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THE EFFECT OF CRYOTHERAPY ON THE SINGLE LEG VERTICAL JUMP
A THESIS
Submitted to the Faculty of the School of Graduate Studies and
Research
of
California University of Pennsylvania in partial fulfillment
of the requirements for the degree of
Master of Science
by
Christine Marie Stache
Research Advisor, Dr. Thomas F. West
California, Pennsylvania
2010
ii
CALIFORNIA UNIVERSITY of PENNSYLVANIA
iii
ACKNOWLEDGEMENTS
I would like to take this opportunity and thank everyone
who helped me with this year.
I would like to thank my
parents and sister for their support and believing in me this
year and always.
I like to thank my family for encouraging me
to apply to graduate school and to move closer to home.
I
also would like to thank my grandparents, aunts and uncles for
support and encouragement.
I would like to thank my old and
new friends for keeping in touch and encouraging me through
everything.
I would also like to thank my chair, Dr. West, and my two
committee members, Dr. Kane and Dr. Barnhart for helping me
with this thesis.
in this study.
I would also like thank all the volunteers
Each volunteer was kind enough to take time
out of their busy schedule to help with participation.
so much to everyone.
Thanks
iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . . . ii
AKNOWLEDGEMENTS . . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS
. . . . . . . . . . . . . . . iv
. . . . . . . . . . . . . . . . vii
. . . . . . . . . . . . . . . . . 1
. . . . . . . . . . . . . . . . . . . 6
Research Design. . . . . . . . . . . . . . . . 6
Subjects
. . . . . . . . . . . . . . . . . . 7
Preliminary Research
. . . . . . . . . . . . . 8
Instruments . . . . . . . . . . . . . . . . . 9
Demographic Form . . . . . . . . . . . . . . . 9
Force Platform
. . . . . . . . . . . . . . . 10
Cryotherapy Treatment . . . . . . . . . . . . . 11
Stationary Bicycle
Procedures
. . . . . . . . . . . . . . 11
. . . . . . . . . . . . . . . . . 11
Single-leg Vertical Jump . . . . . . . . . . . . 12
Hypothesis
. . . . . . . . . . . . . . . . . 14
Data Analysis .
RESULTS
. . . . . . . . . . . . . . . 13
. . . . . . . . . . . . . . . . . . . 15
Demographic Data .
Hypothesis Testing .
. . . . . . . . . . . . . . 15
. . . . . . . . . . . . . 16
Additional Findings . . . . . . . . . . . . . . 18
v
DISCUSSION .
. . . . . . . . . . . . . . . . . 19
Discussion of Results .
Conclusions .
. . . . . . . . . . . . 19
. . . . . . . . . . . . . . . . 23
Recommendations . . . . . . . . . . . . . . . . 24
REFERENCES. . . . . . . . . . . . . . . . . . . 26
APPENDICES .
. . . . . . . . . . . . . . . . . 28
APPENDIX A: Review of Literature .
. . . . . . . . 29
Anatomy of the Ankle . . . . . . . . . . . . . . 30
Musculoskeletal Anatomy .
. . . . . . . . . . . 30
Neurological Anatomy .
. . . . . . . . . . . 31
.
Indications of Cryotherapy. . . . . . . . . . . . 32
The Use of Cryotherapy . . . . . . . . . . . . 34
Contraindications . . . . . . . . . . . . . . 35
Physiological Effects of Cryotherapy .
. . . . 35
Temperature. . . . . . . . . . . . . . . . . . 38
Neurological Effects . . . . . . . . . . . . . . 40
Measuring the Vertical Jump . . . . . . . . . . . 43
Cryotherapy and the Effects on the Vertical Jump
. . 44
Summary . . . . . . . . . . . . . . . . . . . 50
APPENDIX B: The Problem . . . . . . . . . . . . . 51
Definition of Terms . . . . . . . . . . . . . . 52
Basic Assumptions
. . . . . . . . . . . . . . 53
Limitations of the Study . . . . . . . . . . . . 53
Significance of the Study
. . . . . . . . . . . 54
vi
APPENDIX C: Additional Methods . . . . . . . . . . 55
Informed Consent Form (C1) . . . . . . . . . . . 56
IRB: California University of Pennsylvania (C2) . . . 61
Demographic Information (C3)
. . . . . . . . . . 77
Peak Force Trial Example (C4) . . . . . . . . . . 80
Summary of Previous Cryotherapy Research (C5)
. . . 82
REFERENCES . . . . . . . . . . . . . . . . . . 85
ABSTRACT
. . . . . . . . . . . . . . . . . . 88
vii
LIST OF TABLES
Table
Title
1
Peak force scores dependant on cryotherapy
condition and time of test.
2
Page
. . . . . . . 17
ANOVA Results for Main Effects and
Interaction between Cryotherapy and
Time Conditions . . . . . . . . . . . . 17
1
INTRODUCTION
Cryotherapy is a key therapeutic modality in athletic
training.
Cryotherapy can be used for numerous types of
injuries and can also be used on many parts of the body.1-7
The effect of cryotherapy on functional performance has
greatly been debated.7-14
The purpose of the study is to
examine cryotherapy research and the effects cryotherapy
has on the lower extremity and functional performance.
Nadler et al. defined cryotherapy, as “the therapeutic
application of any substance to the body that removes heat
from the body, resulting in decreased tissue temperature”.1
Cryotherapy is and can be used in all three phases of the
injury process, including the acute phase, repair phase and
remodeling phase.
The acute phase is from the point of
injury to approximately forty eight hours after the injury.
The repair phase, immediately follows the acute phase, can
last forty eight hours to approximately six weeks after the
initial injury.
The remodeling phase typically starts
three to six weeks following the initial trauma and can
last up to twelve months, depending on the severity of the
injury.2
2
Cryotherapy is commonly utilized to help decrease
swelling and pain at an injury site.1-7
Cryotherapy can
help prevent and/or reduce swelling, depending on severity,
after an acute injury and can continue to reduce swelling
and pain through all three injury phases when used
appropriately.1-7
There are many uses for cryotherapy but there are also
several contraindications.1-7
Contraindications include
applying cryotherapy before extreme exercise and applying
cryotherapy to patients that may suffer from cold
allergies, arthritis, anesthetic skin and/or cardiovascular
disease.2-5
There are four common physiological effects of
cryotherapy:
vasoconstriction of the blood vessels,
decrease tissue hypoxia, decrease pain and decrease muscle
spasm.
Vasoconstriction is the ability of the blood vessel
to become narrow which leads to a decrease in swelling at
the injured site.2,4,5
Secondly, tissue hypoxia is the loss
of or a decreased amount of oxygen to the tissue site.4
This leads to a decrease in oxygen supply and metabolic
demands at the injury site.
If this is not treated
immediately it can lead to secondary tissue hypoxia.
Thirdly, cryotherapy can be used to decrease pain.1,4,5
Fourth, researchers believe that a decrease in muscle spasm
3
is caused by the decrease in responsiveness of muscle
spindles therefore, each individual responds differently to
muscle spasm.4,6
Research has shown various results for determining the
effects cryotherapy has on functional performance.
Most
studies show that cryotherapy does in fact have an effect
on functional performance, specifically the single-leg
vertical jump.7-14
For the following study the researcher is
specifically looking only at vertical jump results.
Richendollar et al. performed a study to examine the
effects of cryotherapy and warm-up on functional
performance.
Results showed that the vertical jump had a
decrease larger than one centimeter. The authors also found
that overall results for the vertical jump had improved
with the ice and warm-up group but not for the ice and no
warm-up group.8
Fischer et al. examined the effects of cryotherapy on
the shuttle run, co contraction and the single-leg vertical
jump.
Results for the single-leg vertical jump had
decreased significantly after the ten minute cryotherapy
application.
The authors determined that the amount of
time the cryotherapy has been applied and immediate
functional activity are closely correlated.9
4
Cross et al. examined cryotherapy on the shuttle run,
six meter hop and single-leg vertical jump.
Results
determined that the single-leg vertical jump significantly
decreased with the application of cryotherapy.
Patterson et al. examined the effects of cryotherapy
on the vertical jump, 40 yard sprint, t-test and active
range of motion.
Results showed that mean vertical jump
scores were significantly lower than pretest scores and
average power was significantly lower than pretest scores.11
Kinzey et al. examined the effect of cryotherapy on
the vertical jump, specifically the vertical jump impulse,
peak vertical ground reaction force and average vertical
ground reaction.
Results showed that vertical impulse and
peak vertical ground-reaction force had decreased and the
average vertical ground-reaction force was not changed.12
Jameson et al. performed a study to examine the
effects of cryotherapy and vertical ground reaction force.
Results showed that there were no significant differences
between pretest and posttest results within each group.13
Hart et al. examined the effects of cryotherapy on the knee
and the single leg vertical jump.
The authors found no
significant changes in ground reaction force, range of
motion and muscle activity.14
Jameson et al. and Hart et
al. both found no significant differences between pretest
5
and posttest results.
Both studies would suggest that
cryotherapy does not have an effect on functional
performance, specifically the vertical jump.13,14
Five out of the seven studies found an effect which
cryotherapy had on the vertical jump.8-14
Further research
is warranted to determine a more definitive conclusion.
This information will allow certified athletic trainers to
make a more informed decision in regards to return to play
following the application of cryotherapy.
6
METHODS
The purpose of the study is to determine if
cryotherapy had an effect on functional performance over
time as measured by the single-leg vertical jump.
The
following is included in the discussion of the methods:
(1) research design, (2) subjects, (3) preliminary
research, (4) instruments, (5) procedures, (6) hypotheses
and (7) data analysis
Research Design
The type of experiment was a quasi-experimental,
within subjects, repeated measures design.
The first
independent variable in the experiment was the treatment
condition with two levels.
The first level of the
treatment condition was to apply cryotherapy to the
anteriolateral aspect of the ankle.
The second level was
to not apply cryotherapy to the anteriolateral aspect of
the ankle.
conditions.
Subjects were asked to perform under both
7
The second independent variable in the experiment
examined the effect of the passage of time on performance.
Performance was measured at five time periods in this
study.
The first level of time was the pretest, second was
the posttest, third was five minutes after the posttest,
fourth was ten minutes after the posttest and fifth was
twenty minutes after the posttest.
The dependent variable
was the maximal peak force (maximal height) generated
during a series of five single-leg vertical jumps on the
force platform.
Subjects
The subjects that volunteered were 14 healthy,
physically active individuals.
Haskell et al. recommends
performing aerobic activity for either five days per week
at moderate intensity for thirty minutes or three days a
week at hard intensity for twenty minutes to maintain
proper health.15
Haskell et al. also recommends resistance
training two days a week to maintain proper health.15
For
the purpose of this study, physically active individuals
are defined as being active three times a week for twenty
minutes or more.
Being active included cardiovascular
exercise and/or strength training three or more times a
8
week.
All individuals participating were screened for
previous conditions such as lower extremity injury, head
injury/concussion, neurological disorders, cold allergies,
Raynaud’s, poor circulation, diminished sensations, slow
healing wounds, arthritis and any other condition relating
to the application of cold.
The subjects were a
combination of 5 male and 9 females.
The study was approved by the Institutional Review
Board (IRB) at California University of Pennsylvania
(Appendix C1) prior to the collection of data.
All
subjects that were involved in the study signed an approved
Informed Consent Form prior to the study.
All information
on the subjects was kept confidential.
Preliminary Research
A pilot study was performed on one subject, whom also
performed in the study, for the researcher to become
familiar with the use of the force platform and the amount
of time needed to perform the treatments and the single-leg
vertical jumps.
The pilot results showed there was a need
for change to the methods.
Due to the time allotted the
researcher had to limit the study to only two cryotherapy
conditions (cryotherapy and no cryotherapy).
The
9
researcher also made the decision to only have five timing
conditions (pre-test, posttest, five minute posttest, ten
minute posttest and twenty minute posttest) and eliminating
thirty minute posttest due to the findings of the
preliminary testing.
Instruments
Instruments that were used in the experiment included
a demographic form (Appendix C2), AMTI 6-7 force platform
(AMTI Force Plate and Amplifier, Advanced Technology, Inc)
to measure peak force during the single-leg vertical jump,
ice bags, compression wraps to apply the ice and the
stationary bicycle.
Demographic Form
The information that was gathered on the demographic
sheet included age, year of school, gender, previous lower
extremity injury, head injury/concussion, neurological or
cardiovascular disorders, contraindications of ice and
cryotherapy disorders, that the subject may react
negatively towards with the application of cryotherapy.
All individuals were screened prior to the study with the
researcher present.
10
Force Platform
The force platform, also known as the force plate, was
used to measure peak force (power) of the subject’s
individual single-leg vertical jump.
For this study the
AMTI 6-7 (AMTI Force Plate and Amplifier, Advanced
Technology, Inc) was utilized.
The force platform was
connected to a detector-transducer which detects the
subject’s maximal peak force during a jump.
It then
converts the force to an electrical signal which is
comparative to the individual’s maximal peak force. The
signal is then interpreted by the AMTI Netforce data
software as a maximal force number.
The number was then
analyzed by the AMTI Bioanalysis software for extraction of
the dependent variable, peak force.16,17
Peak force is also known as ground reaction force or
force impulse.
For the purpose of this study the
researcher used the term peak force.
Peak force is the
measure of maximal force production of an individual’s
contact with the force platform.
In simple terms, the
individual jumped and the force platform measured the
amount of maximal force as the individual lands on the
force platform.
jump height.
Basically, peak force measures maximal
The peak force number is the number the
11
researcher used to determine if there is a significant
difference with cryotherapy and timing variables.16,17
Cryotherapy Treatment
The cryotherapy treatment included an ice bag placed
directly on the skin for twenty minutes.
The ice used was
cubed ice and the bag and ice weighed approximately two
pounds.
The ice was placed on the anteriolateral aspect of
the ankle.
The ice bag was wrapped on the anteriolateral
aspect of the ankle with a compression wrap.
Stationary Bicycle
The warm-up consists of five consecutive minutes on
the stationary bicycle at a comfortable tempo for the
subject.
The bike seat was set at an appropriate position
for each individual.
Appropriate shoe wear and workout
entire were suggested to the subjects.
Procedures
The first day the subjects reported to complete the
demographic form and signed the IRB approved informed
consent form.
At this time subjects also had the
procedures explained and had an opportunity to perform
12
practice jumps on the force platform. Each subject was
required to come in twice to perform the study, one time
under each treatment condition.
Once the informed consent
form was completed and the procedures had been explained,
the subject bicycled for five consecutive minutes for warmup.
The subjects performed five pretest single-leg
vertical jumps on the force platform.
After the pretest
the subjects participated in either the cryotherapy
condition or no cryotherapy condition. The subjects with
the cryotherapy condition sat with an ice bag over the
anteriolateral aspect of the dominant ankle for twenty
minutes.
The subjects with no cryotherapy condition sat
for twenty minutes.
Immediately after the twenty minutes,
(cryotherapy or no cryotherapy) the subjects performed five
posttest single-leg vertical jumps.
The subjects again sat
and were retested with five single-leg vertical jumps five
minutes, ten minutes and twenty minutes after removal of
cryotherapy (posttest).
Single-leg Vertical Jump
Each time subjects were to perform the single-leg
vertical jumps the following procedures were utilized.
One
set of single-leg vertical jumps consisted of five
individual single-leg vertical jumps.
There were five sets
13
of single-leg vertical jumps.
The first set was the
pretest, second set was posttest, third set was five
minutes after posttest, fourth set was ten minutes after
posttest and fifth set was twenty minutes after posttest.
Each set consisted of five individual single-leg vertical
jumps.
The best peak force was chosen from each series of
five individual single-leg vertical jumps.
The subject was instructed to start and land on the
dominant leg.
The contralateral leg was placed at ninety
degrees to prevent contact with the force platform.
Countermovement of the lower extremity was permitted:
dorsiflexion of the ankle, flexion of the knee and hip.
Countermovement of the upper extremity was not permitted.
Arms were crossed across each subject’s chest or hands were
placed on the subject’s hips to prevent an increase of peak
force. The subject was instructed to jump when verbally
cued.
Between each of the five individual vertical jumps
approximately five seconds of rest was given to each
participant.
The subject was instructed to “stick” the
landing or results would not be included in the study.
subject was instructed to sit when not performing.
The
14
Hypothesis
The following hypothesis is suggested by the
researcher prior to the study.
Hypothesis:
There will be a difference in peak force
production during a single-leg vertical jump depending on
cryotherapy condition and timing of the test.
Data Analysis
All data was analyzed by the SPSS version 17.
Data
was analyzed to determine if cryotherapy and timing had an
effect on the single-leg vertical jump.
The research
hypothesis was analyzed using 2 × 5 repeated measures
factorial analysis of variance (ANOVA).
An alpha level of
.05 was set a priori to determine statistical significance.
15
RESULTS
The purpose of the study was to determine if
cryotherapy and the passage of time has an effect on
functional performance measured by the single-leg vertical
jump.
The single-leg vertical jump was tested on the force
platform to analyze peak force.
includes:
The following section
demographic information, hypothesis testing and
additional information.
Demographic Data
Fourteen physically active California University of
Pennsylvania students with a mean age of
participated in the study.
+
21.8 years
Subjects completed a
demographic form with information including age, year of
school, dominant leg, injury history, head
injury/concussion, neurological disorder, cryotherapy use,
cold allergies and contraindications.
The volunteered
subjects included 5 males and 9 females.
The subjects
included 7 graduate students, 2 senior undergraduate
students, 3 junior undergraduate students and 2 sophomore
undergraduate students.
All but one subject was right leg
16
dominant.
All participants were without neurological
disorders, cold allergies, were symptom free from head
injury/concussion for more than a year and were symptom
free from lower extremity injury for at least four months.
The demographic information and the IRB approved consent
form was completed before each study was started.
Hypothesis Testing
The following hypothesis was tested in the study.
The
hypothesis was tested with the significance level set at α
≤ 0.05.
A 2 × 5 repeated measures Factorial Analysis of
Variance was used to analyze the hypothesis.
Hypothesis 1:
There will be a difference in peak
force production during a single-leg vertical jump
depending on cryotherapy condition and timing of the test.
Conclusion: Hypothesis 1 was not supported.
Mean and
standard deviation of peak force production under the
various conditions can be found in Table 1. Cryotherapy
condition did not affect peak force production during a
single-leg vertical jump (F(1,13) = .039, p=.847).
Timing
also did not affect peak force production during a singleleg vertical jump (F(4,52) = .851, p=.500).
Finally, there
17
was no interactive effect between cryotherapy condition and
timing (F(4,52) = .989, p=.422).
Table 1.
Peak force scores dependant on cryotherapy
condition and time of test
Cryotherapy
Time
No Cryotherapy
Mean (N)
SD
Mean (N)
SD
Pre test
3449N
1566.5
3218N
1334.4
Post test
3053N
1555.0
3117N
1487.7
5
min
3223N
1506.4
3429N
1577.5
10 min
3332N
1342.2
3236N
1624.3
20 min
2928N
1559.5
3270N
1481.7
Table 2.
ANOVA Results for Main Effects and Interaction
between Cryotherapy and Time Conditions
Factor
df
df(error)
F
P
Cryotherapy
1
13
.039
.847
Time
4
52
.851
.5
Cryo. X Time
4
52
.989
.422
18
Additional Findings
An additional ANOVA was done to examine the
interaction between cryotherapy, timing and gender.
additional ANOVA was done to examine the interaction
An
between cryotherapy, timing and dominant leg.
No
significant differences were present in the findings.
19
DISCUSSION
The general purpose of this study was to determine if
cryotherapy had an effect on the single-leg vertical jump.
In addition, the effect of re-warming was also examined.
The following section is divided into three subsections:
Discussion of Results, Conclusions and Recommendations.
Discussion of Results
The single-leg vertical jump was performed on the AMTI
force platform to measure peak force.
Fourteen physically
active college students volunteered to perform in the
study.
The study entailed a warm-up on the stationary
bicycle for five minutes, followed by performing five
single-leg vertical jumps at five different time intervals.
This study demonstrated that cryotherapy does not have
an effect on the single-leg vertical jump.
The
researcher’s original hypothesis was that there would be a
difference in peak force production during a single-leg
vertical jump depending on cryotherapy treatment and time.
It was hypothesized that there would be a decrease of force
produced immediately following cryotherapy treatment with a
20
gradual increase over time.
the hypothesis.
The results did not support
The mean test scores for peak force
dependant upon cryotherapy condition can be found in Table
1. There was no significant difference between cryotherapy
treatment.
This shows that the application of cryotherapy
over the anteriolateral aspect of the ankle did not cause a
decrease or increase in performance for the single-leg
vertical jump.
The mean test scores for peak force dependant upon
timing of test can be found in Table 1. There was no
significant difference between timing condition.
This
shows that over a period of time there was no increase or
decrease in performance with either treatment condition for
the single-leg vertical jump, regardless of test time.
The results in this study were different from results
in several other studies.
A table summarizing the results
of previous research can be found in Appendix C5.
For
example, Richendollar et al. examined the effects of
cryotherapy on the vertical jump, forty yard dash and the
shuttle run.
The authors found that the vertical jump was
reduced greater than one centimeter.
Richendollar et al.
also found that overall results showed that the vertical
jump had improved with ice and warm-up group over ice and
no warm-up group.8
21
Fischer et al. performed a study to determine the
effects of cryotherapy on the single-leg vertical jump, co
contraction and shuttle run.
The results showed that the
single-leg vertical jumps were significantly lower after
the ten minute cryotherapy application and immediately
posttest.9
Cross et al. performed a study to examine cryotherapy
and the effect it had on the shuttle run, 6m hop and
single-leg vertical jump.
Cross et al. found that the
cryotherapy group(experimental) had decreased results in
the single-leg vertical jump.10
The resting group
(comparison) did not use cryotherapy and the single-leg
vertical jump results were unchanged.10
Patterson et al. studied the cold whirlpool and the
effects on the vertical jump, forty yard dash, t-test and
active range of motion.
