Cryotherapy and Muscle Function in Immediate Return-to-Play Scenarios

Abstract

Purpose

This study aimed to investigate the effects of cold spray and cold pack applications on the biomechanical properties, muscle strength, and activity of the quadriceps femoris muscle.

Methods

Fifty-three male participants aged 18 to 25 were included in this randomised controlled study. Participants were randomly assigned to two groups: cold spray (n=27) and cold pack (n=26). The cold spray group received a 10-second application to the quadriceps, whereas the cold pack group received a 5-minute application. Measurements included skin surface temperature, muscle mechanical properties (MyotonPRO), isometric muscle strength (Lafayette dynamometer), and muscle activity (surface EMG). These measurements were conducted at three time points: before the intervention (baseline), immediately after the application, and five minutes post-application.

Results

Participant characteristics were similar between groups (p>0.05). Both groups showed time-dependent changes in muscle properties. Myoton-F, -S, and -D increased following the application, while Myoton-R decreased. Strength increased only in the cold spray group (p<0.05). The mean EMG workload was higher at baseline in the cold spray group (p<0.05), but no time-related change was observed in either group. EMG onset time decreased over time in the cold pack group (p<0.05). Skin temperature dropped significantly in both groups after the application (p<0.05), with a greater and more prolonged effect in the cold spray group (p<0.05).

Conclusion

These findings suggest that both cold spray and cold pack can induce short-term changes in quadriceps muscle function by altering the muscle’s mechanical properties. Cold spray appears to improve muscle strength, while cold pack may influence the timing of muscle activation.

Zusammenfassung

Zielsetzung

Diese Studie hatte zum Ziel, die Auswirkungen von Kältespray- und Kältepackanwendungen auf die biomechanischen Eigenschaften, die Muskelkraft und die Aktivität des Musculus quadriceps femoris zu untersuchen.

Methoden

An dieser randomisiert-kontrollierten Studie nahmen 53 männliche Probanden im Alter von 18–25 Jahren teil. Die Teilnehmer wurden zufällig in 2 Gruppen eingeteilt: Kältespray (n=27) und Kältepack (n=26). Die Kältespray-Gruppe erhielt eine 10-sekündige Applikation auf den Quadrizeps, während die Kältepack-Gruppe eine 5-minütige Applikation erhielt. Erfasst wurden die Hautoberflächentemperatur, die mechanischen Eigenschaften des Muskels (MyotonPRO), die isometrische Muskelkraft (Lafayette-Dynamometer) sowie die Muskelaktivität (Oberflächen-EMG). Diese Messungen wurden zu 3 Zeitpunkten durchgeführt: vor der Intervention (Baseline), unmittelbar nach der Anwendung und 5 Minuten nach der Anwendung.

Ergebnisse

Die Teilnehmercharakteristika waren zwischen den Gruppen vergleichbar (p>0,05). Beide Gruppen zeigten zeitabhängige Veränderungen der Muskelfunktionen. Myoton-F, -S und -D nahmen nach der Anwendung zu, während Myoton-R abnahm. Eine Zunahme der Muskelkraft konnte ausschließlich in der Kältespray-Gruppe festgestellt werden (p<0,05). Der EMG-Arbeitsdurchschnitt war zu Beginn in der Kältespray- Gruppe höher (p<0,05), jedoch wurde in keiner Gruppe ein zeitabhängiger Effekt beobachtet. Die EMG-Onset-Zeit nahm in der Kältepack-Gruppe über die Zeit ab (p<0,05). Die Hauttemperatur sank in beiden Gruppen signifikant nach der Anwendung (p<0,05), wobei der Effekt in der Kältespray-Gruppe stärker und länger anhaltend war (p<0,05).

Schlussfolgerung

Diese Ergebnisse deuten darauf hin, dass sowohl Kältespray als auch Kältepack kurzfristige Veränderungen der Quadrizepsfunktion durch die Modulation mechanischer Muskeleigenschaften hervorrufen können. Kältespray scheint die Muskelkraft zu verbessern, während Kältepack den Zeitpunkt der Muskelaktivierung beeinflussen könnte.

