Cryotherapy and Joint Position Sense in Healthy Participants: A Systematic Review

Abstract

Objective: To (1) search the English-language literature for original research addressing the effect of cryotherapy on joint position sense (JPS) and (2) make recommendations regarding how soon healthy athletes can safely return to participation after cryotherapy.Data Sources: We performed an exhaustive search for original research using the AMED, CINAHL, MEDLINE, and SportDiscus databases from 1973 to 2009 to gather information on cryotherapy and JPS. Key words used were cryotherapy and proprioception, cryotherapy and joint position sense, cryotherapy, and proprioception.Study Selection: The inclusion criteria were (1) the literature was written in English, (2) participants were human, (3) an outcome measure included JPS, (4) participants were healthy, and (5) participants were tested immediately after a cryotherapy application to a joint.Data Extraction: The means and SDs of the JPS outcome measures were extracted and used to estimate the effect size (Cohen d) and associated 95% confidence intervals for comparisons of JPS before and after a cryotherapy treatment. The numbers, ages, and sexes of participants in all 7 selected studies were also extracted.Data Synthesis: The JPS was assessed in 3 joints: ankle (n 5 2), knee (n 5 3), and shoulder (n 5 2). The average effect size for the 7 included studies was modest, with effect sizes ranging from 20.08 to 1.17, with a positive number representing an increase in JPS error. The average methodologic score of the included studies was 5.4/10 (range, 5-6) on the Physiotherapy Evidence Database scale.Conclusions: Limited and equivocal evidence is available to address the effect of cryotherapy on proprioception in the form of JPS. Until further evidence is provided, clinicians should be cautious when returning individuals to tasks requiring components of proprioceptive input immediately after a cryotherapy treatment.

Influence of cryotherapy on balance and joint position sense in healthy subjects: randomized clinical trial.

“…(6) The effect of cryotherapy on proprioception, which is a component of the somatosensory system, is still poorly understood. (7) Proprioceptive acuity is defined as the ability of an individual to determine the joint position sense, motion and strength of the limbs. (8) Consequently, the proprioceptive acuity is an essential component for injury prevention and rehabilitation, but is often ignored, with serious consequences, because the proprioceptive deficit can be responsible for many acute joint lesions.…”

The Acute Effect of Cryotherapy on Muscle Strength and Shoulder Proprioception

“…Although several studies have investigated the impact of cooling upon JPS 27 , the effect of this intervention upon the accuracy of force reproduction has received less attention 29 . It is likely that the viscoelasticity of tissues, particularly the mechanical property of the tendon, might be changed by cryotherapy, thereby suggesting that decreased compliance with the muscle-tendon unit may directly impair its force-generating capacity and also influence neural activation patterns.…”

Effects of cryotherapy on joint position sense and intraarticular blood flow volume in healthy knee joints

“…Ozmun et al 7) reported that ice bag application to the knee had no effect on proprioception. Furthermore, the potential for cryotherapy to degrade JPS is unknown due to a limited number of publications, as noted in a recent systematic review 8) . Thus, the effects of cryotherapy on JPS are not clearly understood.…”