Results for the vertical jump
showed that mean jump scores were all significantly lower
than pretest scores following cold whirlpool.
Average
power for the vertical jump was significantly lower than
pretest scores and peak power was also significantly lower
than pretest scores.11
Kinzey et al. studied the effects of cryotherapy on
vertical jump impulse, peak vertical ground reaction force
and average vertical ground reaction.
Kinzey et al. found
22
that vertical impulse had decreased in sets two and three
compared to sets four and five.
Peak vertical ground-
reaction force was greater in set two then four and five.
Average vertical ground-reaction force was not changed.12
Overall, results of the studies vary slightly but most
results show vertical jump results will decrease with the
application of cryotherapy.8-14
A few studies did agree with the present findings.
Jameson et al. studied the effect of crushed ice on a
specific joint and measured the effect it would have on
vertical ground reaction force.
Results showed no
significant differences between pretest and posttest
results within each group.13
Hart et al. performed a study
to examine the effects of cryotherapy on the knee and
vertical jump measurements.
Hart et al. also found results
which showed that there were no significant changes in
ground reaction force, range of motion and muscle activity.
14
There could be several reasons for discrepancies in
the studies.
First, one main difference was the type of
cryotherapy chosen to cool a specific area.
Cross et al,
Patterson et al. and Kinzey et al. used ice immersion as
the method of cooling a specific area.10,11,12
Fisher et al,
Richendollar et al, Hart et al. and Jameson et al. used
23
either cubed or crushed ice bag(s) as the method of cooling
a specific area.8,9,13,14
The second main difference was the
area chosen to apply the cryotherapy.
Cross et al. and
Patterson et al. chose the ice immersion for the lower
leg.10,11
Richendollar et al. and Fischer et al. chose an
ice bag placed on the thigh.8,9
Hart et al. specifically
chose an ice bag covering the anterior, lateral and medial
aspect of the knee.14
Jameson et al. chose an ice bag
placed on the ankle and/or knee.13
immersion of the leg.12
Kinzey et al. chose ice
The third main difference was the
amount of time the cryotherapy was on a specific joint.
Richendollar et al, Cross et al, Patterson et al, Kinzey et
al, Jameson et al. and Hart et al.
choose to apply the
cryotherapy treatment to a specific area for twenty
minutes.8,10-14
Fisher et al. chose to apply the cryotherapy
treatment to a specific area for only three and ten
minutes.9
These three differences could be why results
slightly differed between the researcher’s study and other
studies.
Conclusions
The significance of these results would allow
professionals that may use cryotherapy on a regular basis
24
to feel comfortable with that decision without
repercussions on performance.
The results of this study
have shown that there were no negative effects on the
single-leg vertical jump with the cryotherapy condition and
lapse of time.
Results were slightly varied between the
cryotherapy application, no cryotherapy and time factor but
no significant differences were found.
There have been several different studies on
functional performance, specifically the vertical jump.
Most studies indicate that cryotherapy can have a negative
effect on the vertical jump and other functional
performances.
Therefore, by this study alone it does not
indicate that an athlete should return to play right after
the application of ice.
It is recommended that further
research is needed.
Recommendations
The results of this study demonstrate that cryotherapy
did not have a negative effect of the single-leg vertical
jump.
There still is insufficient evidence to conclusively
rule out an effect of cryotherapy on performance.
However,
most studies would disagree with the findings in this study
and have found that cryotherapy does have a negative effect
25
on functional performance.
It is very important that
Athletic Trainers take the time to analyze the athlete’s
injury, the use of cryotherapy and when the proper time is
to return the athlete to play after the use of this
modality.
It is recommended that the Athletic Trainer
recommend a warm-up or time to pass before the athlete
immediately returns to play.
Further research in this area
is warranted to have a more definitive answer.
26
REFERENCES
1.
Nadler S, Weingand K, Kruse R. The Physiologic Basis
and Clinical Applications of Cryotherapy and
Thermotherapy for the Pain Practitioner. Pain
Physician. 2004;7:395-399.
2.
Swenson C, Sward L, Karlsson J. Cryotherapy in sports
medicine. Scand J Med Sci Sports. 1996;6(4):193200.
3.
McMaster WC. A literary review on ice therapy in
injuries. Am J Sports Med. 1977; 5(3):124-126.
4.
Ciolek J. Cryotherapy: Review of physiological
effects and clinical application. Cleveland Clin Q.
1985;52(2):193-201.
5.
Meeusen R, Lievens P. The use of cryotherapy in
sports injuries. Sports Med. 1986;3(6):398-414.
6.
Kowal MA. Review of physiological effects of
cryotherapy. J Orthop Sports Phys Ther.
1983;5(2):66-73.
7.
Knight K. Cryotherapy in Sport Injury Management.
Illinois. Human Kinetics. 1995.
8.
Richendollar M, Darby L, Brown T.
Ice bag
application, active warm-up, and 3 measures of
maximal functional performance. J Athl Train.
2006;41(4):364-370.
9.
Fischer J, Branch, Van Lunen B, Branch D. J.D Pirone.
Functional performance following an ice bag
application to the hamstrings. J Strength Condition
Res. 2009;23(1):44-50.
10. Cross KM, Perrin DH, Wilson RW. Functional
performance following an ice immersion to the lower
extremity. J Athl Train. 1996; 31(2): 113-116.
27
11. Patterson S, Udermann B, Doberstein S, Reineke D. The
effects of cold whirlpool on power, speed, agility
and range of motion. J Sports Sci Med. 2008;7:387394.
12. Kinzey SJ, Cordova ML, Gallen KJ, Smith JC, Moore JB.
The effects of cryotherapy on ground reaction forces
produced during a functional task. J Sport Rehabil.
2000;9:3-14.
13. Jameson A, Kinzey S, Hallam JS.
Lower ExtremityJoint-Cryotherapy does not affect Vertical Ground
Reaction Forces During Landing. J Sport Rehabil.
2001;10: 132-142.
14. Hart JM, Ingersoll CD, Leonard JL. Single-leg
landing strategy after knee-joint cryotherapy.
Sport Rehabil. 2005;14:313-320.
J
15. Haskell W, Pate R, Powell K, Blair S, Franklin B,
Macera C, Heath G, Thompson P, Bauman A. Physical
activity and public health: updated recommendation
for adults from the American College of Sports
Medicine and the American Heart Association. Med Sci
Sports Ex. 2007;1423-1434.
16. Cronin J, Hing R, McNair P. Reliability and validity
of a linear position transducer for measuring jump
performance. J Strength Condition Res.
2004;18(3):590-593.
17. Barlett R. Introduction to Sports Biomechanics.
Oxfordshire. Spon Press: Taylor & Francis Ltd. 1997.
28
APPENDICES
29
APPENDIX A
Review of Literature
30
REVIEW OF LITERATURE
The ankle is one of the most commonly injured
joints.16-20
The study was performed because cryotherapy is
most commonly used for ankle injuries.
Specifically,
cryotherapy is used most commonly for the lateral aspect of
the ankle.1-7
It is a small, complex joint with many
anatomy components, including musculoskeletal, ligaments
and neurovascular components.
Anatomy of the Ankle
Musculoskeletal Anatomy
The lateral aspect of the ankle includes the fibula
which contains three borders, the interosseous border,
anterior and posterior border.
The fibula also contains
three surfaces, medial surface, lateral surface and
posterior surface.
The distal end of the fibula forms the
lateral malleolus.7
The two muscles located in the lateral compartment are
the fibularis longus and the fibularis brevis.
The
fibularis longus originates on the upper aspect of the
fibula, head of the fibula and the tibial condyle.
It
inserts into the lateral aspect and distal end of the
31
medial cuneiform and the base of the first metatarsal.
is innervated by the superficial fibular nerve.
It
As the
function, the fibularis longus performs eversion and
plantarflexion of the foot and also helps to support the
arches.
The fibularis brevis originates on the lower
lateral shaft of the fibula.
It inserts into the lateral
tubercle at the base of the fifth metatarsal.
It is
innervated by the superficial fibular nerve.
As the
function, the fibularis brevis performs eversion of the
foot.7
The lateral ligament is made of three ligaments, the
anterior talofibular ligament, the posterior talofibular
ligament and the calcaneofibular ligament.
The anterior
talofibular ligament is from the anterior aspect of the
lateral malleolus to the talus.
The posterior talofibular
ligament is from the lateral malleolus to the posterior
aspect of the talus.
The calcaneofibular ligament is from
the lateral malleolus to the lateral aspect of the
calcaneus.7
Neurological Anatomy
The main nerve in the lateral compartment of the ankle
is the superficial fibular nerve.
The sciatic nerve begins
in the posterior compartment of the upper thigh and then
32
becomes the common fibular nerve.
then divides into two branches.
The common fibular nerve
The one branch is the
superficial fibular nerve and the second is the deep
fibular nerve.7
Indications of Cryotherapy
Nadler et al. defined cryotherapy “as the therapeutic
application of any substance to the body that removes heat
from the body, resulting in decreased tissue temperature.”8
Cryotherapy is one of the most widely used modalities in
athletic training and can be used for various reasons.1-29
Cryotherapy is and can be used in all three phases of the
injury process after the trauma has occurred, including the
acute phase, repair phase and remodeling phase.9
The acute
phase of inflammation is from the point of injury or trauma
to about forty eight hours after the injury.9
The acute
phase is especially vital for the fact that time is of the
essence.8-14
Studies have shown that the quicker the ice has
been applied the faster the recovery process tends to be.10
Hocutt et al. performed a study which involved eighteen
patients that had second-degree ankle sprains and nineteen
patients with greater than second degree ankle sprains.
Each patient was chosen for one of three groups.
The first
33
group was the early cryotherapy group (immediately after
injury), the second group was the late cryotherapy group
(36 hours after injury), the third group was the early
thermotherapy group.
Patients in the early cryotherapy
group were twice as effective as the late cryotherapy
group.
Both early and late cryotherapy was more effective
than the thermotherapy group.10
The repair phase immediately follows the acute phase
and can last from 48 hours to approximately six weeks after
the initial injury.
the recovery process.
The repair phase is a crucial step in
This is the stage where the athlete
gradually starts a rehabilitation program consisting of
range of motion (ROM) exercises as well as strengthening
the injured area.
The combined use of ROM and
strengthening exercises with ice is also known as
cryokinetics.
Cryokinetics allows for an increase in blood
flow and allows for remodeling and re-organization of
collagen.
Last is the remodeling phase which usually
starts around three to six weeks and can last up to twelve
months depending on the severity of the injury.9
34
The Use of Cryotherapy
The most common and main reasons why healthcare
providers take advantage of the use of cryotherapy are to
help decrease swelling and pain at the injury site.8-14
Cryotherapy reduces swelling after an acute injury and can
continue to reduce swelling and pain through all three
phases when used appropriately.8-14
By reducing the amount
of swelling at the injury site, the process of secondary
tissue hypoxia can be reduced and help to reduce
rehabilitation time.12
Cryotherapy not only aids with swelling and pain but
can also help to reduce muscle spasms, cramps and helps to
relieve pain when medications are injected to a specific
site.9,10
Cryotherapy also aids in orthopaedic surgery,
cryosurgery and the rehabilitation process.10
Cryotherapy can be used for both acute and chronic
conditions.
Acute injuries are classified as fractures,
sprains, strains and inflammatory injuries.9
Chronic
injuries that warrant the use of cryotherapy are bursitis,
tendonitis, muscle spasms, trigger points and
osteomyelitis.8-10
35
Contraindications
Cryotherapy is one of the most widely and commonly
accepted modalities because there are very few
contraindications.
Contraindications include applying
cryotherapy before extreme exercise or activities and
applying cryotherapy to patients that may suffer from cold
allergies, arthritis, anesthetic skin and/or cardiovascular
disease.9-13
It is also debated about the time that ice
should be left on an injured area due to damage that may
occur.
If the application of cryotherapy has been left on
the injured site for an extended amount of time the patient
may experience frost-bite or nerve palsy.9
Cryotherapy is a
common modality but like any other modality precautions
must be taken.8-14
Physiological Effects of Cryotherapy
There are four common physiological effects of
cryotherapy, the first being the vasoconstriction of the
blood vessels to decrease swelling and inflammation, the
second is to decrease tissue hypoxia, third is to decrease
pain and fourth is to decrease muscle spasm.12
36
The first physiological effect is vasoconstriction
which is the ability of the blood vessels to get narrower.
Vasoconstriction is the “first response for the superficial
blood vessels through an axon reflex arc that is a
projection of the peripheral autonomic system controlling
sympathetic vasoconstriction” after the trauma has
occurred.12
Vasoconstriction can also work through the
reflexes of the spinal cord.
After this process the cooled
blood then “returns to the general blood and activates the
posterior hypothalamus to help increase vasoconstriction.”12
This leads to a decrease in vascular permeability which
allows for the cell wall to draw in closer and it allows a
decrease in the amount of fluid that goes into the
extracellular spaces.
It also allows for an increase in
blood viscosity and a decrease in blood flow to the
specific injured area.
This entire process is called the
principal mechanism.12
The second physiological effect is a decrease in
tissue hypoxia.
After the initial injury there is a tissue
disturbance at the injury site.
Tissue hypoxia is the loss
of or a decreased amount of oxygen to the tissue site.
This leads to a decrease in oxygen supply and metabolic
demands at the injury site.
If this is not taken care of
immediately it can lead to secondary tissue hypoxia.12
37
Knight determined that when ice is immediately applied to
an individual with an injury there is less secondary
hypoxia and extravascular edema.12
The third physiological effect is a decrease in pain.
It is difficult to accurately measure pain in an objective
manner.
As healthcare providers, we can only measure pain
subjectively as to what the patient has described to us.
There has been no such study proving why there is a
decrease in pain when applying cryotherapy.
Many
hypotheses suggest it may be because of the decrease in
nerve conduction velocity.
Olson and Stravino found that
it is cold that produces a temporary numbness to the area
which then decreases nerve conduction.12
DeJesus et al.
found that cold does in fact produce a decrease in nerve
conduction but there are specific classes of fibers which
are more sensitive than other fibers.12
Lehmann and
DeLateur agreed that there are specific classes of fiber
and these specific fibers depend on myelination and
diameter to produce a decrease in nerve conduction
velocity.12
Most researchers believe there is a decrease in
nerve conduction but further studies need to be done in
this area to be completely accurate and understand why
there is a decrease in nerve conduction.
12
38
The last physiological effect is a decrease in muscle
spasm.
Researchers are lead to believe that a decrease in
muscle spasm is caused by the decrease in responsiveness of
muscle spindles.
Researchers have also found that each
individual responds differently to the response of spasm
and cryotherapy.
A few studies show that some individuals
did not feel relief after the use of cryotherapy.
Further
research is needed to be done in this area.12,14
Temperature
Cryotherapy is a common modality used to rapidly
reduce temperature.15-19 There is still much debate on how
temperature affects functional performance.
Feretti et al.
found that temperature influences both anaerobic and
aerobic power.
The reduction in temperature may cause a
change in rate of adenosine triphosphate (ATP) hydrolysis
and/or synthesis.
Therefore, it is hypothesized that a
decrease in anaerobic power is related to the decrease in
temperature as well as a decrease in ATP hydrolysis.15
Bender et al. studied the superficial and
intramuscular temperature of the triceps surae.
The
subjects first reported for a baseline temperature (pre
treatment) and then proceeded to treatment.
The treatment
39
consisted of the cryotherapy application, which was an ice
bag placed on the triceps surae for thirty minutes at rest
or an ice bag placed on the triceps surae for thirty
minutes while walking on the treadmill.
Results found that
superficial temperatures decreased over a period of time
with the resting group and treadmill walking group.
Results also found that intramuscular temperature had
decreased over a period of time in the resting group
compared with the treadmill walking group.16
Johnson et al. studied the intramuscular temperature
difference of the gastrocnemius in the cold whirlpool.
The
treatments consisted of baseline temperature (pre
treatment), treatment and recovery (post treatment).
The
treatment period consisted of submersion of the lower leg
into the cold whirlpool for thirty minutes.
Results showed
a significant decrease with intramuscular temperature in
the treatment leg compared to the contralateral leg.
After
four hours (post treatment) both lower legs had an overall
decrease in temperature compared to before the cryotherapy
treatment.17
Myrer et al. studied the intramuscular temperature on
the mid-belly of the gastrocnemius and two different
cryotherapy applications.
Myrer et al. chose to examine
two cryotherapy applications which were the crushed ice bag
40
and cold whirlpool.
The treatment consisted of either
crushed ice placed on the left gastrocnemius or the cold
whirlpool on the left gastrocnemius.
Results showed that
there were no significant differences in intramuscular
temperature.
There was a significant decrease in
subcutaneous temperature with the crushed ice group
compared to the cold whirlpool group.
The crushed ice
group also showed significantly more temperature re-warming
than the cold whirlpool group.18
Palmieri et al. studied the core temperature and
surface temperature of the anterior ankle and soleus.
The
procedures consisted of baseline temperatures, an ice bag
placed over the anterior aspect of the ankle and
temperature were assessed immediately, ten minutes, twenty
minutes of trial and ten and twenty minutes after the ice
bag was removed.
Results showed that there was no
significant change in core temperature with conditions and
time.
Results also showed that the ankle and soleus muscle
surface temperatures were different.19
Neurological Effects
Studies have found various neurological effects with
the use of cryotherapy. This paragraph will discuss the
41
various types of nerves and how the nerves react to
cryotherapy.
“Sensation can be divided into three categories:
superficial, deep and combined.”20
The superficial
sensation or superficial sensory nerves react with touch,
temperature and pain.
Deep sensation or deep sensory
nerves react with “muscle, joint position sense, deep
muscle pain and vibration sense.”20
There can also be a
combination between superficial sensory nerves and deep
sensory nerves.20
Ingersoll et al. performed a study to
analyze the effect sensory nerves had on three types of
neurological examinations.
Twenty one subjects had to
submerge the ankle in either hot or cold water for twenty
minutes.
After the subjects completed the twenty minutes
the three examinations were given, topagnosis, two-point
discrimination and postural balance.
Ingersoll et al.
found no significant difference between the three
neurological examinations.20
Research has also discovered that cold induced
sensations are carried by a variety of nerves to the brain.
The cold sensation is mediated by very small myelinated A
delta fibers but cold induced pain is mediated by small
unmyelinated polymodal nocieptors.
As temperature
decreases, as with the case of cryotherapy, the velocity of
42
the sensory nerve impulse transmission will decrease with
temperature.
As temperature decreases conduction will
slowly decrease until eventually it is blocked.
The
conduction will slowly decrease but sensory nerve action
potentials will increase in duration.
As the action
potentials increase this will also increase or extend
refractory periods.10
Denny-Brown et al. found that sensory nerve conduction
is blocked at temperatures below 10º Celsius.
Blocking of
the sensory nerves is considered to be time dependent.
Denny-Brown et al. determined that the longer the duration
of cryotherapy at a given temperature the greater the loss
of function for sensory nerves.10
Research has also shown
that with the use of cryotherapy applied to cold receptors
this can increase activity and transmission to the central
nervous system.
Applying cryotherapy to the sensory nerve,
which is carrying the impulse, decreases the transmission.10
Algafly et al. analyzed the effect of the decrease in
pain when cryotherapy is applied.
There are four main
reasons for a decrease in pain with application of
cryotherapy: “decrease in nerve conduction velocity,
inhibition of nociceptors, decrease in muscle spasms or
metabolic enzyme activity levels.”21
Algafly et al.
analyzed the effect of cryotherapy applied to the posterior
43
lateral aspect of the lateral malleolus, including the
tibial nerve.
Results found that “nerve conduction
velocity was decreased by seventeen percent at fifteen
degrees Celsius.”
21
Nerve conduction velocity decreased “by
thirty three percent at ten degrees Celsius.”21
Measuring the Vertical Jump
The vertical jump is one of the best measurements to
measure anaerobic power.
The vertical jump is a measure of
functional lower extremity strength and is one of the most
sport specific measurements.22 There are two versions of
the vertical jump: the one-legged or single-leg vertical
jump and the two-legged vertical jump.
For the purpose of
this study the focus is on the single-leg vertical jump.
The single-leg vertical jump mimics the movement which
creates similar stresses which are placed upon the body
during a sport.12,9
The single-leg vertical jump is also a
measurement for coordination, center of mass and
proprioception.
The two-legged vertical jump can be
defined as the individual’s “ability to perform daily
functions.”
22
44
Cryotherapy and the Effects on the Vertical Jump
Analyzing cryotherapy and functional performance is an
important aspect in athletic training.
It is important to
measure a specific aspect of functional performance such as
the vertical jump.
Richendollar et al. included twenty four physically
active men for the study.
measures design.
The study was a 2 × 2 repeated
Richendollar et al. divided the subjects
randomly into four separate groups.
The first group was
the control group which consisted of no ice and no warm-up.
The second group was the experimental group which consisted
of no ice and a warm-up.
The third group was the
experimental group which consisted of ice and no warm-up.
The fourth group was the experimental group which consisted
of ice and warm-up.
Three functional tests were performed
which included the single-leg vertical jump, the forty yard
dash and the shuttle run.
For the purpose of this specific
literature review the researcher is looking at the vertical
jump results.
Richendollar et al. found that the vertical
jump decreased greater than one centimeter after the use of
cryotherapy.
Richendollar et al. also found that overall
results showed that the single-leg vertical jump had
45
improved with ice and warm-up (fourth group) over ice and
no warm-up group (third group).23
Jameson et al. studied the effect of crushed ice on a
specific joint and measured the effect it would have on
vertical ground reaction force.
The study was a 2 × 4
repeated measures multivariate analysis of variance
(MANOVA).
The subjects included in the study were ten
physically active men.
separate groups.
Each subject was divided into four
The first group was the control group
which consisted of no ice.
ice on the ankle.
The second group consisted of
The third group consisted of ice on the
knee.
The fourth group consisted of ice on the ankle and
knee.
The second, third and fourth group had crushed ice
bags on both lower extremities and on the instructed
specific joints for twenty minutes.
