Effect of Total Cold Water Immersion Vs Ice Massage Modalities
Condition: Exercise-induced Muscle Damage
Study type: Interventional

Summary: 
      Evidence regarding the effect of the therapeutic modalities on muscle recovery after
      exercise-induced muscle damage (EIMD) was lacking. Therefore, this study played a role in
      bridging this gap, where total cold-water immersion (TCWI) values return to baseline 72 h
      after the muscle damage protocol, regarding creatine kinase (CK) levels, power and strength,
      and delayed onset of muscle soreness (DOMS).
    

Detailed description: 
      Participants were recruited by means of convenience sampling. A message was sent via WhatsApp
      for all the contact list of the investigators. This message included a brief explanation of
      the study purpose, phone numbers of the three investigators and a request to forward this
      message to the contact lists of the recipients.

      At the beginning of the study, all participants' data were recorded, including their physical
      characteristics and eligibility.

      Eligible participants were given information sheets and signed consent forms. Afterward, they
      were familiarized with the experimental procedure and given numbers in order to assure
      blindness during the processes of allocating them into groups and assessing the outcomes.
      Final participants included 60 eligible stratified into two blocks (30 males and 30 females).

      Then a randomization website -website spreadsheet generator; http://www.randomization.com was
      used to randomly allocate each into one of two intervention groups: 1) Total CWI (TCWI) or 2)
      IM.

      Baseline measurements of both groups (TCWI and IM) were taken and include one repetition
      maximun (1-RM), (2) CMJ, (3) VAS, and (4) Serum CK tests. Testing was followed by a warm-up
      session and then by muscle damage protocol. Thereafter, each of the interventions (TCWI or
      IM) were performed and followed by post-exercise measurements at 2; 24, 48 and 72 hours.

      Muscle damage protocol. Muscle damage was induced by 20 sets of 5 drop jumps each, with a
      two-minute rest between sets. Participants were instructed to drop jump from a 60-cm box,
      then perform a maximal bipodal CMJ, then land on the floor with knees flexed to at least 90°,
      while keeping their hands on their knees to eliminate additional force by upper limbs. This
      protocol produces a response similar to that obtained from high-intensity multi-joint
      exercises (Vieira et al., 2016).

      Total cold-water immersion. The best results of recovery from EIMD were provided by TCWI with
      a water temperature between 11 and 15°C and an immersion time of 11 to 15 minutes according
      to Lee et al. (2012) and Machado et al. (2016). For that reason, participants allocated to
      the TCWI group completed a session of 15-minutes in cold water with temperature of 12°C.

      Participants were seated while immersing their whole body in water except their head and
      neck. The water's temperature was continuously measured by a mercury-in-glass thermometer and
      was maintained at a temperature of 12°C by adding blocks of ice when needed.

      With respect to depth, TCWI is more efficient than partial CWI since exposing a larger mass
      of the body including the core is needed for cardiovascular changes to occur, since the major
      heat exchange that leads to cooling occurs via conduction by surrounding water, so the higher
      the level of water immersion is, the greater the surface area of the body in contact with
      water will be, leading to better recovery effect (Murray and Cardinale, 2015; Stephens et
      al., 2016).

      Ice massage. The IM group was seated and subjected to a circular local massage by a cube of
      ice for 15 minutes for each leg on the region of quadriceps muscles.

      Data Analysis The results were analyzed by the Statistical Package for the Social Sciences
      (SPSS) version 21.0 for windows. The Shapiro-Wilk test was used to check the normality of the
      data distribution. A probability (p) value of >0.05 indicates that there is no significant
      difference between groups.

      Analysis of variance (ANOVA) test was used to compute the within-group differences of each
      variable (muscle damage, strength, power, and DOMS) at different testing times (Baseline, 2h,
      24h, 48h and 72h after exercise).

      Factorial repeated measures ANOVA test was used to determine between-group difference between
      TCWI and IM groups, of each variable (muscle damage, strength, power, and DOMS) at different
      testing times (Baseline, 2h, 24h, 48h and 72h after exercise).
    

Intervention name(s): Total cold-water immersion; Ice massage
Intervention type(s): Other; Other
Intervention description(s): TCWI group completed a session of 15-minutes in cold water with a temperature of 12°C.; Ice cubes massage in a clockwise circular motion on the thigh area (quadriceps) for 15 minutes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Total cold-water immersion; ice massage; muscle damage; delayed onset of muscle soreness