 minutes of recovery were assigned, either an ice water immersion or
BCD. Re-assessment of peak torque leg extension and muscle soreness rating were measured
post-recovery. Results: Ice water immersion recovery soreness mean + SD was 2.83 1.34 and
cycling recovery 2.66 1.34. Initial peak torque(165.11+ 52.3 Ft*Lbs), post ice water
immersion peak(135.25 + 43.98 Ft*Lbs), post cycle peak (148.91 + 50.83 Ft*Lbs), initial peak
(86.97+ 30.5 Ft*Lbs), post ice water immersion peak (83.20 + 29.37 Ft*Lbs), post cycle peak
(86.85 + 33.37 Ft*Lbs). Discussion: Findings indicated no significant differences in muscle
soreness in both recovery methods. BCD elicited greater torque percentage for leg extension.
Data can be applied to athletes and individuals seeking to reduce recovery time.

INTRODUCTION
Maintaining a balance between the stresses of training and competition is an essential
component to maximizing performance. Strategies to speed recovery and minimize muscle
damage are sought after by elite and recreational athletes. One strategy commonly used in the
athletic field to combat delayed onset muscle soreness (DOMS) is ice water immersion. The

assumption of this practice is that the decrease in muscle tissue temperature will result in
constriction of local blood vessels and lead to a reduced inflammatory response (Pournot et al.,
2011). DOMS is pain or discomfort in skeletal muscle that typically occurs 1-3 days after
completion of unaccustomed eccentric loading exercises, and generally resolves within 5-7 days
of the unaccustomed eccentric loading exercise (Cheung et al., 2003). Research on the
effectiveness of ice immersion in muscle recovery is inconclusive. Some studies have found that
cryotherapy has a positive effect on performance. Reduction of muscle damage symptoms
including: soreness, swelling, plasma creatine kinase levels, and lactate dehydrogenase levels
may lead to a reduction in recovery time allowing the athlete to train with a higher frequency.
Other studies have found that ice water immersion has no effect on performance, soreness,
swelling, plasma creatine kinase levels, or lactate dehydrogenase levels (Crystal et al., 2013).
These studies used downhill running and high intensity cycling to induce DOMS. Our study
involved active students who had an intermediate level of weightlifting experience. A novel
repetition scheme and tempo of lower body exercises were implemented in attempts to induce
DOMS.
Eccentric muscle contractions have been documented to produce greater damage to
muscle when compared to concentric or isometric contractions. The damage occurs to the
alignment of the normal skeletal muscles banding patterns (Sellwood et al., 2007). Following
muscle damage is an acute inflammatory response which includes the release of inflammatory
cytokines. Immune cells repair muscle damage caused by exercise but also worsen the injury by
releasing reactive oxygen species (ROS). ROS oxidize molecules within the myocyte and cause
symptoms of muscle damage including DOMS and strength and power decrements (Crystal et
al., 2013).

The aim of this study is to determine whether the use of an ice water immersion post
resistance training will elicit a greater recovery response than a low intensity bicycle cool down.
It was hypothesized that ice-bath submersion immediately following resistance training will
elicit an accelerated recovery time and decreased post exercise muscle soreness.

METHODS
Subjects
Subjects included 2 male and 4 female Kinesiology students at California State
University San Marcos (CSUSM), between the ages of 18-40. All subjects were in good health,
exercised a minimum of 2 days per week.Subjects were required to have an intermediate level of
experience with resistance training, and had no history of lower body injuries within the past 2
years (Table 1). A control for race was not necessary. All subjects signed a health history
questionnaire and provided their informed consent.
Design
All subjects were instructed to maintain their dietary intake. Subjects were also instructed
to refrain from any lower body exercise 72 hours prior to the bouts of exercise.
Biodex Protocol
The study took place over a duration of 3 weeks. Prior to any exercise subjects performed
on an isokinetic dynamometer Biodex machine (Biodex Medical Systems, Shirley, NY) to
establish baseline values of peak torque extension and flexion of the dominant leg for a total of 5
repetitions at a speed of 30 deg/sec. After baseline measurements were established, subjects
returned the following week to complete the exercise protocol. Twenty-four hours following the
first bout of exercise, peak torque extension and flexion were re-assessed. The same process was