The subjects were
allotted an orientation session which consisted of a trial
run through the actual icing and vertical jump.
The
testing session consisted of a pretest with five jumps each
with a minute of rest in-between.
The vertical jump was a
two-legged jump at ninety percent of the subject’s ability.
The researcher then instructed the second, third and fourth
group to ice the specific joint for twenty minutes.
After
icing, the subjects concluded with a posttest consisting of
five jumps each with a minute of rest in-between.
The
46
testing session was conducted for four consecutive days.
Results showed no significant differences between pretest
and posttest results within each group.24
Kinzey et al. studied the effects of cryotherapy on
vertical jump impulse, peak vertical ground reaction force
and average vertical ground reaction.
5 factorial repeated measures.
The study was a 1 ×
Kinzey et al. had fifteen
physically active subjects perform a total of twenty five
one-leg jumps on the subject’s preferred leg.
The subjects
first performed the first set of five one-leg vertical
jumps and then received a twenty minute cold whirlpool
treatment with the preferred leg.
The subjects were
instructed to be out of the whirlpool and ready to jump
within two minutes.
The subjects completed four sets of
five one-leg vertical jumps after the whirlpool session.
Kinzey et al. found that vertical impulse (VI) had
decreased in sets two and three compared to sets four and
five.
Peak vertical ground-reaction force (PVGRF) was
greater in set two then four and five.
Average vertical
ground-reaction force (AVGRF) was not changed.22
Patterson et al. performed a study analyzing the cold
whirlpool and the effects it would have on the counter
movement vertical jump, 40 yard sprint, t-test and active
range of motion.
The study was a repeated measures pre-
47
test-posttest design, including twenty one healthy
individuals.
The subjects first performed the pre-test and
were then instructed to place both lower extremities in the
cold whirlpool for twenty minutes. Each posttest was
performed at seven, twelve, seventeen, twenty two, twenty
seven and thirty minutes after the cryotherapy treatment.
Specifically, the results for the vertical jump were
measured by mean vertical jump, average power and peak
power. Mean vertical jump scores, average jump scores and
peak power scores were all significantly lower than pretest scores.25
Hart et al. performed a 1 × 4 repeated measures time
series to examine the effects of cryotherapy on the knee
and vertical jump measurements.
Twenty physically active
subjects volunteered to perform the study.
The subjects
performed five single-leg landings before the use of
cryotherapy.
The subjects were instructed to place an ice
bag on the anterior, lateral and medial aspect of the knee
(all but the posterior aspect of the knee) for twenty
minutes.
After the cryotherapy session the subjects
performed five single-leg landings.
The subjects then
performed five single-leg landings fifteen and thirty
minutes after the cryotherapy treatment.
Results showed
48
that there were no significant changes in ground reaction
force, range of motion and muscle activity.26
Cross et al.
performed a pre-test-posttest with an
untreated control group to find if cryotherapy had an
effect on the shuttle run, 6m hop and single-leg vertical
jump.
Twenty volunteers were randomly chosen for two
groups, the cryotherapy group or the rest group.
The
subjects were allowed one practice trial. The subjects were
instructed to do a pre-test of each functional activity.
The cryotherapy group was then instructed to put their
lower leg in the cold whirlpool for twenty minutes while
the other group rested with no cryotherapy.
Subjects
performed a posttest after the use or non-use (depending on
the group) of cryotherapy.
Cross et al. found that the
cryotherapy group(experimental) had decreased results in
the single-leg vertical jump.27
The resting group
(comparison) did not use cryotherapy and the single-leg
vertical jump results were not changed.27
Fischer et al. performed a study to determine the
effects of cryotherapy on the shuttle run, co contraction
time and single-leg vertical jump.
Twenty five women and
seventeen men volunteered for the study.
The study
included three separate groups; the no ice bag group, three
minute ice bag and the ten minute ice bag.
The study first
49
began with warm-up consisting of a five minute stationary
bicycle warm-up and a thirty second hamstring stretch.
The
subjects were then instructed to perform a pre-test for the
shuttle run, co contraction test and the single-leg
vertical jump.
The subjects were then randomly assigned to
a specific cryotherapy group.
After the cryotherapy
session the subjects performed a posttest and twenty
minutes posttest.
The results for the single-leg vertical
jump were significantly lower after the application of the
ten minute ice bag.
Overall, results showed to be
significant because of the interaction between the ice bag
time and trial session.28
In summary, cryotherapy seems to have an effect on
functional performance in most situations.
Cross,
Richendollar and Fischer et al. tend to think that the
“negative effects of cryotherapy on muscle contractions and
a decrease in nerve conduction velocity may explain the
immediate decrease in performance.”
23,27,28
Further research
is needed to determine the exact effects of cryotherapy on
the vertical jump.
50
Summary
In conclusion, it is exceptionally important to
understand the anatomy components of the ankle.
The ankle
is a complex structure and is a structure that is
frequently injured.
Since the ankle is commonly injured;
healthcare professionals most commonly use a form of
cryotherapy.
When using cryotherapy it is important to
take in consideration the physiological effects,
indications and contraindications.
Cryotherapy is widely used after functional activity and
sometimes used during functional activity.
There are
numerous studies found on the research of cryotherapy and
the effects of functional performance, specifically the
vertical jump.22-28
In conclusion, this study was performed
to analyze the effects of cryotherapy on the vertical jump
to determine when it is safe to return an athlete to
play.22-28
51
APPENDIX B
The Problem
52
THE PROBLEM
The purpose of the experiment is to examine the
effects of cryotherapy and the amount of time to determine
if it has an effect on functional performance, the singleleg vertical jump.
Most research shows that cryotherapy
does have an effect on the vertical jump.
The results can
better help determine when to return athletes to play after
cryotherapy treatment.
Definition of Terms
The following definition of terms will be defined for
this study:
1)
Cryotherapy- In this study, the use of cubed ice for
twenty minutes directly placed on the skin.
2)
Single-leg Vertical jump- In this study it is the
maximal height at which an individual can jump and
land on the dominant leg.
3)
Functional performance- In this study it is the
performance that is a functional activity, closely
related to a sport movement, such as the single-leg
vertical jump.
4)
Peak force- In this study it is maximal jump height
from a single-leg vertical jump.
53
5)
Physically active- In this study the subject performs
three days a week of cardiovascular or weight lifting
activity.
Basic Assumptions
The following are basic assumptions of this study:
1)
The subjects will complete the demographic information
sheet to the best of their knowledge and will not
forge any given information.
2)
The subjects will fully understand the instructions
and have performed the task correctly in the amount of
time.
3)
The subjects will perform to the best of their ability
during testing sessions.
Limitations of the Study
The following are possible limitations of the study:
1)
The subjects are limited to physically active
individuals at California University of PA and
therefore it will not be randomized.
2)
There may be a practice effect while performing the
vertical jump.
54
Significance of the Study
The significance of this study is to help certified
athletic trainers determine when it is best to return an
athlete back to play after the treatment of cryotherapy.
This is an important aspect to study because many athletic
trainers use cryotherapy before, during and/or after
athletic participation.
Knowing if cryotherapy can
decrease performance before an athlete participates in the
sport can affect when athletic trainers apply cryotherapy
to an athlete.
If there is a decrease or harmful effect to
applying cryotherapy we know to apply a warm-up or allow
time to pass before allowing an athlete to return to play
after the use of cryotherapy.
55
APPENDIX C
Additional Methods
56
APPENDIX C1
Informed Consent Form
57
Informed Consent Form
1. Christine Stache, who is a Graduate Athletic Training
Student at California University of Pennsylvania, has
requested my participation in a research study at
California University of Pennsylvania. The title of the
research is The Effect of Cryotherapy on the Single Leg
Vertical Jump
2. I have been informed that the purpose of this study is
to examine if cryotherapy, and warm-up has an effect on
functional performance measured by the single-leg vertical
jump. I understand that I must be 18 years of age or older
to participate. I understand that I have been asked to
participate along with the fact that I do not have a
previous medical history of cold allergies. arthritis,
anesthetic skin, Raynaud’s and/or any other cold related
illness. I may only participate if I do not have a
previous history of neurological or cardiovascular
disorders and I must be free from lower leg injury for at
least one year. (Sprains, strains, fractures,
dislocations, etc.)
3. I have been invited to participate in this research
project. My participation is voluntary and I can choose to
discontinue my participation at any time without penalty or
loss of benefits. My participation will involve…
For the purpose of this study, physically active
individuals will be needed and are defined as being active
three times a week for thirty minutes or more. Being
active included cardiovascular exercise and/or strength
training three or more times a week. The participant must
meet this requirement to be eligible for the study.
I will be required to fill out a demographic form. The
information on the demographic form includes age, gender,
lower extremity injury, contraindications of ice,
cryotherapy disorders, neurological and cardiovascular
disorders. This is to ensure I do have a previous medical
history that may predispose me to injury or further risk.
Any questions or concerns should be brought to the
researcher at this time.
The next step I will take is that the researcher will
explain what is included in the experiment and how the
experiment will be conducted. The first concept I should
58
understand is how to perform the single-leg vertical jump.
The subjects will have to perform five consecutive singleleg maximal vertical jumps for five, ten, twenty and thirty
minute periods. I will be instructed to start and land on
my dominant leg. The contralateral leg is placed at ninety
degrees to prevent contact with the force platform.
Countermovement of the lower extremity was permitted,
dorsiflexion of the ankle, flexion of the knee and hip.
Countermovement of the upper extremity was not permitted.
Arms were crossed across the chest to prevent an increase
of peak ground-reaction force. I will be instructed to
jump when verbally cued. Between each of the five vertical
jumps thirty seconds of rest will be given. I will be
instructed to sit in the chair which will be placed next to
the force platform when resting.
The second concept I should know and understand is how
the force platform works. The force platform, also known
as the force plate, was used to measure peak force of each
single-leg vertical jump. Peak force is the measure of
maximal force production of one’s (my) contact with the
force platform. In simple terms, I will jump and the force
platform will measure the amount of maximal force when I
land on the force platform. The detector-transducer will
then detect my maximal force and allows the force to turn
into an electrical signal which is proportional to my
maximal force.
The third concept I should know and understand is the
cryotherapy treatment. The cryotherapy treatment will
include an ice bag directly on the skin for twenty
minutes. The ice used that will be used is cubed ice and
the bag and ice will weigh approximately two pounds. The
ice will be placed on the anteriolateral aspect of the
ankle. The ice bag was wrapped on the anteriolateral
aspect of the ankle with an elastic bandage.
The fourth concept I should know and understand is the
warm-up procedure. The pre warm-up condition and warm-up
(treatment) followed by the cryotherapy treatment consists
of five consecutive minutes on the stationary bicycle at
eighty five to ninety repetitions per minute (RPM). The
bike seat has been set at an appropriate position.
Appropriate shoe wear and workout entire are strongly
suggested.
Last is the testing schedule. On testing days, I will
participate in the initial warm-up followed by five single-
59
leg pretest vertical jumps. The peak forces of the pretest
vertical jumps will be recorded followed by an application
of the treatment condition for twenty five minutes.
Treatment conditions consisted of twenty minutes of
cryotherapy followed by five minutes of rest, twenty
minutes of cryotherapy followed by five minutes of warm-up
on the stationary bike, or twenty five minutes of rest. I
will be asked to perform five single-leg vertical jumps
five, ten, twenty and thirty minutes after the five minutes
stationary bike warm-up. Peak force results will be
recorded for each single-leg vertical jump.
4. I understand there are foreseeable risks or discomforts
to me if I agree to participate in the study. With
participation in a research program such as this there is
always the potential for unforeseeable risks as well. The
possible risks and/or discomforts include possible ice
injury and/or injuries due to falling from loss of
balance. To minimize these risks I need to be completely
honest when filling out the demographic form. The
researcher will also stand by closely to help minimize
risks and to answer questions.
5. I understand that, in case of injury, I can expect to
receive treatment or care in Hamer Hall’s Athletic Training
Facility. This treatment will be provided by the
researcher, Christine Stache, under the supervision of the
CalU athletic training faculty, all of which can administer
emergency care. Additional services needed for prolonged
care will be referred to the attending staff at the Downey
Garofola Health Services located on campus.
6. There are no feasible alternative procedures available
for this study.
7. I understand that the possible benefits of my
participation in the research is to help Certified Athletic
Trainers to understand the effects of returning an athlete
to play after the use of cryotherapy.
8. I understand that the results of the research study may
be published but my name or identity will not be revealed.
Only aggregate data will be reported. In order to maintain
confidentially of my records, Christine Stache will
maintain all documents in a secure location on campus and
password protect all electronic files so that only the
student researcher and research advisor can access the
data. Each subject will be given a specific subject number
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to represent his or her name so as to protect the anonymity
of each subject.
9. I have been informed that I will not be compensated for
my participation.
10. I have been informed that any questions I have
concerning the research study or my participation in it,
before or after my consent, will be answered by:
Christine Stache, ATC
STUDENT/PRIMARY RESEARCHER
Sta1344@cup.edu
724-263-3359
Dr. Thomas F. West, PhD, ATC
RESEARCH ADVISOR
West_t@cup.edu
724-938-6033
11. I understand that written responses may be used in
quotations for publication but my identity will remain
anonymous.
12. I have read the above information and am electing to
participate in this study. The nature, demands, risks, and
benefits of the project have been explained to me. I
knowingly assume the risks involved, and understand that I
may withdraw my consent and discontinue participation at
any time without penalty or loss of benefit to myself. In
signing this consent form, I am not waiving any legal
claims, rights, or remedies. A copy of this consent form
will be given to me upon request.
13. This study has been approved by the California
University of Pennsylvania Institutional Review Board.
14. The IRB approval dates for this project are from:
02/01/10 to 02/01/11.
Subject's signature:___________________________________
Date:____________________
Witness signature:___________________________________
Date:____________________
61
APPENDIX C2
Institutional Review Board –
California University of Pennsylvania
62
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair
Christine Stache,
Please consider this email as official notification that your proposal titled “The
Effect of Cryotherapy on the Single Leg Vertical Jump” (Proposal #09-037)
has been approved by the California University of Pennsylvania Institutional
Review Board as amended.
The effective date of the approval is 2-26-2010 and the expiration date is 226-2011. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly regarding
any of the following:
(1) Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated
by any events reported in (2).
(4) To continue your research beyond the approval expiration date of 2-262011 you must file additional information to be considered for
continuing review. Please contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board
63
Proposal Number
Date Received
PROTOCOL for Research
Involving Human Subjects
Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human subjects
(Reference IRB Policies and Procedures for clarification)
Project Title The Effect of Cryotherapy on the Single Leg Vertical Jump
Researcher/Project Director
Christine Stache
Phone # 724-263-3359
E-mail Address sta1344@calu.edu
Faculty Sponsor (if required) Dr. Thomas West
Department Health Science
Project Dates January 1, 2010 to December 1, 2010
Sponsoring Agent (if applicable)
Project to be Conducted at California University of PA
Project Purpose:
Thesis
Research
Class Project
Keep a copy of this form for your records.
Other
64
Please attach a typed, detailed summary of your project AND complete items 2
through 6.
1. Provide an overview of your project-proposal describing what you plan to do and how you
will go about doing it. Include any hypothesis(ses)or research questions that might be
involved and explain how the information you gather will be analyzed. For a complete list of
what should be included in your summary, please refer to Appendix B of the IRB Policies and
Procedures Manual.
The purpose of the study is to determine if cryotherapy and warm-up has an effect on
functional performance measured by the single-leg vertical jump.
Research Design
The type of experiment is a quasi-experimental, within subjects, repeated measures
design. There are two independent variables, treatment condition (ice) and time. The first
level of the treatment condition is to apply cryotherapy to the subject's ankle, the second level
is to apply cryotherapy to the subject's ankle plus a five minute warm-up on the stationary
bike and the third level is not applying cyrotherapy to the ankle and there is no warm-up. The
second independent variable in the experiment is time, with six levels. The first level of time
is the pretest, second is the posttest, third is five minutes after the posttest, fourth is ten
minutes after the posttest, fifth is twenty minutes after the posttest and sixth is thirty minutes
after the posttest. The testing is described in more detail below. The dependant variable is
the peak force generated during a maximal vertical jump on the force platform.
Subjects
Approximately 20 healthy, physically active individuals will participate. Physically
active individuals are defined as being active three times a week. Being active includes
cardiovascular exercise and/or strength training three or more times a week. All individuals
will be screened for previous conditions such as cold allergies, Raynaud's and any other
condition relating to the application of cold. All individuals will be examined for lower leg
injuries as well. The subjects will be a mix of male and females.
On each of the testing days, each subject will perform an initial warm-up which will
consist of a five minute warm-up on the stationary bike. The warm-up will be followed by the
pretest which consists of five single-leg vertical jumps. After the pretest, subjects will (1)
have an ice bag applied to the anteriolateral aspect of the ankle for twenty minutes followed
by five minutes of rest, (2) have an ice bag applied to the anteriolateral aspect of the ankle for
twenty minutes followed by a five minute warm-up on the stationary bike or (3) have no ice
or warm-up applied and will remain seated for twenty five minutes. After the treatment
groups have been assigned the subjects will immediately perform the five maximal single-leg
vertical jumps. The subjects will also perform five maximal single-leg vertical jump five
minutes after posttest, ten minutes after posttest, and twenty minutes after posttest and thirty
minutes after posttest. The warm-up, treatment condition and the vertical jump will be
described in further detail in the procedure section. The order of the three treatments will be
assigned to subjects in a counter balanced order. The subjects will be given a two week
period to perform in all three treatment groups. All subjects will sign an approved Informed
Consent Form prior to the experiment. All information on the subjects will be kept
confidential.
Instruments
Instruments that will be used in the experiment are the demographic form, force platform
to measure peak force during the single-leg vertical jump, the ice bag and the stationary bike.
65
The information that will be gathered on the demographic sheet will include age, gender,
dominant leg, lower extremity injury, contraindications of ice, cryotherapy disorders,
neurological and/or cardiovascular disorders that the subject may react negatively towards
with the use of cryotherapy.
The force platform is located in Hamer Hall and it is located in the only classroom in the
pool area. The force platform blends with the floor in a safe location. It is not elevated or
inclined when the subjects are performing the single-leg vertical jump. All objects will be
removed from the surrounding force platform site. The force platform and the floor are not
wet, dirty or slippery and have no potential risk for injury. The subject will perform five
single-leg vertical jumps and after each jump I will ask if the subject feels fine to continue.
There is little to no potential risks for the subjects while using the force platform. The force
platform will be used to measure peak force of the subject’s individual single-leg vertical
jump. Peak force is the measure of maximal force production during a functional activity.
Specifically in this study I will measure the initial push-off the subject takes with the singleleg vertical jump. Each subject will be required to perform five maximal single-leg vertical
jumps for a total of six jump series. After the subject will perform the five single-leg vertical
jumps, the best jump out of the five jumps will be recorded. The subject will be performing
five single-leg vertical jumps for the pretest, post test and four additional time periods for a
total of six jump series.
The cryotherapy treatment will include an ice bag that will weigh approximately weigh
two and a half pounds with cubed ice. The subjects will have the ice bag placed directly on
the skin on the anteriolateral aspect of the ankle for twenty minutes. The ice bag will be
wrapped on the anteriolateral aspect of the ankle with an elastic bandage.
The stationary bike will be used for a pre-warm-up for all subjects in the experiment. The
subjects will also use the stationary bike for a warm-up after the cryotherapy treatment. The
warm-up will consists of five minutes on the stationary bike.
Procedures
The first day the subjects will report to complete the demographic form and informed
consent form. At this time subjects will have the methods explained and have an opportunity
to perform a trial run of the experiment. Days two, three and four consist of the actual
experiment. Sessions will be scheduled over a two week period. Again, all subjects will be
selected in a random order.
On testing days, all subjects will participate in the initial or pre-warm-up followed by the
pretest. The warm-up will be five minutes on the stationary bike. The pre-test will be five
maximal single-leg vertical jumps. The subjects are to jump when verbally cued. The
subject will be instructed to start and land on the dominant leg. The subjects will have ten
seconds in-between each jump. The subject is to hold the landing for five seconds. Subjects
will be required to sit when not being tested. The peak force of the pretest vertical jump will
then be recorded. Next, the subjects, depending on the subject's random selection, will
receive specific treatment condition protocol. Treatment conditions consist of (1) twenty
minutes of cryotherapy followed by five minutes of rest or (2) twenty minutes of cryotherapy
followed by five minutes of warm-up on the stationary bike, or (3) twenty five minutes of
rest. Each subject will have each treatment condition on an assigned day. After the treatment
condition, the subjects will then perform five single-leg maximal vertical jumps for the
posttest. The posttest will follow the same procedure as the pre-test. The subjects are to
jump when verbally cued. The subject will be instructed to start and land on the dominant
66
leg. The subjects will have ten seconds in-between each jump. The subject is to hold the
landing for five seconds. Subjects will be required to sit when not being tested. The peak
force of the posttest vertical jump will then be recorded. The subjects will be tested on the
five maximal single-leg vertical jump five minutes posttest, ten minutes posttest, twenty
minutes posttest and thirty minutes posttest. The five maximal single-leg vertical jump
protocols will be exactly the same as the five maximal single-leg vertical jump pre-test
protocol. The peak force will be recorded five minutes posttest, ten minutes posttest, twenty
minutes posttest and thirty minutes posttest. The best out of the five jumps will be recorded
for each jumping session.
The pre warm-up condition and warm-up followed by the cryotherapy treatment will
consist of five consecutive minutes on the stationary bicycle. The cryotherapy treatment
includes an ice bag applied directly on the skin for twenty minutes, a standard treatment
utilized in the practice of athletic training. Cubed ice will be utilized and the bag and ice will
weigh approximately two and a half pounds. The ice will be placed on the anteriolateral
aspect of the ankle. The ice bag will be wrapped on the anteriolateral aspect of the ankle with
an elastic bandage.
The pretest and all posttest vertical jumps consist of five single-leg maximal vertical
jumps. The subject will be instructed to start and land on the dominant leg. The contra
lateral leg will be placed at ninety degrees to prevent contact with the force platform.
