Moisés Augusto de Oliveira Borges*

m.oliveiraborges@hotmail.com

Gabriel Costa e Silva**

fisiologia.costaesilva@gmail.com

Fabrizio Di Masi***

fabdimasi@gmail.com

*Graduado em Educação Física

pela Universidade Federal Rural do Rio de Janeiro (UFRRJ)

Especialista em Atividade Física e Fisiologia do Exercício,

ênfase em Psicofisiologia e Recuperação Pós-Exercício

Mestre em Psicologia (PPGPSI - UFRRJ),

ênfase em Psicologia do Esporte. Pesquisador

e orientador no Laboratório de Avaliação e Saúde (LAVs)

Associado do Colégio Brasileiro de Ciências do Esporte (CBCE-RJ)

Associado da Associação Brasileira de Gestão do Esporte.

**Doutor em Medicina Celular e Molecular

pelo Programa de Pós-Graduação em Ciências da Saúde

da Faculdade de Medicina do ABC (FMABC)

Laboratório de Ciência do Movimento Humano Colégio Pedro II
***Doutor em Ciências (UNIRIO)

Mestre em Ciência da Motricidade Humana (UCB)

Universidade Federal Rural do Rio de Janeiro

Laboratório de Fisiologia e Desempenho Humano UFRRJ/DEFD/IE

(Brasil)

Reception: 02/28/2024 - Acceptance: 05/03/2024

1st Review: 04/20/2024 - 2nd Review: 04/30/2024

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Suggested reference: Borges, M.A.O., Costa e Silva, G., & Di Masi, F. (2024). Subacute Influence of Body Cooling on the Perception of Delayed Onset Muscle Pain. Lecturas: Educación Física y Deportes, 29(313), 98-110. https://doi.org/10.46642/efd.v29i313.7492

 

Abstract

    Objective: To investigate the subacute influence of the use of body cooling by immersion in cold water on the perception of Delayed Muscle Pain (DOMS), in the posterior leg muscles, 24, 48 and 72 hours after carrying out a three-course muscle fatigue protocol. series of repetitions until concentric failure of the bilateral plantar flexion and dorsiflexion movement. Methods: 22 untrained participants (age: 20.4±1.7 years; body mass: 65.91±15.38kg; height: 166.86±8.47cm) participated in an effort protocol that consisted of three sets of repetitions until concentric failure of the leg muscles, of plantar flexion and bilateral dorsiflexion movement, with one's own body weight. After one minute, through a draw, one of the legs was designated for immersion, up to the height of the popliteal fold, in a vat of ice water (between 12 and 14º C), during three stages of 5 minutes with a 1 minute break between each stage, totaling 15 minutes of immersion. At the same time, the other leg remained in passive recovery, serving as control. After 24, 48 and 72 hours, the individuals were evaluated regarding the perception of DOMS, in both legs, with an analog pressure algometer (pressure of 6kgf/cm²). The perception of pain was signaled by the participants using the Pain Visual Analogue Scale (VAS). Results and conclusions: No statistically significant differences (p<0.05) were found between body cooling and passive recovery, in both groups, in the assessment of perception of DOMS 24, 48 and 72 hours after the exercise protocol.

    Keywords: Cold-water immersion. Muscle damage. Injuries. Post-exercise recovery.

 

Resumo

    Objetivo: Investigar a influência subaguda do uso do resfriamento corporal por imersão em água fria na percepção da Dor Muscular Tardia (DMT), nos músculos posteriores da perna, 24, 48 e 72 horas após a realização de um protocolo de fadiga muscular, de três séries de repetições até a falha concêntrica do movimento de flexão plantar e dorsiflexão bilateral. Métodos: 22 participantes destreinados (idade: 20,4±1,7 anos; massa corporal: 65,91±15,38kg; estatura: 166,86±8,47 cm) participaram de um protocolo de esforço que consistia em três séries de repetições até a falha concêntrica da musculatura da perna, do movimento de flexão plantar e dorsiflexão bilateral, com o próprio peso corporal. Após um minuto, por meio de sorteio, uma das pernas foi designada para imersão, até a altura da dobra poplítea, em tonel de água com gelo (entre 12 e 14º C), durante três etapas de 5 minutos com 1 minuto de intervalo entre cada etapa, totalizando 15 minutos de imersão. Neste mesmo tempo, a outra perna permaneceu em recuperação passiva, servido de controle. Após 24, 48 e 72 horas, os indivíduos foram avaliados em relação a percepção da DMT, em ambas as pernas, com algômetro analógico de pressão (pressão de 6kgf/cm²). A percepção de dor foi sinalizada pelos participantes através da Escala Visual Analógica (EVA) de dor. Resultados e Conclusões: Não foram encontradas diferenças estatísticas significativas (p<0,05) entre o resfriamento corporal e a recuperação passiva, em ambos os grupos, na avaliação de percepção de DMT 24, 48 e 72 horas pós protocolo de esforço.

