THE EFFECT OF CRYOTHERAPY ON LANDING FORCES DURING A SINGLE
LEG 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
Danielle Wilson

Research Advisor, Dr. Thomas F. West
California, Pennsylvania
2011

ii

iii

ACKNOWLEDGEMENTS
I would first like to say that this thesis and this
year was the hardest thing I have ever done, and my biggest
academic accomplishment. With that said I would like to
take this opportunity to thank everyone who has helped me
this year. I want to thank my mom, dad, and brothers for
all of their support and believing in me, even when I
thought I could not get through this year. I would also
like to thank Brett for listening to me daily on the phone,
whether it was smiles or tears he was always there to give
support and advice. I want to also thank my friends from
home and undergrad as well as the GA’s here at CalU.
Without your encouragement I would have never made it
through this year with my sanity intact.
I would like to thank my thesis chair, Dr. West, and
my two committee members, Shelly and Dr. Z for helping me
with this thesis. You all have left a huge impact on my
life and with all that has happened this year, I know my
name will not be forgotten by you.
Lastly, I would like to thank Christine Stache. Thank
you so much for allowing me to use your data collection
that you worked very hard on. Thank you everyone!

iv
TABLE OF CONTENTS
Page
SIGNATURE PAGE

. . . . . . . . . . . . . . . ii

AKNOWLEDGEMENTS . . . . . . . . . . . . . . . iii
TABLE OF CONTENTS .

. . . . . . . . . . . . . iv

LIST OF TABLES

. . . . . . . . . . . . . . . vi

INTRODUCTION .

. . . . . . . . . . . . . . . 1

METHODS .

. . . . . . . . . . . . . . . . . 5

Research Design. . . . . . . . . . . . . . . 5
Subjects. . . . . . . . . . . . . . . . . . 6
Preliminary Research. . . . . . . . . . . . . 7
Instruments. . . . . . . . . . . . . . . . . 7
Procedures. . . . . . . . . . . . . . . . . 8
Hypothesis. . . . . . . . . . . . . . . . . 9
Data Analysis. . . . . . . . . . . . . . . . 10
RESULTS .

. . . . . . . . . . . . . . . . . 11

Demographic Information .

.

. . . . . . . . . 11

Hypothesis Testing. . . . . . . . . . . . . . 12
DISCUSSION . . . . . . . . . . . . . . . . . 14
Discussion of Results. . . . . . . . . . . . . 14
Conclusions .

. . . . . . . . . . . . . . . 18

Recommendations. . . . . . . . . . . . . . . 19
REFERENCES. . . . . . . . . . . . . . . . . . 21
APPENDICES .

. . . . . . . . . . . . . . . . 24

v
APPENDIX A: Review of Literature .

. . . . . . . 25

Introduction . . . . . . . . . . . . . . . . 26
Cryotherapy. . . . . . . . . . . . . . . . . 27
Cryotherapy Effects on the Body
Methods of Application

. . . . . 28

. . . . . . . . . 30

Cryotherapy and Functional Performance. . . . . . 32
Force Production

. . . . . . . . . . . . 33

Agility

. . . . . . . . . . . . . . . . 34

Balance

. . . . . . . . . . . . . . . . 36

Speed

. . . . . . . . . . . . . . . . . 38

Fatigue . . . . . . . . . . . . . . . . . 40
Summary . . . . . . . . . . . . . . . . . . . 42
APPENDIX B: The Problem . . . . . . . . . . . . 43
Statement of the Problem . . . . . . . . . . 44
Definition of Terms . . . . . . . . . . . . . 45
Basic Assumptions . . . . . . . . . . . . . . 46
Limitations of the Study . . . . . . . . . . . 46
Significance of the Study . . . . . . . . . . . 46
APPENDIX C: Additional Methods .

. . . . . . . . 48

IRB: California University of Pennsylvania(C1) . . 49
Excel Spreadsheet Data Collection(C2) . . . . . . 63
REFERENCES . . . . . . . . . . . . . . . . . 66
ABSTRACT

. . . . . . . . . . . . . . . . . 71

vi
LIST OF TABLES

Table

Title

Page

1

Peak Landing Forces Dependent on
Cryotherapy and Time of Test . . . . . . 13

2

ANOVA Results for Main Effects
and Interaction between Cryotherapy
and Time Conditions . . . . . . . . . . 13

3

Mean Peak Landing Forces: The
Cryotherapy Group . . . . . . . . . . . 64

4

Mean Peak Landing Forces: The Control
Group
. . . . . . . . . . . . . . . 64

1

INTRODUCTION

Cryotherapy is one of the most commonly used
modalities in athletic training today.1-3 This modality is
used frequently for acute injury treatment.

Studies have

shown that cryotherapy is effective in reducing pain,
decreasing inflammation, and decreasing muscle spasms.1-9
Several studies have examined the effect of this modality
on various measures of performance; however, there are few
studies examining the effects of cryotherapy on peak
landing force immediately after cryotherapy application and
over the time necessary to rewarm. Force production and
force absorption are critical parts of athletic
performance.

Being able to produce a great enough force to

jump or run, then absorb that force is highly important
from a performance standpoint as well as for return to play
criteria.
Athletes use various forms of cryotherapy such as ice
bags, cold whirlpools, and ice immersion prior to, during,
and after participating in athletic events. Cryotherapy has
the potential to decrease force production, alter body
kinematics and increase the rate of fatigue due to its

2
physiological effects on the circulatory and nervous
systems.

4,6,7

Several researchers have examined the effect

of cryotherapy on force production and absorption.

There

are conflicting findings about whether there is a decrease
in landing force absorption after the application of
cryotherapy.

A decrease in force absorption has the

potential to hinder performance prior to participating in
sports.
Force is defined as a generation of tension and
pressure created in the body via muscle, muscle fibers,
nerves and neural functioning.10 If the body is not able to
produce a great enough force to jump or run, or absorb the
force the body produces, it can significantly decrease
athletic performance and potentially increase the risk of
injury. Force production can be measured by single or
double leg jumping measuring the landing ground force.11-13
Force absorption can be measured as vertical ground
reaction forces (VGRF).14 Vertical ground reaction force is
equal in magnitude in the opposite direction to the force
that that body exerts on the supporting surface through the
foot.15 However for this study, force absorption, also
referred to as peak landing force, was measured by the
maximum of the landing force production on the BioAnalysis
analysis sheet.

