EFFECTS OF ICE MASSAGE ON PRESSURE PAIN THRESHOLDS
AND ELECTROMYOGRAPHY ACTIVITY POSTEXERCISE:
A RANDOMIZED CONTROLLED CROSSOVER STUDY
Laura Anaya-Terroba, PT,a Manuel Arroyo-Morales, MD, PT, PhD, a César Fernández-de-las-Peñas, PT, PhD,b,c
Lourdes Diaz-Rodri
́
guez,
́
PhD,d and Joshua A. Cleland, PT, PhD e,f,g
ABSTRACT
Objective: The purpose of this study was to investigate the effects of ice massage postexercise on pressure pain
thresholds (PPTs) over the quadriceps muscle and the electromyography (EMG) root mean square (RMS).
Methods: Fifteen athletes (female, 8; age, 19 ± 2 years) participated. Subjects were required to visit the laboratory on
2 separate occasions with a 1-week interval between sessions. Participants performed 5 isokinetic concentric dominant
knee extension contractions at 60°, 120°, 180°, and 240°/s. After exercise, they were randomly assigned to receive either
an ice massage or detuned ultrasound for 15 minutes, 1 on each session. The PPT and RMS during maximal voluntary
contraction were measured over the vastus medialis (VM), vastus lateralis (VL), and rectus femoris (RF) muscles at
baseline, postexercise, and 5 minutes postintervention. The hypothesis of interest was the intervention × time interaction.
Results: The analysis of covariance found a significant intervention × time interaction for PPT over the VM (F = 17.3,
P b .001) and VL (F = 5.4, P = .03) muscles but not over the RF (F = 1.2, P = .3), indicating an increase in PPT after the
ice massage. An intervention × time interaction was found for RMS of the VL (F = 5.8, P = .01) but not of the VM (F = 0.5,
P = .5) or RF (F = 0.01, P = .9) muscles, indicating an increase in RMS after the ice massage. A significant positive
correlation between PPT and RMS for the VL muscle was identified (r = 0.6, P = .03).
Conclusion: Ice massage after isokinetic exercise produced an immediate increase of PPT over the VL and VM and
EMG activity over the VL muscle in recreational athletes, suggesting that ice massage may result in a hypoalgesic
effect and improvements in EMG activity. (J Manipulative Physiol Ther 2010;33:212-219)
Key Indexing Terms: Pain Threshold; Massage; Ice; Electromyography; Exercise
a
Professor, Department of Physical Therapy, Health Sciences
School, Universidad Granada, Spain.
b
Professor, Esthesiology Laboratory of Universidad Rey Juan
Carlos, Alcorcón, Madrid, Spain.
c
Professor, Department of Physical Therapy, Occupational
Therapy, Physical Medicine and Rehabilitation of Universidad
Rey Juan Carlos, Alcorcón, Spain.
d
Professor, Department of Nursing, Universidad Granada,
Spain.
e
Professor, Department of Physical Therapy, Franklin Pierce
University, Concord, NH.
f
Physical Therapist, Rehabilitation Services, Concord
Hospital, NH.
g
Faculty, Manual Therapy Fellowship Program, Regis University, Denver, Colo.
Submit requests for reprints to: César Fernández de las Peñas,
Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos,
Avenida de Atenas s/n, 28922 Alcorcón, Madrid, Spain
(e-mail: cesar.fernandez@urjc.es).
Paper submitted September 26, 2009; in revised form
November 25, 2009; accepted December 7, 2009.
0161-4754/$36.00
Copyright © 2010 by National University of Health Sciences.
doi:10.1016/j.jmpt.2010.01.015
212
he use of ice or cryotherapy in the management of
sport injuries is widely accepted in clinical
practice.1,2 A number of physiologic benefits of
ice have been proposed including peripheral cooling of
superficial tissues,3 a reduction of the inflammatory
response,4 pain reduction,5 reduction of edema formation,6
and decrease in secondary hypoxic cell death.7 Ice massage
is an effective and an inexpensive modality resulting in
cooling of superficial and deep tissues in a relatively short
application period when compared with other methods.8 Ice
massage has been shown to be effective for reducing labor
pain,9 decreasing pain and improving function in knee
osteoarthritis patients,10 and reducing neuropathic pain.11
However, Howatson et al12 found that massage was not
effective in reducing symptoms associated with exerciseinduced muscle damage.
