Immediate and Late Effect of Cryotherapy on Balance

Immediate and Late Effect of Cryotherapy on Balanceimmediate and late tack together of cryotherapy on proportionateness IN HEALTHY SUBJECTs solicitBackground cryotherapy natural covering is commonly apply as a physical therapy tools with some(prenominal) known advantage, however several research obligate reported drop in subject balance which affect quality of movement sideline cryotherapy application, in that respectfore the purpose of sketch to investigate the immediate and late loading of cryotherapy on ankle avowling joint on smooth balance and discharge the difference in static balance change between both(prenominal) sexes. Methods 30 normal subjects, Subjects had their static balance scrutinyed during two conditions (1) an observational condition where the subject received the cryotherapy application by using cooled gel pack to the ascendant ankle joint for 15 proceedings right away onwards static balance tryouting and (2) a control condition finished at mode temperature. The drift of testing condition was randomized by using a coin flip. Biodex balance system was apply to measure static balance. Result psychoanalysis of data using ANOVA and unpaired test , put down in probatoryly statistic altogethery effect in all aspect of static balance within womanish group with p range of overall perceptual constancy force =0.669,Anterior/posterior constancy index =0.196 and medial/lateral stability index =0.989,in heartyly statistically effect in all aspect of static balance within male group with p value of overall stability index =0.382,Anterior/posterior stability index =0.552 and Medial/lateral stability index =0.46 and insignificant statistically difference between male and female in all aspect of static balance. Conclusion The essence of trustworthy study suggest that fifteen minutes of cold gel pack on ankle dominant extremity have no effect on static balance on both sexes .Key words static balance, cryotherapyIntroductionc ryotherapy therapy is a popular non-pharmacological intervention, The term cryotherapy was utilise in year 1908 by A.W. Pusey to describe the treatment of skin injuries with low temperatures1,2 , The primary aim of cryotherapy is the removal of heat energy from the site of detriment, in order to facilitate a therapeutic effect 3 by produces a number of physiological personal effects to the human body including a reduction in air flow, edema, hemorrhage4, cellular metabolic rate, hypoxia, enzymatic activity and tissue damage5. Cryotherapy has also been demonstrated to significantly increase the pain threshold and pain tolerance by simplification nerve conduction velocity and musclebuilder spasm 6.Cryotherapy often used in athletic and rehabilitation cases to manage injury during the immediate and rehabilitative phases 7. Cryotherapy treats the muscle damage caused by High-intensity exercise including predominantly eccentric activity, unaccustomed activity, and exercise of long du ration and/or exalted intensity which has been shown to induce an inflammatory rejoinder 8.In spite of the characterized treatment advantage of cryotherapy, there atomic number 18 reduction in subjects performance variables are likely to occur later on returning to normal movement straightway after cryotherapy application,9especially , decrease speed of running, muscle strength speed and agility measures have been noted after cryotherapy application over many anatomical areas and studies10,11.The ability to conserve postural control or balance is important for the correct carrying out of all daily activity ranging from standing and move to sitting and standing from a chair 12. Possessing the ability to conserve several positions, to react automatically to voluntary movements of the body, and to react to external disturbance repre moves a postural control domain needed in daily life 13.The maintenance of balance is important in the prevention of injuries and this ability depend s on proprioceptive commentary from capsuloligamentous and musculotendinous mechanoreceptors in combining with vestibular and visual input to the central nervous system (CNS)14,15 . This input used in feedback and feed-forward loops to provide the proper neuromuscular chemical reaction 16-17. Variations in any of these inputs would disturb balance and increase the danger of injury 18.There is also growing awareness that rehabilitation using cryotherapy has deleterious effects on balance, or return patients to their previous functional levels 19, 20.Quality of movement is important as strength of movement, and the key of movement quality is balance 21. Even if a patient has regained full strength and range of motion, if they still have