3
The effects of cryotherapy on force production and
absorption have conflicting findings through the
literature. Jameson examined the effects of cryotherapy on
vertical-ground-reaction-force during a double leg landing
from a double leg vertical jump.13 Subjects jumped five
times prior to cryotherapy treatment and five times after
cryotherapy treatment. Subjects were placed in four
conditions; no ice, ice on the ankle joint only, ice to the
knee joint only, and ice to both ankle and knee joints
combined. Ultimately, this study did not find a significant
difference in vertical ground reaction force as a result of
cryotherapy.
In a study by Simon et al,10 force production was
tested by means of isometric force production of the lower
leg. This study suggested that subjects attempting to
produce equal lower limb forces would generate equal
percentages of force of their bilateral maximum voluntary
strength rather than equal absolute limb forces. This study
used ten male and female subjects who performed isometric
extensions of the lower limb. Subjects were asked to match
forces in their lower limbs at three different sub-maximal
levels. It was found that subjects continually produced
less force in the weaker limb during all force matching
levels.

4
Force production and absorption is a major component
to athletic performance with fatigue as a possible
hindrance.10 If cryotherapy decreases force absorption and
increases how quickly the muscles fatigue, then
professionals who use this modality need to be aware of the
possible effects cryotherapy has on athletic performance.
Thus, the purpose of this study is to examine the effect
cryotherapy has on lower extremity peak landing forces over
time in college age students, which could in turn impact
the athlete’s performance and injury risk.

5

METHODS

The primary purpose of this study is to determine if
cryotherapy effects lower extremity peak landing force
during a single-leg vertical jump. The secondary purpose of
this study is to examine if cryotherapy has an affect on
peak landing forces over time. This section will include
the following subsections:

(1) research design, (2)

subjects, (3) preliminary research, (4) instruments, (5)
procedures, (6) hypotheses, and (7) data analysis.

Research Design

This is a quasi-experimental, within-subjects,
research design. The study will use preexisting data from a
study entitled “The Effect of Cryotherapy on Single Leg
Vertical Jump” by Stache.16 For the present study, the
independent variables are cryotherapy condition, tested at
two levels and time tested at five levels. The first level
of cryotherapy was application of an ice bag to the
anterolateral aspect of the ankle. The second level was no
application of cryotherapy to the anterolateral aspect of
the ankle. Peak landing force was measured over time with

6
subjects performing five vertical jumps at five different
times. The first level of time was a pretest, second was a
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 peak
landing force. The dependent variable was measured through
passage of time. Maximal landing force generated in a
series of five single-leg vertical jump was measured using
the force platform.

Subjects

Stache16 used 14 healthy volunteers who were physically
active individuals. Physically active was 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 week. Subjects were screened
for previous conditions; lower extremity injury, head
injury/concussions, neurological disorders and
contraindications of ice such as cold allergies, poor
circulation diminished sensations, slow healing wounds and
Raynaud’s Syndrome.

7
For this present study, only 12 subjects’ from the
previous study had data that could be used. The study was
approved by the Institutional Review Board at California
University of Pennsylvania (Appendix C1). There were no
identifiers in the data to link the participants to the
performance data. Each participant’s identity was kept
confidential and was not included in the study.

Preliminary Research

Before research was conducted and after IRB approval,
the researcher received the data from the previous
researcher. Stache performed a pilot study on one subject,
whose data also remained in the study.

This preliminary

study was performed to become familiar with the force
platform and the amount of time that was needed for
testing.

Instruments

The instrument that was used in this study was
BioAnalysis, computer software program running on a Windows
based personal computer that analyzed the force that was

8
produced on the force platform in the previous study.
Stache’s16 instruments included an AMTI 6-7 force platform
(AMTI Force Platform and Amplifier, Advanced Technology,
Inc: Advanced Mechanical Technology, Inc.
176 Waltham Street, Watertown, MA 02472-4800 USA) to
measure forces during the single-leg vertical jump.
Additionally, a demographics sheet, ice bags, compression
wraps and a stationary bike were used.

Procedure

For the previous study, Stache16 had performed data
collection twice. The first day was used to complete the
demographic sheet, and sign the informed consent. After
this was completed the procedures were explained to the
subjects. With the subjects understanding of the directions
and the procedures of research, they were allowed to
perform practice single leg vertical jumps on the force
platform. Once the subject was comfortable with the jumps
they bicycled for five consecutive minutes for a warm-up.
After the warm-up, the subjects performed five pretest
single-leg vertical jumps on the force platform. After the
pretest the subjects participated in their cryotherapy

9
condition; cryotherapy or no cryotherapy. The subjects in
the cryotherapy condition sat with an ice bag placed over
the anterolateral aspect of their ankle in their dominant
jumping leg for twenty minutes. When subjects were in the
no cryotherapy condition, they were asked to sit quietly
for twenty minutes. Immediately after the completion of the
cryotherapy condition, subjects then performed five
posttest single-leg vertical jumps. The subjects then sat
and waited to jump five minutes, ten minutes and twenty
minutes after the cryotherapy removal.
For the present study, the data was collected from the
previous research to elicit additional findings. The
current researcher took the five sets of five jumps per
subject and looked at peak landing force via BioAnalysis.
Each peak landing force was put into an Excel spreadsheet
(Appendix C2) to later be entered into SPSS.

Hypothesis

The following hypothesis was based on previous
research and the researcher’s institution based on a review
of the literature.

10
There will be no difference in peak landing force dependent
on cryotherapy conditions and the passage of time.

Data Analysis

All data was analyzed by PASW version 18.0. The data
was analyzed to determine if cryotherapy has an effect on
peak landing force and if peak landing force is affected by
time. The research hypothesis was analyzed using a 2 x 5
repeated measures factorial analysis of variance (ANOVA).
An alpha level of 0.05 was used to determine statistical
significance.

11

RESULTS

The purpose of the study was to determine if
cryotherapy and the passage of time had an effect on peak
landing force during a single-leg vertical jump. Data was
collected during a single-leg-vertical-jump onto a force
platform in a previous study by Stache, and the data were
analyzed via BioAnalysis by the current researcher. The
following section includes: Demographic Information and
Hypothesis Testing.