Pressure algometry has often been used to assess
changes in pain sensitivity after the application of different
physical therapy modalities.13,14 A recent study has found
that massage results in a reduction in symptoms and
increases in pressure pain threshold (PPT) after the
induction of delayed-onset muscle soreness.15 However,
the overall benefits of massage remain controversial.16,17
T
Journal of Manipulative and Physiological Therapeutics
Volume 33, Number 3
Surface electromyography (EMG) has been used to
investigate muscle fatigue 18 or changes in muscle
recruitment19 after exercise. It has been shown that the
application of cryotherapy over muscles can result in
changes in electrical function of the muscle20 by reducing
nerve conduction velocity.21 Therefore, it is expected that
the application of ice massage may perhaps induce
alterations in muscle properties. Krause et al22 demonstrated
that the amplitude in EMG tracings is a reliable parameter of
muscle force and that it may be a useful marker for
therapeutic approaches targeted at muscle tissues. Nevertheless, EMG changes induced by the application of
cryotherapy have not been clearly evaluated.
To the best of the authors' knowledge, no study has
previously investigated changes in sensory and motor
properties over the quadriceps muscle after the application
of ice massage during the postexercise recovery period.
Therefore, the purpose of the current study was to
investigate the effects of ice massage as a postexercise
recovery method on PPTs and surface EMG amplitude over
the quadriceps muscle. A second purpose of the study was to
analyze the relationship between sensory and motor changes
within the quadriceps muscle in recreational athletes.
METHODS
A placebo-controlled, repeated-measures, crossover,
single-blind, randomized trial was used to investigate the
effects of ice massage on PPTs and EMG root mean square
(RMS) of the quadriceps muscle in recreational athletes.
Anaya-Terroba et al
Sensory and Motor Changes After Ice Massage
and EMG activity were obtained after a 15-minute rest
period with the subject in the supine position.
Pressure Pain Threshold Assessment
Pressure pain threshold is defined as the amount of
pressure required for sensation of pressure to change to
pain.23 An electronic algometer (Somedic AB, Fastar,
Sweden) was used to measure PPT levels. The algometer
consists of a 1-cm2 rubber-tipped plunger mounted on a
force transducer. The pressure was applied at a rate of 30
kPa/s. The participants were instructed to press a switch the
instant the sensation changed from pressure to pain. The
mean of 3 trials was calculated and used for the main
analysis. A 30-second rest period was provided between
each measurement. This method of measuring PPT has
been shown to exhibit high reliability (intraclass correlation
coefficient = 0.91 [95% confidence interval, 0.82-0.97]).24
The PPT levels were assessed over the following 3
points located over the quadriceps muscle: (a) rectus
femoris (RF), midway between the anterosuperior iliac
spine and the apex of the patella bone; (b) vastus lateralis
(VL), midway between the great trochanter and the lateral
epicondyle femoris; and (c) vastus medialis (VM), 3 cm
over the patella within the medial side of the thigh. The PPT
data were collected at baseline, postexercise, and 5 minutes
postintervention. The PPT data were collected by an
assessor blinded to the treatment allocation of the subject.
Subjects
Surface EMG
Fifteen recreational athletes (female, 8) from the Health
Science School, University of Granada (age, 19 ± 2 years)
were recruited for the study. To be eligible to participate,
subjects should participate in regular exercise (amateur sport
teams with more than 10 hours training a week). Subjects
were excluded if they exhibited any of the following criteria:
(1) history of trauma or fracture in any part of the body, (2)
history of pain in the lower quarter within 12 months of the
study, (3) any musculotendinous injury in the lower
extremity within 12 months of the study, or (4) regular use
of any analgesic or anti-inflammatory medications. Ethical
approval was granted by the Universidad Granada Ethics
Committee (Granada 066). Informed consent was obtained
from all subjects, and procedures were conducted according
to the Declaration of Helsinki.
Surface EMG activity was used to quantify activation of
the RF, VL, and VM muscles. Biometrics EMG hardware
and software (Gwent, London, United Kingdom) was used
for data collection. The EMG signals were obtained by
means of a Datalink EMG sensor SX320 and were analyzed
with Datalink version 3.0 software (Biometrics, London,
United Kingdom). Data were notch filtered at 60 Hz.
