Dissertation Proposal For LinkedIn
- 1. Determining the effectiveness and optimal time length of cryotherapy as a means to facilitate recovery time following exercise-induced muscle damage. Word Count: 2491 Student ID: 640039852
- 2. Introduction The current climate of elite sport places extremely high physiological demands upon athletes, due to an excessive amount of games in an increasingly short amount of time becoming common place during the competitive season in a variety of sports. Additionally, international tournaments commonly take place every 2 years resulting in an environment of severely increased physical demands. The expectancy of athletes to be performing to their highest level in each game as well as being able to cope with the increased intensity of training in days prior to competition are the main sources of these demands. As a result, athlete recovery is increasingly becoming one of the most vital aspects of successful sporting competition. In particular, an individual’s ability to recover from a condition called delayed-onset of muscular soreness (DOMS) that becomes a debilitating factor to performance. DOMS is characterised by localized soreness, muscle shortening and increased stiffness and swelling. It further effects performance through power and strength decreases as well as reduced proprioception (Proske and Morgan, 2001). It is known to most commonly occur following intense, unaccustomed or eccentric exercise with the onset occurring sometimes as early as 12 hours post-exercise, but more commonly at the 24 hour mark. The symptoms usually peak between 48-72 hours post exercise and may last for up to 7 days. Two main issues arise due to the onset of DOMS; reduce performance and injuries. Professional athletes typically return to training within 24 hours following a competitive match and may sometimes have less than 72 hours before their next competitive match, as commonly seen in football. Regardless, even if athletes
- 3. receive a week to recover, they are expected to be able to meet the increased intensity demands of training that are commonly seen in the days leading up to a competitive match. Meaning they are required to be recovered to an optimum level of performance within 72 hours of their previous competitive match. Herein lies the issue with suffering from DOMS. A decreased level of performance in training occurs due to the inherent reduction of muscular strength and power as well as disturbed proprioception. Additionally, the symptoms of DOMS can also cause psychological weaknesses related to performance as the sensation of pain and stiffness in the muscles can lead to a reduction in effort as well as a demotivated mind-set, further decreasing performance levels. Relatedly, the length of the sarcomere within the muscle, as well as the muscles own elasticity properties, are greatly reduced which subsequently increases the risk of injury as well as reducing the range of motion available to the athlete (Proske and Morgan, 2001). Disturbances in proprioception and coordination also increase the risk of injury due to reductions of the cushioning capabilities of joints. This causes increased shock absorption at other joints which, in turn, places further unaccustomed strain on muscles, joints, ligaments and tendons (Edgerton et al., 1996). Increasingly, clubs and sporting bodies are utilizing a number of different modalities in order to enhance recovery following training and competition. It now seems apparent that there is a universal agreement that natural recovery methods are no longer adequate for top-level sport and that at the very least, an additional method should be utilized to facilitate recovery. Some notable methods that have previously been used are nutrition programmes, strict sleep patterns, cool downs, stretching, active recovery, massage, icing, contrast water baths and even acupuncture (Venter et al., 2010). However, in recent years cryotherapy has gained wide-spread and
- 4. mainstream popularity amongst a variety of sports as a means to alleviate DOMS and augment recovery 3(Nédélec et al., 2013) with successful implementations of cryotherapy on varied physical stressors observed in football (Ascensão et al., 2011), cycling (Vaile et al., 2008), rugby (Pointon and Duffield, 2012), simulated team sports (Ingram et al., 2009) and jiu-jitsu (Santos et al., 2012) thus displaying its effectiveness across sports. Despite this, there is a general lack of empirical evidence to support the notion that cryotherapy is an effective means of facilitating both recovery and performance, with a large body of literature suggesting findings are equivocal at best (Bailey et al., 2007). A ubiquitous finding is present, however; that further, high quality research is required within the area (Cochrane, 2004; Howatson et al., 2009; Bleakley et al., 2012; Versey et al., 2013). Cryotherapy is an umbrella term for the use of local or general exposure to cold temperatures as a form of therapy. It was initially proposed some 30 years ago to relieve pain caused by rheumatic diseases, particularly rheumatoid arthritis. Since rheumatic diseases are characterised by joint, tendon and muscular pain as well as inflammation, it is unsurprising that cryotherapy began to be utilized by sportsmen as a means to facilitate recovery. There are many variations of the treatment such as whole-body cryotherapy (WBC) at temperatures between -110°C and -195°C for 2-3 minutes (Ferreira et al., 2014a), partial-body cryotherapy (PBC) which is similar to WBC with the exception of the head being exposed to cold (Hausswirth et al., 2013), contrast water therapy which involves alternate submersions of an athlete’s lower body in warm (38°C) and cold (15°C) water (Vaile et al., 2008), cold-water immersion (CWI) of the lower body at 10°C (Pournot et al., 2011a) as well as application of ice packs to the skin. This study will focus on CWI.