Countermovement of the lower extremity will be permitted and countermovement of the
upper extremity is not permitted. Arms will be crossed across each subject’s chest to prevent
an increase of peak ground-reaction force. The subject will be instructed to jump when
verbally cued. Between each of the five vertical jumps 10 seconds of rest will be given to
each participant. The subject will be instructed to sit in the chair next to the force platform
when resting.
Hypothesis
The following hypothesis is suggested by the researcher prior to the study.
There will be a difference in peak force production during a single-leg vertical jump
depending on cryotherapy condition and timing of the test.
Data Analysis
All data will analyzed by the SPSS version 17 . Data was analyzed to determine if
cryotherapy and warm-up condition had an effect on vertical jump. The research hypothesis
was analyzed using 3 x 6 Repeated Measures Factorial Analysis of Variance. An alpha level
of .05 was set a priori to determine statistical significance.
2. Section 46.11 of the Federal Regulations state that research proposals involving human
subjects must satisfy certain requirements before the IRB can grant approval. You should
describe in detail how the following requirements will be satisfied. Be sure to address each
area separately.
a. How will you insure that any risks to subjects are minimized? If there are potential
risks, describe what will be done to minimize these risks. If there are risks, describe
why the risks to participants are reasonable in relation to the anticipated benefits.
Before the study is performed the subjects are required to fill out a demographic
form. The demographic form will include health related questions pertaining to the
lower leg and cryotherapy. The demographic form will help to determine which
67
subjects will be able to perform the study with minimal risk. Subjects may also have
the potential to injure the lower extremity from the single-leg vertical jump. The
risks for the subjects are extremely low and unlikely but possible. If injury were to
occur, the subjects will be under the supervision of the researcher and will treat the
subjects to the appropriate medical care as needed. The researcher is (myself) is a
Certified Athletic Trainer. I am qualified to assist a volunteer when medical help is
needed while doing the vertical jump.
The subjects will perform the vertical jumps on a force platform. It is located in
Hamer Hall which it is located in the only classroom in the pool area. The force
platform blends with the floor in a safe location. It is not elevated or inclined when
the subjects are performing the single-leg vertical jump. All objects will be removed
from the surrounding force platform site. The force platform and the floor are not
wet, dirty or slippery and have no potential risk for injury. The subject will perform
five single leg vertical jumps and after each jump I will ask if the subject feels fine to
continue. There is little to no potential risks for the subjects while using the force
platform. If a possible injury does occur I am a Certified Athletic Trainer and I am
certified to assist the subject in his/her medical needs. I am trained and certified in
First Aid and Cardiopulmonary Resuscitation (CPR). I also know where the Athletic
Training room is and where needed supplies are as well as I also know where the
Automated External Deliberators (AED) are located if needed.
b. How will you insure that the selection of subjects is equitable? Take into account
your purpose(s). Be sure you address research problems involving vulnerable
populations such as children, prisoners, pregnant women, mentally disabled persons,
and economically or educationally disadvantaged persons. If this is an in-class
project describe how you will minimize the possibility that students will feel coerced.
The subjects that will volunteer are approximately 20 healthy, physically active
individuals. Volunteers will be recruited from the CalU Health Science and Exercise
Science and Sport Studies populations. Children, prisoner, pregnant women,
mentally disabled persons, and economically or educationally disadvantaged persons
will not be included in the study. This is also not an in-class assignment and by no
means will students feel coerced. Any participant may withdraw from the study at
any time without any loss.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately
documented? Be sure to attach a copy of your consent form to the project summary.
The subjects will report to complete the informed consent form and demographic
form on the first day. At this time subjects also will have the directions explained
and will be allowed to ask questions about their participation. They also will have an
opportunity to perform a trial run of the experiment. The subjects will not be allowed
to perform in the study unless all required data (informed consent form and
demographic form) have been completed. All informed consent forms and
demographic forms will be kept strictly confidential and locked in a file cabinet.
68
d. Show that the research plan makes provisions to monitor the data collected to insure
the safety of all subjects. This includes the privacy of subjects’ responses and
provisions for maintaining the security and confidentiality of the data.
All material and data are strictly confident and will be locked in a file cabinet in the
Graduate Athletic Training Program Directors office. This will ensure the privacy
rights of all subjects included in the trial. Only approved members of the study will
be able to access the data.
3. Check the appropriate box(es) that describe the subjects you plan to use.
Adult volunteers
Mentally Disabled People
CAL University Students
Economically Disadvantaged People
Other Students
Educationally Disadvantaged People
Prisoners
Fetuses or fetal material
Pregnant Women
Children Under 18
Physically Handicapped People
Neonates
4. Is remuneration involved in your project?
5. Is this project part of a grant?
Yes or
Yes or
No
No. If yes, Explain here.
If yes, provide the following information:
Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.
Does your project involve the debriefing of those who participated?
Yes or
No
If Yes, explain the debriefing process here.
7. If your project involves a questionnaire interview, ensure that it meets the requirements of
Appendix
in the Policies and Procedures Manual.
69
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the remainder
of this form
Does your survey/interview/questionnaire cover letter or explanatory statement include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?
70
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or
explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?
71
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the “Survey/Interview/Questionnaire
Consent Checklist” instead.
NO—Complete the remainder of this form.
1.
Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without penalty or loss of
benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of action are available
should there be some physical, emotional, or psychological harm?
(4.6) Is there a description of the benefits, if any, to the participant or to others that may be
reasonably expected from the research and an estimate of the likelihood of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of treatment that
might be advantageous to the participant?
5. Records and documentation. (check each)
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a secure location?
(5.3) Is there a statement as to who will have access to the records?
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other medical or counseling
treatments that are available if the participants are injured through participation?
(6.2) Is there a statement where further information can be obtained regarding the treatments?
(6.3) Is there information regarding who to contact in the event of research-related injury?
7. Contacts.(check each)
72
(7.1) Is the participant given a list of contacts for answers to questions about the research and the
participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision whether or not to
participate, and that his/her signature indicates that he/she has decided to participate having read and
discussed the information in the informed consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of Pennsylvania
Institutional Review Board. This approval is effective nn/nn/nn and expires mm/mm/mm”? (the actual
dates will be specified in the approval notice from the IRB)
9. Specific Considerations (check as appropriate)
(9.1) If the participant is or may become pregnant is there a statement that the particular treatment
or procedure may involve risks, foreseeable or currently unforeseeable, to the participant or to the
embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation may be terminated
by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for orderly
termination spelled out?
(9.5) Is there a statement that the Principal Investigator will inform the participant or any
significant new findings developed during the research that may affect them and influence their
willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must sign the consent
form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the parent/guardian is giving
permission for their child to participate?
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse to participate or
discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended participant can
understand? (generally, 8th grade level for adults, age-appropriate for children)
73
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email
address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your
faculty research advisor
(1.2) Project dates (must be in the future—no studies will be approved
which have already begun or scheduled to begin before final IRB approval—
NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through
2d?
2a: NOTE: No studies can have zero risk, the lowest risk is
“minimal risk”. If more than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes
due to these risks.
iv. Cite peer reviewed references in support of your
explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all
study records must be housed in a secure (locked) location ON
UNIVERSITY PREMISES. The actual location (department, office,
etc.) must be specified in your explanation and be listed on any
consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the
age of 18 years are to be included (regardless of what the study involves) you
MUST:
(1.4.1) Obtain informed consent from the parent or guardian—
consent forms must be written so that it is clear that the
parent/guardian is giving permission for their child to participate.
(1.4.2) Document how you will obtain assent from the child—
This must be done in an age-appropriate manner. Regardless of
whether the parent/guardian has given permission, a child is
completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate
(“assent”).
74
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18
YEARS OF AGE: attached a copy of all assent forms (if such a form is used)?
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the
Survey/Interview/Questionnaire Consent Checklist? (see that checklist for
instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire
questions in their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request
form indicates that they have thoroughly reviewed your proposal and verified
that it meets all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?
75
Project Director’s Certification
Program Involving HUMAN SUBJECTS
The proposed investigation involves the use of human subjects and I am submitting the complete
application form and project description to the Institutional Review Board for Research Involving
Human Subjects.
I understand that Institutional Review Board (IRB) approval is
required before beginning any research and/or data collection
involving human subjects.
If the Board grants approval of this
application, I agree to:
1. Abide by any conditions or changes in the project required by the Board.
2. Report to the Board any change in the research plan that affects the method of using
human subjects before such change is instituted.
3. Report to the Board any problems that arise in connection with the use of human subjects.
4. Seek advice of the Board whenever I believe such advice is necessary or would be
helpful.
5. Secure the informed, written consent of all human subjects participating in the project.
6. Cooperate with the Board in its effort to provide a continuing review after investigations
have been initiated.
I have reviewed the Federal and State regulations concerning the use of human subjects in
research and training programs and the guidelines. I agree to abide by the regulations and
guidelines aforementioned and will adhere to policies and procedures described in my
application. I understand that changes to the research must be approved by the IRB before they
are implemented.
Professional Research
Project Director’s Signature
Department Chairperson’s Signature
Student or Class Research
Student Researcher’s Signature
Supervising Faculty Member’s
Department Chairperson’s Signature
76
Signature if required
ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application to
ascertain whether or not the proposed project:
1.
2.
3.
4.
5.
provides adequate safeguards of the rights and welfare of human subjects involved in the
investigations;
uses appropriate methods to obtain informed, written consent;
indicates that the potential benefits of the investigation substantially outweigh the risk involved.
provides adequate debriefing of human participants.
provides adequate follow-up services to participants who may have incurred physical, mental, or
emotional harm.
Approved[_________________________________]
Disapproved
___________________________________________
_________________________
Chairperson, Institutional Review Board
Date
77
Appendix C3
Demographic Information
78
Demographic Information
Age: __________________________
Year school: __________________
Gender:
Male
Female
Which is your dominant leg? Right or Left
(Which leg would you use to kick a soccer ball)
Injury History:
Any history of lower extremity injury? (i.e. hip, knee,
ankle) Yes or No
If answered yes:
Date of last injury _____________________
Severity
_____________________
Any history of head injury/concussion? Yes or No
If answered yes:
Date of last injury _____________________
Severity
_____________________
Any neurological disorder that affect performance? Yes or
No
If answered yes:
Please explain _______________________________
Have you used ice before as an injury treatment? Yes or no
Raynauds phenomenon: Yes or no
(Disruption of blood flow in the extremities arteries)
Cold allergy: Yes or No
Poor circulation: Yes or No
Diminished sensation: Yes or No
Long-lasting/slow healing wounds: Yes or No
Arthritis:
Yes or No
79
(Rhematoid, gouty, pseudogout, lupus, infectious,
hemorrhagic, osteoarthritis, inflammatory, psoriactic,
reactive and anklyosing spondylitis)
Any other cold allergy or cold condition not previously
mentioned:
______________________________________________________
80
Appendix C4
Peak Force Trial Example
81
82
Appendix C5
Summary of Previous Cryotherapy Research
83
Study
Richendollar et
al.
Results
Negative Effect on
Functional
Performance
1. Vertical
jump
decreased
more than 1
cm.23
2. Overall
results
improved
with ice and
warm-up over
ice and no
warm-up.23
Jameson et al.
Kinzey et al.
No significant
differences of
pretest and
posttest results.24
1.
2.
3.
Patterson et al.
Results
No Effect on
Functional
Performance
1.
Vertical
jump impulse
decreased in
sets 2 & 3
compared
with sets 4
& 5.22
Peak
vertical
groundreaction
force was
greater in
set 2 then 4
& 5.22
Average
vertical
groundreaction
force was
unchanged.22
Mean
vertical
jump scores
were all
84
2.
3.
significantl
y lower.25
Average
power was
significantl
y lower. 25
Peak power
scores were
significantl
y lower. 25
Hart et al.
Cross et al.
Fischer et al.
No significant
changes in ground
reaction force,
range of motion
and muscle
activity. 26
The cryotherapy
group had
significantly lower
results than the
resting group for
the single-leg
vertical jump. 27
The results of the
single-leg vertical
jump were
significantly lower
after 10 minutes of
ice bag and
immediately
posttest. 28
85
REFERENCES
1.
Hatzel B, Kaminski T. The effects of ice immersion on
concentric and eccentric isokinetic muscle
performance. Isokin Ex Sci. 2000;(8):103-107.
2.
Mohammad A, Hossein K, Hossein F, Soghrat F. Balance
problems after unilateral lateral ankle sprains. J
of Rehabil Res and Dev. 2006;43(7):819-824.
3.
Eils E. The role of proprioception in the primary
prevention of ankle sprains in athletes. Int Sports
Med J. 2003;4(5).
4.
Hertel J. Functional instability following lateral
ankle sprain. Sports Med. 2000;29(5):361-371.
5.
Hubbard T. Hicks-Little, C. Ankle ligament healing
after an acute ankle sprain an evidence-based
approach. J Athl Train. 2008;43(5):523-529.
6.
Tik-Pui Fong D, Hong Y, Chan L, Yung P, Chan K. A
Systematic review on ankle injury and ankle sprain in
sports. Sports Med. 2007;37(1):73-94.
7.
Drake R, Vogl W, Mitchell A. Gray’s Anatomy for
Students. Philadelphia. Elsevier. 2005.
8.
Nadler S, Weingand K, Kruse R. The physiologic basis
and clinical applications of cryotherapy and
thermotherapy for the pain practitioner. Pain
Physician. 2004;7:395-399.
9.
Swenson C, Sward L, Karlsson J. Cryotherapy in sports
medicine. Scand J Med Sci Sports. 1996;6(4:193-200.
10. Knight K. Cryotherapy in Sport Injury Management.
Illinois. Human Kinetics. 1995.
11. McMaster WC. A literary review on ice therapy in
injuries. Am J Sports Med. 1977; 5(3):124-126.
12. Ciolek J. Cryotherapy: Review of physiological
effects and clinical application. Cleveland Clin Q.
1985;52(2):193-201.
86
13. Meeusen R, Lievens P. The use of cryotherapy in
sports injuries. Sports Med. 1986;3(6):398-414.
14. Kowal MA. Review of physiological effects of
cryotherapy. J Orthop Sports Phys Ther.
1983;5(2):66-73.
15. Ferretti G. Cold and muscle performance.
Sports Med. 1992;13 (S1):185-187.
Int J
16. Bender A, Kramer E, Brucker J, Demchak T, Cordova M,
Stone M. Local ice-bag application and triceps surae
muscle temperature during treadmill walking. J Athl
Train. 2005;40(4): 271-275.
17. Johnson D, Moore S, Moore J, Oliver R. Effect of
cold submersion on intramuscular temperature of the
gastrocnemius muscle. Phys Ther. 59(10): 1238-1242.
18. Myrer W, Measom G, Fellingham G. Temperature changes
in the human leg during and after two methods of
cryotherapy. J Athl Train. 1998; 33:25-29.
19. Palmieri RM.
temperature.
Peripheral ankle cooling and core body
J Athl Train. 2006;41(2):185-188.
20. Ingersoll CD. Sensory perception of the foot and
ankle following therapeutic applications of heat and
cold. J Athl Train. 1992;27(3):231-234.
21. Algafly AA. The effect of cryotherapy on nerve
conduction velocity, pain threshold and pain
tolerance. Br J Sports Med. 2007;41:365-369.
22. Kinzey SJ, Cordova ML, Gallen KJ, Smith JC, Moore JB.
The effects of cryotherapy on ground reaction forces
produced during a functional task. J Sport Rehabil.
2000; 9:3-14.
23. Richendollar M, Darby L, Brown T.
Ice bag
application, active warm-up, and 3 measures of
maximal functional performance. J Athl Train.
2006;41(4):364-370.
24. Jameson A, Kinzey S, Hallam JS.
Lower ExtremityJoint-Cryotherapy does not affect Vertical Ground
87
Reaction Forces During Landing.
2001;10:132-142.
J Sport Rehabil.
25. Patterson S, Udermann B, Doberstein S, Reineke D. The
effects of cold whirlpool on power, speed, agility
and range of motion. J Sports Sci Med. 2008;7: 387394.
26. Hart JM, Ingersoll CD, Leonard JL. Single-leg
landing strategy after knee-joint cryotherapy.
Sport Rehabil. 2005;14:313-320.
J
27. Fischer J, Branch JD, Pirone J, Van Lunen B.
Functional performance following an ice bag
application to the hamstrings. J Strength Condition
Res. 2009;23(1):44-50.
28. Cross KM, Perrin DH, Wilson RW. Functional
performance following an ice immersion to the lower
extremity. J Athl Train. 1996; 31(2): 113-116.
29. MacAuley D. Ice therapy: How good is the evidence?
Int J Sports Med. 2001;22(5): 379-384.
88
ABSTRACT
Title:
The Effects of Cryotherapy and the SingleLeg Vertical Jump
Researcher:
Christine M. Stache
Advisor:
Dr. Thomas F. West
Research Type: Master’s Thesis
Context:
Many studies suggest that there is a
difference in functional performance after
the use of cryotherapy. Some studies have
conflicting findings suggesting there is not
a difference in functional performance after
the use of cryotherapy. Many studies
analyzing functional performance have chosen
to analyze the vertical jump. The vertical
jump is a standard measurement of lower
extremity functional strength and power.
Objective:
The purpose of the study is to examine the
effects of cryotherapy on the lower
extremity and functional performance as
measured by the single-leg vertical jump.
Design:
Quasi-experimental, within subjects,
repeated measures design.
Setting:
Controlled laboratory setting.
Participants:
14 physically active college students who
volunteered with no previous injuries or
cold contraindications.
Interventions: Subjects were required fill
out a demographic and approved informed
consent form upon arrival for the first
time. Subjects were required to come in
twice for testing. Testing first started
with a 5 minute warm-up on the bicycle.
Immediately following the warm-up the
subject was to perform five single-leg
vertical jumps (pretest. The subject was
then instructed to sit and received
treatment (cryotherapy or no cryotherapy).
89
Immediately after the treatment the subject
performed five single-leg vertical jumps
(posttest) and again performed five singleleg vertical jumps five minutes after
posttest, ten minutes and twenty minutes
after posttest.
Main Outcome
Measures:
Peak force (maximal jump height
was the measurement used to measure to
compare two conditions: treatment
(cryotherapy and no cryotherapy) and time.
Results:
The results showed that there was no
significant difference with cryotherapy
conditions: treatment and time. The
results also showed there was no significant
difference with the interaction of
treatments and time.
Conclusions:
Results of this study would suggest it is
safe to return an athlete to play
immediately after cryotherapy has been
applied. It is still recommended by
numerous other studies that warm-up or an
elapse of time should be given to the
athlete before returning to play.
Word Count:
343
A THESIS
Submitted to the Faculty of the School of Graduate Studies and
Research
of
California University of Pennsylvania in partial fulfillment
of the requirements for the degree of
Master of Science
by
Christine Marie Stache
Research Advisor, Dr. Thomas F. West
California, Pennsylvania
2010
ii
CALIFORNIA UNIVERSITY of PENNSYLVANIA
iii
ACKNOWLEDGEMENTS
I would like to take this opportunity and thank everyone
who helped me with this year.
I would like to thank my
parents and sister for their support and believing in me this
year and always.
I like to thank my family for encouraging me
to apply to graduate school and to move closer to home.
I
also would like to thank my grandparents, aunts and uncles for
support and encouragement.
I would like to thank my old and
new friends for keeping in touch and encouraging me through
everything.
I would also like to thank my chair, Dr. West, and my two
committee members, Dr. Kane and Dr. Barnhart for helping me
with this thesis.
in this study.
I would also like thank all the volunteers
Each volunteer was kind enough to take time
out of their busy schedule to help with participation.
so much to everyone.
Thanks
iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE
. . . . . . . . . . . . . . . . ii
AKNOWLEDGEMENTS . . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS
LIST OF TABLES
INTRODUCTION
METHODS
. . . . . . . . . . . . . . . iv
. . . . . . . . . . . . . . . . vii
. . . . . . . . . . . . . . . . . 1
. . . . . . . . . . . . . . . . . . . 6
Research Design. . . . . . . . . . . . . . . . 6
Subjects
. . . . . . . . . . . . . . . . . . 7
Preliminary Research
. . . . . . . . . . . . . 8
Instruments . . . . . . . . . . . . . . . . . 9
Demographic Form . . . . . . . . . . . . . . . 9
Force Platform
. . . . . . . . . . . . . . . 10
Cryotherapy Treatment . . . . . . . . . . . . . 11
Stationary Bicycle
Procedures
. . . . . . . . . . . . . . 11
. . . . . . . . . . . . . . . . . 11
Single-leg Vertical Jump . . . . . . . . . . . . 12
Hypothesis
. . . . . . . . . . . . . . . . . 14
Data Analysis .
RESULTS
. . . . . . . . . . . . . . . 13
. . . . . . . . . . . . . . . . . . . 15
Demographic Data .
Hypothesis Testing .
. . . . . . . . . . . . . . 15
. . . . . . . . . . . . . 16
Additional Findings . . . . . . . . . . . . . . 18
v
DISCUSSION .
. . . . . . . . . . . . . . . . . 19
Discussion of Results .
Conclusions .
. . . . . . . . . . . . 19
. . . . . . . . . . . . . . . . 23
Recommendations . . . . . . . . . . . . . . . . 24
REFERENCES. . . . . . . . . . . . . . . . . . . 26
APPENDICES .
. . . . . . . . . . . . . . . . . 28
APPENDIX A: Review of Literature .
. . . . . . . . 29
Anatomy of the Ankle . . . . . . . . . . . . . . 30
Musculoskeletal Anatomy .
. . . . . . . . . . . 30
Neurological Anatomy .
. . . . . . . . . . . 31
.
Indications of Cryotherapy. . . . . . . . . . . . 32
The Use of Cryotherapy . . . . . . . . . . . . 34
Contraindications . . . . . . . . . . . . . . 35
Physiological Effects of Cryotherapy .