Parameters were as follows: bandwidth, 15 to 450 Hz; input
impedance, 2 MΩ (differential); common mode rejection
ratio, 92 dB; maximum input voltage, ±3 V; sampling rate,
1000 Hz; and gain, 1000. This EMG procedure has been
used in previous studies.25,26 Subjects performed 1 weightbearing isometric maximal voluntary contraction with their
dominant limb (uniplanar knee extension). Three 5-second
trials of each contraction were performed, separated by
2-minute rest periods. The EMG data for each muscle (RF,
VL, and VM) were integrated, and the maximum RMS
activity over a 0.5-second window was assessed. Data were
not normalized because all comparisons made in this study
were within-day. The EMG RMS data were collected at
baseline, postexercise, and 5 minutes postintervention. The
EMG and RMS data were collected by an assessor blinded
to the treatment allocation of the subject.
Study Protocol
Subjects were required to present to the examination/
treatment laboratory at the same time of the day on 2
separate occasions with a 1-week interval between sessions.
All sessions took place between 8:00 AM and 11:00 AM to
avoid circadian rhythm–induced variations. The PPT levels
213
214
Anaya-Terroba et al
Sensory and Motor Changes After Ice Massage
After preintervention data were collected, subjects
performed the following isokinetic protocol. A warm-up
consisting of 3 repetitions at 120°/s and 3 repetitions at 60%
was performed to familiarize subjects with the isokinetic
equipment (Genu Easytech; Borgo San Lorenzo, Florencia,
Italy). After a 1-minute rest period, subjects performed 5
isokinetic concentric dominant knee extensions contractions at 60°, 120°, 180°, and 240°/s according to the
protocol described by Hunter et al.27 Subjects were
instructed to perform maximum effort on each contraction.
After the exercise protocol, PPT and EMG RMS were again
assessed.
After the second outcome assessment, participants were
randomly assigned to a treatment (either the ice massage or
the detuned ultrasound) for 15 minutes. At the second
treatment sessions, subjects received the other intervention
(the one they did not receive on the first session). The order
of the interventions was randomly assigned by an assistant
unaware of the purpose of the study. A computerized
program was used to generate intervention allocation (ice
massage or detuned ultrasound) of the population. Five
minutes after the intervention, posttreatment measurements
of PPT and EMG activity were again collected.
Interventions
Participants attended 2 treatment sessions with a 1-week
interval between sessions, where they were randomly assigned
to one of the following interventions at each visit: ice massage
(experimental) or detuned ultrasound (placebo). Both interventions were administered by a manual therapist with more
than 5 years of clinical experience in sport medicine.
In the experimental session, participants received an ice
massage for 15 minutes over the dominant quadriceps muscle.
A 200-mL bottle was filled with water and frozen to form an
ice cylinder. The water was not wiped away as the ice melted.
The therapist applied the ice cylinder directly to the skin of the
subjects as described by Howatson et al8 (Figs 1 and 2). The
placebo condition consisted of a 15-minute application of
detuned ultrasound applied over the same area of the
quadriceps as the ice massage. The position of the subject
and the areas treated were identical in both treatments.
Statistical Analysis
Data were analyzed using the SPSS package version 16.0
(SPSS Inc, Chicago, IL). Mean and standard deviations or
95% confidence intervals of the values were calculated for
each variable. The Kolmogorov-Smirnov test showed a
normal distribution of the data (P N .05). Preintervention
values before each condition were compared using the
independent t tests for continuous data. A 2 × 3 mixedmodel repeated-measure analysis of covariance (ANCOVA)
with intervention (ice massage or detuned ultrasound) as the
between-subjects variable and time (preexercise, postexercise, posttreatment) as the within-subjects variable with sex
Journal of Manipulative and Physiological Therapeutics
March/April 2010
1st: soft, superficial, and quicker longitudinal maneuvers
3 Times on the VM musculature
3 Times on the RF musculature
3 Times on the VL musculature
(×2)
2nd: slower longitudinal maneuvers by exerting low pressure
Twice on the VM musculature
Twice on the RF musculature
Twice on the VL musculature
3rd: crenel maneuvers by exerting low pressure
Twice on the VM musculature
Twice on the RF musculature
Twice on the VL musculature
4th: pressure maneuvers
5 s of maintained pressure on the VM trigger point
5 s of maintained pressure on the RF trigger point
5 s of maintained pressure on the VL trigger point
The 2nd, 3rd, and 4th maneuvers are repeated cyclically until
completion of 15 min of the treatment
Fig 1. Ice massage protocol.
as covariate was used to examine the effects of the
intervention on PPTs and RMS. Separate ANCOVAs
were performed with each dependent variable (PPT over
VL, PPT over VM, PPT over RF, RMS over VL, RMS over
VM, and RMS over RF). The hypothesis of interest was
intervention × time interaction. The Bonferroni test was
used for post hoc analysis. Finally, the Pearson correlation
test (r) was used to analyze the association between PPT
levels and RMS over each muscle. A P value b .05 was
considered statistically significant.