poor balance and proprioception, they are at risk for re-injury.During the management of acute distortion, cryotherapy is commended after the injury and in rehabilitation, ice application is supposed to promote the beginning of active exercise and i ts progression 7. In practice it can happen that sportsmen are sent back to exercising or competition immediately after cryotherapy. Although the question is controversially discussed, if physical activities after ice application can be re-established without risk or increase liability to injury. This study takes up the problems if cryotherapy application at the ankle disrupts static balance so that an increased risk of injury could firmness and the study also clarify the immediate and late effect and test the difference in static balance between both sex.MethodologyThe current study was conducted at biomechanics laboratory at faculty of physical therapy, modern university, in the period from December 2015 to April 2016 to investigate the immediate and late effect of cryotherapy application on dominant ankle joint on static standing balance and test the difference in static balance between both sexes.Design of studyCross over (single repeated measurements) design used in this study to determine the immediate and late effect of cryotherapy application on dominant ankle joint on static standing balance and test the difference in the static standing balance between both sexes.SubjectsA sample of thirty healthy normal subjects (fifteen male and fifteen female), subjects were recruited using publically distributed posters and by online social media. Subjects had their static balance examined during two situations (1) an experimental situation where the subject received the cryotherapy application by using cooled gel pack to the dominant ankle joint for fifteen minutes immediately out front static balance testing and (2) a control situation finished at room temperature. The order of examining situation was randomized by using a coin flip. Participant finished the control situation first immediately finished the experimental situation following assessment. Participants randomized to the cryotherapy situation first had the control session arranged at a separate time to confirm no lingering effects remain from the cryotherapy procedures.Subjects participate in the current study after approval of ethical committee of faculty of physical therapy, Cairo University with number P.T.REC/012/001035 and all subjects provided written informed consent. Subjects were included if their age range from 18 to 40 years 22 free from musculoskeletal diseases and neurological diseases affecting the lower limb. Excluded if had musculoskeletal disorders in lower limb, had infected skin diseases and loss of sensation, had Metabolic or vascular disease with neurological component such as diabetes, had previous ankle operation and had recent injury of ankle joint.InstrumentationMeasurement instrumentationThe device used in this study (Biodex Medical Systems Inc., Shirley, New York, USA) was a infrastructure platform (circular in shape with a diameter of 21.5, which permits up to 20 tilting from horizontal in all directions), support rails that were adfairable from 25 to 36.5 above the platform, and could be swung away if desired, a display module whose height was adjustable from 53 to 68 above the platform and angle was adjustable from vertical back to 45, with a display viewing area of 24.8 - 18.4 cm and a printer. This testing machine has 12 dynamic levels plus locked for static measurements 23. constancy indexesthe stability index represents the variance of platform displacement in stages from level. An increase in number indicate considerable motion, which indicates a problem with balance 24 . The role players ability to control the platforms angle of tilt was measured by the system and noted as a stability index. The data on the balance of the tested participants were supplied to the system. These data included anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI). The smaller the amount of sway, the lower the numerical value of these indexes 24.OSI represented the variance of foot platform displacement in degrees, from level, in all motions during the test. A high number was indicative of considerable movement during this test.APSI represented the variance of foot platform displacement, in degrees, from level, for motion in the sagittal plane.MLSI represented the variance of foot platform displacement, in degrees from level, for motion in the frontal plane 24 .Therapeutic instrumentationReusable cold gel pack 25.4 x 48.1 cm. 5 +/- degree C 25 was frozen and wrapped with a towel and supported with elastic strap around the ankle joint of