performed 24 hours following the subjects second bout of exercise which took place one week
later.
Gym Protocol
Following the biodex protocol, subjects proceeded to the gym protocol. Subjects were
escorted to The Clarke Gym at CSUSM to establish workload for subsequent 1 rep max (1RM)
on both the leg press and leg extension machine. 1RM was established based on the maximum
amount of weight lifted with proper form (Astorino et al., 2010). Once 1RM was determined,
subjects returned 48 hours to perform a preset workout based on the individual subjects 1RM.
Subject first completed 4 sets of 10 repetitions of approximately 70% of their 1RM with a rest
period of 60 seconds between sets on the leg press machine. Repetitions on the leg press machine
were performed in order to pre-exhaust the quadriceps muscle group by using a compound
movement. Preceding the 4 sets of leg presses, subjects then performed 4 sets of 10 repetitions at
approximately 70% of 1RM on the leg extension machine. Immediately following these 10
repetitions, subjects then completed 5 forced eccentric repetitions each lasting 5 seconds with
manual assistance from an individual overseeing the experiment, . A rest period of 90-120
seconds was implemented between sets on the leg extension machine. Eccentric contractions
were included to ensure DOMS was elicited based on the ability to produce greater muscle
damage (Sellwood et al., 2007). After leg press, extension with forced eccentric contractions,
subjects completed 4 sets of bodyweight lunges with a two second pause at the bottom of the
movement to increase time under tension. Subjects alternated between both legs during the set.
Lunges were completed for a pre-determined distance of 30 meters as their final form of
exercise. Lunges were also included in the exercise protocol to ensure DOMS was elicited by
further exhausting quadriceps muscles. Immediately following bodyweight lunges, subjects were

randomly assigned to spend 10 minutes in either an ice water immersion or on a low-intensity

bicycle cool-down as a form of recovery.
Recovery
In order to assess rate of recovery with alternative forms of cool down, subjects were
randomly assigned to a recovery station immediately following the completion of the exercise
bout. Recovery stations included either a 10-minute ice water immersion with a standard
temperature used in previous studies of (55F/13C), or a traditional 10-minute cool-down on a
stationary cycle (Crystal, 2013). In order to test efficiency of recovery methods and prevent
adaptations to the exercise bout, subjects assigned to the ice water immersion recovery in the
first week were then assigned to the cool-down on the stationary cycle the following week.
Post-Recovery peak torque assessment
After completing the first exercise bout and form of recovery, subjects returned the
following day to have peak torque re-assessed on the isokinetic dynamometer. Subjects
completed a low-intensity 5 minute warm-up on an ergometer prior to reassessment of peak
torque. During the warm-up, subjects were asked to rate their soreness based on the Likert Scale
of Muscle Soreness (Table 2). The same procedure was applied to peak torque re-assessment
following the second bout of exercise and recovery method.
Data analysis
Peak and mean torque values of extension and flexion for all subjects were recorded from
the Biodex machine. Researchers manually collected soreness values. All data was reported in
mean and standard deviation values. Peak torque and soreness values were imputed into the
SPSS software version 20.0 (SPSS, IL) in order to conduct a repeated measures ANOVA test and
paired T-test. Both tests was used to analyze data in order to determine if a significant difference

(p < 0.05) existed between measures. A p value less than 0.05 indicated there was a significant
difference between torque values and recovery methods.

Table 1: Inclusion criteria of all subjects. 4 female subjects identified as (F) and 2 male subjects
(M). Age measured in years (yr), weight in kilograms (kg), and height in centimeters (cm).
Average and standard deviation of age, weight, and height reported for each subject.
Subject

Sex

Age (yr)

Weight (kg)

23

54.43

162.56

20

54.43

157.48

21

62.14

160.02

22

52.16

157.48

40

104.32

190.5

21

70.30

177.8

24.5 + 7.66

66.3 + 19.8

avg+stdv

Height (cm)

167.64 + 13.54

Table 2: Likert Scale of muscle soreness (Vickers, 2001). Subjects reported soreness values 1-6
24 hours following the exercise bout based on the Likert Scale of muscle soreness.

RESULTS
No significant difference in muscle soreness between recovery methods

Mean SD muscle soreness value for the ice water immersion recovery method was 2.83 1.34
in comparison to the cycling recovery mean soreness value of 2.66 1.34. A Paired t-test (p
<0.05) was implemented in order to determine a significant difference between soreness values
of subjects in the ice water immersion recovery method and cycling. P-value of 0.865 was
obtained from the paired t-test indicating there is no significant difference between soreness
values in the two different recovery methods.

Post workout cycling promotes a greater recovery percentage when compared to initial peak and
initial mean torques values for leg extension

Figure 1: Peak torque and mean torque of leg extension post-cycling and post-ice water
immersion represented on the the X-axis. Initial peak and mean torque indicated by the
horizontal lines above bars. Torque measured in Ft*lbs indicated on the y-axis. Initial peak and
mean (165.11+ 52.3 Ft*Lbs ,152.58 + 46.82 Ft*Lbs), post ice water immersion peak and mean
(135.25 + 43.98 Ft*Lbs, 124.38 + 39.77 Ft*Lbs, ), post cycle peak and mean (148.91 + 50.83
Ft*Lbs, 130.32 + 39.63 Ft*Lbs), torque values measured on the Biodex for knee extension. An *
designates a difference (P <0.05) when compared to initial torque values and a # designates a
difference (P <0.05) from torque values of the post-ice water immersion recovery method.
Significant difference between post-ice water immersion and post-cycle torque existed during leg
extension.