RESULTS
All subjects completed the protocol. Therefore, 7 male
and 8 female recreational athletes (mean age, 19 ± 1.5 years;
mean weight, 65 ± 11 kg; and mean height, 168 ± 11 cm)
were included in the data analyses. Preintervention scores
for each variable were not significantly different between
each treatment session: PPT over the VM (P = .531), VL
(P = .921), and RF (P = .431) and RMS of the VM (P =
.637), the VL (P = .339), and RF (P = .612) (Table 1).
Effects of Ice Massage on Pressure Pain Sensitivity
The ANCOVA showed a significant decrease in PPT
over the VM (337.9 ± 122.0 vs 319.7 ± 132.5 kPa, F =
12.3, P = .002) and the RF (333.4 ± 96.7 vs 308.0 ± 108.5
kPa, F = 9.8, P = .004), but not over the VL (335.1 ±
145.3 vs 328.2 ± 150.3 kPa, F = 0.6, P = .4) muscles
immediately after exercise. The ANCOVA also showed a
significant intervention × time interaction for PPT over the
VM (F = 17.3, P b .001) and VL (F = 5.4, P = .03), but
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Volume 33, Number 3
Anaya-Terroba et al
Sensory and Motor Changes After Ice Massage
Table 1. Pre- and postintervention and change scores of PPTs
(in kilopascals) over the VM, RF, and VL muscles between
interventions
PPTs over the VM
Baseline
Postexercise
Recovery intervention
PPTs over the RF
Baseline
Postexercise
Recovery intervention
PPTs over the VL
Baseline
Postexercise
Recovery intervention
Fig 2. Application of ice massage.
not over the RF (F = 1.2, P = .3) muscles. Sex did not
influence the comparative analysis (F = 0.22, P = .7).
Pairwise comparisons found that, after the subjects
received the ice massage, they exhibited an increase in
PPT over both VM and VL muscles (P = .03), whereas no
changes were identified after the placebo intervention (P =
.6, Fig 3A, B). No significant changes in PPT over the RF
muscle were found (P = .5, Fig 3C). Table 1 summarizes
the pre- and postintervention data and change scores of
PPT over the VM, VL, and RF muscles.
Effects of Ice Massage on EMG RMS
The ANCOVA found a significant decrease in RMS of
the VM (215.8 ± 79.6 vs 197.2 ± 86.4 μV, F = 4.3, P = .04)
but not for the RF (135.1 ± 76.9 vs 125.8 ± 69.9 μV, F = 1.3,
P = .3) or the VL (127.1 ± 61.1 vs 119.7 ± 57.5 μV, F = 2.1,
P = .2) muscles immediately after exercise in both groups.
The ANCOVA also revealed a significant intervention ×
time interaction for RMS of the VL (F = 5.8, P = .03) but not
the VM (F = 0.5, P = .5) or the RF (F = 0.01, P = .9) muscles.
Sex did not influence the comparative analysis (F = 0.42,
P = .6). Pairwise comparisons found that, after the ice
massage, subjects exhibited an increase in RMS of the VL
muscle (P = .04), whereas no changes were identified after
Sham US
intervention
Ice massage
intervention
345.2 ± 151.2
(261.5-428.9)
317.3 ± 159.0
(229.2-405.4)
316.1 ± 162.7
(225.9-406.3)
330.7 ± 103.6
(273.3-388.1)
322.2 ± 113.8
(259.2-385.3)
365.1 ⁎ ± 129.9
(293.3-437.0)
324.7 ± 114.6
(261.2-388.3)
301.6 ± 119.6
(235.4-367.9)
290.1 ± 111.1
(228.5-351.6)
342.1 ± 95.1
(289.5-394.8)
314.3 ± 114.1
(251.1-377.5)
331.7 ± 113.0
(269.2-394.3)
334.3 ± 164.2
(243.4-425.3)
327.2 ± 182.3
(226.9-428.9)
317.7 ± 147.8
(235.9-399.6)
335.9 ± 131.7
(263.0-408.9)
328.6 ± 124.3
(259.8-397.5)
356.7 ⁎ ± 139.1
(279.7-433.8)
Data (in kilopascals) are expressed as mean ± standard deviation (95%
confidence interval). US, Ultrasound.
⁎ P b .05, ANCOVA test.
the placebo condition (P = .6, Fig 4A). No significant
changes in RMS of the RF or VM muscles were found (P =
.5, Fig 4B, C). Table 2 shows the pre- and postintervention
scores of RMS for the VM, VL, and RF muscles.
