Alonso A, Hekeik P, Adams R

Predicting a recovery time from the initial assessment of a quadriceps contusion injury. [JOURNAL ARTICLE]
Aust J Physiother 2000; 46(3):167-177.

Six quadriceps contusion tests were evaluated for inter-rater reliability and ability to predict the recovery time of
100 injured rugby players. All subjects were treated with a standardised and disciplined treatment program
incorporating cryokinetics and modified training. Muscle firmness ratings, thigh circumference and passive knee
flexion range of movement (ROM) measurements, and the unilateral palpation, brush-swipe and tap tests were all
found to have substantial to excellent reliability (range: 0.66-1.00). Multiple regression analysis demonstrated that
64 per cent of the variance in the time taken to return to full training could be accounted for by an equation
involving the uninjured-injured difference in knee range, relative firmness rating of the injured muscle, difference
in circumferences at the suprapatellar border, being able to play on following injury and the time delay before
starting treatment.

Title Sensory Perception of the Foot and Ankle Following Therapeutic

Applications of Heat and Cold.
Author(s) Ingersoll CD, Knight KL, Merrick MA

Source J Athl Train 1992; 27(3):231-234.

Abstract Many athletes are treated with hot and cold modalities prior to
therapeutic exercise, but the effects of these treatments on sensory
perception are not clear. The purpose of this study was to examine the
effects of hot and cold treatments on sensory perception. We recruited
21 volunteer subjects, who reported for testing on three separate
occasions. One of three treatments was applied to the left ankle and foot
each day for 20 minutes: cold immersion, hot immersion, or quiet sitting
(control). Three variables were measured following treatment:
topagnosis, two-point discrimination, and one-legged balance. We
assigned treatments and the testing order according to a Greco Latin
square. Data were analyzed using a multivariate analysis of variance
(MANOVA). No significant differences were detected for the three
dependent measures, suggesting that therapeutic applications of heat and
cold do not affect sensory perception. These findings indicate that heat
and cold applications can be used prior to therapeutic exercise programs
without interfering with normal sensory perception as do other analgesic
and anesthetic agents. For example, the hypalgesic effect of cold, which
is essential to cryokinetics, can be realized without fear of altered
sensory perception.
Language ENG
Pub Type(s) JOURNAL ARTICLE
PubMed ID 16558166

Knight KL, Londeree BR

Comparison of blood flow in the ankle of uninjured subjects during therapeutic applications of heat, cold,
and exercise. [Journal Article]
Med Sci Sports Exerc 1980; 12(1):76-80.

Based on clinical evidence, cryokinetics (alternating cold and exercise) is replacing heat modalities as the preferred
therapy for rehabilitation of traumatic musculoskeletal injuries in athletes. Theories have been advanced to explain
the clinical successes of cryokinetics, but little scientific data have been collected. Strain gauge plethysmography
was used to measure blood flow to the ankle of 12 uninjured male subjects. A repeated measures design was
utilized with each subject being tested under six experimental conditions: 1) heat packs, 2) cold packs, 3) control,
4) heat-exercise, 5) cold-exercise, 6) control-exercise. Exercise consisted of 5 three-minute bouts (3.5 mph)
interspersed with heat, cold, or control throughout a 45-minute period. Non-exercise, heat and cold were
administered for 25 minutes each, followed by 20 minutes without treatment. Instantaneous blood flow was
measured regularly during non-exercise periods, estimated during exercise, and total flow was computed by
integrating over the 45 minute treatment-post treatment period. Total flow (ml flow/100 ml tissue/min) was
greater/p. less than .0002) during cold-exercise than during heat treatments. Contrary to some theories, there was
neither cold-induced vasodilatation during, nor a reflex vasodilatation following, the 25-minute cold application.
These data suggest that during cryokinetics, exercise causes the increased blood flow, and that cold applications
function only to allow active motion in a painful joint.

The effect of immersion cryotherapy on medial-lateral postural sway variability in

individuals with a lateral ankle sprain
Thomas W. Kernozek 1 *, John F. Greany 1, Danielle R. Anderson 1, Douglas Van Heel 1, Roderick L. Youngdahl 1, Benjamin G.
Benesh 1, Christopher J. Durall 2
1
La Crosse Institute for Movement Science, Department of Health Professions, Physical Therapy Program, Health Science
Center, University of Wisconsin-La Crosse
2
Student Health Center, Department of Physical Therapy, University of Wisconsin-La Crosse
email: Thomas W. Kernozek (kernozek.thom@uwlax.edu)
*
Correspondence to Thomas W. Kernozek, Department of Health Professions, University of Wisconsin - La Crosse,
La Crosse, WI 54601.

This study was approved by the University of Wisconsin - La Crosse Institutional Review Board for human
research. Funding for this research was provided by the Graduate Student Research Program at the University of
Wisconsin - La Crosse.
KEYWORDS

ankle • balance • cryotherapy • postural sway

ABSTRACT

Background and Purpose. Postural stability has been shown to be impaired after a lateral ankle sprain (LAS) and after
immersion cryotherapy in healthy ankles. This study was performed to determine the effects of cryotherapy on postural stability
after LAS. Method. A single-session, repeated measures design was used. Fifteen 18- to 29-year-old males (mean age 21.33 ±
3.54, height 71.23 ± 2.50 cm, mass 170.33 ± 19.77 kg) with relatively recent grade I LAS volunteered. Medial-lateral postural
sway variability was assessed during single-leg barefoot stance using a Bertec force platform. Sway was tested before

cryotherapy ( Pre ), immediately after 20 minutes of lower-leg immersion cryotherapy ( Post0 ), and 10 and 20 minutes after

cryotherapy ( Post10 and Post20 ). Both legs were tested (individually) before cryotherapy; the involved leg was tested alone
after cryotherapy. The uninvolved leg served as a control. Results. Postural sway variability of the involved le was significantly
greater than the uninvolved le before cryotherapy (p= 0.001). Postural sway variability of the involved le was also significantly
greater than the uninvolved LE during Post0 (p = 0.000), Post10 (p = 0.000) and Post20 testing (p = 0.003) with the largest increase
in sway variability occurring at Post0. Conclusions. Medial-lateral postural sway variability was greater after LAS. This effect
was augmented by immersion cryotherapy. Copyright © 2008 John Wiley & Sons, Ltd.

Received: April 2007; Accepted: November 2007