- 5. In order to understand the mechanisms of cryotherapy, a knowledge of the mechanisms of DOMS itself is required. It is believed that damage occurs to structural properties of the muscle, particularly at the z-lines of the sarcolemma, following intensive exercise. This damage causes the passive leakage of creatine kinase (CK) into the plasma of the blood from the damaged muscle (Smith, 1991). Accumulation of calcium ions (Ca2+) also develop as a result of muscle damage causing the inhibition of cellular respiration as the increased concentrations of Ca2+ activate enzymes that cause the deterioration of z-lines, troponin and tropomyosin (Smith, 1991). Within 8 hours of exercise-induced muscle damage (EIMD), elevated levels of neutrophils are in circulation and are drawn to the damaged muscle before permeating the muscle tissue. This can lead to an imbalance of the neutrophil function resulting in healthy muscle tissue inadvertently being disintegrated and additional muscle damage (Bleakley et al., 2014). Neutrophils, in part, are also responsible for the production of pro-inflammatory cytokines and reactive oxygen species which cause intramuscular degradation resulting in heightened muscle damage (Ferreira et al., 2014b). Multiple aspects of the process of EIMD result in localized tissue oedema (Meeusen and Livens, 1986). In summary, the combined mechanical and inflammatory responses to EIMD lead to the sensitising and activation of type III and type IV pain receptors, resulting in the sensation of DOMS (Bleakley et al., 2014). Cryotherapy, or CWI, causes constriction of localized blood vessels resulting in a reduction of lower limb blood flow to the area of muscle damage. This decreases the rate of metabolism which in turn leads to the abating of the inflammatory response and subsequent oedema associated with EIMD as a result of regaining homeostasis of CK, lactate dehydrogenase (LDH) and Ca2+ within the muscle tissue
- 6. (Glasgow et al., 2013; Rossato et al., 2015). A simultaneous increase in anti- inflammatory cytokines alongside a decreased activity of pro-inflammatory cytokines as a result of cryotherapy has also been reported by both Lubkowska et al. (2011) and Pournot et al. (2011b). It is suggested that this serves the dual purpose of reducing both initial and secondary inflammatory damage to the muscle. Bailey et al. (2007) reports that the above processes combine to alter pain perception, specifically the reduction of oedema inducing a decrease in the sensitivity of pain receptors. There is evidence that cryotherapy may benefit performance as Pournot et al. (2011a) reported that reduced plasma concentrations of inflammatory and damage markers may result in increased force production in ensuing bouts of exercise, when compared to a control group. The amalgamation of these findings lead to the belief that cryotherapy results in an increased rate of recovery following EIMD. However, these findings are contested by Takeda et al., 2014; Goodall and Howatson, 2008; Jakeman et al., 2009. Interestingly, Singh et al. (2001) reported that cryotherapy possesses the additional benefit of increasing sleeping quality, an aspect of recovery that is stated as vital by both Davis et al. (2002) and Williams (2007). However, there are a few considerations within the literature to be noted. A contemporary study states CWI may lead to reduced long-term training gains in muscular strength and hypertrophy (Roberts et al., 2015). A different type of issue that also needs to be taken in to consideration is the psychological aspect of cryotherapy. The lack of a placebo condition within a study (due to the nature of cryotherapy) may be a source of weakness as subjects who receive cryotherapy will likely be expecting the intervention to work which could raise issues of bias. In contrast, if an athlete finds the temperatures involved in cryotherapy particularly
- 7. uncomfortable then the desired effects could be limited as their stress levels increase causing a negative effect on recovery. A common theme amongst the literature is the lack of an agreed upon procedure between researchers. In fact, it is likely that the large number of inconclusive and opposing findings within this area of study stems from the inconsistencies of the methodological approach between studies. Particularly within CWI studies, timings vary from 5-30 minutes without any real consistency. This gap in the literature presents an opportunity for research and thus the aim of this study is to consolidate findings from existing literature and determine the optimal time length of CWI in order to improve recovery from EIMD. Hypothesis H1 Cryotherapy will decrease biochemical and functional markers of muscle damage, leading to an enhanced rate of recovery to baseline performance levels in comparison to the control group. H2 The 30 minute cryotherapy condition will lead to an enhanced rate of recovery to baseline performance levels more effectively than the 15 minute cryotherapy condition. Methods Subjects The study would aim to recruit 12 male performance-level athletes who are currently active in their specific sport and within an age range of 18 to 25 years old.
