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Bleakley 2012.
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Bleakley CM, Costello JT, Glasgow PD. Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Sports Med. 2012 Jan 1;42(1):69-87.
Design: Systematic Review Methods: Eligible studies were trials involving healthy human participants, describing the effects of cooling on outcomes relating to functional performance. Two reviewers independently assessed the validity of included trials and calculated effect sizes. The mean sample size was 19. Results: • 35 trials met the inclusion criteria; all had a high risk of bias. • The majority of studies used cooling durations > 20 minutes. • Strength (peak torque/force) was reported by 25 studies with approximately 75% recording a decrease in strength immediately following cooling. • There was evidence from six studies that cooling adversely affected speed, power and agility-based running tasks; two studies found this was negated with a short rewarming period. • There was conflicting evidence on the effect of cooling on isolated muscular endurance. • A small number of studies found that cooling decreased upper limb dexterity and accuracy. • The current evidence base suggests that athletes will probably be at a performance disadvantage if they return to activity immediately after cooling. • This is based on cooling for longer than 20 minutes, which may exceed the durations employed in some sporting environments. In addition, some of the reported changes were clinically small and may only be relevant in elite sport.
Key message: When applying cryotherapy, practitioners should use short cooling applications (<20 minutes) and/or undertake a progressive warm up prior to returning to play.
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