Demographic Information

The previous study utilized fourteen physically active
California University of Pennsylvania students with a mean
age of 21.8 years. Subjects consisted of five male and nine
female volunteers. The subjects completed a demographic
form that contained information including age, year in
school, dominant leg, injury history, head
injury/concussions, neurological disorders, cryotherapy
use, cold allergies and contraindications. All participants
had no neurological disorders or cold allergies, and were

12
symptom free of head injuries for more than a year and free
of lower extremity injuries for four months.
For the current study, none of the demographic
information was passed on to the current researcher,
therefore the subjects remained anonymous and could not be
identified by any information in the data. Of the fourteen
subjects used in the previous research only twelve subjects
could be used in the current research due to data missing
in the data files.

Hypothesis Testing

The following hypothesis was tested in the study. The
hypothesis was tested with a significance level of α ≤
0.05. A 2 x 5 repeated measures factorial analysis of
variance was used to analyze if mean scores were different
due to the independent variables.
Hypothesis: There will be no difference in peak
landing force dependent upon cryotherapy conditions and the
passage of time.
Conclusion: A 2 x 5 repeated measure ANOVA was
calculated comparing cryotherapy conditions (no
cryotherapy, cryotherapy) and time (pretest, posttest, five
minutes, ten minutes and twenty minutes after posttest).

13
Mean performance scores for all subjects under the various
conditions can be found in Table 1. Results of the ANOVA
testing are found in Table 2. No significant cryotherapy x
time effect was found (F(4,44)=.757, p>.05). There was also
no significant main effects with cryotherapy (F(1,11)=.261,
p>.05) and time (F(1,11)=.935, p>.05).

Table 1: Peak Landing Forces Dependent on Cryotherapy and
Time of Test
Cryotherapy

No Cryotherapy

Time

Mean (SD)

Mean (SD)

Pre test

3766N (1407.2)

3454 (1.007.9)

Post test

3289N (1254.2)

3405 (1038.0)

5 min

3524N (1284.2)

3512 (1248.5)

10 min

3655N (1269.2)

3547 (1211.6)

20 min

3545N (1122.0)

3398 (1068.4)

Table 2: ANOVA Results for Main Effects and Interaction
between Cryotherapy and Time Conditions.
Factor
Cryotherapy
Time
Cryotherapy x
Time

df
1
1
4

df (error)
11
11
44

F
0.261
0.935
0.757

P
0.62
0.452
0.559

14
DISCUSSION

The main purpose of this study was to determine if
cryotherapy had an effect on single-leg vertical jump peak
landing force. In addition to the main purpose, this study
also determined if cryotherapy had an effect on peak
landing forces over time due to a re-warming affect. The
following section is divided into three subsections:
Discussion of Results, Conclusions and Recommendations.

Discussion of Results

A single-leg vertical jump was performed by fourteen
physically active subjects in a previous study to examine
cryotherapy’s effect on jumping forces. The present study
examined twelve of these subject’s data, via BioAnalysis,
to determine if cryotherapy and passage of time had an
effect on peak landing forces.
This study concluded that cryotherapy had no
significant effect on single-leg vertical jump landing
forces. The original hypothesis of the researcher was that
there would be no difference in peak landing forces
dependent on cryotherapy conditions and passage of time.
The results did support the hypothesis. The mean test

15
scores for peak landing force dependent on cryotherapy
condition can be found in Table 1. There was no significant
difference in performance due to cryotherapy treatment.
This shows that the application of cryotherapy on the ankle
did not cause a decrease in landing force for the singleleg vertical jump.
The mean test scores for peak landing force dependent
upon passage of time can be found in Table 1. There were no
significant findings in the functional performance over
time after the removal of cryotherapy. This shows that
increasing the time after cryotherapy is removed does not
decrease the landing forces in a single-leg vertical jump.
The results of this study were different than that of
other studies. For example, Patterson et al17 performed a
study to examine if cryotherapy had an effect on single-leg
vertical jumps, t-test and 40 yard dash. The results
suggested that functional performance was affected
immediately following cryotherapy and that there was a
gradual increasing in performance over time with muscular
re-warming.
Surenkok et al18 assessed knee joint position and
static balance after the application of cryotherapy.

The

results showed a significant difference in joint position
sense before and after cold application. Thus, joint

16
position sense is negatively affected with cryotherapy use
which will alter body balance and can adversely affect an
athlete and athletic performance immediately after
cryotherapy.
An article by Rivers19 investigated the effects of
cryotherapy on total body balance and proprioception after
cryotherapy and bracing. There was a significant decrease
in total body balance immediately after the cryotherapy
treatment but not over time.
Overall, the results from these studies varied
slightly but showed that functional performance was
decreased after the application of cryotherapy. Some
studies did agree with the findings of the present study.
Jameson et al examined the effects of cryotherapy on
vertical- ground-reaction- force during a double leg
landing from a double leg jump.20 Subjects were placed in
four conditions; no ice, ice on the ankle joint only, ice
to the knee joint only, and ice to both ankle and knee
joints combined. Ultimately, this study did not find a
significant difference in vertical- ground- reaction- force
as a result of cryotherapy.
Hart et al21 performed a study to examine the effects
of cryotherapy on vertical jump measurements. Subjects
performed five single-leg landings before cryotherapy. Ice

17
was placed on the anterior, lateral and medial knee for
twenty minutes. After cryotherapy the subjects performed
five single-leg landings immediately, fifteen and thirty
minutes after treatment was removed. The results showed
that there were no significant changes in ground reaction
force, knee range of motion or muscle activity.
Vescovi22 investigated the effects on work, velocity
and power when icing the arm and shoulder between weight
lifting sets. Cryotherapy between sets resulted in having a
significant effect on the increased number of arm pull
sets, an increase of the speed with which the sets were
completed and increase in power produced during the set.
Thus, interval cryotherapy decreases fatigue rate and
increases work, velocity and power.
The results vary for several reasons. First, the main
difference is the form of cryotherapy that was applied to
the body. Patterson et al17, Surenkok et al18, and Rivers19
used ice immersion or cold spray as the method of cooling.
Hart et al21, and Jameson20 used crushed or cubed ice bags
for a specific area of cooling.