    Unitermos: Imersão em água fria. Dano muscular. Lesão. Recuperação pós-exercício.

 

Resumen

    Objetivo: Investigar la influencia subaguda del uso de enfriamiento corporal por inmersión en agua fría sobre la percepción del Dolor Muscular Tardío (DMT), en músculos posteriores de la pierna, 24, 48 y 72 horas después de realizar un protocolo de fatiga muscular de tres series de repeticiones hasta el fallo concéntrico del movimiento de flexión plantar y dorsiflexión bilateral. Métodos: 22 participantes no entrenados (edad: 20,4±1,7 años; masa corporal: 65,91±15,38 kg; altura: 166,86±8,47 cm) participaron en un protocolo de esfuerzo que consistió en tres series de repeticiones hasta el fallo concéntrico de los músculos de piernas, del movimiento de flexión plantar y dorsiflexión bilateral, con el propio peso corporal. Al cabo de un minuto, una de las piernas era sumergida en agua entre 12 y 14º C, durante tres etapas de 5 minutos con 1 minuto de duración, totalizando 15 minutos de inmersión. Al mismo tiempo, la otra pierna permaneció en recuperación pasiva, sirviendo de control. Después de 24, 48 y 72 horas, los individuos fueron evaluados en cuanto a la percepción de DMT, en ambas piernas, con un algómetro de presión analógico (presión de 6kgf/cm²). La percepción del dolor fue señalada por los participantes mediante la Escala Analógica Visual del Dolor (EVA). Resultados y conclusiones: No se encontraron diferencias estadísticamente significativas (p<0,05) entre el enfriamiento corporal y la recuperación pasiva, en ambos grupos, en la valoración de la percepción del DMT a las 24, 48 y 72 horas después del protocolo de ejercicio.

    Palabras clave: Inmersión en agua fría. Daño muscular. Lesiones. Recuperación post-ejercicio.

 

Lecturas: Educación Física y Deportes, Vol. 29, Núm. 313, Jun. (2024)

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Introduction 

 

    The techniques to accelerate post-exercise recovery have been gaining a lot of space in the high-performance training scenario and, therefore, are under much investigation. Among the most popular techniques, body cooling (BC) is one of the most used (Knight, 2000). Various cooling modalities are performed: ice pack, ice water immersion, cold water immersion and cooled air. (Castro, 2010; Stearns et al., 2018; Krueger et al., 2018)

 

    BC, through the compression effect, induces changes within the intracellular fluid, interstitial and intravascular spaces, by shifting fluid from the periphery to the cavity center, which results in several physiological changes (Wilcock, Cronin, & Hing, 2006). Cooling therapy increases peripheral vasoconstriction, providing an analgesic effect due to reduced metabolism in injured areas, as well as a decrease in inflammatory cells and cytokines, reducing the firing frequency of nerve afferents that carry the pain signal and thus reducing its perception. (Gregson et al., 2011)

 

    Muscle damage and Delayed Onset Muscle Soreness (DOMS) can happen in different magnitudes (Friden, & Lieber, 1998). DOMS begins with the process of muscle contraction/injury with tension on the functional unit of the muscle, the sarcomere, damage thereto, accumulation of intracellular calcium, increased demands on the connective tissue and inflammatory response with the recruitment of inflammatory cells and cytokines that enhance pain perception and nerve endings; and the main characteristic is the sensation of discomfort in the skeletal muscles as a result of physical exercise performed hours before, with a certain overload that the body is not used to performing. (Tricoli, 2001; Lewis, Ruby, & Bush-Joseph, 2012)

 

    Despite being a widely studied theme, the results are still inconclusive. Studies have shown that BC can be an effective method for post-exercise recovery (Knight, 2000; Gregson et al., 2011). However, recent researches do not reveal in their results an advantage in the use of the body cooling technique. (Stearns et al., 2018; Krueger et al., 2018)

 

    Due to controversial data and gaps in the literature, such as the lack of consensus between the ideal temperature for immersion, the duration of immersion, whether performed continuously or at intervals, in addition to other issues, such as the percentage of fat in the cooled area and personal characteristics of the subjects, an investigation into the effects of cooling on DOMS is opportune. Therefore, a study is proposed with the objective of investigating the subacute influence of the use of BC by immersion in cold water on the perception of Delayed Onset Muscle Pain in the posterior leg muscles, 24, 48 and 72 hours after carrying out a muscle fatigue protocol, of three sets of repetitions until concentric failure of the plantar flexion and bilateral dorsiflexion movements.

 

Methods 

 

    This is a Quasi-Experimental study, proposed by Thomas, Nelson, & Silverman (2012) as research in which researchers seek to prepare a design for the environment closest to reality while seeking to control, as much as possible, some variables that affect internal validity. Furthermore, the selection of subjects was not random as occurs in experimental research.

