Acute Effects of Cryotherapy Duration in Healthy Individuals

Study Overview
=================
Brief Summary
-----------------
The study will investigate the acute effects of cryotherapy duration on shoulder muscle strength, flexibility, endurance and dynamic balance in healthy individuals.

Detailed Description
-----------------
Cryotherapy is a practice that induces therapeutic effects by reducing tissue temperature to produce an analgesic effect. Cryotherapy application methods vary from simple ice packs and cold water immersion to whole body cryotherapy methods. The purpose of cryotherapy treatment is to reduce tissue damage, muscle spasm, edema and pain and to provide a faster rehabilitation process after injury. It is also used as a recovery technique after high-intensity training in different sports branches. Despite the proven benefits of cryotherapy according to the literature, discussions continue about its effect on some parameters and there is no consensus on the duration of cryotherapy application. In addition, although there are studies on the effects of cryotherapy on the lower extremities, studies for the upper extremity are limited and the results of these studies are inconsistent. In the literature, no study was found that evaluated the effect of cryotherapy application time on shoulder muscle strength, endurance, flexibility and balance. Therefore, in this study, the acute effects of cryotherapy duration on shoulder muscle strength, flexibility, endurance and dynamic balance in healthy individuals will be investigated and the optimum duration of cryotherapy on these parameters will be determined. In addition, the results of the research will contribute to the planned rehabilitation and exercise program.

Official Title
-----------------
Acute Effects of Cryotherapy Duration on Muscle Strength, Flexibility, Endurance and Balance in Healthy Individuals

Conditions
-----------------
Cryotherapy Effect

Intervention / Treatment
-----------------
* Other: Cryotherapy application


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Individuals between the ages of 18-25 who volunteer to participate in the study No upper extremity orthopedic problems No history of shoulder injury or surgery in the past two years Absence of Raynaud's disease or cold intolerance Exclusion Criteria: Having a history of shoulder injury or surgery Cervical or thoracic spine disorders People with any neurological disorder or known balance/proprioceptive deficits Decreased sensation or decreased blood flow Have Raynaud's disease or any cold intolerance

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 25 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
Accepts Healthy Volunteers