The second difference is

where the ice was applied to the body. Patterson et al,
selected a cryotherapy condition of ice immersion to the
lower leg. Hart et al, covered specifically the anterior,
lateral and medial aspects of the knee. Jameson et al chose

18
to ice the ankle and/or the knee. Lastly, the difference of
the time allotted between cryotherapy and testing varied.
Normally, studies use twenty minutes of testing after
cryotherapy is removed to allow for the effect of rewarming. However, the studies used a passage of time that
ranged from three, to ten, to twenty minutes. The decrease
in testing time after cryotherapy is removed can alter the
testing results because re-warming does not occur. These
differences could be the reason for differing results
between researchers.

Conclusions

The results of this study show cryotherapy has no
significant effect on peak landing force over the passage
of time. The significance of these results is that they
allow Athletic Trainers to continue to treat athletic
injuries with cryotherapy at any time during athletic
performance and return athletes to play without hindering
their athletic performance.
There have been multiple studies that examined
cryotherapy’s effect on jumping, balance, speed and agility
which are all important components of athletic performance.
These studies have split conclusions on the negative and

19
positive effects that cryotherapy can have on performance.
Therefore, the present study alone does not conclude that
an athlete can return to play immediately after the removal
of cryotherapy. Thus, it is recommended that an athlete
perform a warm-up before returning to play after the use of
cryotherapy to decrease the chance of future injury and rewarm the muscles to better enhance athletic performance.

Recommendations

The results of this study show that cryotherapy did
not have an effect on peak landing forces during a singleleg vertical jump. This study supports the use of
cryotherapy and returning athletes to play immediately
afterwards with no negative effect on athletic performance.
Unfortunately, there is not a conclusive outcome in the
current research to conclude that cryotherapy has no effect
on athletic performance.
For future research, this study could be altered and/
or advanced by testing the subjects specifically instead of
analyzing previously collected data. Future study would
also benefit from testing a larger number of subjects.
These alterations could enhance the acceptance of the
results found in the study. To improve research further,

20
cryotherapy’s effect on peak landing force can be examined
by having the subjects jump from a specific height. Testing
the subjects in this manner will remove the muscular
fatigue that can occur during repeated eccentric
contractions, such as jumping. This will allow subjects to
absorb their landing force and there will be no variation
in the amount of force produced during jumping between
subjects. Lastly, a future researcher could increase the
surface area to which cryotherapy is applied on the body to
examine if increased surface area covered with cryotherapy
will have an effect on force absorption.

21
REFERENCES

1.

Merrick MA, Knight KL, Ingersol CD, Potteiger JA. The
effects of ice and compression wraps on intramuscular
temperatures at various depths. J Athl Train. 1996; 28
(3):236-245.

2.

Richendoller ML, Darby LA, Brown TM. Ice bag
application, active warmup and three measures of
maximal functional performance. J Athl Train. 2006;
41(4):364-370.

3.

Evans TA, Ingersoll C, Knight K.L, Worrell T. Agility
following the application of cold therapy. J Athl
Train. 1995; 30(3):231-234.

4.

Merrick MA. Secondary injury after musculoskeletal
trauma; a review and update. J Athl Train.
2002;37:209-217.

5.

Merrick MA, Rankin JM, Anders FA, Hinman CL. A
preliminary examination of cryotherapy and secondary
injury in skeletal muscle. Med Sci Sports Exerc.
1999;31:1516-1521.

6.

Knight KL. The effects of hypothermia on inflammation
and swelling. J Athl Train. 1976;11:7-10.

7.

Knight KL. Cryotherapy in sports injury management.
Champaing, IL: Human Kindetics; 1995.

8.

Prentice W. Therapeutic Modalities in Sports Medicine.
2nd ed. St. Louis, MO: Mosby; 1990.

9.

Rubley MD, Denegar CR, Buckley WE, Newell KM.
Cryotherapy, Sensation, and
Isometric-force
variability. J Athl Train. 2003; 38(2):113-119.

10.

Cross KM, Wilson RW, Perrin DH. Functional Peformance
following an ice immersion to the lower extremity. J
Athl Train. 1996;31(2):113-116.

11.

Simon AM, Ferris DP. Lower limb force production and
bilateral force asymmetries are based on sense of
effort. Exp Brain Res. 2008;187:129-138.

22

12.

Gross TS, Nelson RC. The shock attenuation role of the
ankle during landing from vertical jump. Med Sci
Sports Exerc. 1998;20(5):506-514.

13.

Prapavessis H, McNair PJ. Effects of instruction in
jumping technique and experience jumping on ground
reaction forces. J Orthop Sports Phys Ther.
1999;29(6):352-356.

14.

Cordova M, Takahaski Y, Kress G. Influence of external
ankle support on lower extremity joint mechanics
during drop landings. J Sport Rehab. 2010;19:136-148.

15.

Winter D. Kinematic and Kinetc patterns in human gait.
Human Movement Science. 1984;3:51-76.

16.

Stache C. The effect of cryotherapy on the single leg
vertical jump [Master’s Thesis]. California, PA:
California University of Pennsylvania; 2009.

17.

Patterson S, Uderman B, Doberstein S, Reineke D. The
effects of cold whirlpool on power, speed, agility and
range of motion. J Sport Sci Med. 2008;7:387-389.

18.

Surkok O, Ayter A, Tuzun EH, Akman MN. Cryotherapy
impairs knee joint position sense and balance. Iso &
Exer Sci. 2008;16(1):69-73.

19.

Rivers D.A. The influence of cryotherapy and Aircast
bracing on total body balance and proprioception. J.
Athl Train. Microform Publications, Int'l Institute
for Sport and Human Performance, University of Oregon.
1995.

20. Jameson A, Kinzey S, Hallam J. Lower-extremity-joint
cryotherapy does not affect vertical ground reaction
force during landing. J Sport Rehabil. 2001;10:132-142.
21.
22.