 

    The study sample consisted of 22 untrained participants (age: 20±2 years; body mass: 65.91±15.38 kg; height: 166.86±8.47 cm), of both sexes, with each participant being their own control. Other characteristics of the sample can be seen in Table 1.

 

Variable	Participants (n = 22)
	Average	SD (±)	Skewness	Kurtosis
Age (years)	20.4	1.7	-0,58	0,26
Height (cm)	166.86	8.47	-0,12	-0,62
Body Mass (kg)	65.91	15.38	0,85	1,74
Body Density	1.05	0.01	-0,05	-0,72
Skin fold Sum (mm)	60.55	20.59	0,66	0,01
Fat percentage (%)	20.81	7.76	0,11	-0,71
Leg Skin Fold (mm)	16.6	6.02	0,39	-0,73

Label: SD = Standard Deviation. Source: Elaborated by the authors themselves

 

    The sample power was calculated at 0.832 using the G*Power program version 3.1.9.2, with effect size 0.8 and adopting an α err prob of 0.05. Individuals were excluded from the study if they had physical limitations or musculoskeletal problems in the lower limbs that could affect the tests; if there were contraindications to the use of cryotherapy; and if they regularly used a chemical/pharmacological substance that could influence the test.

 

    The project was approved by the Ethics Committee of the Universidad Federal Rural do Rio de Janeiro, protocol 989/17, and the procedures used complied with the norms of the National Health Council 496/12 and the Declaration of Helsinki of 1995.

 

    On the first day, participants underwent the physical assessment protocol, consisting of, in this order: measurement of height using a stadiometer, total body mass using an anthropometric scale and fat percentage (G%) with the aid of an analog adipometer. The protocol to determine the G% chosen was that of Pollock and the SIRI formula, with three skinfolds for men (pectoral, abdominal and thigh) and women (triceps, suprailiac and thigh), with a fourth fold being measured, on the leg, as which would correspond to the area affected by the protocols (not considered in the calculation of fat percentage). These procedures were carried out by a single evaluator, with all measurements to calculate G% carried out on the participant's right side, with the participant wearing as few pieces of clothing as possible. (Carnaval, 1995)

 

    To promote DOMS, an muscle fatigue protocol of three sets of repetitions was designed until concentric failure of the bilateral plantar flexion and dorsiflexion movement, using only body weight, with support of the forefoot in a 20-centimeter block, with a 30-second interval between the series. The speed of movement should be constant, maintaining a duration of 2 seconds for the concentric and eccentric phases, in each repetition. After the effort protocol, a draw was carried out to select which leg the CR would be performed on (right or left). The draw was not influenced or induced by the participant's dominant limb, preference or sampling distribution.

 

    At the end of the effort protocol, the subjects were instructed to remain seated on an adjustable height bench that was adjusted so that the participant remained with their knees flexed at 90°, feet parallel and, subsequently, each leg of the participants was randomly designated for cooling or control (passive recovery - without cooling), the leg selected for cooling was immersed up to the height of the popliteal fold, in a vat of water with ice, during three stages of 5 min with a 1-min interval between each stage, totaling 15 minutes of immersion and 2 minutes of breaks.

 

    The water temperature was kept between 12° and 14° C, controlled by a digital thermometer, and this temperature range was indicated by the literature as a parameter for reducing blood flow and analgesia (Machado et al., 2016). This cooling protocol was developed taking into account publications of recent experimental research articles, evidenced by surveys of systematic reviews and applied research. (Machado et al., 2016; Santos et al., 2012; Crowther, 2017)

 

    After 24 hours of the effort protocol, the individuals were evaluated in relation to the perception of DOMS, in both legs, through a standardized pressure stimulus of 6kgf/cm¬2, for 2 seconds, with an analog pressure Algometer (Enterprises /USA), at three points on the back of the leg: proximal, medial and distal (Figure 1), previously defined based on initial test evaluations, with these points being identified as having the greatest pain perception. The perception of pain at each of the points was signaled by the participants using the Visual Analogue Scale (VAS). Data collection procedures were carried out 24 hours, 48 hours and 72 hours after the Effort and Cooling Protocols.

 

Source: Elaborated by the authors themselves

 

    A non-parametric statistic was adopted using the Kruskal-Wallis test to compare the Analog Pain Scale (VAS) values between the different situations (Cooling leg x control leg), in the periods of 24, 48 and 72 hours post-exertion. The effect size was calculated using the Cohen test (Cohen, 1992).Statistical analyzes were performed using the GraphPad Prism 5.0 statistical software package. In all tests, the critical level of significance was set at 5% (p<0.05).