. . . . 35
Temperature. . . . . . . . . . . . . . . . . . 38
Neurological Effects . . . . . . . . . . . . . . 40
Measuring the Vertical Jump . . . . . . . . . . . 43
Cryotherapy and the Effects on the Vertical Jump
. . 44
Summary . . . . . . . . . . . . . . . . . . . 50
APPENDIX B: The Problem . . . . . . . . . . . . . 51
Definition of Terms . . . . . . . . . . . . . . 52
Basic Assumptions
. . . . . . . . . . . . . . 53
Limitations of the Study . . . . . . . . . . . . 53
Significance of the Study
. . . . . . . . . . . 54
vi
APPENDIX C: Additional Methods . . . . . . . . . . 55
Informed Consent Form (C1) . . . . . . . . . . . 56
IRB: California University of Pennsylvania (C2) . . . 61
Demographic Information (C3)
. . . . . . . . . . 77
Peak Force Trial Example (C4) . . . . . . . . . . 80
Summary of Previous Cryotherapy Research (C5)
. . . 82
REFERENCES . . . . . . . . . . . . . . . . . . 85
ABSTRACT
. . . . . . . . . . . . . . . . . . 88
vii
LIST OF TABLES
Table
Title
1
Peak force scores dependant on cryotherapy
condition and time of test.
2
Page
. . . . . . . 17
ANOVA Results for Main Effects and
Interaction between Cryotherapy and
Time Conditions . . . . . . . . . . . . 17
1
INTRODUCTION
Cryotherapy is a key therapeutic modality in athletic
training.
Cryotherapy can be used for numerous types of
injuries and can also be used on many parts of the body.1-7
The effect of cryotherapy on functional performance has
greatly been debated.7-14
The purpose of the study is to
examine cryotherapy research and the effects cryotherapy
has on the lower extremity and functional performance.
Nadler et al. defined cryotherapy, as “the therapeutic
application of any substance to the body that removes heat
from the body, resulting in decreased tissue temperature”.1
Cryotherapy is and can be used in all three phases of the
injury process, including the acute phase, repair phase and
remodeling phase.
The acute phase is from the point of
injury to approximately forty eight hours after the injury.
The repair phase, immediately follows the acute phase, can
last forty eight hours to approximately six weeks after the
initial injury.
The remodeling phase typically starts
three to six weeks following the initial trauma and can
last up to twelve months, depending on the severity of the
injury.2
2
Cryotherapy is commonly utilized to help decrease
swelling and pain at an injury site.1-7
Cryotherapy can
help prevent and/or reduce swelling, depending on severity,
after an acute injury and can continue to reduce swelling
and pain through all three injury phases when used
appropriately.1-7
There are many uses for cryotherapy but there are also
several contraindications.1-7
Contraindications include
applying cryotherapy before extreme exercise and applying
cryotherapy to patients that may suffer from cold
allergies, arthritis, anesthetic skin and/or cardiovascular
disease.2-5
There are four common physiological effects of
cryotherapy:
vasoconstriction of the blood vessels,
decrease tissue hypoxia, decrease pain and decrease muscle
spasm.
Vasoconstriction is the ability of the blood vessel
to become narrow which leads to a decrease in swelling at
the injured site.2,4,5
Secondly, tissue hypoxia is the loss
of or a decreased amount of oxygen to the tissue site.4
This leads to a decrease in oxygen supply and metabolic
demands at the injury site.
If this is not treated
immediately it can lead to secondary tissue hypoxia.
Thirdly, cryotherapy can be used to decrease pain.1,4,5
Fourth, researchers believe that a decrease in muscle spasm
3
is caused by the decrease in responsiveness of muscle
spindles therefore, each individual responds differently to
muscle spasm.4,6
Research has shown various results for determining the
effects cryotherapy has on functional performance.
Most
studies show that cryotherapy does in fact have an effect
on functional performance, specifically the single-leg
vertical jump.7-14
For the following study the researcher is
specifically looking only at vertical jump results.
Richendollar et al. performed a study to examine the
effects of cryotherapy and warm-up on functional
performance.
Results showed that the vertical jump had a
decrease larger than one centimeter. The authors also found
that overall results for the vertical jump had improved
with the ice and warm-up group but not for the ice and no
warm-up group.8
Fischer et al. examined the effects of cryotherapy on
the shuttle run, co contraction and the single-leg vertical
jump.
Results for the single-leg vertical jump had
decreased significantly after the ten minute cryotherapy
application.
The authors determined that the amount of
time the cryotherapy has been applied and immediate
functional activity are closely correlated.9
4
Cross et al. examined cryotherapy on the shuttle run,
six meter hop and single-leg vertical jump.
Results
determined that the single-leg vertical jump significantly
decreased with the application of cryotherapy.
Patterson et al. examined the effects of cryotherapy
on the vertical jump, 40 yard sprint, t-test and active
range of motion.
Results showed that mean vertical jump
scores were significantly lower than pretest scores and
average power was significantly lower than pretest scores.11
Kinzey et al. examined the effect of cryotherapy on
the vertical jump, specifically the vertical jump impulse,
peak vertical ground reaction force and average vertical
ground reaction.
Results showed that vertical impulse and
peak vertical ground-reaction force had decreased and the
average vertical ground-reaction force was not changed.12
Jameson et al. performed a study to examine the
effects of cryotherapy and vertical ground reaction force.
Results showed that there were no significant differences
between pretest and posttest results within each group.13
Hart et al. examined the effects of cryotherapy on the knee
and the single leg vertical jump.
The authors found no
significant changes in ground reaction force, range of
motion and muscle activity.14
Jameson et al. and Hart et
al. both found no significant differences between pretest
5
and posttest results.
Both studies would suggest that
cryotherapy does not have an effect on functional
performance, specifically the vertical jump.13,14
Five out of the seven studies found an effect which
cryotherapy had on the vertical jump.8-14
Further research
is warranted to determine a more definitive conclusion.
This information will allow certified athletic trainers to
make a more informed decision in regards to return to play
following the application of cryotherapy.
6
METHODS
The purpose of the study is to determine if
cryotherapy had an effect on functional performance over
time as measured by the single-leg vertical jump.
The
following is included in the discussion of the methods:
(1) research design, (2) subjects, (3) preliminary
research, (4) instruments, (5) procedures, (6) hypotheses
and (7) data analysis
Research Design
The type of experiment was a quasi-experimental,
within subjects, repeated measures design.
The first
independent variable in the experiment was the treatment
condition with two levels.
The first level of the
treatment condition was to apply cryotherapy to the
anteriolateral aspect of the ankle.
The second level was
to not apply cryotherapy to the anteriolateral aspect of
the ankle.
conditions.
Subjects were asked to perform under both
7
The second independent variable in the experiment
examined the effect of the passage of time on performance.
Performance was measured at five time periods in this
study.
The first level of time was the pretest, second was
the posttest, third was five minutes after the posttest,
fourth was ten minutes after the posttest and fifth was
twenty minutes after the posttest.
The dependent variable
was the maximal peak force (maximal height) generated
during a series of five single-leg vertical jumps on the
force platform.
Subjects
The subjects that volunteered were 14 healthy,
physically active individuals.
Haskell et al. recommends
performing aerobic activity for either five days per week
at moderate intensity for thirty minutes or three days a
week at hard intensity for twenty minutes to maintain
proper health.15
Haskell et al. also recommends resistance
training two days a week to maintain proper health.15
For
the purpose of this study, physically active individuals
are defined as being active three times a week for twenty
minutes or more.
Being active included cardiovascular
exercise and/or strength training three or more times a
8
week.
All individuals participating were screened for
previous conditions such as lower extremity injury, head
injury/concussion, neurological disorders, cold allergies,
Raynaud’s, poor circulation, diminished sensations, slow
healing wounds, arthritis and any other condition relating
to the application of cold.
The subjects were a
combination of 5 male and 9 females.
The study was approved by the Institutional Review
Board (IRB) at California University of Pennsylvania
(Appendix C1) prior to the collection of data.
All
subjects that were involved in the study signed an approved
Informed Consent Form prior to the study.
All information
on the subjects was kept confidential.
Preliminary Research
A pilot study was performed on one subject, whom also
performed in the study, for the researcher to become
familiar with the use of the force platform and the amount
of time needed to perform the treatments and the single-leg
vertical jumps.
The pilot results showed there was a need
for change to the methods.
Due to the time allotted the
researcher had to limit the study to only two cryotherapy
conditions (cryotherapy and no cryotherapy).
The
9
researcher also made the decision to only have five timing
conditions (pre-test, posttest, five minute posttest, ten
minute posttest and twenty minute posttest) and eliminating
thirty minute posttest due to the findings of the
preliminary testing.
Instruments
Instruments that were used in the experiment included
a demographic form (Appendix C2), AMTI 6-7 force platform
(AMTI Force Plate and Amplifier, Advanced Technology, Inc)
to measure peak force during the single-leg vertical jump,
ice bags, compression wraps to apply the ice and the
stationary bicycle.
Demographic Form
The information that was gathered on the demographic
sheet included age, year of school, gender, previous lower
extremity injury, head injury/concussion, neurological or
cardiovascular disorders, contraindications of ice and
cryotherapy disorders, that the subject may react
negatively towards with the application of cryotherapy.
All individuals were screened prior to the study with the
researcher present.
10
Force Platform
The force platform, also known as the force plate, was
used to measure peak force (power) of the subject’s
individual single-leg vertical jump.
For this study the
AMTI 6-7 (AMTI Force Plate and Amplifier, Advanced
Technology, Inc) was utilized.
The force platform was
connected to a detector-transducer which detects the
subject’s maximal peak force during a jump.
It then
converts the force to an electrical signal which is
comparative to the individual’s maximal peak force. The
signal is then interpreted by the AMTI Netforce data
software as a maximal force number.
The number was then
analyzed by the AMTI Bioanalysis software for extraction of
the dependent variable, peak force.16,17
Peak force is also known as ground reaction force or
force impulse.
For the purpose of this study the
researcher used the term peak force.
Peak force is the
measure of maximal force production of an individual’s
contact with the force platform.
In simple terms, the
individual jumped and the force platform measured the
amount of maximal force as the individual lands on the
force platform.
jump height.
Basically, peak force measures maximal
The peak force number is the number the
11
researcher used to determine if there is a significant
difference with cryotherapy and timing variables.16,17
Cryotherapy Treatment
The cryotherapy treatment included an ice bag placed
directly on the skin for twenty minutes.
The ice used was
cubed ice and the bag and ice weighed approximately two
pounds.
The ice was placed on the anteriolateral aspect of
the ankle.
The ice bag was wrapped on the anteriolateral
aspect of the ankle with a compression wrap.
Stationary Bicycle
The warm-up consists of five consecutive minutes on
the stationary bicycle at a comfortable tempo for the
subject.
The bike seat was set at an appropriate position
for each individual.
Appropriate shoe wear and workout
entire were suggested to the subjects.
Procedures
The first day the subjects reported to complete the
demographic form and signed the IRB approved informed
consent form.
At this time subjects also had the
procedures explained and had an opportunity to perform
12
practice jumps on the force platform. Each subject was
required to come in twice to perform the study, one time
under each treatment condition.
Once the informed consent
form was completed and the procedures had been explained,
the subject bicycled for five consecutive minutes for warmup.
The subjects performed five pretest single-leg
vertical jumps on the force platform.
After the pretest
the subjects participated in either the cryotherapy
condition or no cryotherapy condition. The subjects with
the cryotherapy condition sat with an ice bag over the
anteriolateral aspect of the dominant ankle for twenty
minutes.
The subjects with no cryotherapy condition sat
for twenty minutes.
Immediately after the twenty minutes,
(cryotherapy or no cryotherapy) the subjects performed five
posttest single-leg vertical jumps.
The subjects again sat
and were retested with five single-leg vertical jumps five
minutes, ten minutes and twenty minutes after removal of
cryotherapy (posttest).
Single-leg Vertical Jump
Each time subjects were to perform the single-leg
vertical jumps the following procedures were utilized.
One
set of single-leg vertical jumps consisted of five
individual single-leg vertical jumps.
There were five sets
13
of single-leg vertical jumps.
The first set was the
pretest, second set was posttest, third set was five
minutes after posttest, fourth set was ten minutes after
posttest and fifth set was twenty minutes after posttest.
Each set consisted of five individual single-leg vertical
jumps.
The best peak force was chosen from each series of
five individual single-leg vertical jumps.
The subject was instructed to start and land on the
dominant leg.
The contralateral leg was placed at ninety
degrees to prevent contact with the force platform.
Countermovement of the lower extremity was permitted:
dorsiflexion of the ankle, flexion of the knee and hip.
Countermovement of the upper extremity was not permitted.
Arms were crossed across each subject’s chest or hands were
placed on the subject’s hips to prevent an increase of peak
force. The subject was instructed to jump when verbally
cued.
Between each of the five individual vertical jumps
approximately five seconds of rest was given to each
participant.
The subject was instructed to “stick” the
landing or results would not be included in the study.
subject was instructed to sit when not performing.
The
14
Hypothesis
The following hypothesis is suggested by the
researcher prior to the study.
Hypothesis:
There will be a difference in peak force
production during a single-leg vertical jump depending on
cryotherapy condition and timing of the test.
Data Analysis
All data was analyzed by the SPSS version 17.
Data
was analyzed to determine if cryotherapy and timing had an
effect on the single-leg vertical jump.
The research
hypothesis was analyzed using 2 × 5 repeated measures
factorial analysis of variance (ANOVA).
An alpha level of
.05 was set a priori to determine statistical significance.
15
RESULTS
The purpose of the study was to determine if
cryotherapy and the passage of time has an effect on
functional performance measured by the single-leg vertical
jump.
The single-leg vertical jump was tested on the force
platform to analyze peak force.
includes:
The following section
demographic information, hypothesis testing and
additional information.
Demographic Data
Fourteen physically active California University of
Pennsylvania students with a mean age of
participated in the study.
+
21.8 years
Subjects completed a
demographic form with information including age, year of
school, dominant leg, injury history, head
injury/concussion, neurological disorder, cryotherapy use,
cold allergies and contraindications.
The volunteered
subjects included 5 males and 9 females.
The subjects
included 7 graduate students, 2 senior undergraduate
students, 3 junior undergraduate students and 2 sophomore
undergraduate students.
All but one subject was right leg
16
dominant.
All participants were without neurological
disorders, cold allergies, were symptom free from head
injury/concussion for more than a year and were symptom
free from lower extremity injury for at least four months.
The demographic information and the IRB approved consent
form was completed before each study was started.
Hypothesis Testing
The following hypothesis was tested in the study.
The
hypothesis was tested with the significance level set at α
≤ 0.05.
A 2 × 5 repeated measures Factorial Analysis of
Variance was used to analyze the hypothesis.
Hypothesis 1:
There will be a difference in peak
force production during a single-leg vertical jump
depending on cryotherapy condition and timing of the test.
Conclusion: Hypothesis 1 was not supported.
Mean and
standard deviation of peak force production under the
various conditions can be found in Table 1. Cryotherapy
condition did not affect peak force production during a
single-leg vertical jump (F(1,13) = .039, p=.847).
Timing
also did not affect peak force production during a singleleg vertical jump (F(4,52) = .851, p=.500).
Finally, there
17
was no interactive effect between cryotherapy condition and
timing (F(4,52) = .989, p=.422).
Table 1.
Peak force scores dependant on cryotherapy
condition and time of test
Cryotherapy
Time
No Cryotherapy
Mean (N)
SD
Mean (N)
SD
Pre test
3449N
1566.5
3218N
1334.4
Post test
3053N
1555.0
3117N
1487.7
5
min
3223N
1506.4
3429N
1577.5
10 min
3332N
1342.2
3236N
1624.3
20 min
2928N
1559.5
3270N
1481.7
Table 2.
ANOVA Results for Main Effects and Interaction
between Cryotherapy and Time Conditions
Factor
df
df(error)
F
P
Cryotherapy
1
13
.039
.847
Time
4
52
.851
.5
Cryo. X Time
4
52
.989
.422
18
Additional Findings
An additional ANOVA was done to examine the
interaction between cryotherapy, timing and gender.
additional ANOVA was done to examine the interaction
An
between cryotherapy, timing and dominant leg.
No
significant differences were present in the findings.
19
DISCUSSION
The general purpose of this study was to determine if
cryotherapy had an effect on the single-leg vertical jump.
In addition, the effect of re-warming was also examined.
The following section is divided into three subsections:
Discussion of Results, Conclusions and Recommendations.
Discussion of Results
The single-leg vertical jump was performed on the AMTI
force platform to measure peak force.
Fourteen physically
active college students volunteered to perform in the
study.
The study entailed a warm-up on the stationary
bicycle for five minutes, followed by performing five
single-leg vertical jumps at five different time intervals.
This study demonstrated that cryotherapy does not have
an effect on the single-leg vertical jump.
The
researcher’s original hypothesis was that there would be a
difference in peak force production during a single-leg
vertical jump depending on cryotherapy treatment and time.
It was hypothesized that there would be a decrease of force
produced immediately following cryotherapy treatment with a
20
gradual increase over time.
the hypothesis.
The results did not support
The mean test scores for peak force
dependant upon cryotherapy condition can be found in Table
1. There was no significant difference between cryotherapy
treatment.
This shows that the application of cryotherapy
over the anteriolateral aspect of the ankle did not cause a
decrease or increase in performance for the single-leg
vertical jump.
The mean test scores for peak force dependant upon
timing of test can be found in Table 1. There was no
significant difference between timing condition.
This
shows that over a period of time there was no increase or
decrease in performance with either treatment condition for
the single-leg vertical jump, regardless of test time.
The results in this study were different from results
in several other studies.
A table summarizing the results
of previous research can be found in Appendix C5.
For
example, Richendollar et al. examined the effects of
cryotherapy on the vertical jump, forty yard dash and the
shuttle run.
The authors found that the vertical jump was
reduced greater than one centimeter.
Richendollar et al.
also found that overall results showed that the vertical
jump had improved with ice and warm-up group over ice and
no warm-up group.8
21
Fischer et al. performed a study to determine the
effects of cryotherapy on the single-leg vertical jump, co
contraction and shuttle run.
The results showed that the
single-leg vertical jumps were significantly lower after
the ten minute cryotherapy application and immediately
posttest.9
Cross et al. performed a study to examine cryotherapy
and the effect it had on the shuttle run, 6m hop and
single-leg vertical jump.
Cross et al. found that the
cryotherapy group(experimental) had decreased results in
the single-leg vertical jump.10
The resting group
(comparison) did not use cryotherapy and the single-leg
vertical jump results were unchanged.10
Patterson et al. studied the cold whirlpool and the
effects on the vertical jump, forty yard dash, t-test and
active range of motion.
Results for the vertical jump
showed that mean jump scores were all significantly lower
than pretest scores following cold whirlpool.
Average
power for the vertical jump was significantly lower than
pretest scores and peak power was also significantly lower
than pretest scores.11
Kinzey et al. studied the effects of cryotherapy on
vertical jump impulse, peak vertical ground reaction force
and average vertical ground reaction.
Kinzey et al. found
22
that vertical impulse had decreased in sets two and three
compared to sets four and five.
Peak vertical ground-
reaction force was greater in set two then four and five.
Average vertical ground-reaction force was not changed.12
Overall, results of the studies vary slightly but most
results show vertical jump results will decrease with the
application of cryotherapy.8-14
A few studies did agree with the present findings.
Jameson et al. studied the effect of crushed ice on a
specific joint and measured the effect it would have on
vertical ground reaction force.
Results showed no
significant differences between pretest and posttest
results within each group.13
Hart et al. performed a study
to examine the effects of cryotherapy on the knee and
vertical jump measurements.
Hart et al. also found results
which showed that there were no significant changes in
ground reaction force, range of motion and muscle activity.
14
There could be several reasons for discrepancies in
the studies.
First, one main difference was the type of
cryotherapy chosen to cool a specific area.
Cross et al,
Patterson et al. and Kinzey et al. used ice immersion as
the method of cooling a specific area.10,11,12
Fisher et al,
Richendollar et al, Hart et al. and Jameson et al. used
23
either cubed or crushed ice bag(s) as the method of cooling
a specific area.8,9,13,14
The second main difference was the
area chosen to apply the cryotherapy.
Cross et al. and
Patterson et al. chose the ice immersion for the lower
leg.10,11
Richendollar et al. and Fischer et al. chose an
ice bag placed on the thigh.8,9
Hart et al. specifically
chose an ice bag covering the anterior, lateral and medial
aspect of the knee.14
Jameson et al. chose an ice bag
placed on the ankle and/or knee.13
immersion of the leg.12
Kinzey et al. chose ice
The third main difference was the
amount of time the cryotherapy was on a specific joint.
Richendollar et al, Cross et al, Patterson et al, Kinzey et
al, Jameson et al. and Hart et al.
choose to apply the
cryotherapy treatment to a specific area for twenty
minutes.8,10-14
Fisher et al. chose to apply the cryotherapy
treatment to a specific area for only three and ten
minutes.9
These three differences could be why results
slightly differed between the researcher’s study and other
studies.
Conclusions
The significance of these results would allow
professionals that may use cryotherapy on a regular basis
24
to feel comfortable with that decision without
repercussions on performance.
The results of this study
have shown that there were no negative effects on the
single-leg vertical jump with the cryotherapy condition and
lapse of time.
Results were slightly varied between the
cryotherapy application, no cryotherapy and time factor but
no significant differences were found.
There have been several different studies on
functional performance, specifically the vertical jump.
Most studies indicate that cryotherapy can have a negative
effect on the vertical jump and other functional
performances.
Therefore, by this study alone it does not
indicate that an athlete should return to play right after
the application of ice.
It is recommended that further
research is needed.
Recommendations
The results of this study demonstrate that cryotherapy
did not have a negative effect of the single-leg vertical
jump.
There still is insufficient evidence to conclusively
rule out an effect of cryotherapy on performance.
However,
most studies would disagree with the findings in this study
and have found that cryotherapy does have a negative effect
25
on functional performance.