Hart JM, Ingresoll CD, Leonard JL. Single-leg landing
strategy after knee-joint cryotherapy. J Sport
Rehabil. 2005;14:313-320.
Vescovi J, McGuigan M. Relationships between
sprinting, agility, and jump ability in female
athletes. J Sport Sci. 2008: 26:97-107.

23

24

APPENDICES

25

APPENDIX A
Review of Literature

26

REVIEW OF LITERATURE

Cryotherapy is the most commonly used therapeutic and
rehabilitative treatment when an acute injury is present.1
Specifically, cryotherapy is used when the goal is to
decrease pain, inflammation, metabolism and swelling.
Through education, cryotherapy is taught to be used after
activity due to its diminishing effects on the function of
the vasculature and musculature which can decrease athletic
performance.
Athletic performance is a combination of agility,
balance, force production, speed and the body’s ability to
decrease the fatigue rate.2 Without these components,
athletic performance could be impaired. Furthermore, many
athletes use cryotherapy before athletic performance in
order to play without pain. However, it is unclear if
cryotherapy decreases athletic performance to a degree at
which athletic performance is significantly decreased. The
purpose of this literature review is to review cryotherapy
and cryotherapy’s effects on athletic performance with a
focus on force production and force absorption. The
following sections will describe the indications of

27
cryotherapy, cryotherapy’s effects and different methods of
cryotherapy. Additionally, this literature review will
debate whether or not cryotherapy has a diminishing effect
on musculature by testing athletic performance and if
cryotherapy can affect muscle force production over time.

Cryotherapy

Cryotherapy is a treatment where ice or cold
application is used therapeutically. Cryotherapy is the
most commonly used modality in athletics today.1-3 Athletes
use cryotherapy as a rehabilitative measure daily or before
practice to decrease the pain and swelling that is present
from a previous or existing injury. Cryotherapy is used in
the beginning phases of acute injury treatment to reduce
metabolism, inflammation, and muscle spasms as well as for
controlling pain.4-9
Cryotherapy has multiple effects, such as reducing
nerve conduction, reducing local blood flow9, and decreasing
muscle functioning.10-12 Cryotherapy also reduces tissue
temperature, blood flow, pain and metabolism.13 These
cooling effects on the body are mediated by conduction and
convection. Conduction is heat loss or gain through direct
contact with an object, such as cold pack, ice immersion,

28
ice massage, cold spray, contrast bath, cryo-cuff, or
cryokinetics.14 Convection is heat loss or gain through the
movement of water molecules across the skin, such as cold
whirlpool.14
In regards to the treatment of cryotherapy, Bleackly
et al15 reported that cold seemed to be more effective in
limiting swelling and decreasing pain in the short term.
Unfortunately, as stated previously there are many effects
of cryotherapy but all of which are effects that are needed
to control pain, swelling and inflammation. As described by
Knight in Cryotherapy in Sports Injury Management, cooling
the ankle joint considerably improves a patient’s ability
to perform active exercise and decrease injury-recovery
time.7

Cryotherapy Effects on the Body
Cryotherapy’s most known effect on the body is
cooling, resulting in therapeutic relief for pain. Many
studies have examined how cooling takes place in the body,
and all are in agreement that cooling happens when cold
agents undergo a substance change; such as from a solid to
a liquid.16-18 Initially the nociceptors and cold receptors
will be affected by cryotherapy. This initiates the
sensations of cold and pain in the body. Thermoreceptors

29
are superficial receptors that respond quickly to changes
in temperature.19-22 Overall, it was found that crushed ice
pack, ice massage, and cold water immersion are considered
the most effective clinical modalities for reducing tissue
temperature based on testing of skin and intramuscular
temperatures.17,20
Cryotherapy also reduces nerve conduction velocity
(NCV) in the sensory and motor nerves.21,22 Cooling decreases
nerve conduction velocity, synaptic transmission, and
sensory nerve action potentials.7,8,23 This means that if
muscles are directly cooled, the nerves firing will not be
as quick as normal and nerve impulses on the muscle will
impair the muscles ability to contract as it would
normally.24
Cryotherapy has other additional effects on the body
such as decreased metabolism, and vasoconstriction which
will ultimately decrease swelling. Cryotherapy will slow
down cellular processes which will inhibit the body from
repairing the damage done by the injury.25 Additional
vasoconstriction occurs when the cold temperatures causes
the smooth muscle to contract in the blood vessels. The
smooth muscle contraction will decrease the radius of the
vessel, resulting in a decreased amount of blood being able

30
to get to the area that is under the influence of
cryotherapy.26

Methods of Application
Cryotherapy can be applied to the body in various
ways; these include, but are not limited to: cold
whirlpools, ice bags, ice immersion, and chemical ice
packs.

These methods of application have the same

indications for use but may have differing effects on the
body.
In a study by Pfeiffer et al, the researchers tested
the effects of a 20 minute cold water immersion on
neuromuscular function, rectal and skin temperature and
femoral venous diameter after exercise in the heat. After
the subjects completed two, 90 minute cycling periods they
were either tested with a cold water immersion or a control
recovery group. It was shown that rectal temperature was
significantly lower in cold water immersion; skin
temperature and femoral vein diameter were also
significantly lower than the control recovery group from 25
to 50 minutes after the cycling trial. This study suggests
that cold water immersion decreases rectal temperature but
has a negative effect on neuromuscular function.16

31
In another study, Dykstra et al compared the
difference of skin temperature in different cold therapies.
These cold therapies included: ice pack with cubed ice,
crushed ice, and wetted ice. Subjects’ intramuscular and
skin temperatures were taken before and after application
of the cold treatment. It was found that cubed ice and
wetted ice produced lower surface and intramuscular
temperatures when compared to crushed ice. Wetted ice
produced a greater decrease in surface temperature.14 The
outcomes of both of the articles show that ice bags are the
best source of cryotherapy that will give the effects of
decreased skin temperature as well as decreased blood flow
to the area via vasoconstriction.
With cryotherapy being the most commonly used modality
in athletics today it has been shown to be effective in
treating soft tissue injuries.13 As discussed previously
there are many different ways to apply cryotherapy, such as
ice bags, ice immersion and cold whirlpools. Each
cryotherapy modality has its own specific parameters of
treatment time and effectiveness, but all have been shown
to decrease pain, swelling, metabolism and blood flow.13,6,9,16

32
Cryotherapy and Functional Performance

Functional performance is a great testing tool done by
an athletic trainer to see how athletes perform in certain
physical activities such as balance, jumping, speed,
agility and the ability of resist muscle fatigue.
Functional performance testing is implemented to track how
an athlete is progressing with and through activities by
comparing functional testing outcomes. Functional
performance testing can be very sports specific, which
raises the question; does cryotherapy have an effect on
functional performance in athletes?
Cryotherapy does have its benefits as a therapeutic
modality for acute injuries but these benefits can have
depressive effects on the body such as nerve conduction and
force production.14-16,27-29 These depressive effects can in
turn have a diminishing effect on functional performance.
It is the focus for this section to identify and
understand specific aspects of functional performance, to
identify any alternative effects on functional performance
with the use of ice and how cryotherapy can affect muscular
fatigue.

