Effects of air-pulsed cryotherapy on neuromuscular recovery subsequent to exercise-induced muscle damage

Am J Sports Med. 2013 Aug;41(8):1942-51. doi: 10.1177/0363546513490648. Epub 2013 Jun 5.


Background: Localized cooling has been proposed as an effective strategy to limit the deleterious effects of exercise-induced muscle damage on neuromuscular function. However, the literature reports conflicting results.

Purpose: This randomized controlled trial aimed to determine the effects of a new treatment, localized air-pulsed cryotherapy (-30°C), on the recovery time-course of neuromuscular function following a strenuous eccentric exercise.

Study design: Controlled laboratory study.

Methods: A total of 24 participants were included in either a control group (CONT) or a cryotherapy group (CRYO). Immediately after 3 sets of 20 maximal isokinetic eccentric contractions of elbow flexors, and then 1, 2, and 3 days after exercise, the CRYO group received a cryotherapy treatment (3 × 4 minutes at -30°C separated by 1 minute). The day before and 1, 2, 3, 7, and 14 days after exercise, several parameters were quantified: maximal isometric torque and its associated maximal electromyographic activity recorded by a 64-channel electrode, delayed-onset muscle soreness (DOMS), biceps brachii transverse relaxation time (T2) measured using magnetic resonance imaging, creatine kinase activity, interleukin-6, and C-reactive protein.

Results: Maximal isometric torque decreased similarly for the CONT (-33% ± 4%) and CRYO groups (-31% ± 6%). No intergroup differences were found for DOMS, electromyographic activity, creatine kinase activity, and T2 level averaged across the whole biceps brachii. C-reactive protein significantly increased for CONT (+93% at 72 hours, P < .05) but not for CRYO. Spatial analysis showed that cryotherapy delayed the significant increase of T2 and the decrease of electromyographic activity level for CRYO compared with CONT (between day 1 and day 3) in the medio-distal part of the biceps brachii.

Conclusion: Although some indicators of muscle damage after severe eccentric exercise were delayed (ie, local formation of edema and decrease of muscle activity) by repeated air-pulsed cryotherapy, we provide evidence that this cooling procedure failed to improve long-term recovery of muscle performance.

Clinical relevance: Four applications of air-pulsed cryotherapy in the 3 days after a strenuous eccentric exercise are ineffective overall in promoting long-term muscle recovery. Further studies taking into account the amount of exercise-induced muscle damage would allow investigators to make stronger conclusions regarding the inefficiency of this recovery modality.

Keywords: cold application; damage markers; eccentric contraction; edema; fatigue; high-density EMG.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analysis of Variance
  • Arm
  • Biomarkers / blood
  • Cryotherapy / methods*
  • Electromyography
  • Exercise*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Muscle Contraction
  • Muscle Strength Dynamometer
  • Muscle, Skeletal / injuries*
  • Muscle, Skeletal / physiopathology
  • Recovery of Function
  • Sprains and Strains / blood
  • Sprains and Strains / etiology
  • Sprains and Strains / physiopathology
  • Sprains and Strains / therapy*
  • Treatment Outcome


  • Biomarkers