- 8. These parameters are set so that the findings can be reliably transferred to real- life, elite level sporting climates. Participants should be free from injury and illness and not be suffering from any muscle soreness or swelling at the time of testing, so as to not interfere with results. Participants will also be asked to refrain from taking any anti-inflammatory drugs during the course of the study. Experimental Design This study will follow a pre-experimental, repeated measures design with the same group of subjects participating in each of the three conditions. Subjects will be required to attend the laboratory a total of 12 times, 4 times for each condition. Age, height and weight shall only be recorded on each subject’s first visit to the laboratory. Baseline measures of damage-markers such as blood lactate (BLa) (mmol/L) and creatine kinase (IU/L), thigh circumference (cm) and visual analogue scale (VAS) will also be taken upon arrival to the laboratory prior to completion of the muscle damaging protocol. Once these have been recorded, each subject will be taken into the gym to determine their one-rep max (1RM) using a barbell and a squat rack. Due to the ability level of the subjects recruited, it is assumed they will be familiar with performing a barbell squat as well as determining their 1RM. However, there will be researchers present in the gymnasium to act as spotters as well as ensuring the safe, uniform process of determination of subjects 1RM. Following a 15 minute recovery period, subjects will then return to the laboratory and complete the muscle-damaging protocol. The protocol will be a drop-jump session consisting of 10 sets of 10 repetitions from a height of 50cm, with 1 minute rest periods between sets. Drop-jumps are an eccentric-biased exercise which ensures sufficient damage as it is the most capable
- 9. type of contraction to induce muscle damage24, 25. Upon completion of the protocol, repeated measurements of the muscle-damage markers shall be recorded immediately with the exception of squat 1RM. This will serve the purpose of ensuring damage has been induced and subsequently assessing the effectiveness of each condition on rate of recovery. Subjects are then required to return to the laboratory and repeat the measurements 24, 48 and 72 hours post-exercise. Squat 1RM will also be recorded at these intervals, but not immediately post-exercise, and will serve as a functional marker of recovery. The three conditions of this study are control (no cryotherapy), 15 minute cryotherapy and 30 minute cryotherapy. During the control condition, participants will receive no treatment following exercise. For the two cryotherapy conditions, participants will have their lower body’s submerged in an ice bath (temp. 10°C) for 15 minutes and 30 minutes respectively following the completion of the protocol and damage-marker measurements. Data Analysis Using the SPSS analysis software, a two-way repeated measures ANOVA will be conducted in order to compare the differences between the biochemical and mechanical damage markers, stated previously, across time (0, 24, 48 and 72h post- exercise) and conditions (control, 15m and 30m CWI). Statistical significance will be accepted when p<0.05. Ethical Considerations Prior to taking part, all participants will be required to complete an informed consent form that outlines the objective of the investigation, the protocol to be
- 10. followed, associated risks and benefits of the interventions and informs the client that they are free to withdraw from the process at any point without consequence. It is also to be stated that the client’s confidentiality will be upheld with the greatest respect as well as all data gathered being protected by the Data Protection Act of 1984, adhering to the BASES code of conduct. In relation, the 10 points of the Nuremberg Code and the principles of the Declaration of Helsinki will be followed rigorously. Additionally, each participant’s health and suitability to the study will be evaluated via a PAR-Q form prior to testing. The exact procedure of the study will be outlined in advance with clear mentions of any associated risks or benefits. The side effects of heavy exercise (dizziness, nausea) and submersion in cold water (breathlessness, hyperventilating, panic attacks, and shock) will be outlined clearly, with reassurance that they are only temporary effects. To mitigate these possible risks water temperature will be regulated, room temperature within the laboratory could be increased and towels will be provided. Furthermore, a research leader will always be present with the sole purpose of maintaining the client’s wellbeing. With reference to the PAR-Q, clients identified to be at risk due to the nature of the study will be removed from the process. Every precautionary measure will be taken to minimise any undesired risk or harm, with warm-ups, practices and sufficient rest periods enforced to reduce any additional physiological damage. Gloves and lab coats are to be worn by research leaders when collecting blood samples as a means to avoid contamination.
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