Correlation Between Pressure Pain Sensitivity and EMG Activity
In addition, a significant positive correlation between
PPT and RMS was found for the VL muscle (r = 0.6, P =
.03, Fig 5): the greater the PPT, the greater the RMS. On
the contrary, PPT and RMS of the VM and RF did not
exhibit a statistically significant relationship.
DISCUSSION
The results of this study demonstrated that a single
session of ice massage applied as a recovery intervention
after isokinetic exercise produced an immediate increase in
PPT and RMS over the quadriceps in recreational athletes.
This was particularly evident in the VM and VL muscles.
We found a decrease in PPT over the VM and RF muscles
after the isokinetic exercise that is not consistent with the
findings of Koltyn et al28,29 who found an increase in PPT
after intense exercise. Nevertheless, Padawer and Levine30
questioned the hypoalgesic effect of exercise. The differences
found between our study and that of Koltyn et al28,29 may be
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216
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Sensory and Motor Changes After Ice Massage
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March/April 2010
Fig 3. Mean and standard error of PPTs (in kilopascals) over the
VM (A), VL (B), and RF (C) muscles. ⁎Statistically significant
(P b .05, ANCOVA test).
Fig 4. Mean and standard error of surface EMG (in millivolts)
over the VM (A), VL (B), and RF (C) muscles. ⁎Statistically
significant (P b .05, ANCOVA test).
related to the possibility that changes in PPT are dependent on
intensity or dose of the exercise.29 Research conducted on
animal models has shown that the stressor properties of
exercise are important in determining which analgesic system
is activated during exercise.31 Hoffman et al have determined
that an intensity greater than 50% VO2max and a duration
Journal of Manipulative and Physiological Therapeutics
Volume 33, Number 3
Anaya-Terroba et al
Sensory and Motor Changes After Ice Massage
Table 2. Pre- and postintervention and change scores of EMG
RMSs (in microvolts) over the VM, RF, and VL muscles between
interventions
EMG RMS of the VM
Baseline
Postexercise
Recovery intervention
EMG RMS of the RF
Baseline
Postexercise
Recovery intervention
EMG RMS of the VL
Baseline
Postexercise
Recovery intervention
Sham US
intervention
Ice massage
intervention
208.1 ± 87.8
(149.8-266.3)
182.9 ± 102.1
(119.4-246.4)
199.1 ± 116.9
(122.8-275.5)
223.6 ± 105.8
(165.5-281.9)
211.6 ± 110.0
(148.1-275.2)
235.0 ± 137.3
(158.7-311.4)
130.4 ± 67.9
(80.6-180.1)
125.1 ± 64.4
(80.4-169.7)
140.9 ± 89.7
(82.5-199.4)
139.9 ± 95.9
(90.2-189.7)
126.6 ± 83.5
(81.9-171.3)
151.3 ± 105.0
(92.8-209.8)
115.0 ± 46.6
(73.2-156.8)
111.6 ± 39.3
(73.2-150.1)
109.4 ± 37.7
(63.3-155.5)
139.2 ± 87.0
(97.5-181.0)
127.8 ± 81.9
(89.4-166.3)
158.1 ⁎ ± 102.2
(112.1–204.3)
Data (in microvolts) are expressed as mean ± standard deviation
(95% confidence interval).
⁎ P b .05, ANCOVA test.
longer than 10 minutes are the minimum thresholds required
for eliciting exercise-induced analgesia.32 The fact that we
used a low-intensity exercise may be the reason for the
identified reduction in PPT levels found over the VM and RF
in the current study. In addition, to the best of our knowledge,
the hypoalgesic effects of isokinetic exercise have not been
previously assessed. Finally, the intensity and duration of the
exercise protocol applied in the current study may be not
enough to stimulate the endogenous system, responsible for
exercise-induced analgesia.31,32
In the current study, the PPT increased after the
application of ice massage. These findings are similar to
those of other studies examining the effects of
cryotherapy. 1,33 However, cryotherapy has not been
shown to be effective for reducing the pain associated
with delayed-onset muscle soreness.8,12 Determining the
mechanisms associated with pain relief from ice massage is
beyond the scope of the current study; nevertheless, a few
hypotheses can be formulated. It has been reported that joint
mobilization interventions induce mechanical hypoalgesic
effects34 concurrent with motor excitation,35 supporting the
hypothesis that these treatment techniques can stimulate
descending inhibitory pain systems.36,37 In our study, we
found that ice massage induced a mechanical hypoalgesic
effect concurrent with motor excitation, at least within the
VL muscle. It is also plausible that ice massage may
Fig 5. Scatter plot of the relationship between PPTs (in
kilopascals) and EMG RMS (in millivolts) in the VL muscle (n =
15). A positive linear regression line is fitted to the data.
stimulate descending inhibitory pain pathways similar to
manual interventions; however, future studies are needed to
investigate this hypothesis.