Keywords

cryotherapy - Electromyography - muscle strength - muscle tonus - quadriceps muscle - stiffness

Schlüsselwörter

Kryotherapie - Elektromyographie - Muskelkraft - Muskeltonus - Musculus quadriceps - Steifigkeit

Publikationsverlauf

Eingereicht: 06. Oktober 2025

Angenommen nach Revision: 28. November 2025

Artikel online veröffentlicht:
26. Januar 2026

• References

• 1 Swenson C, Swärd L, Karlsson J. Cryotherapy in sports medicine. Scand J Med Sci Sports 1996; 6 (04) 193-200
• 2 Pritchard KA, Saliba SA. Should athletes return to activity after cryotherapy?. J Athl Train 2014; 49 (01) 95-100
• 3 White GE, Wells GD. Cold-water immersion and other forms of cryotherapy: physiological changes potentially affecting recovery from high-intensity exercise. Extrem Physiol Med 2013; 2: 26
• 4 Miranda JPD, Figueiredo RCC, Saragiotto B. et al. Effectiveness of cryotherapy on pain intensity, range of motion, swelling and function in the postoperative care of musculoskeletal disorders: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. Published Online First: 05 October 2025;
• 5 Ahsan M, Alzahrani A. The effect of the quadriceps muscle on sports performance and injury prevention: biomechanical perspective. Tuijin Jishu/Journal of Propulsion Technology 2024; 45 (02) 532-546
• 6 Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med 1986; 3 (06) 398-414
• 7 Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med 2007; 41 (06) 365-369
• 8 Surenkok O, Aytar A, Tüzün EH. et al. Cryotherapy impairs knee joint position sense and balance. Isokinet Exerc Sci 2008; 16 (01) 69-73
• 9 Kalli K, Fousekis K. The effects of cryotherapy on athletes’ muscle strength, flexibility, and neuromuscular control: a systematic review of the literature. J Bodyw Mov Ther 2020; 24 (01) 159-166
• 10 Oksa J. Neuromuscular performance limitations in cold. Int J Circumpolar Health 2002; 61 (02) 174-185
• 11 Point M, Guilhem G, Hug F. et al. Cryotherapy induces an increase in muscle stiffness. Scand J Med Sci Sports 2018; 28 (01) 260-266
• 12 Merrick MA, Knight KL, Ingersoll CD. et al. The effects of ice and compression wraps on intramuscular temperatures at various depths. J Athl Train 1993; 28 (03) 236-245
• 13 Thorsson O, Lilja B, Ahlgren L. et al. The effect of local cold application on intramuscular blood flow at rest and after running. Med Sci Sports Exerc 1985; 17 (06) 710-713
• 14 Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. J Athl Train 2004; 39 (03) 278-285
• 15 Lettner J, Królikowska A, Ramadanov N. et al. Evaluating the reliability of MyotonPro in assessing muscle properties: a systematic review of diagnostic test accuracy. Medicina 2024; 60 (06) 851
• 16 Trybulski R, Kużdżał A, Wilk M. et al. Reliability of MyotonPro in measuring the biomechanical properties of the quadriceps femoris muscle in people with different levels and types of motor preparation. Front Sports Act Living 2024; 6: 1453730
• 17 de la Cierva SF, Terrasa D, Garaycochea O. et al. MyotonPRO as a new valid tool for measuring cervical muscle tension: a reliability study. Logoped Phoniatr Vocol 2024; 1: 1-8
• 18 Aird L, Samuel D, Stokes M. Quadriceps muscle tone, elasticity and stiffness in older males: reliability and symmetry using the MyotonPRO. Arch Gerontol Geriatr 2012; 55 (02) 403-408
• 19 Mullix J, Warner M, Stokes M. Testing muscle tone and mechanical properties of rectus femoris and biceps femoris using a novel hand-held MyotonPRO device: relative ratios and reliability. Work Pap Health Sci 2012; 1 (01) 1-8