It is very important that
Athletic Trainers take the time to analyze the athlete’s
injury, the use of cryotherapy and when the proper time is
to return the athlete to play after the use of this
modality.
It is recommended that the Athletic Trainer
recommend a warm-up or time to pass before the athlete
immediately returns to play.
Further research in this area
is warranted to have a more definitive answer.
26
REFERENCES
1.
Nadler S, Weingand K, Kruse R. The Physiologic Basis
and Clinical Applications of Cryotherapy and
Thermotherapy for the Pain Practitioner. Pain
Physician. 2004;7:395-399.
2.
Swenson C, Sward L, Karlsson J. Cryotherapy in sports
medicine. Scand J Med Sci Sports. 1996;6(4):193200.
3.
McMaster WC. A literary review on ice therapy in
injuries. Am J Sports Med. 1977; 5(3):124-126.
4.
Ciolek J. Cryotherapy: Review of physiological
effects and clinical application. Cleveland Clin Q.
1985;52(2):193-201.
5.
Meeusen R, Lievens P. The use of cryotherapy in
sports injuries. Sports Med. 1986;3(6):398-414.
6.
Kowal MA. Review of physiological effects of
cryotherapy. J Orthop Sports Phys Ther.
1983;5(2):66-73.
7.
Knight K. Cryotherapy in Sport Injury Management.
Illinois. Human Kinetics. 1995.
8.
Richendollar M, Darby L, Brown T.
Ice bag
application, active warm-up, and 3 measures of
maximal functional performance. J Athl Train.
2006;41(4):364-370.
9.
Fischer J, Branch, Van Lunen B, Branch D. J.D Pirone.
Functional performance following an ice bag
application to the hamstrings. J Strength Condition
Res. 2009;23(1):44-50.
10. Cross KM, Perrin DH, Wilson RW. Functional
performance following an ice immersion to the lower
extremity. J Athl Train. 1996; 31(2): 113-116.
27
11. Patterson S, Udermann B, Doberstein S, Reineke D. The
effects of cold whirlpool on power, speed, agility
and range of motion. J Sports Sci Med. 2008;7:387394.
12. Kinzey SJ, Cordova ML, Gallen KJ, Smith JC, Moore JB.
The effects of cryotherapy on ground reaction forces
produced during a functional task. J Sport Rehabil.
2000;9:3-14.
13. Jameson A, Kinzey S, Hallam JS.
Lower ExtremityJoint-Cryotherapy does not affect Vertical Ground
Reaction Forces During Landing. J Sport Rehabil.
2001;10: 132-142.
14. Hart JM, Ingersoll CD, Leonard JL. Single-leg
landing strategy after knee-joint cryotherapy.
Sport Rehabil. 2005;14:313-320.
J
15. Haskell W, Pate R, Powell K, Blair S, Franklin B,
Macera C, Heath G, Thompson P, Bauman A. Physical
activity and public health: updated recommendation
for adults from the American College of Sports
Medicine and the American Heart Association. Med Sci
Sports Ex. 2007;1423-1434.
16. Cronin J, Hing R, McNair P. Reliability and validity
of a linear position transducer for measuring jump
performance. J Strength Condition Res.
2004;18(3):590-593.
17. Barlett R. Introduction to Sports Biomechanics.
Oxfordshire. Spon Press: Taylor & Francis Ltd. 1997.
28
APPENDICES
29
APPENDIX A
Review of Literature
30
REVIEW OF LITERATURE
The ankle is one of the most commonly injured
joints.16-20
The study was performed because cryotherapy is
most commonly used for ankle injuries.
Specifically,
cryotherapy is used most commonly for the lateral aspect of
the ankle.1-7
It is a small, complex joint with many
anatomy components, including musculoskeletal, ligaments
and neurovascular components.
Anatomy of the Ankle
Musculoskeletal Anatomy
The lateral aspect of the ankle includes the fibula
which contains three borders, the interosseous border,
anterior and posterior border.
The fibula also contains
three surfaces, medial surface, lateral surface and
posterior surface.
The distal end of the fibula forms the
lateral malleolus.7
The two muscles located in the lateral compartment are
the fibularis longus and the fibularis brevis.
The
fibularis longus originates on the upper aspect of the
fibula, head of the fibula and the tibial condyle.
It
inserts into the lateral aspect and distal end of the
31
medial cuneiform and the base of the first metatarsal.
is innervated by the superficial fibular nerve.
It
As the
function, the fibularis longus performs eversion and
plantarflexion of the foot and also helps to support the
arches.
The fibularis brevis originates on the lower
lateral shaft of the fibula.
It inserts into the lateral
tubercle at the base of the fifth metatarsal.
It is
innervated by the superficial fibular nerve.
As the
function, the fibularis brevis performs eversion of the
foot.7
The lateral ligament is made of three ligaments, the
anterior talofibular ligament, the posterior talofibular
ligament and the calcaneofibular ligament.
The anterior
talofibular ligament is from the anterior aspect of the
lateral malleolus to the talus.
The posterior talofibular
ligament is from the lateral malleolus to the posterior
aspect of the talus.
The calcaneofibular ligament is from
the lateral malleolus to the lateral aspect of the
calcaneus.7
Neurological Anatomy
The main nerve in the lateral compartment of the ankle
is the superficial fibular nerve.
The sciatic nerve begins
in the posterior compartment of the upper thigh and then
32
becomes the common fibular nerve.
then divides into two branches.
The common fibular nerve
The one branch is the
superficial fibular nerve and the second is the deep
fibular nerve.7
Indications of Cryotherapy
Nadler et al. defined cryotherapy “as the therapeutic
application of any substance to the body that removes heat
from the body, resulting in decreased tissue temperature.”8
Cryotherapy is one of the most widely used modalities in
athletic training and can be used for various reasons.1-29
Cryotherapy is and can be used in all three phases of the
injury process after the trauma has occurred, including the
acute phase, repair phase and remodeling phase.9
The acute
phase of inflammation is from the point of injury or trauma
to about forty eight hours after the injury.9
The acute
phase is especially vital for the fact that time is of the
essence.8-14
Studies have shown that the quicker the ice has
been applied the faster the recovery process tends to be.10
Hocutt et al. performed a study which involved eighteen
patients that had second-degree ankle sprains and nineteen
patients with greater than second degree ankle sprains.
Each patient was chosen for one of three groups.
The first
33
group was the early cryotherapy group (immediately after
injury), the second group was the late cryotherapy group
(36 hours after injury), the third group was the early
thermotherapy group.
Patients in the early cryotherapy
group were twice as effective as the late cryotherapy
group.
Both early and late cryotherapy was more effective
than the thermotherapy group.10
The repair phase immediately follows the acute phase
and can last from 48 hours to approximately six weeks after
the initial injury.
the recovery process.
The repair phase is a crucial step in
This is the stage where the athlete
gradually starts a rehabilitation program consisting of
range of motion (ROM) exercises as well as strengthening
the injured area.
The combined use of ROM and
strengthening exercises with ice is also known as
cryokinetics.
Cryokinetics allows for an increase in blood
flow and allows for remodeling and re-organization of
collagen.
Last is the remodeling phase which usually
starts around three to six weeks and can last up to twelve
months depending on the severity of the injury.9
34
The Use of Cryotherapy
The most common and main reasons why healthcare
providers take advantage of the use of cryotherapy are to
help decrease swelling and pain at the injury site.8-14
Cryotherapy reduces swelling after an acute injury and can
continue to reduce swelling and pain through all three
phases when used appropriately.8-14
By reducing the amount
of swelling at the injury site, the process of secondary
tissue hypoxia can be reduced and help to reduce
rehabilitation time.12
Cryotherapy not only aids with swelling and pain but
can also help to reduce muscle spasms, cramps and helps to
relieve pain when medications are injected to a specific
site.9,10
Cryotherapy also aids in orthopaedic surgery,
cryosurgery and the rehabilitation process.10
Cryotherapy can be used for both acute and chronic
conditions.
Acute injuries are classified as fractures,
sprains, strains and inflammatory injuries.9
Chronic
injuries that warrant the use of cryotherapy are bursitis,
tendonitis, muscle spasms, trigger points and
osteomyelitis.8-10
35
Contraindications
Cryotherapy is one of the most widely and commonly
accepted modalities because there are very few
contraindications.
Contraindications include applying
cryotherapy before extreme exercise or activities and
applying cryotherapy to patients that may suffer from cold
allergies, arthritis, anesthetic skin and/or cardiovascular
disease.9-13
It is also debated about the time that ice
should be left on an injured area due to damage that may
occur.
If the application of cryotherapy has been left on
the injured site for an extended amount of time the patient
may experience frost-bite or nerve palsy.9
Cryotherapy is a
common modality but like any other modality precautions
must be taken.8-14
Physiological Effects of Cryotherapy
There are four common physiological effects of
cryotherapy, the first being the vasoconstriction of the
blood vessels to decrease swelling and inflammation, the
second is to decrease tissue hypoxia, third is to decrease
pain and fourth is to decrease muscle spasm.12
36
The first physiological effect is vasoconstriction
which is the ability of the blood vessels to get narrower.
Vasoconstriction is the “first response for the superficial
blood vessels through an axon reflex arc that is a
projection of the peripheral autonomic system controlling
sympathetic vasoconstriction” after the trauma has
occurred.12
Vasoconstriction can also work through the
reflexes of the spinal cord.
After this process the cooled
blood then “returns to the general blood and activates the
posterior hypothalamus to help increase vasoconstriction.”12
This leads to a decrease in vascular permeability which
allows for the cell wall to draw in closer and it allows a
decrease in the amount of fluid that goes into the
extracellular spaces.
It also allows for an increase in
blood viscosity and a decrease in blood flow to the
specific injured area.
This entire process is called the
principal mechanism.12
The second physiological effect is a decrease in
tissue hypoxia.
After the initial injury there is a tissue
disturbance at the injury site.
Tissue hypoxia is the loss
of or a decreased amount of oxygen to the tissue site.
This leads to a decrease in oxygen supply and metabolic
demands at the injury site.
If this is not taken care of
immediately it can lead to secondary tissue hypoxia.12
37
Knight determined that when ice is immediately applied to
an individual with an injury there is less secondary
hypoxia and extravascular edema.12
The third physiological effect is a decrease in pain.
It is difficult to accurately measure pain in an objective
manner.
As healthcare providers, we can only measure pain
subjectively as to what the patient has described to us.
There has been no such study proving why there is a
decrease in pain when applying cryotherapy.
Many
hypotheses suggest it may be because of the decrease in
nerve conduction velocity.
Olson and Stravino found that
it is cold that produces a temporary numbness to the area
which then decreases nerve conduction.12
DeJesus et al.
found that cold does in fact produce a decrease in nerve
conduction but there are specific classes of fibers which
are more sensitive than other fibers.12
Lehmann and
DeLateur agreed that there are specific classes of fiber
and these specific fibers depend on myelination and
diameter to produce a decrease in nerve conduction
velocity.12
Most researchers believe there is a decrease in
nerve conduction but further studies need to be done in
this area to be completely accurate and understand why
there is a decrease in nerve conduction.
12
38
The last physiological effect is a decrease in muscle
spasm.
Researchers are lead to believe that a decrease in
muscle spasm is caused by the decrease in responsiveness of
muscle spindles.
Researchers have also found that each
individual responds differently to the response of spasm
and cryotherapy.
A few studies show that some individuals
did not feel relief after the use of cryotherapy.
Further
research is needed to be done in this area.12,14
Temperature
Cryotherapy is a common modality used to rapidly
reduce temperature.15-19 There is still much debate on how
temperature affects functional performance.
Feretti et al.
found that temperature influences both anaerobic and
aerobic power.
The reduction in temperature may cause a
change in rate of adenosine triphosphate (ATP) hydrolysis
and/or synthesis.
Therefore, it is hypothesized that a
decrease in anaerobic power is related to the decrease in
temperature as well as a decrease in ATP hydrolysis.15
Bender et al. studied the superficial and
intramuscular temperature of the triceps surae.
The
subjects first reported for a baseline temperature (pre
treatment) and then proceeded to treatment.
The treatment
39
consisted of the cryotherapy application, which was an ice
bag placed on the triceps surae for thirty minutes at rest
or an ice bag placed on the triceps surae for thirty
minutes while walking on the treadmill.
Results found that
superficial temperatures decreased over a period of time
with the resting group and treadmill walking group.
Results also found that intramuscular temperature had
decreased over a period of time in the resting group
compared with the treadmill walking group.16
Johnson et al. studied the intramuscular temperature
difference of the gastrocnemius in the cold whirlpool.
The
treatments consisted of baseline temperature (pre
treatment), treatment and recovery (post treatment).
The
treatment period consisted of submersion of the lower leg
into the cold whirlpool for thirty minutes.
Results showed
a significant decrease with intramuscular temperature in
the treatment leg compared to the contralateral leg.
After
four hours (post treatment) both lower legs had an overall
decrease in temperature compared to before the cryotherapy
treatment.17
Myrer et al. studied the intramuscular temperature on
the mid-belly of the gastrocnemius and two different
cryotherapy applications.
Myrer et al. chose to examine
two cryotherapy applications which were the crushed ice bag
40
and cold whirlpool.
The treatment consisted of either
crushed ice placed on the left gastrocnemius or the cold
whirlpool on the left gastrocnemius.
Results showed that
there were no significant differences in intramuscular
temperature.
There was a significant decrease in
subcutaneous temperature with the crushed ice group
compared to the cold whirlpool group.
The crushed ice
group also showed significantly more temperature re-warming
than the cold whirlpool group.18
Palmieri et al. studied the core temperature and
surface temperature of the anterior ankle and soleus.
The
procedures consisted of baseline temperatures, an ice bag
placed over the anterior aspect of the ankle and
temperature were assessed immediately, ten minutes, twenty
minutes of trial and ten and twenty minutes after the ice
bag was removed.
Results showed that there was no
significant change in core temperature with conditions and
time.
Results also showed that the ankle and soleus muscle
surface temperatures were different.19
Neurological Effects
Studies have found various neurological effects with
the use of cryotherapy. This paragraph will discuss the
41
various types of nerves and how the nerves react to
cryotherapy.
“Sensation can be divided into three categories:
superficial, deep and combined.”20
The superficial
sensation or superficial sensory nerves react with touch,
temperature and pain.
Deep sensation or deep sensory
nerves react with “muscle, joint position sense, deep
muscle pain and vibration sense.”20
There can also be a
combination between superficial sensory nerves and deep
sensory nerves.20
Ingersoll et al. performed a study to
analyze the effect sensory nerves had on three types of
neurological examinations.
Twenty one subjects had to
submerge the ankle in either hot or cold water for twenty
minutes.
After the subjects completed the twenty minutes
the three examinations were given, topagnosis, two-point
discrimination and postural balance.
Ingersoll et al.
found no significant difference between the three
neurological examinations.20
Research has also discovered that cold induced
sensations are carried by a variety of nerves to the brain.
The cold sensation is mediated by very small myelinated A
delta fibers but cold induced pain is mediated by small
unmyelinated polymodal nocieptors.
As temperature
decreases, as with the case of cryotherapy, the velocity of
42
the sensory nerve impulse transmission will decrease with
temperature.
As temperature decreases conduction will
slowly decrease until eventually it is blocked.
The
conduction will slowly decrease but sensory nerve action
potentials will increase in duration.
As the action
potentials increase this will also increase or extend
refractory periods.10
Denny-Brown et al. found that sensory nerve conduction
is blocked at temperatures below 10º Celsius.
Blocking of
the sensory nerves is considered to be time dependent.
Denny-Brown et al. determined that the longer the duration
of cryotherapy at a given temperature the greater the loss
of function for sensory nerves.10
Research has also shown
that with the use of cryotherapy applied to cold receptors
this can increase activity and transmission to the central
nervous system.
Applying cryotherapy to the sensory nerve,
which is carrying the impulse, decreases the transmission.10
Algafly et al. analyzed the effect of the decrease in
pain when cryotherapy is applied.
There are four main
reasons for a decrease in pain with application of
cryotherapy: “decrease in nerve conduction velocity,
inhibition of nociceptors, decrease in muscle spasms or
metabolic enzyme activity levels.”21
Algafly et al.
analyzed the effect of cryotherapy applied to the posterior
43
lateral aspect of the lateral malleolus, including the
tibial nerve.
Results found that “nerve conduction
velocity was decreased by seventeen percent at fifteen
degrees Celsius.”
21
Nerve conduction velocity decreased “by
thirty three percent at ten degrees Celsius.”21
Measuring the Vertical Jump
The vertical jump is one of the best measurements to
measure anaerobic power.
The vertical jump is a measure of
functional lower extremity strength and is one of the most
sport specific measurements.22 There are two versions of
the vertical jump: the one-legged or single-leg vertical
jump and the two-legged vertical jump.
For the purpose of
this study the focus is on the single-leg vertical jump.
The single-leg vertical jump mimics the movement which
creates similar stresses which are placed upon the body
during a sport.12,9
The single-leg vertical jump is also a
measurement for coordination, center of mass and
proprioception.
The two-legged vertical jump can be
defined as the individual’s “ability to perform daily
functions.”
22
44
Cryotherapy and the Effects on the Vertical Jump
Analyzing cryotherapy and functional performance is an
important aspect in athletic training.
It is important to
measure a specific aspect of functional performance such as
the vertical jump.
Richendollar et al. included twenty four physically
active men for the study.
measures design.
The study was a 2 × 2 repeated
Richendollar et al. divided the subjects
randomly into four separate groups.
The first group was
the control group which consisted of no ice and no warm-up.
The second group was the experimental group which consisted
of no ice and a warm-up.
The third group was the
experimental group which consisted of ice and no warm-up.
The fourth group was the experimental group which consisted
of ice and warm-up.
Three functional tests were performed
which included the single-leg vertical jump, the forty yard
dash and the shuttle run.
For the purpose of this specific
literature review the researcher is looking at the vertical
jump results.
Richendollar et al. found that the vertical
jump decreased greater than one centimeter after the use of
cryotherapy.
Richendollar et al. also found that overall
results showed that the single-leg vertical jump had
45
improved with ice and warm-up (fourth group) over ice and
no warm-up group (third group).23
Jameson et al. studied the effect of crushed ice on a
specific joint and measured the effect it would have on
vertical ground reaction force.
The study was a 2 × 4
repeated measures multivariate analysis of variance
(MANOVA).
The subjects included in the study were ten
physically active men.
separate groups.
Each subject was divided into four
The first group was the control group
which consisted of no ice.
ice on the ankle.
The second group consisted of
The third group consisted of ice on the
knee.
The fourth group consisted of ice on the ankle and
knee.
The second, third and fourth group had crushed ice
bags on both lower extremities and on the instructed
specific joints for twenty minutes.
The subjects were
allotted an orientation session which consisted of a trial
run through the actual icing and vertical jump.
The
testing session consisted of a pretest with five jumps each
with a minute of rest in-between.
The vertical jump was a
two-legged jump at ninety percent of the subject’s ability.
The researcher then instructed the second, third and fourth
group to ice the specific joint for twenty minutes.
After
icing, the subjects concluded with a posttest consisting of
five jumps each with a minute of rest in-between.
The
46
testing session was conducted for four consecutive days.
Results showed no significant differences between pretest
and posttest results within each group.24
Kinzey et al. studied the effects of cryotherapy on
vertical jump impulse, peak vertical ground reaction force
and average vertical ground reaction.
5 factorial repeated measures.
The study was a 1 ×
Kinzey et al. had fifteen
physically active subjects perform a total of twenty five
one-leg jumps on the subject’s preferred leg.
The subjects
first performed the first set of five one-leg vertical
jumps and then received a twenty minute cold whirlpool
treatment with the preferred leg.
The subjects were
instructed to be out of the whirlpool and ready to jump
within two minutes.
The subjects completed four sets of
five one-leg vertical jumps after the whirlpool session.
Kinzey et al. found that vertical impulse (VI) had
decreased in sets two and three compared to sets four and
five.
Peak vertical ground-reaction force (PVGRF) was
greater in set two then four and five.
Average vertical
ground-reaction force (AVGRF) was not changed.22
Patterson et al. performed a study analyzing the cold
whirlpool and the effects it would have on the counter
movement vertical jump, 40 yard sprint, t-test and active
range of motion.
The study was a repeated measures pre-
47
test-posttest design, including twenty one healthy
individuals.
The subjects first performed the pre-test and
were then instructed to place both lower extremities in the
cold whirlpool for twenty minutes. Each posttest was
performed at seven, twelve, seventeen, twenty two, twenty
seven and thirty minutes after the cryotherapy treatment.
Specifically, the results for the vertical jump were
measured by mean vertical jump, average power and peak
power. Mean vertical jump scores, average jump scores and
peak power scores were all significantly lower than pretest scores.25
Hart et al. performed a 1 × 4 repeated measures time
series to examine the effects of cryotherapy on the knee
and vertical jump measurements.
Twenty physically active
subjects volunteered to perform the study.
The subjects
performed five single-leg landings before the use of
cryotherapy.
The subjects were instructed to place an ice
bag on the anterior, lateral and medial aspect of the knee
(all but the posterior aspect of the knee) for twenty
minutes.
After the cryotherapy session the subjects
performed five single-leg landings.
The subjects then
performed five single-leg landings fifteen and thirty
minutes after the cryotherapy treatment.
Results showed
48
that there were no significant changes in ground reaction
force, range of motion and muscle activity.26
Cross et al.
performed a pre-test-posttest with an
untreated control group to find if cryotherapy had an
effect on the shuttle run, 6m hop and single-leg vertical
jump.
Twenty volunteers were randomly chosen for two
groups, the cryotherapy group or the rest group.
The
subjects were allowed one practice trial. The subjects were
instructed to do a pre-test of each functional activity.
The cryotherapy group was then instructed to put their
lower leg in the cold whirlpool for twenty minutes while
the other group rested with no cryotherapy.
Subjects
performed a posttest after the use or non-use (depending on
the group) of cryotherapy.