dominant lower extremity.Procedure distributively participant received a verbal explanation about the test steps. When the system was on, the first displayed mask was the main menu. It allowed us to choose entering testing, training, or system utilities. Choosing to enter testing showed the next projection screen, which allowed determination of the test parameters such as test duration and the stability level chosen. The ex ercising weight and height of the participant were recorded and the next screen was used for the centering process. The next screen was the stability test screen, where the start key was pressed to lock or unlock the platform and begin the test. A cursor appeared during the test tracing the movement of the platform while the clock counted till the time of the test ends. The next screen showed a menu. The examiner chooses the numeric report option on this screen to allow the participants numeric screen appear. Pressing start while on this screen initiates printing of the report, which includes the numeric values of the APSI, MLSI, and OSI (operation and service manual).Step 1 balance assessmentthe participants were tested without footwear and asked to perform two test trials before a ad hoc test condition for the purpose of instrument familiarity before data collection. Then, the participant was first asked to assume the test position (standing on dominant foot) with arms held at th e sides, eye closed and to attempt to control his/her balance as much as possible. Each participant was asked to center him/herself on the foot platform before commencement the test.The test parameters introduced into the device wereParticipants age , weight and height perceptual constancy level all participants were tested on stability level 0 for 15 s.Then, the start key was pressed in the control panel (which took 5 s) with an auditory alarm just before the beginning of the test. The participant was instructed that the test was started just after the alarm. Each participant was instructed to maintain his/her balance for the period of the test. Three trials were performing prior to the measurement.There was report obtained at the end of each test include information on OSI, APSI, and MLSI.Step 2 cryotherapy applicationReusable cold gel pack 25.4 x 48.1 cm. 5 +/- degree C was use as the cryotherapy modality in this study. Application duration forget be 15 minutes. Wrapping of pa ck by towel will applied all around ankle joint of domain extremity with towel in between .Two elastic straps will used to secure the ice pack. The subject will asked to relax during cryotherapy application to limit activity of muscle and lessen any change in temperature of tissue.Step 3 balance reassessmentthe participant was asked to repeat the same balance testing procedures directly after cryotherapy application, 30 minutes later and 60 minutes later to measure post OSI, MLSI, and APSI.Statistical analysisAll statistical analysis were carried out by using SPSS,version 23 for windows SPSS Inc., Chicago,Illinois,USA.the normality of data distribution was tested through the Shapiro-wilk test.Descriptive data for participants, characteristics was calculated as the blotto(a), standard remainder and range minimum maximum of measured variables, ANOVA tests used to compare between pretest and posttest. Unpaired test used to compare between male and female. direct of significant wil l set at ResultsGeneral characteristics of the subjectsIn this study, thirty subjects were assigned randomly, the range of the ages is between 18 to 40 years overall. There was no statistically significant differences between the groups in their ages as the p-value are 0.412. The range of the weight is between 50 to 105 kg. There was no statistically significant differences between the groups in their weight as the p-value are 0.214. The range of the Height is between 156 to 195 cm. There was no statistically significant differences between the groups in their weight as the p-value are 0.366.Table (1) Demographics DistributionItemsMaleFemaleComparisonSignificantMeanSDMeanSDT-valueP-valueAge (years)26.4 6.0825.533 5.410.4120.682No SignificantWeight (Kg)70.89 14.5777.2 5.41-1.2700.214No SignificantHeight (cm)165.27 4.57166.66 6.41-0.4110.366No Significant trope. (1) Demographics DistributionAs for the gender distribution, 15 subjects (50%) were male and 15 subjects (50%) were fe males. In addition, 26 subjects (86.7%) had their dominant right limb tested, and 4 subjects (13.3%) had their dominant left leg tested.Static BalancePre-testThe results are shown using the following table (2) and illustrated in figure (2).1) Overall Stability forefinger freelance t-test was used to show difference between pretest for