 

Results 

 

    The descriptive results of pain perception using the VAS are presented in Figures 2, 3 and 4. No significant differences (p>0.05) were found in pain perception between the different situations (Cooling vs. Control) in the periods of 24, 48 and 72 hours post muscle fatigue protocol. Cohen's d test revealed that the effect size was small in most comparisons. Below, the VAS results (mean ± SD) with pressure algometer stimulation.

 

Source: Elaborated by the authors themselves

 

Source: Elaborated by the authors themselves

 

Source: Elaborated by the authors themselves

 

Discussion 

 

    The literature indicates that muscle pain does not manifest itself in the first hours after exercise, but its pain peaks between 48 hours and 72 hours (Lewis, Ruby, & Bush-Joseph, 2012; Hotfiel et al., 2018). However, no statistically significant difference was identified in the reported pain perception between the 24, 48 and 72 hours periods. The results of the present study indicate that, in both groups, BC was not able to significantly reduce the perception of DOMS at 24, 48 and 72 hours after exertion.

 

    A possible explanation for this would be the high percentage of fat (20.8±7.8), mainly in the skin fold of the leg, 16.6±6.0 mm (Table 1), as it is the target area of the BC protocol in this study. Corroborating this idea, Myrer et al. (2001) found that the gastrocnemius temperature decreases gradually and more slowly during BC in individuals with a higher percentage of subcutaneous fat, in addition to returning to basal temperature more slowly.

 

    This argument is based on the fact that one of the most important body composition factors that directly affect the effectiveness of BC is body fat (Stephens et al., 2018), since adipose tissue has relatively low thermal conductivity and is considered a good thermal insulator, and the reduction of local muscle temperature to ideal levels is essential for the effectiveness of the technique. (Guyton, & Hall, 2006)

 

    The answers to BC depend on the individual characteristics of the participants, both physical and psychological, although this factor is still little explored in the literature. Thus, considering the impact of immersion therapies on different physiological and performance variables, it is understood why some individuals respond positively to the technique and others do not. (Vaile et al., 2009)

 

    Although no statistically significant differences were found between BC and control in the periods of 24, 48 and 72 hours post-exercise, visually a small decrease in the mean values in the perception of DOMS after 48 and 72 hours could be observed, which could suggest the existence of a tendency to decrease pain due to cooling. Other studies also obtained similar responses, where the effect of cold water immersion on DOMS was noted, but the effect size was small. (Bleakley et al., 2012; Leeder et al., 2012)

 

    In the study by Abaïdia et al. (2017), ten physically active men performed eccentric hamstring exercises in a single leg and then were exposed to CWI recovery (10 minutes at 10° C). The results showed a moderate effect in favor of BC, where pain was moderately lower 48h after exercise and the perception of recovery was moderately high 24 hours after exercise.

 

    In line with this study, Stearns et al. (2018), investigated the influence of cold water immersion on markers of muscle damage, inflammation and muscle pain in 22 male and 11 female triathletes participating in the World Ironman Championship post-race, where the participants were randomly assigned to a 10-min 10° C session of CWI or no-intervention control group. Data collection occurred pre-intervention, post-intervention, 16h and 40h after the race and, after analyzing the results, no significant differences were found that indicated the existence of physiological benefit for the use of this recovery technique. These results are in line with research suggesting that cooling appears not to improve but rather to delay recovery from muscle damage. (Tseng et al., 2013; Duply et al., 2018)

 

    This study had some limitations, such as: no measurement of biochemical parameters of the lesion and no sample randomization. In addition, although the procedures and muscle fatigue protocol and cooling were standardized, considering performance variables, temperature and duration of the technique, intervals, depth and environmental conditions, the adopted protocols were not adapted in relation to the individual characteristics of the studied sample (gender, physical characteristics and ethnicity). Thus, the hypothesis that the observed results provide an inadequate indication of BC efficacy is not discarded. (Stephens et al., 2017)

 

    In Mullaney et al. (2021), although there was a reduction in pain after 24 hours, no significant differences were found. Other studies, such as Paiva et al. (2016) and Machado et al. (2016), which also used a control group, did not find significant differences. On the other hand, Dantas et al. (2020) and Sánchez-Ureña et al. (2017) obtained lower DOMS perception scores, which reinforces the discussion about the multidimensionality of pain and the variability of pain perception according to the patient profile. pain. intervention procedures.

 

Conclusions 

 

    Although an average reduction on the perception of DOMS in the muscles of the lower limbs after cooling situations, it can be concluded that the BC was not able to significantly reduce the perception of DOMS in 24, 48 and 72 hours after the muscle fatigue protocol in comparison with the passive recovery technique. These results contribute to the discussion of the constant use of BC, including because it is one of the main post-exercise recovery strategies in sport. New research is needed to better understand the effects of using BC, helping decision making in the practical universe of training.

 

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Lecturas: Educación Física y Deportes, Vol. 29, Núm. 313, Jun. (2024)