Cryotherapy in sport: a warm reception for the translation of evidence into applied practice.

Research contributing to the understanding of the mechanisms that underpin cryotherapy application in sport are evident. The translation of impactful findings that contribute to the design and implementation of cryotherapy protocols which are advantageous to the athlete in an applied sport setting, however, are still being explored. The role of cryotherapy for acute sport injury management is challenged in recent literature and discrepancies around the periodisation of cooling to maximise injury management or recovery, contribute to the confusion around optimal applications of cryotherapy in sport. The purpose of this work was to provide a contemporary summary of current perspectives, challenges and approaches for the use, application and translation of cryotherapy evidence into applied practice in a sporting context. The intention being to stimulate further debate on the topic and highlight key considerations for future study designs that reflect current practices. For improved translation of evidence for or against the use of cryotherapy in sport, it is suggested that future study design and methodologies should reflect contemporary demands within sporting environments where cryotherapy protocols for injury, rehabilitation or recovery are a feature of athlete management through investigation of individual response, and multi-measures of wellbeing and performance.

COMPARISON OF CRYOTHERAPY MODALITY APPLICATION OVER THE ANTERIOR THIGH ACROSS RUGBY UNION POSITIONS; A CROSSOVER RANDOMIZED CONTROLLED TRIAL.

BACKGROUND: In deliberation of the diverse physical traits of rugby union and the known interference adipose tissue has on the ability to cool deeper tissues, evidence is required to understand the effect of cryotherapy modalities to provide optimum outcomes post-injury. PURPOSE: To investigate differences in the cooling ability of three different cryotherapy modalities in a rugby union population in an attempt to describe optimum cooling protocols for the anterior thigh. STUDY DESIGN: Within-subjects randomized control crossover. METHODS: Twenty-one healthy male rugby union players took part. Skin surface temperature measured via thermal imaging camera (ThermoVision A40M, Flir Systems, Danderyd, Sweden) alongside Thermal Comfort and Sensation questionnaires following interventions of either Wetted Ice (WI), Crushed Ice (CI) applied in a polythene bag secured by plastic wrap, or CryoCuff® (CC), applied for 20-minutes over the anterior thigh. Participants were grouped by their typical playing position for the sport of rugby union; i.e. forwards and backs. RESULTS: Significant differences (p=<0.05) in T sk for all modalities compared to baseline and comparing post T sk between CI and CC (p=0.01) and WI to CC (p=0.01) were displayed. Significantly greater reductions in T sk noted immediately-post in the 'forwards' group (p=≤0.05) compared to the 'backs' group for, all modalities (p=≤0.05). Thermal Comfort and Sensation scores demonstrated significant changes baseline compared to post for all modalities (p=<0.05). No significant differences were found when comparing between modalities for Thermal Comfort (p=0.755) or Sensation (p=0.225) for whole group or between positional groups. CONCLUSIONS: Physiological responses to cooling differed across modalities with WI producing the greatest decrease in T sk. Significant variability in T sk was also displayed between positional factions. Results uphold the importance of the individualization of local cooling protocols when considering physical traits and characteristics within a rugby union population. Findings provide further understanding of the physiological responses to cooling through T sk quantification in specific populations, helping to guide sports medicine practitioners on optimal cooling application development in sport. LEVEL OF EVIDENCE: Level 2b.