33
Force Production
Force is a generation of tension and pressure created
in the body via muscle, muscle fibers, nerves and neural
functioning.30 Humans generate force in everyday activities
such as walking, running, jumping, lifting and moving
objects. Force production is one of the many tested aspects
of functional performance in athletes. Force production can
be tested by jumping and measuring single or double leg
landing ground forces; eccentric loading, distal to
proximal, of the lower-extremity musculature controlling
joint flexion.31-33
Jameson examined the effects of cryotherapy on
vertical- ground-reaction- force during a double leg
landing from a double leg jump.33 Subjects jumped five times
prior to cryotherapy treatment and five times after
cryotherapy treatment. Subjects were placed in four
conditions; no ice, ice on the ankle joint only, ice to the
knee joint only, and ice to both ankle and knee joints
combined. Ultimately, this study did not find a significant
difference in vertical- ground- reaction- force as a result
of cryotherapy.
In a study by Simon et al30, force production was
tested by means of isometric force production of the lower
leg. This study suggested that subjects attempting to

34
produce equal lower limb forces would generate equal
percentages of force of their bilateral maximum voluntary
strength rather than equal absolute limb forces. This study
used ten male and ten female subjects, who performed
isometric extensions of the lower limb. Subjects were asked
to match forces in their lower limbs at three different
sub-maximal levels. It was found that subjects continually
produced less force in the weaker limb during all force
matching levels.
These articles are different in many ways but the main
focal point is these are only two of the many ways force
production can be measured.

The articles demonstrate

decreasing force production in the lower leg whether it is
between cryotherapy treatments or dominant versus non
dominant leg strength.

Agility
Agility is defined as the ability to change direction
rapidly and also to change that direction accurately.34-38
Agility is frequently compared to speed; however, speed is
movement in a straight path whereas agility is
multidirectional.
Vescovi et al39 studied the relationships between
different agility tests in female athletes.

This study

35
examined 83 high school soccer, 51 college soccer and 79
college lacrosse athletes. These athletes were tested by
linear sprinting, countermovement jump, and agility. Test
outcomes were determined through Pearson’s correlation
coefficients when pairing the testing trials. Correlation
categories were low, moderate and high. The relationships
in linear sprint times were strongly correlated. The
relationship between countermovement jump height and linear
sprinting was stronger with longer distance compared to
shorter distances. The results of this study indicate
linear sprinting, agility, and vertical jumping are
independent locomotor skills and suggest a variety of tests
ought to be included in an assessment protocol for high
school and college female athletes.39
Patterson et al40 tried to determine if cold whirlpool
treatment decreases functional performances equally
regardless of gender. This study also looked at the time
functional performance increased after cold whirlpool.
Subjects were volunteers, all of college age. All subjects
performed four measures of functional performance including
vertical jump, t- test, 40 yard dash and active range of
motion of the ankle. Subjects were treated with 20 minutes
of a cold whirlpool after the pre-tests. In testing after
the cold whirlpool, subjects showed significant decreases

36
in all four measures of performance immediately after
treatment. After 32 minutes, vertical jump was the only
test that was still decreased. In addition, subjects showed
decreased levels of peak power and average power. These
results suggest functional performance was affected
immediately following and up to 32 minutes after the cold
whirlpool treatment. It also shows that there is a gradual
increase in functional performance over time after
cryotherapy application. Agility is an important athletic
attribute for any athlete to have and it can be affected by
cryotherapy prior to athletic performance.

Balance
Balance is the body’s steady state of which the body
finds its center and has a base of support.41 Balance is
necessary for athletic performance. Balance is the basis
for body support, postural control, center of gravity and
proprioception.

Surenkok et al42 assessed fifteen healthy

basketball players in their sense of knee joint position
and static balance after the application of a cold pack and
cold spray. Subjects were tested first after a cold pack
application and then a week later with a cold spray
application. Joint position sense was measured with a
isokinetic dynamometer and assessed by a single leg balance

37
before and after cryotherapy. Subject’s knees were tested
with a continuous passive motion machine. Knee passive
range of motion was flexion and extension from 0 to 90
degrees and movement at a velocity of five degrees per
second. Significant differences were found in joint
position sense before and after cold spray application and
between joint position sense scores and pain. However,
results on the single-leg balance tests showed no
significant differences. Thus, joint position sense is
negatively affected with cryotherapy use which will alter
body balance and can adversely affect an athlete and
athletic performance immediately after cryotherapy.
An article by Rivers41 investigated the effects of
cryotherapy on total body balance and proprioception with
an Aircast bracing in 25 males and females. Subjects were
tested for one minute trials and were in treatment
conditions of cryotherapy and bracing or the control which
was neither cryotherapy nor bracing. There was a pre-test
followed by a 20 minute treatment and five, one minute
balance trials. There was a significant decrease in total
body balance after the first three minutes post treatment,
but no significant decrease from four to ten minutes after
cryotherapy treatment. There was no significant difference
in balance with or without the bracing. From these two

38
articles we find that cryotherapy does have an adverse
effect on whole body balance. Additionally from the article
by Rivers, we know that the addition of a brace cannot
compensate for the balance lost by cryotherapy.