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Individuals aged 18-25 years who volunteer to participate in the study will be included in this study and randomly assigned to 3 groups. After the demographic information of the volunteers is obtained and their dominant upper extremities are determined, the shoulder isometric muscle strength will be measured with a hand dynamometer. The back scratch test will be used to evaluate the shoulder flexibility of the participants, the modified push-up test will be used to evaluate the endurance, and the upper extremity Y balance test will be used to evaluate the shoulder dynamic balance. Then, cryotherapy will be applied on the shoulder for 10 minutes in Group 1, 15 minutes in Group 2 and 20 minutes in Group 3.After the application, the same measurements will be repeated and the values before and after the application will be compared.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: 10-minute Cryotherapy Application<br>A cold application will be made on the shoulder for 10 minutes. Before and after the application, individuals will be evaluated in terms of muscle strength, flexibility, endurance and balance. The values before and after the application will be compared. | Other: Cryotherapy application<br>* The temperature sense test was applied on the dominant side shoulder of the participants against the risk of sensory loss or decreased sensation. In order to test cold intolerance, a cold pack was placed on the forearm of the individuals. After waiting 2-3 minutes, the region was evaluated. Individuals meeting the inclusion criteria were assigned to the groups according to the randomization list created by the computer. Then, the participants' shoulder isometric muscle strength, shoulder flexibility, shoulder endurance and shoulder balance was evaluated. Except for shoulder endurance, all measurements were repeated three times, with a 30-second rest period between each repetition. A 2-3-minute rest period was given after each test. Then, the cold pack was wrapped in a thin and wet cloth on the shoulders of the participants. The treated area was checked every 5 minutes and the participants were asked to say when they felt any unusual symptoms.<br>|
| Active Comparator: 15-minute Cryotherapy Application<br>A cold application will be made on the shoulder for 15 minutes. Before and after the application, individuals will be evaluated in terms of muscle strength, flexibility, endurance and balance. The values before and after the application will be compared. | Other: Cryotherapy application<br>* The temperature sense test was applied on the dominant side shoulder of the participants against the risk of sensory loss or decreased sensation. In order to test cold intolerance, a cold pack was placed on the forearm of the individuals. After waiting 2-3 minutes, the region was evaluated. Individuals meeting the inclusion criteria were assigned to the groups according to the randomization list created by the computer. Then, the participants' shoulder isometric muscle strength, shoulder flexibility, shoulder endurance and shoulder balance was evaluated. Except for shoulder endurance, all measurements were repeated three times, with a 30-second rest period between each repetition. A 2-3-minute rest period was given after each test. Then, the cold pack was wrapped in a thin and wet cloth on the shoulders of the participants. The treated area was checked every 5 minutes and the participants were asked to say when they felt any unusual symptoms.<br>|
| Active Comparator: 20-minute Cryotherapy Application<br>A cold application will be made on the shoulder for 20 minutes. Before and after the application, individuals will be evaluated in terms of muscle strength, flexibility, endurance and balance. The values before and after the application will be compared. | Other: Cryotherapy application<br>* The temperature sense test was applied on the dominant side shoulder of the participants against the risk of sensory loss or decreased sensation. In order to test cold intolerance, a cold pack was placed on the forearm of the individuals. After waiting 2-3 minutes, the region was evaluated. Individuals meeting the inclusion criteria were assigned to the groups according to the randomization list created by the computer. Then, the participants' shoulder isometric muscle strength, shoulder flexibility, shoulder endurance and shoulder balance was evaluated. Except for shoulder endurance, all measurements were repeated three times, with a 30-second rest period between each repetition. A 2-3-minute rest period was given after each test. Then, the cold pack was wrapped in a thin and wet cloth on the shoulders of the participants. The treated area was checked every 5 minutes and the participants were asked to say when they felt any unusual symptoms.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Shoulder Muscle Strength | Isometric strength of shoulder flexors, extensors, abductors, adductors, internal and external rotators will be measured with a hand dynamometer and recorded in kg. Each muscle group will be tested in three repetitions according to the procedures described by Kendall et al. The average of the three scores will be used for analysis. | Just before and within 5 minutes after cryotherapy cryotherapy | 
| Change in Shoulder Flexibility | It will be evaluated with the Back Scratch Test. In this test, while in a standing position, the person's fingers are extended (stretched) and the arm is rotated outward with the palm facing the back, towards the ground over the shoulder and while doing this, the other arm is internally rotated, with the palm facing forward and the fingers extended. The distance between the middle fingers of both hands will be measured. If the middle fingers do not touch, the distance between them is recorded as (-) in cm, if the middle fingers touch end to end, the value is (0), if the middle finger crosses the other, the distance between the middle finger is recorded as (+) in cm. Keith et al. reported that the test had a high reliability coefficient (left hand, rxy=0.77 and right hand rxy=0.75). | Just before and within 10 minutes after cryotherapy | 
| Change in Shoulder Functional Balance | The Y Balance Test kit will be used in the medial, superolateral and inferolateral directions with an angle of 135-135-90 degrees between them. While the dominant hand on the test kit is in the push-up position with the hand at the junction of the angles, the farthest point that the participants can reach with the fingertip of the other hand. and the distance he can reach will be measured in cm. | Just before and within 10 minutes after cryotherapy | 
| Change in Shoulder Muscle Endurance | Modified Push-up Test will be used. In the test, individuals are positioned face down on the mat with their knees and elbows flexed. The participant will be asked to push his torso backwards by extending his elbows without disturbing the flexion of the knees. The number of correct moves in 30 seconds will be recorded. | Just before and within 15 minutes after cryotherapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Temperature Sensation | The test will be performed on the shoulder with eyes closed, by putting hot water (40-45 degrees) in one of two glass tubes of equal diameter and cold water (5-10 degrees) in the other. Then, these tubes will be touched to the person and the person will be asked to tell which is hot and which is cold. | Before cryotherapy | 
| Cold Intolerance | There are four types of symptoms in cold intolerance: pain/discomfort, stiffness, dysesthesia (numbness or tingling), and discoloration. In order to test cold intolerance, cold application will be made on the forearm of the individuals and waited for 2-3 minutes. | Before cryotherapy | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Cryotherapy, Muscle strength, Flexibility, Endurance, Balance, Healthy people, Cold pack, Shoulder