females and males. The female fee-tail value of overall stability index (3.471.42) was significantly diametrical from (5.042.31) with t test = -2.242 and p value = 0.033*.2) A/P Stability magnate free-lance t-test was used to show difference between pretest for females and males. The female mean value of A/P Stability index (2.41 0.85) was significantly different from (3.3931.65) with t test = -2.157 and p value = 0.043.3) M/L Stability superpowerIndependent t-test was used to show difference between pretest for females and males. The female mean value of M/L Stability index (2.01 1.08) was insignificantly different from (2.991.72) with t test = -1.887 and p value = 0.072.Table (2) The pre-test results for the Stability Indices StaticStability advocateOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test for Females3.671.412.4070.852.011.08Pre-test for Males5.042.33.391.652.991.72Independent t-valuep value-2.4920.033*Significant-2.1570.045*Significant-1.8840.072peanutData are expressed as mean SD.P 0.05= insignificant.*PFigure (2) The pre-test results for the Stability Indices StaticB) Within Group (Females)The results are shown using the following table (3) and illustrated in figure (3).ANOVA F-test was used to show difference between pre and post-test in the stability indices.Overall Stability IndexThe mean value was pretest (3.471.42) when compared with its corresponding no significant difference after assessment immediately (3.781.868), after 30 minutes (3.41 2.27), and after 60 minutes (4.29 2.86) with f test = 0.521 and p value = 0.66.A/P Stability IndexThe mean value was pretest (2.41 0.85) when compared with its corresponding no significant difference after assessment immediately (2.47 1.52), after 30 minutes (2.14 1.27), and after 60 minutes (3.27 1.43) with f test = 1.616 and p value = 0.196.M/L Stability IndexThe mean value was pretest (2.01 1.08) when compared with its corresponding no significant difference after assessment immediately (2.2 1.07), after 30 minutes (2.12 1.84), and after 60 minutes (2.13 1.98) with f test = 0.04 and p value = 0.989.Table (3) The mean values and S.D of Stability Indices before starting and after the test for Females StaticData of evaluationsOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test3.47 1.422.41 0.852.01 1.08Post-Immediate3.73 1.8682.47 1.522.2 1.07Post-30 minutes3.41 2.272.141.272.12 1.84Post-60 minutes4.29 2.863.27 1.432.13 1.98F-value ANOVA0.5211.6160.04p value0.669Insignificant Difference0.196Insignificant Difference0.989Insignificant DifferenceData are expressed as mean SD.P 0.05= insign ificant.*PFigure (3) The mean values and S.D of Stability Indices before starting and after the test for Females StaticD) Within groups (Males)The results are shown using the following table (4) and illustrated in figure (4). ANOVA F-test was used to show the difference between post-test in the stability indices.Overall Stability IndexThe mean value was pretest (5.042.3) when compared with its corresponding no significant difference after assessment immediately (5.01 1.765), after 30 minutes (4.422.22), and after 60 minutes (3.951.56) with f test = 1.039and p value = 0.382.A/P Stability IndexThe mean value was pretest (3.391.69) when compared with its corresponding no significant difference after assessment immediately (3.41.42), after 30 minutes (3.11 1.78), and after 60 minutes (2.67 1.416) with f test = 0.707and p value = 0.525.M/L Stability IndexThe mean value was pretest (2.99 1.72) when compared with its corresponding no significant difference after assessment immediately (3. 021.28), after 30 minutes (2.52 1.55), and after 60 minutes (2.33 1.02) with f test = 0.874and p value = 0.46.Table (4) The mean values and S.D of Stability Indices before starting and after the test for Males StaticData of evaluationsOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test5.042.313.391.652.99 1.72Post-Immediate5.01 1.7653.4 1.423.02 1.28Post-30 minutes4.42 2.2293.11 1.782.52 1.55Post-60 minutes3.951.562.67 1.422.33 1.02F-value ANOVA1.0390.7070.874p value0.382Insignificant Difference0.552Insignificant Difference0.46Insignificant DifferenceData are expressed as mean SD.P 0.05= insignificant.