Speed
Speed is commonly measured in a 40 yard sprint.34
Patterson et al40 was testing the effects of a cold
whirlpool on power, speed, agility and range of motion on
twenty-one subjects. For the sprint portion, subjects ran
40 yards on an indoor track surface. Prior to testing,
subjects lightly jogged a lap of 200 meters for a warm up.
The warm up was followed by four to six trials of
submaximal level sprints for practice. No stretching was
allowed. After practice a 60 second rest was given before
the 40 yard sprint was completed. After the testing was
completed the subject’s legs, fibular head down, were
placed in a cold whirlpool for twenty minutes. Once
treatment was completed the 40 yard dash was performed in
intervals for 32 minutes. The mean times for the 40 yard
dash were significantly increased at 2, 7, 12, and 22
minutes after the cold whirlpool compared to the pre test.
There was no difference in the 17, 27, and 32 minutes after
cold whirlpool immersion. Thus, cooling the body before a

39
sprint run can decrease performance regarding sprint time
up to 22 minutes.
Castle et al43 examined the effects of pre-cooling the
body with an ice vest. The subjects were in the following
conditions: 1)the upper body cooled via cold packs, 2)the
thigh muscles cooled locally, 3)and the whole body immersed
in a cold tub chest down; to counter act the effects of
muscle fatigue when sprinting in a hot, humid condition.
The hypothesis was that if the hot and humid condition was
controlled with pre-cooling of muscles, the muscles would
not increase their temperature as quickly which in turn
would decrease the amount and quickness of cross-bridging
occurring. This in turn would decrease the fatigue rate in
sprinting. Twelve males completed four cycling sprints with
10 seconds of passive rest, five seconds of maximal sprint
against a resistance of 7.5% their body mass, and 105
seconds of active recovery. After the sprint, subjects were
either not cooled, cooled with a vest, cold ice packs or
both for 20 minutes. This study showed that fatigue due to
the heat occurred the quickest in the control group but was
similar to the vest cooling group. The cold packs and water
immersion did not have humidity effects; increased muscle
temperature and decreases in peak power output occurred
until 16 minutes into the exercise. Thus, this study

40
determining that pre-cooling reduced heat strain in sprint
cycling.

Fatigue
Muscle fatigue is a limitation to athletic performance
in which the muscles are no longer able to produce a
sufficient amount of force to continue physical activity.44
Although fatigue is developed at a muscular level, mental
processes, such as motivation and outside influences, can
also affect the reduction in power output and/or fatigue.44
Muscle fatigue can be affected by long duration of
specific physical activity; however, short-durations of
local application of cryotherapy can lower muscle
temperature and delay the onset of work fatigue.40,41
Verducci39 investigated the effects on work, velocity
and power when icing the arm and shoulder between weight
lifting sets.

Ten males, all members of a private athletic

club, participated in this study. Each subject had to pull
75% of their one repetition 22 times for each set as fast
as possible. Afterward, subjects were either iced or had
towels placed over their arms for three minutes and rested
for 4.5 minutes. The testing continued in this fashion
until 22 pulls could not be completed without stopping.
Work was measured by the number of arm pull sets completed

41
before fatiguing, velocity was measured by the time it took
to complete each set, and power was determined by dividing
work by velocity. Cryotherapy between sets resulted in
having a significant effect on the number of arm pull sets,
how fast the sets were completed and how much power was
produced during the set. Thus, interval cryotherapy
decreases fatigue rate and increases work, velocity and
power.
Crowley et al44 used the Wingate anaerobic power test
to examine if peripheral hypothermia caused an impairment
in peak power and anaerobic performance before and after
testing. Three males participated in this study, with a
warm up on the bike prior to the subjects being tested on
the Wingate test. After testing, subjects were treated with
a no cooling process or a leg cooling from the waist down
in an ice bath. After this, another Wingate test was taken
and then a re-warming bath took place until skin and rectal
temperatures returned to normal. This study found that peak
power, average power output and point of fatigue were
decreased with cooling. Although this is a great test to
illustrate a fatiguing process, this study is limited in
the use of only three subjects.
For a short term power output in the major limb
muscles, the temperature required appears to be slightly

42
higher than that found in resting muscle in a thermoneutral
environment.43 Higher temperatures resulted in a
significantly faster onset of work fatigue44-46, while mildly
cold applications resulted in significantly longer work
periods.46,47

Summary

Cryotherapy is the most commonly used modality in
athletics today.1-3 Cryotherapy is used in the beginning
phases of acute injury treatment and many studies have
shown that cryotherapy reduces metabolism, inflammation,
and muscle spasms as well as controlling pain.4-9 All studies
that were looked at showed negative effects on performance
but none looked at the effect of cryotherapy on fatigue
rate.
Therefore more research needs to be done in the field
to obtain a conclusive result of how cryotherapy affects
performance in all aspects. The findings could eventually
impact the player’s ability to return to play after injury
and the Athletic Trainer’s decision to apply cryotherapy
during and before play.

43

APPENDIX B
The Problem

44
THE PROBLEM

Statement of the Problem
Cryotherapy is the most commonly used therapeutic and
rehabilitative treatment when an acute injury is present.1
Specifically, cryotherapy is used when pain, inflammation,
metabolism and swelling need to be decreased. Through
education, cryotherapy is taught to be used after activity
due to its diminishing effects on the vasculature and
musculature which can decrease athletic performance.
Athletic performance is a combination of agility,
balance, force production, speed and the body’s ability to
decrease the fatigue rate.2 Without these components
athletic performance could be impaired. Furthermore, many
athletes use cryotherapy before athletic performance in
order to play without pain. However, it is unclear if
cryotherapy can decrease athletic performance enough to
cause an injury. Unfortunately, after activity is not the
only time cryotherapy is used. Cryotherapy can be seen in
use before and during activity.
The purpose of this study is to examine the effects of
cryotherapy on peak landing force on single-leg vertical
jumps. There have been many conflicting studies reporting
differing effects of this modality on peak landing forces.

45
Most research has found that cryotherapy decreases peak
landing force immediately after cryotherapy treatment with
diminishing effects as re-warming occurs.

This information

is important to know, if there is a limiting effect on peak
landing force after cryotherapy than there is a decrease in
performance.

This may change the usage patterns of this

modality immediate before participation.

