Critically Appraised Topic STUDENT EXAMPLE
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Medicine
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Dec 6, 2023
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Uploaded by DoctorYak3442
Effects of Cold Water Immersion (CWI) on Delayed Onset Muscle Soreness
(DOMS) in Athletes: a Critically Appraised Topic
Clinical Scenario:
Delayed onset muscle soreness (DOMS) is a common experience by numerous athletes that has traditionally been treated with cold water immersion (CWI) therapy. However, the effectiveness of this treatment is highly inconclusive, as research on the topic increases. Focused Clinical Question:
In an active population, what is the effect of using CWI compared to nonimmersion rest on the effects of DOMS following an exercise bout? Summary of Key Findings: All three studies showed no significant difference between subjects who underwent CWI compared to those who did not. One study did find a potentially clinically important difference in plasma chemokine ligand (CCL2) concentration while another found differences in perceived soreness. The third study did find improvements in peak power output (PPO) after CWI in severe temperatures (~5
o
C). Clinical Bottom Line: Evidence does not exist to support the use of CWI in the treatment of DOMS as each study reported no statistically significant difference between CWI and nonimmersion rest. However, athletes may find the minimal improvements in DOMS symptoms as important in their training. Strength of Recommendation:
Grade B evidence shows no statistical support for the use of CWI in the
treatment of DOMS. Keywords:
delayed onset muscle soreness, cold water immersion, ice baths, cryotherapy, recovery, athlete, lower extremity Clinical Scenario
Although delayed onset muscle soreness (DOMS) is such a common experience among all levels of athletes, much of this training antagonist remains unknown. Specifically, modes of development, treatment, and impact on performance all remain undefined.
1
Delayed onset muscle soreness is common
at the beginning of training plans when new exercises are introduced and/or athletes have come off of a period of reduced training.
1
Symptoms may range from slight muscle tenderness all the way to performance-inhibiting pain.
1 Cryotherapy methods, such as cold water immersion (CWI) through the use of ice baths, are commonly believed to relieve pain and reduce inflammation due to the vasoconstrictive effects.
2
Although CWI has been used by athletes for decades, many meta-analyses are noting the trivial effects on the reduction of muscle soreness.
3 Thus, examining different studies that show the difference in outcome measures of groups who use cryotherapy compared to those who do not can provide insight into the true importance, or lack thereof, in utilizing CWI. Therefore, the purpose of this paper is to examine the level of benefits CWI brings to subduing the manifestations of DOMS in athletes, if any.
Focused Clinical Question
In an active population, what is the effect of using CWI compared to nonimmersion rest on the indicators of DOMS following an exercise bout?
Summary of Search, “Best Evidence” Appraised, and Key Findings
The literature search identified 9 studies. Of the 9 studies, 1 was excluded as a duplicate study, 5 studies were excluded based on their title or abstract, and no studies were excluded based on lack of relevance to this critically appraised topic (CAT) (Figure 1).
Three randomized controlled trials (RCT) met the inclusion and exclusion criteria (Table 1).
All studies compared CWI, each including a group immersed in 5-6
o
C amongst other CWI methods, with nonimmersion recovery. Perceived muscle soreness ratings with a visual analogue
scale (VAS)
4,5
or 10-point scale
3
were used by each study as an outcome measure. Levels of 1
2
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Parlier 3
creatine kinase (CK)
3,5
or CCL2
4
in the blood were also used by each study to signify extent of muscle damage. Each study had other outcome measures in addition to these listed (Table 2).
In the included studies, all researchers agree that CWI does not show significant benefits in reductions in DOMS. However, it does not pose negative effects to recovery and the perception of athlete’s on CWI may aid in a placebo effect of the recovery method. In addition, severe CWI
(at temperatures around 5
o
C) may pose the most benefits, although not statistically significant.
The author independently used the PEDro scale to analyze the quality of each article. The average score for included articles was 7/10.
Figure 1 – Search Strategy.
Table 1 Summary of Study Designs of Articles Retrieved
Level of Evidence
Study Design
Number Located Reference
1b
Randomized, double-blinded controlled trial 1
Glasgow et al.
5
Randomized, controlled trial
2
Crystal et al.
4
Anderson et al.
3
42
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Parlier 4
Clinical Bottom Line
Evidence does not exist to support the use of CWI in the treatment of DOMS as each study reported no statistically significant difference between CWI and nonimmersion rest. However, there may be a clinically important difference in the perceived soreness,
5
CCL2 concentrations,
4
and PPO
3
after CWI in
severe temperatures (~5
o
C). Strength of Recommendation:
Grade B evidence
6
does not support the use of CWI for the treatment of
DOMS. Search Strategy
A computerized search was completed in November 2020 (Figure 1). Terms Used to Guide Search Strategy
Patient/Client group: DOMS, delayed onset muscle soreness
Intervention/Assessment: icing, ice bath
Comparison: No terms listed (compared to rest)
Outcome: soreness, recovery, muscle recovery
Sources of Evidence Searched
Academic Search Ultimate
CINAHL Plus
Health Source – Consumer Edition
Health Source – Nursing/Academic Edition
MEDLINE
SPORTDiscus
Inclusion and Exclusion Criteria Inclusion Criteria
Compared CWI with nonimmersion rest on the lower extremities
Written in the English language
Written in the last 10 years (2011-2020)
Human Subjects Exclusion Criteria
Compared to massaging with foam rollers instead of nonimmersion rest
Systematic Reviews
Results of Search
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