Cross et al. found that the
cryotherapy group(experimental) had decreased results in
the single-leg vertical jump.27
The resting group
(comparison) did not use cryotherapy and the single-leg
vertical jump results were not changed.27
Fischer et al. performed a study to determine the
effects of cryotherapy on the shuttle run, co contraction
time and single-leg vertical jump.
Twenty five women and
seventeen men volunteered for the study.
The study
included three separate groups; the no ice bag group, three
minute ice bag and the ten minute ice bag.
The study first
49
began with warm-up consisting of a five minute stationary
bicycle warm-up and a thirty second hamstring stretch.
The
subjects were then instructed to perform a pre-test for the
shuttle run, co contraction test and the single-leg
vertical jump.
The subjects were then randomly assigned to
a specific cryotherapy group.
After the cryotherapy
session the subjects performed a posttest and twenty
minutes posttest.
The results for the single-leg vertical
jump were significantly lower after the application of the
ten minute ice bag.
Overall, results showed to be
significant because of the interaction between the ice bag
time and trial session.28
In summary, cryotherapy seems to have an effect on
functional performance in most situations.
Cross,
Richendollar and Fischer et al. tend to think that the
“negative effects of cryotherapy on muscle contractions and
a decrease in nerve conduction velocity may explain the
immediate decrease in performance.”
23,27,28
Further research
is needed to determine the exact effects of cryotherapy on
the vertical jump.
50
Summary
In conclusion, it is exceptionally important to
understand the anatomy components of the ankle.
The ankle
is a complex structure and is a structure that is
frequently injured.
Since the ankle is commonly injured;
healthcare professionals most commonly use a form of
cryotherapy.
When using cryotherapy it is important to
take in consideration the physiological effects,
indications and contraindications.
Cryotherapy is widely used after functional activity and
sometimes used during functional activity.
There are
numerous studies found on the research of cryotherapy and
the effects of functional performance, specifically the
vertical jump.22-28
In conclusion, this study was performed
to analyze the effects of cryotherapy on the vertical jump
to determine when it is safe to return an athlete to
play.22-28
51
APPENDIX B
The Problem
52
THE PROBLEM
The purpose of the experiment is to examine the
effects of cryotherapy and the amount of time to determine
if it has an effect on functional performance, the singleleg vertical jump.
Most research shows that cryotherapy
does have an effect on the vertical jump.
The results can
better help determine when to return athletes to play after
cryotherapy treatment.
Definition of Terms
The following definition of terms will be defined for
this study:
1)
Cryotherapy- In this study, the use of cubed ice for
twenty minutes directly placed on the skin.
2)
Single-leg Vertical jump- In this study it is the
maximal height at which an individual can jump and
land on the dominant leg.
3)
Functional performance- In this study it is the
performance that is a functional activity, closely
related to a sport movement, such as the single-leg
vertical jump.
4)
Peak force- In this study it is maximal jump height
from a single-leg vertical jump.
53
5)
Physically active- In this study the subject performs
three days a week of cardiovascular or weight lifting
activity.
Basic Assumptions
The following are basic assumptions of this study:
1)
The subjects will complete the demographic information
sheet to the best of their knowledge and will not
forge any given information.
2)
The subjects will fully understand the instructions
and have performed the task correctly in the amount of
time.
3)
The subjects will perform to the best of their ability
during testing sessions.
Limitations of the Study
The following are possible limitations of the study:
1)
The subjects are limited to physically active
individuals at California University of PA and
therefore it will not be randomized.
2)
There may be a practice effect while performing the
vertical jump.
54
Significance of the Study
The significance of this study is to help certified
athletic trainers determine when it is best to return an
athlete back to play after the treatment of cryotherapy.
This is an important aspect to study because many athletic
trainers use cryotherapy before, during and/or after
athletic participation.
Knowing if cryotherapy can
decrease performance before an athlete participates in the
sport can affect when athletic trainers apply cryotherapy
to an athlete.
If there is a decrease or harmful effect to
applying cryotherapy we know to apply a warm-up or allow
time to pass before allowing an athlete to return to play
after the use of cryotherapy.
55
APPENDIX C
Additional Methods
56
APPENDIX C1
Informed Consent Form
57
Informed Consent Form
1. Christine Stache, who is a Graduate Athletic Training
Student at California University of Pennsylvania, has
requested my participation in a research study at
California University of Pennsylvania. The title of the
research is The Effect of Cryotherapy on the Single Leg
Vertical Jump
2. I have been informed that the purpose of this study is
to examine if cryotherapy, and warm-up has an effect on
functional performance measured by the single-leg vertical
jump. I understand that I must be 18 years of age or older
to participate. I understand that I have been asked to
participate along with the fact that I do not have a
previous medical history of cold allergies. arthritis,
anesthetic skin, Raynaud’s and/or any other cold related
illness. I may only participate if I do not have a
previous history of neurological or cardiovascular
disorders and I must be free from lower leg injury for at
least one year. (Sprains, strains, fractures,
dislocations, etc.)
3. I have been invited to participate in this research
project. My participation is voluntary and I can choose to
discontinue my participation at any time without penalty or
loss of benefits. My participation will involve…
For the purpose of this study, physically active
individuals will be needed and are defined as being active
three times a week for thirty minutes or more. Being
active included cardiovascular exercise and/or strength
training three or more times a week. The participant must
meet this requirement to be eligible for the study.
I will be required to fill out a demographic form. The
information on the demographic form includes age, gender,
lower extremity injury, contraindications of ice,
cryotherapy disorders, neurological and cardiovascular
disorders. This is to ensure I do have a previous medical
history that may predispose me to injury or further risk.
Any questions or concerns should be brought to the
researcher at this time.
The next step I will take is that the researcher will
explain what is included in the experiment and how the
experiment will be conducted. The first concept I should
58
understand is how to perform the single-leg vertical jump.
The subjects will have to perform five consecutive singleleg maximal vertical jumps for five, ten, twenty and thirty
minute periods. I will be instructed to start and land on
my dominant leg. The contralateral leg is placed at ninety
degrees to prevent contact with the force platform.
Countermovement of the lower extremity was permitted,
dorsiflexion of the ankle, flexion of the knee and hip.
Countermovement of the upper extremity was not permitted.
Arms were crossed across the chest to prevent an increase
of peak ground-reaction force. I will be instructed to
jump when verbally cued. Between each of the five vertical
jumps thirty seconds of rest will be given. I will be
instructed to sit in the chair which will be placed next to
the force platform when resting.
The second concept I should know and understand is how
the force platform works. The force platform, also known
as the force plate, was used to measure peak force of each
single-leg vertical jump. Peak force is the measure of
maximal force production of one’s (my) contact with the
force platform. In simple terms, I will jump and the force
platform will measure the amount of maximal force when I
land on the force platform. The detector-transducer will
then detect my maximal force and allows the force to turn
into an electrical signal which is proportional to my
maximal force.
The third concept I should know and understand is the
cryotherapy treatment. The cryotherapy treatment will
include an ice bag directly on the skin for twenty
minutes. The ice used that will be used is cubed ice and
the bag and ice will weigh approximately two pounds. The
ice will be placed on the anteriolateral aspect of the
ankle. The ice bag was wrapped on the anteriolateral
aspect of the ankle with an elastic bandage.
The fourth concept I should know and understand is the
warm-up procedure. The pre warm-up condition and warm-up
(treatment) followed by the cryotherapy treatment consists
of five consecutive minutes on the stationary bicycle at
eighty five to ninety repetitions per minute (RPM). The
bike seat has been set at an appropriate position.
Appropriate shoe wear and workout entire are strongly
suggested.
Last is the testing schedule. On testing days, I will
participate in the initial warm-up followed by five single-
59
leg pretest vertical jumps. The peak forces of the pretest
vertical jumps will be recorded followed by an application
of the treatment condition for twenty five minutes.
Treatment conditions consisted of twenty minutes of
cryotherapy followed by five minutes of rest, twenty
minutes of cryotherapy followed by five minutes of warm-up
on the stationary bike, or twenty five minutes of rest. I
will be asked to perform five single-leg vertical jumps
five, ten, twenty and thirty minutes after the five minutes
stationary bike warm-up. Peak force results will be
recorded for each single-leg vertical jump.
4. I understand there are foreseeable risks or discomforts
to me if I agree to participate in the study. With
participation in a research program such as this there is
always the potential for unforeseeable risks as well. The
possible risks and/or discomforts include possible ice
injury and/or injuries due to falling from loss of
balance. To minimize these risks I need to be completely
honest when filling out the demographic form. The
researcher will also stand by closely to help minimize
risks and to answer questions.
5. I understand that, in case of injury, I can expect to
receive treatment or care in Hamer Hall’s Athletic Training
Facility. This treatment will be provided by the
researcher, Christine Stache, under the supervision of the
CalU athletic training faculty, all of which can administer
emergency care. Additional services needed for prolonged
care will be referred to the attending staff at the Downey
Garofola Health Services located on campus.
6. There are no feasible alternative procedures available
for this study.
7. I understand that the possible benefits of my
participation in the research is to help Certified Athletic
Trainers to understand the effects of returning an athlete
to play after the use of cryotherapy.
8. I understand that the results of the research study may
be published but my name or identity will not be revealed.
Only aggregate data will be reported. In order to maintain
confidentially of my records, Christine Stache will
maintain all documents in a secure location on campus and
password protect all electronic files so that only the
student researcher and research advisor can access the
data. Each subject will be given a specific subject number
60
to represent his or her name so as to protect the anonymity
of each subject.
9. I have been informed that I will not be compensated for
my participation.
10. I have been informed that any questions I have
concerning the research study or my participation in it,
before or after my consent, will be answered by:
Christine Stache, ATC
STUDENT/PRIMARY RESEARCHER
Sta1344@cup.edu
724-263-3359
Dr. Thomas F. West, PhD, ATC
RESEARCH ADVISOR
West_t@cup.edu
724-938-6033
11. I understand that written responses may be used in
quotations for publication but my identity will remain
anonymous.
12. I have read the above information and am electing to
participate in this study. The nature, demands, risks, and
benefits of the project have been explained to me. I
knowingly assume the risks involved, and understand that I
may withdraw my consent and discontinue participation at
any time without penalty or loss of benefit to myself. In
signing this consent form, I am not waiving any legal
claims, rights, or remedies. A copy of this consent form
will be given to me upon request.
13. This study has been approved by the California
University of Pennsylvania Institutional Review Board.
14. The IRB approval dates for this project are from:
02/01/10 to 02/01/11.
Subject's signature:___________________________________
Date:____________________
Witness signature:___________________________________
Date:____________________
61
APPENDIX C2
Institutional Review Board –
California University of Pennsylvania
62
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair
Christine Stache,
Please consider this email as official notification that your proposal titled “The
Effect of Cryotherapy on the Single Leg Vertical Jump” (Proposal #09-037)
has been approved by the California University of Pennsylvania Institutional
Review Board as amended.
The effective date of the approval is 2-26-2010 and the expiration date is 226-2011. These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly regarding
any of the following:
(1) Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated
by any events reported in (2).
(4) To continue your research beyond the approval expiration date of 2-262011 you must file additional information to be considered for
continuing review. Please contact instreviewboard@calu.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board
63
Proposal Number
Date Received
PROTOCOL for Research
Involving Human Subjects
Institutional Review Board (IRB) approval is required before
beginning any research and/or data collection involving human subjects
(Reference IRB Policies and Procedures for clarification)
Project Title The Effect of Cryotherapy on the Single Leg Vertical Jump
Researcher/Project Director
Christine Stache
Phone # 724-263-3359
E-mail Address sta1344@calu.edu
Faculty Sponsor (if required) Dr. Thomas West
Department Health Science
Project Dates January 1, 2010 to December 1, 2010
Sponsoring Agent (if applicable)
Project to be Conducted at California University of PA
Project Purpose:
Thesis
Research
Class Project
Keep a copy of this form for your records.
Other
64
Please attach a typed, detailed summary of your project AND complete items 2
through 6.
1. Provide an overview of your project-proposal describing what you plan to do and how you
will go about doing it. Include any hypothesis(ses)or research questions that might be
involved and explain how the information you gather will be analyzed. For a complete list of
what should be included in your summary, please refer to Appendix B of the IRB Policies and
Procedures Manual.
The purpose of the study is to determine if cryotherapy and warm-up has an effect on
functional performance measured by the single-leg vertical jump.
Research Design
The type of experiment is a quasi-experimental, within subjects, repeated measures
design. There are two independent variables, treatment condition (ice) and time. The first
level of the treatment condition is to apply cryotherapy to the subject's ankle, the second level
is to apply cryotherapy to the subject's ankle plus a five minute warm-up on the stationary
bike and the third level is not applying cyrotherapy to the ankle and there is no warm-up. The
second independent variable in the experiment is time, with six levels. The first level of time
is the pretest, second is the posttest, third is five minutes after the posttest, fourth is ten
minutes after the posttest, fifth is twenty minutes after the posttest and sixth is thirty minutes
after the posttest. The testing is described in more detail below. The dependant variable is
the peak force generated during a maximal vertical jump on the force platform.
Subjects
Approximately 20 healthy, physically active individuals will participate. Physically
active individuals are defined as being active three times a week. Being active includes
cardiovascular exercise and/or strength training three or more times a week. All individuals
will be screened for previous conditions such as cold allergies, Raynaud's and any other
condition relating to the application of cold. All individuals will be examined for lower leg
injuries as well. The subjects will be a mix of male and females.
On each of the testing days, each subject will perform an initial warm-up which will
consist of a five minute warm-up on the stationary bike. The warm-up will be followed by the
pretest which consists of five single-leg vertical jumps. After the pretest, subjects will (1)
have an ice bag applied to the anteriolateral aspect of the ankle for twenty minutes followed
by five minutes of rest, (2) have an ice bag applied to the anteriolateral aspect of the ankle for
twenty minutes followed by a five minute warm-up on the stationary bike or (3) have no ice
or warm-up applied and will remain seated for twenty five minutes. After the treatment
groups have been assigned the subjects will immediately perform the five maximal single-leg
vertical jumps. The subjects will also perform five maximal single-leg vertical jump five
minutes after posttest, ten minutes after posttest, and twenty minutes after posttest and thirty
minutes after posttest. The warm-up, treatment condition and the vertical jump will be
described in further detail in the procedure section. The order of the three treatments will be
assigned to subjects in a counter balanced order. The subjects will be given a two week
period to perform in all three treatment groups. All subjects will sign an approved Informed
Consent Form prior to the experiment. All information on the subjects will be kept
confidential.
Instruments
Instruments that will be used in the experiment are the demographic form, force platform
to measure peak force during the single-leg vertical jump, the ice bag and the stationary bike.
65
The information that will be gathered on the demographic sheet will include age, gender,
dominant leg, lower extremity injury, contraindications of ice, cryotherapy disorders,
neurological and/or cardiovascular disorders that the subject may react negatively towards
with the use of cryotherapy.
The force platform is located in Hamer Hall and it is located in the only classroom in the
pool area. The force platform blends with the floor in a safe location. It is not elevated or
inclined when the subjects are performing the single-leg vertical jump. All objects will be
removed from the surrounding force platform site. The force platform and the floor are not
wet, dirty or slippery and have no potential risk for injury. The subject will perform five
single-leg vertical jumps and after each jump I will ask if the subject feels fine to continue.
There is little to no potential risks for the subjects while using the force platform. The force
platform will be used to measure peak force of the subject’s individual single-leg vertical
jump. Peak force is the measure of maximal force production during a functional activity.
Specifically in this study I will measure the initial push-off the subject takes with the singleleg vertical jump. Each subject will be required to perform five maximal single-leg vertical
jumps for a total of six jump series. After the subject will perform the five single-leg vertical
jumps, the best jump out of the five jumps will be recorded. The subject will be performing
five single-leg vertical jumps for the pretest, post test and four additional time periods for a
total of six jump series.
The cryotherapy treatment will include an ice bag that will weigh approximately weigh
two and a half pounds with cubed ice. The subjects will have the ice bag placed directly on
the skin on the anteriolateral aspect of the ankle for twenty minutes. The ice bag will be
wrapped on the anteriolateral aspect of the ankle with an elastic bandage.
The stationary bike will be used for a pre-warm-up for all subjects in the experiment. The
subjects will also use the stationary bike for a warm-up after the cryotherapy treatment. The
warm-up will consists of five minutes on the stationary bike.
Procedures
The first day the subjects will report to complete the demographic form and informed
consent form. At this time subjects will have the methods explained and have an opportunity
to perform a trial run of the experiment. Days two, three and four consist of the actual
experiment. Sessions will be scheduled over a two week period. Again, all subjects will be
selected in a random order.
On testing days, all subjects will participate in the initial or pre-warm-up followed by the
pretest. The warm-up will be five minutes on the stationary bike. The pre-test will be five
maximal single-leg vertical jumps. The subjects are to jump when verbally cued. The
subject will be instructed to start and land on the dominant leg. The subjects will have ten
seconds in-between each jump. The subject is to hold the landing for five seconds. Subjects
will be required to sit when not being tested. The peak force of the pretest vertical jump will
then be recorded. Next, the subjects, depending on the subject's random selection, will
receive specific treatment condition protocol. Treatment conditions consist of (1) twenty
minutes of cryotherapy followed by five minutes of rest or (2) twenty minutes of cryotherapy
followed by five minutes of warm-up on the stationary bike, or (3) twenty five minutes of
rest. Each subject will have each treatment condition on an assigned day. After the treatment
condition, the subjects will then perform five single-leg maximal vertical jumps for the
posttest. The posttest will follow the same procedure as the pre-test. The subjects are to
jump when verbally cued. The subject will be instructed to start and land on the dominant
66
leg. The subjects will have ten seconds in-between each jump. The subject is to hold the
landing for five seconds. Subjects will be required to sit when not being tested. The peak
force of the posttest vertical jump will then be recorded. The subjects will be tested on the
five maximal single-leg vertical jump five minutes posttest, ten minutes posttest, twenty
minutes posttest and thirty minutes posttest. The five maximal single-leg vertical jump
protocols will be exactly the same as the five maximal single-leg vertical jump pre-test
protocol. The peak force will be recorded five minutes posttest, ten minutes posttest, twenty
minutes posttest and thirty minutes posttest. The best out of the five jumps will be recorded
for each jumping session.
The pre warm-up condition and warm-up followed by the cryotherapy treatment will
consist of five consecutive minutes on the stationary bicycle. The cryotherapy treatment
includes an ice bag applied directly on the skin for twenty minutes, a standard treatment
utilized in the practice of athletic training. Cubed ice will be utilized and the bag and ice will
weigh approximately two and a half pounds. The ice will be placed on the anteriolateral
aspect of the ankle. The ice bag will be wrapped on the anteriolateral aspect of the ankle with
an elastic bandage.
The pretest and all posttest vertical jumps consist of five single-leg maximal vertical
jumps. The subject will be instructed to start and land on the dominant leg. The contra
lateral leg will be placed at ninety degrees to prevent contact with the force platform.
Countermovement of the lower extremity will be permitted and countermovement of the
upper extremity is not permitted. Arms will be crossed across each subject’s chest to prevent
an increase of peak ground-reaction force. The subject will be instructed to jump when
verbally cued. Between each of the five vertical jumps 10 seconds of rest will be given to
each participant. The subject will be instructed to sit in the chair next to the force platform
when resting.
Hypothesis
The following hypothesis is suggested by the researcher prior to the study.
There will be a difference in peak force production during a single-leg vertical jump
depending on cryotherapy condition and timing of the test.
Data Analysis
All data will analyzed by the SPSS version 17 . Data was analyzed to determine if
cryotherapy and warm-up condition had an effect on vertical jump. The research hypothesis
was analyzed using 3 x 6 Repeated Measures Factorial Analysis of Variance. An alpha level
of .05 was set a priori to determine statistical significance.
2. Section 46.11 of the Federal Regulations state that research proposals involving human
subjects must satisfy certain requirements before the IRB can grant approval. You should
describe in detail how the following requirements will be satisfied. Be sure to address each
area separately.
a. How will you insure that any risks to subjects are minimized? If there are potential
risks, describe what will be done to minimize these risks. If there are risks, describe
why the risks to participants are reasonable in relation to the anticipated benefits.
Before the study is performed the subjects are required to fill out a demographic
form. The demographic form will include health related questions pertaining to the
lower leg and cryotherapy. The demographic form will help to determine which
67
subjects will be able to perform the study with minimal risk. Subjects may also have
the potential to injure the lower extremity from the single-leg vertical jump. The
risks for the subjects are extremely low and unlikely but possible. If injury were to
occur, the subjects will be under the supervision of the researcher and will treat the
subjects to the appropriate medical care as needed. The researcher is (myself) is a
Certified Athletic Trainer. I am qualified to assist a volunteer when medical help is
needed while doing the vertical jump.
The subjects will perform the vertical jumps on a force platform. It is located in
Hamer Hall which it is located in the only classroom in the pool area. The force
platform blends with the floor in a safe location. It is not elevated or inclined when
the subjects are performing the single-leg vertical jump. All objects will be removed
from the surrounding force platform site. The force platform and the floor are not
wet, dirty or slippery and have no potential risk for injury. The subject will perform
five single leg vertical jumps and after each jump I will ask if the subject feels fine to
continue. There is little to no potential risks for the subjects while using the force
platform. If a possible injury does occur I am a Certified Athletic Trainer and I am
certified to assist the subject in his/her medical needs. I am trained and certified in
First Aid and Cardiopulmonary Resuscitation (CPR). I also know where the Athletic
Training room is and where needed supplies are as well as I also know where the
Automated External Deliberators (AED) are located if needed.
b. How will you insure that the selection of subjects is equitable? Take into account
your purpose(s). Be sure you address research problems involving vulnerable
populations such as children, prisoners, pregnant women, mentally disabled persons,
and economically or educationally disadvantaged persons. If this is an in-class
project describe how you will minimize the possibility that students will feel coerced.