Definition of Terms
The following definitions of terms will be defined for
this study:
1) Cryotherapy- the application of a cold modality,
specifically for this study it will include ice
immersion and ice bags.
2) Single-leg Vertical Jump- is the maximal height at
which an individual can jump straight up and land on
the dominant leg.
3) Peak Landing Force- the greatest amount of force that
is produced during the landing portion of the singleleg vertical jump.
4) Re-warming- the tissue reaction after a cryotherapy
modality is removed, blood flow increases to the area
and the tissues begin to re-warm, maybe increased by
activity.

46
5) Physically active- participating in moderate to
intense exercise at least 3 times per week.
Basic Assumptions
The following are basic assumptions of this study:
1) The previous subjects honestly completed the
demographic sheet.
2) The previous subjects understood the instructions
given to them during the study.
3) Subjects performed to the best of their ability.
4) The data that was collected was collected
accurately.
5) The data that was collected was utilized accurately.
Limitations of the Study
The following are possible limitations of the study:
1) The subjects are volunteers and are limited to
physically active subjects from California
University of Pennsylvania.
2) Testing done with previously collected data.
Significance of the Study
This study is relevant because many Athletic Trainers
prescribe cryotherapy for their athletes before
participating in sporting events.

Frequently cryotherapy

treatment can be indicated at half time if an injury

47
occurred during the game. For these Athletic Trainers,
knowing whether cryotherapy causes a diminishing effect on
peak landing force may have professionals re-evaluate the
application of cryotherapy before or during physical
performance. If cryotherapy has an effect on physical
performance then it should be known that a sufficient warm
up is needed after the removal of cryotherapy before
returning the athlete to play. If it is found that
cryotherapy does not have any effect on physical
performance then professionals can know that it is safe to
put an athlete back to play after using cryotherapy.

48

APPENDIX C
Additional Methods

49

APPENDIX C1
Institutional Review Board –
California University of Pennsylvania

50
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair
Ms. Wilson,
Please consider this email as official notification
that your proposal titled “The Efects of Cryotherapy on
Landing Forces During a Single Leg Jump” (proposal # 10066), described as re-analysis of existing anonymous data
from a previous CalU IRB approved study (proposal #09-037:
"The Effect of Cryotherapy on the Single Leg Vertical
Jump") has been approved by the California University of
Pennsylvania Institutional Review Board with the following
stipulations:
-Only currently existing data (as of 03-28-11) from study
#09-037 (listed above) may be used. No additional data may
be collected from new or prior participants.
-Data must be provided to you stripped of any identifiers
that can be linked to participant identity.
-Communication with the researchers from study #09-037 (if
any) must be conducted in a manner that does not reveal
participant identity/identifiers to you.
The effective date of the approval is 03-28, 2011 and the
expiration date is 03-27-2012. 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 03-22-2012 you must file additional
information to be considered for continuing review. Please
contact instreviewboard@calu.edu

51
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

52

53

54

55

56

57

58

59

60

61

62

63

APPENDIX C2
Excel Spreadsheet Data Collection

64

Table 3: Mean Peak Landing Forces: The Cryotherapy Group
Subject

Pretest

Posttest

5 min

10 min

20 min

1

1302.678

1454.809

1073.738

1588.884

2145.062

2

2603.1218

1804.31

1585.893

1759.621

2542.827

3

2574.8536

2520.11

2610.605

2425.146

2740.54

5

3284.3458

3090.873

3191.118

3412.208

2449.415

6

2784.111

2479.68

2853.577

2250.278

1559.135

7

4933.6224

3959.965

5023.578

3382.363

3963.336

8

1943.2996

1838.223

1905.264

2237.103

2077.899

10

4989.9684

5311.623

2911.031

5705.027

5205.072

12

4685.1774

3028.782

3499.896

3742.943

3651.279

13

3086.3194

2476.876

2954.488

2350.63

2519.33

14

2089.293

2420.022

2420.827

2396.807

2126.353

15

2667.9722

3098.05

3076.823

2797.518

2608.149

Table 4: Mean Peak Landing Forces: The Control Group
Subject

Pretest

Posttest

5 min

10 min

20 min

1

1180.341

1239.555

1382.559

1555.728

1376.923

2

2106.846

2083.754

2189.751

2333.313

2061.389

3

2489.037

2283.597

2413.615

2328.705

2355.53

5

3945.647

2853.889

3118.37

2523.796

3103.627

6

2869.606

2751.731

2446.73

2394.76

2042.223

7

3909.152

4181.195

4315.261

4316.937

3976.185

8

2734.954

2778.525

2564.019

2724.899

2650.604

10

4352.129

4771.087

5372.709

4423.073

4419.162

12

3641.019

3157.263

3710.811

3565.172

3762.762

13

2400.112

2193.867

2371.304

2000.594

2280.655

14

2532.923

3224.296

4023.108

3117.043

4202.422

15

2749.99

2604.798

2066.298

2762.884

2813.159

65
EXAMPLE OF BIOANALYSIS GRAPH: A SINGLE-LEG VERTICAL JUMP

66

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ABSTRACT
TITLE:

THE EFFECT OF CRYOTHERAPY ON LANDING FORCES
DURING A SINGLE LEG JUMP

RESEARCHER:

Danielle Wilson

ADVISOR:

Dr. Thomas F. West

RESEARCH TYPE: Master’s Thesis
OBJECTIVE:

The purpose of the study is to examine the
effects of cryotherapy on the lower
extremity and peak landing forces measured
during a single-leg vertical jump.

DESIGN:

Quasi-experimental, within subjects,
repeated measures design.

PARTICIPANTS:

Twelve physically active college age
students who volunteered with no previous
injuries or cold contraindications.

MAIN OUTCOME
MEASURES:

Peak landing force, treatment (cryotherapy
and no cryotherapy), and time (pretest,
posttest, five minutes, ten minutes, twenty
minutes after posttest).

RESULTS:

The results showed there was no significant
difference with cryotherapy treatments on
peak landing forces or time. The results
also showed that there was no significant
difference with the interaction of
cryotherapy and time.

CONCLUSIONS:

The results being insignificant, suggests
that it is safe to have an athlete return to
play immediately after cryotherapy
treatment. However, it is recommended
through other studies that a warm-up should
be performed before the athlete returns to
play.

WORD COUNT:

175