• 20 Mooney K, Warner M, Stokes M. Symmetry and within-session reliability of mechanical properties of biceps brachii muscles in healthy young adult males using the MyotonPRO device. Work Pap Health Sci 2013; 1 (01) 1-6
• 21 Quinlan S, Sinclair P, Hunt A. et al. Excellent reliability of toe strength measurements in children aged ten to twelve years achieved with a novel fixed dynamometer. Gait Posture 2021; 85: 191-196
• 22 Mentiplay BF, Perraton LG, Bower KJ. et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One 2015; 10 (10) e0140822
• 23 Al-Ayyad M, Owida HA, De Fazio R. et al. Electromyography monitoring systems in rehabilitation: a review of clinical applications, wearable devices and signal acquisition methodologies. Electronics 2023; 12 (07) 1520
• 24 Armshaw B, Vaidya M, Saha S. Surface electromyography-based biofeedback can facilitate recovery from total knee arthroplasty. J Appl Behav Anal 2024; 57 (03) 560-573
• 25 Yan JF, Wang HW, Liu J. et al. Feasibility study on using an infrared thermometer for evaluation and administration of cryosurgery. Minim Invasive Ther Allied Technol 2007; 16 (03) 170-178
• 26 Cholewka A, Drzazga Z, Sieroń A. Monitoring of whole body cryotherapy effects by thermal imaging: preliminary report. Phys Med 2006; 22 (02) 57-60
• 27 Cohen S. Statistical power analysis. Curr Dir Psychol Sci 1992; 1 (03) 98-101
• 28 Alaca N, Kablan N. Acute effects of cold spray application on mechanical properties of the rectus femoris muscle in athletes. J Bodyw Mov Ther 2022; 30: 135-140
• 29 Mustalampi S, Ylinen J, Kautiainen H. et al. Acute effects of cold pack on mechanical properties of the quadriceps muscle in healthy subjects. Phys Ther Sport 2012; 13 (04) 265-269
• 30 Palmieri-Smith RM, Leonard-Frye JL, Garrison CJ. et al. Peripheral joint cooling increases spinal reflex excitability and serum norepinephrine. Int J Neurosci 2007; 117 (02) 229-242
• 31 Tornberg E. Effects of heat on meat proteins: implications on structure and quality of meat products. Meat Sci 2005; 70 (03) 493-508
• 32 Green MAJ, Sinkus R, Gandevia SC. et al. Measuring changes in muscle stiffness after eccentric exercise using elastography. NMR Biomed 2012; 25 (06) 852-858
• 33 Janecki D, Jarocka E, Jaskólska A. et al. Muscle passive stiffness increases less after the second bout of eccentric exercise compared to the first bout. J Sci Med Sport 2011; 14 (04) 338-343
• 34 Kawakami Y, Ichinose Y, Fukunaga T. Architectural and functional features of human triceps surae muscles during contraction. J Appl Physiol 1998; 85 (02) 398-404
• 35 McHugh MP, Connolly DAJ, Eston RG. et al. Exercise-induced muscle damage and potential mechanisms for the repeated bout effect. Sports Med 1999; 27 (03) 157-170
• 36 Witvrouw E, Mahieu N, Danneels L. et al. Stretching and injury prevention: an obscure relationship. Sports Med 2004; 34 (07) 443-449
• 37 Ruiz DH, Myrer JW, Durrant E. et al. Cryotherapy and sequential exercise bouts following cryotherapy on concentric and eccentric strength in the quadriceps. J Athl Train 1993; 28 (04) 320-326
• 38 Catlaw K, Arnold BL, Perrin DH. Effect of cold treatment on the concentric and eccentric torque-velocity relationship of the quadriceps femoris. Isokinet Exerc Sci 1996; 5 (04) 157-163
• 39 Côté RW. The relationship of temperature to strength and power production in intact human skeletal muscle. In: Cryotherapy: Theory, Technique, and Physiology. 1985: 119-130