Post workout cycling and Post workout ice water immersions have no effect on recovery
percentage when compared to initial peak and initial mean torques values for leg flexion

Figure 2: Peak torque and mean torque of leg flexion post-cycling and post-ice water immersion
represented on the the X-axis. Initial peak and mean torque indicated by the horizontal lines
above bars. Torque measured in Ft*lbs indicated on the y-axis. Initial peak and mean (86.97+
30.5 Ft*Lbs ,83.15 + 29.77 Ft*Lbs), post ice water immersion peak and mean (83.20 + 29.37
Ft*Lbs, 76.88 + 27.26 Ft*Lbs, ), post cycle peak and mean (86.85 + 33.37 Ft*Lbs, 81.12 +
30.46 Ft*Lbs), torque values measured on the Biodex for knee flexion. No significant
differences were found (P>.0.05) among any of the groups.
DISCUSSION
The primary aim of this study is to examine ice water immersion and cycling recovery
methods in eliciting a greater recovery response. Findings indicated there was no significant
difference of muscle soreness in both recovery methods. Post workout cycling prompted a
greater increase in recovery during leg extension in comparison to ice water immersion recovery
(Figure 1). However, both recovery methods had no effect on increasing recovery in leg flexion
(Figure 2). These data can be applied to athletes and individuals (active or not) who engage in
lower body exercise and seek to reduce recovery time in order to increase training frequency.

Our data displays how a low intensity cool down of cycling elicits a greater recovery percentage
and may be more tolerable recovery method than ice water immersion. Also, post-exercise
cycling is more practical in athletes who have little recovery time between competitions because
of the time requirements and equipment needed to set up an ice water immersion (Crystal, 2013).
Furthermore, for athletes that do not have sufficient recovery time between competitive bouts of
exercise, ice water immersion is not practical given that their muscles would have to be warm
prior to their next bout of competitive exercise.
Previous studies examining cooling during an eccentric bout of exercise, similar to our
study , indicated elevated values of pain and fatigue based on a soreness scale (Tseng et al.,
2013). Our study followed a similar trend in that subjects had higher soreness values when they
participated in the ice water immersion recovery in comparison to cycling. Previous studies have
also indicated that ice submersion does not have a significant effect on recovery in subjects who
participated in a bout of damaging exercise of 5 sets of 100 drop jumps (Howatson, 2009). There
were no significant differences in recovery (p > 0.05) in subjects who participated in cold water
immersion and in the control group who had 12 minutes of seated rest as recovery (Howatson,
2009). Our study showed similar findings, recovery was not improved through ice water
immersion. This previous studies data and our data show that zero intensity (seated rest) and
low-intensity (cycling) cool downs may elicit greater recovery in comparison to cold water
submersion.
Another study that examined ice water immersion after submaximal squat exercise found
improvements in performance. Their finding showed a reduced levels of myoglobin
concentration within the plasma and may show that ice water immersion reduces secondary

tissue damage. This study also showed a post ice water immersion reduction in swelling and
soreness of the muscle. (Roberts et al., 2014)
Limitations
The small sample size of only 6 subjects (4 female, 2 male) is considered a large
limitation of this study as it does not accurately represent the trained population. Soreness levels
were self-reported with a numerical scale. These measures can be considered to be subjective as
the subjects had no baseline soreness levels assessed prior to experimentation. The population
chosen to participate in this study were made up solely of individuals who weight-trained
regularly, which explained the low elicitation of DOMS in the trained subjects. Also, because
participants were trained, this may have allowed for adaptation to the prescribed workouts
quicker than utilizing untrained subjects. Furthermore, all of the exercises performed largely
focused on hip and knee extension. Focus on hip and knee extension could have accounted for
the minimal decrease and difference in torque measurements of knee flexion (Figure 2).
The post-exercise ice water immersion cool down was composed of one trash can and
one kiddie pool. The trash can allowed for subjects to fully submerge their lower body into the
ice water, whereas the kiddie-pool did not allow subjects to fully submerge because the
circumference and depth of the pool was too small and most subjects had their knees sticking out
of the pool. While subjects were instructed to abstain from engagement in exercise 3 days prior
to the study, we were unable to control this factor because of the increased difficulty for
individuals who exercise regularly to refrain from exercising for days at a time.
Although our data indicated that cycling elicits a greater increase in percentage recovery
for leg extension, the effects of ice water immersion and the benefits of cryotherapy in the
recovery of muscle damage should be further investigated. Cryotherapy clinics are becoming

more popular, allowing both professional and nonprofessional athletes to enhance performance
and recovery through cryotherapy. Therefore, it is essential to continue research and provide
clinicians with adequate knowledge cryotherapy. Also, when examining force output and
cryotherapy, further investigation needs to be placed on muscle torque post-cryotherapy because
current literature is not conclusive (Tseng, et al., 2013).

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