The subjects that will volunteer are approximately 20 healthy, physically active
individuals. Volunteers will be recruited from the CalU Health Science and Exercise
Science and Sport Studies populations. Children, prisoner, pregnant women,
mentally disabled persons, and economically or educationally disadvantaged persons
will not be included in the study. This is also not an in-class assignment and by no
means will students feel coerced. Any participant may withdraw from the study at
any time without any loss.
c. How will you obtain informed consent from each participant or the subject’s legally
authorized representative and ensure that all consent forms are appropriately
documented? Be sure to attach a copy of your consent form to the project summary.
The subjects will report to complete the informed consent form and demographic
form on the first day. At this time subjects also will have the directions explained
and will be allowed to ask questions about their participation. They also will have an
opportunity to perform a trial run of the experiment. The subjects will not be allowed
to perform in the study unless all required data (informed consent form and
demographic form) have been completed. All informed consent forms and
demographic forms will be kept strictly confidential and locked in a file cabinet.
68
d. Show that the research plan makes provisions to monitor the data collected to insure
the safety of all subjects. This includes the privacy of subjects’ responses and
provisions for maintaining the security and confidentiality of the data.
All material and data are strictly confident and will be locked in a file cabinet in the
Graduate Athletic Training Program Directors office. This will ensure the privacy
rights of all subjects included in the trial. Only approved members of the study will
be able to access the data.
3. Check the appropriate box(es) that describe the subjects you plan to use.
Adult volunteers
Mentally Disabled People
CAL University Students
Economically Disadvantaged People
Other Students
Educationally Disadvantaged People
Prisoners
Fetuses or fetal material
Pregnant Women
Children Under 18
Physically Handicapped People
Neonates
4. Is remuneration involved in your project?
5. Is this project part of a grant?
Yes or
Yes or
No
No. If yes, Explain here.
If yes, provide the following information:
Title of the Grant Proposal
Name of the Funding Agency
Dates of the Project Period
6.
Does your project involve the debriefing of those who participated?
Yes or
No
If Yes, explain the debriefing process here.
7. If your project involves a questionnaire interview, ensure that it meets the requirements of
Appendix
in the Policies and Procedures Manual.
69
California University of Pennsylvania Institutional Review Board
Survey/Interview/Questionnaire Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview or questionnaire?
YES—Complete this form
NO—You MUST complete the “Informed Consent Checklist”—skip the remainder
of this form
Does your survey/interview/questionnaire cover letter or explanatory statement include:
(1) Statement about the general nature of the survey and how the data will be
used?
(2) Statement as to who the primary researcher is, including name, phone, and
email address?
(3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information
provided?
(4) Statement that participation is voluntary?
(5) Statement that participation may be discontinued at any time without penalty
and all data discarded?
(6) Statement that the results are confidential?
(7) Statement that results are anonymous?
(8) Statement as to level of risk anticipated or that minimal risk is anticipated?
(NOTE: If more than minimal risk is anticipated, a full consent form is required—and
the Informed Consent Checklist must be completed)
(9) Statement that returning the survey is an indication of consent to use the data?
(10) Who to contact regarding the project and how to contact this person?
(11) Statement as to where the results will be housed and how maintained? (unless
otherwise approved by the IRB, must be a secure location on University premises)
(12) Is there text equivalent to: “Approved by the California University of
Pennsylvania Institutional Review Board. This approval is effective nn/nn/nn and
expires mm/mm/mm”? (the actual dates will be specified in the approval notice from
the IRB)?
70
(13) FOR ELECTRONIC/WEBSITE SURVEYS: Does the text of the cover letter
or
explanatory statement appear before any data is requested from the participant?
(14) FOR ELECTONIC/WEBSITE SURVEYS: Can the participant discontinue
participation at any point in the process and all data is immediately discarded?
71
California University of Pennsylvania Institutional Review Board
Informed Consent Checklist (v021209)
This form MUST accompany all IRB review requests
Does your research involve ONLY a survey, interview, or questionnaire?
YES—DO NOT complete this form. You MUST complete the “Survey/Interview/Questionnaire
Consent Checklist” instead.
NO—Complete the remainder of this form.
1.
Introduction (check each)
(1.1) Is there a statement that the study involves research?
(1.2) Is there an explanation of the purpose of the research?
2. Is the participant. (check each)
(2.1) Given an invitation to participate?
(2.2) Told why he/she was selected.
(2.3) Told the expected duration of the participation.
(2.4) Informed that participation is voluntary?
(2.5) Informed that all records are confidential?
(2.6) Told that he/she may withdraw from the research at any time without penalty or loss of
benefits?
(2.7) 18 years of age or older? (if not, see Section #9, Special Considerations below)
3. Procedures (check each).
(3.1) Are the procedures identified and explained?
(3.2) Are the procedures that are being investigated clearly identified?
(3.3) Are treatment conditions identified?
4. Risks and discomforts. (check each)
(4.1) Are foreseeable risks or discomforts identified?
(4.2) Is the likelihood of any risks or discomforts identified?
(4.3) Is there a description of the steps that will be taken to minimize any risks or discomforts?
(4.4) Is there an acknowledgement of potentially unforeseeable risks?
(4.5) Is the participant informed about what treatment or follow up courses of action are available
should there be some physical, emotional, or psychological harm?
(4.6) Is there a description of the benefits, if any, to the participant or to others that may be
reasonably expected from the research and an estimate of the likelihood of these benefits?
(4.7) Is there a disclosure of any appropriate alternative procedures or courses of treatment that
might be advantageous to the participant?
5. Records and documentation. (check each)
(5.1) Is there a statement describing how records will be kept confidential?
(5.2) Is there a statement as to where the records will be kept and that this is a secure location?
(5.3) Is there a statement as to who will have access to the records?
6. For research involving more than minimal risk (check each),
(6.1) Is there an explanation and description of any compensation and other medical or counseling
treatments that are available if the participants are injured through participation?
(6.2) Is there a statement where further information can be obtained regarding the treatments?
(6.3) Is there information regarding who to contact in the event of research-related injury?
7. Contacts.(check each)
72
(7.1) Is the participant given a list of contacts for answers to questions about the research and the
participant’s rights?
(7.2) Is the principal researcher identified with name and phone number and email address?
(7.3) FOR ALL STUDENTS: Is the faculty advisor’s name and contact information provided?
8. General Considerations (check each)
(8.1) Is there a statement indicating that the participant is making a decision whether or not to
participate, and that his/her signature indicates that he/she has decided to participate having read and
discussed the information in the informed consent?
(8.2) Are all technical terms fully explained to the participant?
(8.3) Is the informed consent written at a level that the participant can understand?
(8.4) Is there text equivalent to: “Approved by the California University of Pennsylvania
Institutional Review Board. This approval is effective nn/nn/nn and expires mm/mm/mm”? (the actual
dates will be specified in the approval notice from the IRB)
9. Specific Considerations (check as appropriate)
(9.1) If the participant is or may become pregnant is there a statement that the particular treatment
or procedure may involve risks, foreseeable or currently unforeseeable, to the participant or to the
embryo or fetus?
(9.2) Is there a statement specifying the circumstances in which the participation may be terminated
by the investigator without the participant’s consent?
(9.3) Are any costs to the participant clearly spelled out?
(9.4) If the participant desires to withdraw from the research, are procedures for orderly
termination spelled out?
(9.5) Is there a statement that the Principal Investigator will inform the participant or any
significant new findings developed during the research that may affect them and influence their
willingness to continue participation?
(9.6) Is the participant is less than 18 years of age? If so, a parent or guardian must sign the consent
form and assent must be obtained from the child
Is the consent form written in such a manner that it is clear that the parent/guardian is giving
permission for their child to participate?
Is a child assent form being used?
Does the assent form (if used) clearly indicate that the child can freely refuse to participate or
discontinue participation at any time without penalty or coercion?
(9.7) Are all consent and assent forms written at a level that the intended participant can
understand? (generally, 8th grade level for adults, age-appropriate for children)
73
California University of Pennsylvania Institutional Review Board
Review Request Checklist (v021209)
This form MUST accompany all IRB review requests.
Unless otherwise specified, ALL items must be present in your review request.
Have you:
(1.0) FOR ALL STUDIES: Completed ALL items on the Review Request Form?
Pay particular attention to:
(1.1) Names and email addresses of all investigators
(1.1.1) FOR ALL STUDENTS: use only your CalU email
address)
(1.1.2) FOR ALL STUDENTS: Name and email address of your
faculty research advisor
(1.2) Project dates (must be in the future—no studies will be approved
which have already begun or scheduled to begin before final IRB approval—
NO EXCEPTIONS)
(1.3) Answered completely and in detail, the questions in items 2a through
2d?
2a: NOTE: No studies can have zero risk, the lowest risk is
“minimal risk”. If more than minimal risk is involved you MUST:
i. Delineate all anticipated risks in detail;
ii. Explain in detail how these risks will be minimized;
iii. Detail the procedures for dealing with adverse outcomes
due to these risks.
iv. Cite peer reviewed references in support of your
explanation.
2b. Complete all items.
2c. Describe informed consent procedures in detail.
2d. NOTE: to maintain security and confidentiality of data, all
study records must be housed in a secure (locked) location ON
UNIVERSITY PREMISES. The actual location (department, office,
etc.) must be specified in your explanation and be listed on any
consent forms or cover letters.
(1.4) Checked all appropriate boxes in Section 3? If participants under the
age of 18 years are to be included (regardless of what the study involves) you
MUST:
(1.4.1) Obtain informed consent from the parent or guardian—
consent forms must be written so that it is clear that the
parent/guardian is giving permission for their child to participate.
(1.4.2) Document how you will obtain assent from the child—
This must be done in an age-appropriate manner. Regardless of
whether the parent/guardian has given permission, a child is
completely free to refuse to participate, so the investigator must
document how the child indicated agreement to participate
(“assent”).
74
(1.5) Included all grant information in section 5?
(1.6) Included ALL signatures?
(2.0) FOR STUDIES INVOLVING MORE THAN JUST SURVEYS,
INTERVIEWS, OR QUESTIONNAIRES:
(2.1) Attached a copy of all consent form(s)?
(2.2) FOR STUDIES INVOLVING INDIVIDUALS LESS THAN 18
YEARS OF AGE: attached a copy of all assent forms (if such a form is used)?
(2.3) Completed and attached a copy of the Consent Form Checklist? (as
appropriate—see that checklist for instructions)
(3.0) FOR STUDIES INVOLVING ONLY SURVEYS, INTERVIEWS, OR
QUESTIONNAIRES:
(3.1) Attached a copy of the cover letter/information sheet?
(3.2) Completed and attached a copy of the
Survey/Interview/Questionnaire Consent Checklist? (see that checklist for
instructions)
(3.3) Attached a copy of the actual survey, interview, or questionnaire
questions in their final form?
(4.0) FOR ALL STUDENTS: Has your faculty research advisor:
(4.1) Thoroughly reviewed and approved your study?
(4.2) Thoroughly reviewed and approved your IRB paperwork? including:
(4.2.1) Review request form,
(4.2.2) All consent forms, (if used)
(4.2.3) All assent forms (if used)
(4.2.4) All Survey/Interview/Questionnaire cover letters (if used)
(4.2.5) All checklists
(4.3) IMPORTANT NOTE: Your advisor’s signature on the review request
form indicates that they have thoroughly reviewed your proposal and verified
that it meets all IRB and University requirements.
(5.0) Have you retained a copy of all submitted documentation for your records?
75
Project Director’s Certification
Program Involving HUMAN SUBJECTS
The proposed investigation involves the use of human subjects and I am submitting the complete
application form and project description to the Institutional Review Board for Research Involving
Human Subjects.
I understand that Institutional Review Board (IRB) approval is
required before beginning any research and/or data collection
involving human subjects.
If the Board grants approval of this
application, I agree to:
1. Abide by any conditions or changes in the project required by the Board.
2. Report to the Board any change in the research plan that affects the method of using
human subjects before such change is instituted.
3. Report to the Board any problems that arise in connection with the use of human subjects.
4. Seek advice of the Board whenever I believe such advice is necessary or would be
helpful.
5. Secure the informed, written consent of all human subjects participating in the project.
6. Cooperate with the Board in its effort to provide a continuing review after investigations
have been initiated.
I have reviewed the Federal and State regulations concerning the use of human subjects in
research and training programs and the guidelines. I agree to abide by the regulations and
guidelines aforementioned and will adhere to policies and procedures described in my
application. I understand that changes to the research must be approved by the IRB before they
are implemented.
Professional Research
Project Director’s Signature
Department Chairperson’s Signature
Student or Class Research
Student Researcher’s Signature
Supervising Faculty Member’s
Department Chairperson’s Signature
76
Signature if required
ACTION OF REVIEW BOARD (IRB use only)
The Institutional Review Board for Research Involving Human Subjects has reviewed this application to
ascertain whether or not the proposed project:
1.
2.
3.
4.
5.
provides adequate safeguards of the rights and welfare of human subjects involved in the
investigations;
uses appropriate methods to obtain informed, written consent;
indicates that the potential benefits of the investigation substantially outweigh the risk involved.
provides adequate debriefing of human participants.
provides adequate follow-up services to participants who may have incurred physical, mental, or
emotional harm.
Approved[_________________________________]
Disapproved
___________________________________________
_________________________
Chairperson, Institutional Review Board
Date
77
Appendix C3
Demographic Information
78
Demographic Information
Age: __________________________
Year school: __________________
Gender:
Male
Female
Which is your dominant leg? Right or Left
(Which leg would you use to kick a soccer ball)
Injury History:
Any history of lower extremity injury? (i.e. hip, knee,
ankle) Yes or No
If answered yes:
Date of last injury _____________________
Severity
_____________________
Any history of head injury/concussion? Yes or No
If answered yes:
Date of last injury _____________________
Severity
_____________________
Any neurological disorder that affect performance? Yes or
No
If answered yes:
Please explain _______________________________
Have you used ice before as an injury treatment? Yes or no
Raynauds phenomenon: Yes or no
(Disruption of blood flow in the extremities arteries)
Cold allergy: Yes or No
Poor circulation: Yes or No
Diminished sensation: Yes or No
Long-lasting/slow healing wounds: Yes or No
Arthritis:
Yes or No
79
(Rhematoid, gouty, pseudogout, lupus, infectious,
hemorrhagic, osteoarthritis, inflammatory, psoriactic,
reactive and anklyosing spondylitis)
Any other cold allergy or cold condition not previously
mentioned:
______________________________________________________
80
Appendix C4
Peak Force Trial Example
81
82
Appendix C5
Summary of Previous Cryotherapy Research
83
Study
Richendollar et
al.
Results
Negative Effect on
Functional
Performance
1. Vertical
jump
decreased
more than 1
cm.23
2. Overall
results
improved
with ice and
warm-up over
ice and no
warm-up.23
Jameson et al.
Kinzey et al.
No significant
differences of
pretest and
posttest results.24
1.
2.
3.
Patterson et al.
Results
No Effect on
Functional
Performance
1.
Vertical
jump impulse
decreased in
sets 2 & 3
compared
with sets 4
& 5.22
Peak
vertical
groundreaction
force was
greater in
set 2 then 4
& 5.22
Average
vertical
groundreaction
force was
unchanged.22
Mean
vertical
jump scores
were all
84
2.
3.
significantl
y lower.25
Average
power was
significantl
y lower. 25
Peak power
scores were
significantl
y lower. 25
Hart et al.
Cross et al.
Fischer et al.
No significant
changes in ground
reaction force,
range of motion
and muscle
activity. 26
The cryotherapy
group had
significantly lower
results than the
resting group for
the single-leg
vertical jump. 27
The results of the
single-leg vertical
jump were
significantly lower
after 10 minutes of
ice bag and
immediately
posttest. 28
85
REFERENCES
1.
Hatzel B, Kaminski T. The effects of ice immersion on
concentric and eccentric isokinetic muscle
performance. Isokin Ex Sci. 2000;(8):103-107.
2.
Mohammad A, Hossein K, Hossein F, Soghrat F. Balance
problems after unilateral lateral ankle sprains. J
of Rehabil Res and Dev. 2006;43(7):819-824.
3.
Eils E. The role of proprioception in the primary
prevention of ankle sprains in athletes. Int Sports
Med J. 2003;4(5).
4.
Hertel J. Functional instability following lateral
ankle sprain. Sports Med. 2000;29(5):361-371.
5.
Hubbard T. Hicks-Little, C. Ankle ligament healing
after an acute ankle sprain an evidence-based
approach. J Athl Train. 2008;43(5):523-529.
6.
Tik-Pui Fong D, Hong Y, Chan L, Yung P, Chan K. A
Systematic review on ankle injury and ankle sprain in
sports. Sports Med. 2007;37(1):73-94.
7.
Drake R, Vogl W, Mitchell A. Gray’s Anatomy for
Students. Philadelphia. Elsevier. 2005.
8.
Nadler S, Weingand K, Kruse R. The physiologic basis
and clinical applications of cryotherapy and
thermotherapy for the pain practitioner. Pain
Physician. 2004;7:395-399.
9.
Swenson C, Sward L, Karlsson J. Cryotherapy in sports
medicine. Scand J Med Sci Sports. 1996;6(4:193-200.
10. Knight K. Cryotherapy in Sport Injury Management.
Illinois. Human Kinetics. 1995.
11. McMaster WC. A literary review on ice therapy in
injuries. Am J Sports Med. 1977; 5(3):124-126.
12. Ciolek J. Cryotherapy: Review of physiological
effects and clinical application. Cleveland Clin Q.
1985;52(2):193-201.
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13. Meeusen R, Lievens P. The use of cryotherapy in
sports injuries. Sports Med. 1986;3(6):398-414.
14. Kowal MA. Review of physiological effects of
cryotherapy. J Orthop Sports Phys Ther.
1983;5(2):66-73.
15. Ferretti G. Cold and muscle performance.
Sports Med. 1992;13 (S1):185-187.
Int J
16. Bender A, Kramer E, Brucker J, Demchak T, Cordova M,
Stone M. Local ice-bag application and triceps surae
muscle temperature during treadmill walking. J Athl
Train. 2005;40(4): 271-275.
17. Johnson D, Moore S, Moore J, Oliver R. Effect of
cold submersion on intramuscular temperature of the
gastrocnemius muscle. Phys Ther. 59(10): 1238-1242.
18. Myrer W, Measom G, Fellingham G. Temperature changes
in the human leg during and after two methods of
cryotherapy. J Athl Train. 1998; 33:25-29.
19. Palmieri RM.
temperature.
Peripheral ankle cooling and core body
J Athl Train. 2006;41(2):185-188.
20. Ingersoll CD. Sensory perception of the foot and
ankle following therapeutic applications of heat and
cold. J Athl Train. 1992;27(3):231-234.
21. Algafly AA. The effect of cryotherapy on nerve
conduction velocity, pain threshold and pain
tolerance. Br J Sports Med. 2007;41:365-369.
22. Kinzey SJ, Cordova ML, Gallen KJ, Smith JC, Moore JB.
The effects of cryotherapy on ground reaction forces
produced during a functional task. J Sport Rehabil.
2000; 9:3-14.
23. Richendollar M, Darby L, Brown T.
Ice bag
application, active warm-up, and 3 measures of
maximal functional performance. J Athl Train.
2006;41(4):364-370.
24. Jameson A, Kinzey S, Hallam JS.
Lower ExtremityJoint-Cryotherapy does not affect Vertical Ground
87
Reaction Forces During Landing.
2001;10:132-142.
J Sport Rehabil.
25. Patterson S, Udermann B, Doberstein S, Reineke D. The
effects of cold whirlpool on power, speed, agility
and range of motion. J Sports Sci Med. 2008;7: 387394.
26. Hart JM, Ingersoll CD, Leonard JL. Single-leg
landing strategy after knee-joint cryotherapy.
Sport Rehabil. 2005;14:313-320.
J
27. Fischer J, Branch JD, Pirone J, Van Lunen B.
Functional performance following an ice bag
application to the hamstrings. J Strength Condition
Res. 2009;23(1):44-50.
28. Cross KM, Perrin DH, Wilson RW. Functional
performance following an ice immersion to the lower
extremity. J Athl Train. 1996; 31(2): 113-116.
29. MacAuley D. Ice therapy: How good is the evidence?
Int J Sports Med. 2001;22(5): 379-384.
88
ABSTRACT
Title:
The Effects of Cryotherapy and the SingleLeg Vertical Jump
Researcher:
Christine M. Stache
Advisor:
Dr. Thomas F. West
Research Type: Master’s Thesis
Context:
Many studies suggest that there is a
difference in functional performance after
the use of cryotherapy. Some studies have
conflicting findings suggesting there is not
a difference in functional performance after
the use of cryotherapy. Many studies
analyzing functional performance have chosen
to analyze the vertical jump. The vertical
jump is a standard measurement of lower
extremity functional strength and power.
Objective:
The purpose of the study is to examine the
effects of cryotherapy on the lower
extremity and functional performance as
measured by the single-leg vertical jump.
Design:
Quasi-experimental, within subjects,
repeated measures design.
Setting:
Controlled laboratory setting.
Participants:
14 physically active college students who
volunteered with no previous injuries or
cold contraindications.
Interventions: Subjects were required fill
out a demographic and approved informed
consent form upon arrival for the first
time. Subjects were required to come in
twice for testing. Testing first started
with a 5 minute warm-up on the bicycle.
Immediately following the warm-up the
subject was to perform five single-leg
vertical jumps (pretest. The subject was
then instructed to sit and received
treatment (cryotherapy or no cryotherapy).
89
Immediately after the treatment the subject
performed five single-leg vertical jumps
(posttest) and again performed five singleleg vertical jumps five minutes after
posttest, ten minutes and twenty minutes
after posttest.
Main Outcome
Measures:
Peak force (maximal jump height
was the measurement used to measure to
compare two conditions: treatment
(cryotherapy and no cryotherapy) and time.
Results:
The results showed that there was no
significant difference with cryotherapy
conditions: treatment and time. The
results also showed there was no significant
difference with the interaction of
treatments and time.
Conclusions:
Results of this study would suggest it is
safe to return an athlete to play
immediately after cryotherapy has been
applied. It is still recommended by
numerous other studies that warm-up or an
elapse of time should be given to the
athlete before returning to play.
Word Count:
343