* PFigure (4) The mean values and S.D of Stability Indices before starting and after the test for Males StaticD) Post test results StaticThe results are shown using the following table (5) and illustrated in figure (5). Independent t-test was used to show difference between post-test in the stability indices.1) Overall Stability IndexIndependent t-test was used to show difference between immediately post-test for females and males. The female mean value of overall stability index (3.73 1.868) was insignificantly different from (5.01 1.765) with t test = -1.913and p value = 0.063.Independent t-test was used to show difference between 30 minutes post-test for females and males. The female mean value of overall stability index (3.41 2.27) was insignificantly different from (4.42 2.229) with t test = -1.227and p value = 0.23.Independent t-test was used to show difference between 60 minutes post-test for females and males. The female mean value of overall stability index (4.29 2.86) was insignificantly different from (3.95 1.56) with t test = 0.415 and p value = 0.682.Stability IndexImmediate30 minutes60 minutesOverall Stability IndexPost-test for Females3.73 1.8683.41 2.274.29 2.86Post-test for Males5.01 1.7654.42 2.2293.95 1.56Independent t-valuep value-1.9130.063Insignificant-1.2270.23Insignificant0.4150.682InsignificantTable (5. a) The mean values and S.D of Overall Stability Index post-test for both Females and Males-StaticData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.a) The mean values and S.D of Overall Stability Index post-test for both Females and Males-Static2) A/P Stability IndexIndependent t-test was used to show difference between immediate post-test for females and males. The female mean value of A/P Stability index (2.47 1.52) was insignificantly different from (3.4 1.42) with t test = -1.699and p value = 0.1.Independent t-test was used to show difference between 30 minutes post-test for females and males. The female mean value of A/P stability index (2.14 1.27) was insignificantly different from (3.11 1.78) with t test = -1.723and p value = 0.096.A/P Stability IndexImmediate30 Minutes60 MinutesA/P Stability IndexPost-test for Females2.47 1.522.14 1.273.27 1.43Post-test for Males3.4 1.423.11 1.782.67 1.42Independent t-valuep value-1.6990.1Insignificant-1.7230.096Insign ificant-0.9250.363InsignificantIndependent t-test was used to show difference between 60 Minutes post-test for females and males. The female mean value of A/P stability index (3.27 1.43) was insignificantly different from (2.67 1.42) with t test = -0.925 and p value = 0.363.Table (5.b) The mean values and S.D of A/P Stability Index post-test for both Females and Males-StaticData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.b) The mean values and S.D of A/P Stability Index post-test for both Females and Males-Static3) M/L Stability IndexIndependent t-test was used to show difference between immediate post-test for females and males. The female mean value of M/L Stability index (2.21.07) was insignificantly different from (3.02 1.28) with t test = -1.898and p value = 0.068.Independent t-test was used to show difference between 30 Minutes post-test for females and males. The female mean value of M/L stability index (2.12 1.84) was insignificantly different from (2.5 2 1.55) with t test = -0.656and p value = 0.518.Independent t-test was used to show difference between 60 Minutes post-test for females and males. The female mean value of M/L stability index (2.13 1.98) was insignificantly different from (2.33 1.02) with t test =0.097and p value = 0.729.Table (5.c) The mean values and S.D of M/L Stability Index post-test for both Females and Males-StaticM/L Stability IndexImmediate30 Minutes60 MinutesM/L Stability IndexPost-test for Females2.2 1.072.12 1.842.13 1.98Post-test for Males3.02 1.282.52 1.552.33 1.02Independent t-valuep value-1.8980.068Insignificant-0.6560.518Insignificant0.0970.729InsignificantData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.c) The mean values and S.D of M/L Stability Index post-test for both Females and Males-StaticDiscussionThe purposes of the study were To determine the immediate and late effect of cryotherapy on the dominant ankle joint on static balance and To determine the difference in st atic balance changes between both sexes.Our result revealed that the females have significant difference in static balance than male when measured before application of cold gel pack to ankle dominant extremity with p value of overall stability index = 0.033 , p value of A/P stability index=0.043 and not for ML stability index with p value of =0.072.Our result revealed that after using cold gel pack to ankle dominant extremity for 15 minutes has no statistically significant difference on all aspect of static balance in female group. In over stability index there was no statistically significant difference after assessment immediately, after 30 minutes and after 60 minutes with p value =0.66. In over A/P stability index there was no statistically significant difference after assessment immediately, after 30 minutes and after 60 minutes with p value =0.196. and In over M/L stability index there was no statistically significant difference after assessment immediately,