In addition, a central modulating effect does not exclude
a possible local and muscle-specific mechanism of ice
massage. For instance, Kerschan-Schindl et al found that
the application of ice over a muscle results in reduction of
nerve conduction velocity.21 Other local mechanism may
be a decrease of free radical release from exercise-related
muscle exercise, as the application of ice is usually used to
recover performance from exercise-induced heat stress.38
Finally, a recent study has demonstrated that the application
of ice significantly increased the muscle fiber conduction
velocity of the quadriceps muscle after the induction of
arthrogenic pain.39 Hence, it is also possible that nerve
conduction velocity has been altered by ice massage. Both
local and central mechanisms can be involved in sensory
and motor effects of ice massage.
We also found a reduction in EMG activity after
isokinetic exercise, possibly the result of decrease in
motor unit recruitment.40,41 However, after the application
of an ice massage, the VL exhibited EMG activity with
greater values that exceeded those at baseline. These
findings are contradictory to those previously found by
Krause et al,22 who did not identify any change in EMG
activity after the application of cold packs. One possible
reason for discrepancies between the studies may be that ice
massage appears to be more effective in reducing
intramuscular temperature as compared with an ice bag.42
However, we cannot directly compare our results with those
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218
Anaya-Terroba et al
Sensory and Motor Changes After Ice Massage
of Krause et al22 because our intervention was applied as a
recovery treatment method after the application of exercise.
We do not know if the increase in EMG activity in the VL
muscle may be related to an increase in motor unit
recruitment or other neuromuscular modulation. Studies
investigating motor unit recruitment and unit firing after the
application of ice massage are needed.
In addition, we did not find the same response among the
different muscles of the quadriceps. For instance, increases
in PPT levels over the VL and VM but not over the RF
muscles were found. A recent study showing novel
topographic mapping of PPT and surface EMG of the
quadriceps muscle revealed site-dependent effects of
eccentric exercise, probably attributable to variations in
the morphologic and architectural characteristics of the
muscle fibers.43 This study found greater manifestations of
delayed-onset muscle soreness in the distal region of the
quadriceps muscle,43 which may explain why the VL and
VM showed a greater response than the RF muscle.
An interesting finding in this study was that both EMG
activity and mechanical pain thresholds were directly
correlated in the VL muscle. This finding is similar to
previous studies where EMG amplitude decreased after
increasing nociceptive input that was elicited by infusion of
hypertonic saline during voluntary contractions in either
isometric44,45 or dynamic46 functional tasks. The decrease
in EMG activity may have been related to a decrease in
motor unit discharge rates.47,48 Therefore, it has been
suggested that treating pain is important to facilitate
performance of the affected muscle.49 In the current study,
we found that PPT and EMG activity were correlated,
possibly suggesting that both sensory and motor outcomes
are related.
Limitations
There are a few limitations to the current study that must
be considered. First, we used a small sample and included
only a short-term (5 minutes) postexercise follow-up
period. Future studies should use larger sample sizes and
include a longer-term follow-up to determine if the effects
found in the current study continue to exist hours or days
after the application of the ice massage. Furthermore, we
used a sample of asymptomatic individuals. This does not
allow us to make direct inferences to a patient population.
CONCLUSIONS
The application of ice massage post–isokinetic exercise
produced an immediate increase in PPT, that is, hypoalgesic
effect, over the VM and VL muscles and an increase in
EMG activity over the VL muscle that suggests that ice
massage may activate descending inhibitory pathways.
Future studies are needed to elucidate the neurophysiologic
mechanisms of ice massage.
Journal of Manipulative and Physiological Therapeutics
March/April 2010
Practical Applications
• The application of a single session of ice massage
as a postexercise recovery method produced
hypoalgesic (increase in PPTs) and motor effects
over the quadriceps muscle.
• The results of this study provide preliminary
evidence suggesting that ice massage may activate
descending inhibitory pathways.
FUNDING SOURCES AND POTENTIAL CONFLICTS OF INTEREST
No funding sources or conflicts of interest were reported
for this study.
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