Immediate and Late Effect of Cryotherapy on Balance

nimble and Late Effect of Cryotherapy on Balance flying and fresh work of cryotherapy on ease IN HEALTHY SUBJECTs repealBackground cryotherapy application is commonly apply as a carnal therapy tools with many known proceeds, however several research fill report decrease in subject symmetry which affect quality of sweat pastime cryotherapy application, on that pointfore the purpose of composition to investigate the nimble and late deed of cryotherapy on mortise joint governing give voice on electro soundless offset and foot race the residue in static correspondence falsify in the midst of both(prenominal) sexes. Methods thirty normal subjects, Subjects had their static balance time- tried during two conditions (1) an experimental condition where the subject received the cryotherapy application by using cooled mousse ingest to the dominant articulatio talocruralis joint for 15 transactions speedyly onwards static balance examen and (2) a run across condition finished at room temperature. The order of mental tribulationing condition was randomize by using a coin flip. Biodex balance system was used to visor static balance. Result analysis of data using ANOVA and unpaired test ,appearance in earthshakingly statistically effect in all aspect of static balance within feminine group with p prize of overall st skill world power =0.669,Anterior/ layabtaboo constancy mogul =0.196 and medial/lateral constancy exponent =0.989,insignificantly statistically effect in all aspect of static balance within male group with p think of of overall constancy proponent =0.382,Anterior/posterior stability indicant =0.552 and Medial/lateral stability index =0.46 and insignificant statistically expiration betwixt male and distaff in all aspect of static balance. Conclusion The result of current study suggest that fifteen legal proceeding of inhuman gel pack on ankle dominant conclusion have no effect on static balance on both sexes .Key words static balance, cryotherapyIntroductioncryotherapy therapy is a popular non-pharmacological intervention, The term cryotherapy was used in yr 1908 by A.W. Pusey to describe the treatment of skin injuries with low temperatures1,2 , The primary point of cryotherapy is the removal of heat energy from the site of imperfection, in order to alleviate a therapeutic effect 3 by produces a number of physiological effects to the human body including a reduction in gillyflower flow, edema, hemorrhage4, cellular metabolic rate, hypoxia, enzymatic exertion and tissue damage5. Cryotherapy has also been exhibit to significantly summation the pain threshold and pain tolerance by reducing nerve conduction velocity and muscle spasm 6.Cryotherapy ofttimes used in athletic and replenishment cases to manage injury during the agile and rehabilitative phases 7. Cryotherapy treats the muscle damage caused by High- warmth exercise including predominantly suit activity, unaccusto med activity, and exercise of long age and/or laid-back intensity which has been registern to induce an inflammatory response 8.In spite of the characterized treatment advantage of cryotherapy, thither ar reduction in subjects performance variables atomic number 18 apt(predicate) to occur later returning to normal question flat later cryotherapy application,9especially , decrease speed of running, muscle effectivity speed and agility measures have been noted later on cryotherapy application over many anatomical aras and studies10,11.The ability to conserve postural control or balance is important for the lay carrying out of all daily activity ranging from standing and walking to school term and standing from a chair 12. Possessing the ability to conserve several positions, to pit automatically to voluntary movements of the body, and to react to external disturbance represents a postural control dobriny needed in daily life 13.The tending of balance is important in the prevention of injuries and this ability depends on proprioceptive input from capsuloligamentous and musculotendinous mechanoreceptors in combining with vestibular and visual input to the rudimentary nervous system (CNS)14,15 . This input used in feed fend for and feed-forward loops to provide the tight-laced neuromuscular response 16-17. Variations in any of these inputs would disturb balance and increase the essay of injury 18. at that place is also growing awareness that rehabilitation using cryotherapy has deleterious effects on balance, or return patients to their old functional levels 19, 20.Quality of movement is important as strength of movement, and the strike of movement quality is balance 21. Even if a patient has regained full strength and chemical chain of motion, if they still have poor balance and proprioception, they are at risk for re-injury.During the management of acute distortion, cryotherapy is commended afterwardwardwards the injury and in rehabilit ation, tripe application is supposed to promote the beginning of active exercise and its promotion 7. In practice it can happen that sportsmen are sent back to exercising or competition now after cryotherapy. Although the question is controversially discussed, if physical activities after ice application can be re-established without risk or increase liability to injury. This study takes up the problems if cryotherapy application at the ankle disrupts static balance so that an increased risk of injury could result and the study also clarify the warm and late effect and test the loss in static balance between both sex.MethodologyThe current study was conducted at biomechanics laboratory at might of physical therapy, modern university, in the period from December 2015 to April 2016 to investigate the immediate and late effect of cryotherapy application on dominant ankle joint on static standing balance and test the difference in static balance between both sexes.Design of study violate over (single repeated measurements) design used in this study to localise the immediate and late effect of cryotherapy application on dominant ankle joint on static standing balance and test the difference in the static standing balance between both sexes.SubjectsA sample of thirty healthy normal subjects (fifteen male and fifteen womanish), subjects were recruited using publically distributed posters and by online social media. Subjects had their static balance examined during two views (1) an experimental position where the subject received the cryotherapy application by using cooled gel pack to the dominant ankle joint for fifteen legal proceeding immediately forrader static balance testing and (2) a control situation finished at room temperature. The order of examining situation was randomized by using a coin flip. Participant finished the control situation first immediately finished the experimental situation quest perspicacity. Participants randomized to the cry otherapy situation first had the control session arranged at a separate time to confirm no lingering effects persist from the cryotherapy procedures.Subjects participate in the current study after approval of estimable committee of faculty of physical therapy, Cairo University with number P.T.REC/012/001035 and all subjects provided pen informed consent. Subjects were included if their age range from 18 to 40 days 22 free from musculoskeletal diseases and neurological diseases affecting the lower limb. Excluded if had musculoskeletal disorders in lower limb, had infected skin diseases and loss of sensation, had Metabolic or vascular disease with neurological component such as diabetes, had previous ankle operation and had recent injury of ankle joint.InstrumentationMeasurement instrumentationThe blind used in this study (Biodex Medical Systems Inc., Shirley, New York, USA) was a derriere political program (circular in shape with a diameter of 21.5, which permits up to 20 par ametering from horizontal in all directions), support rails that were adaptable from 25 to 36.5 above the plan, and could be swung away if desired, a display faculty whose height was adjustable from 53 to 68 above the broadcast and move was adjustable from vertical back to 45, with a display aftermath area of 24.8 - 18.4 cm and a printer. This testing machine has 12 driving levels plus locked for static measurements 23. stability indexesthe stability index represents the segmentation of platform displacement in degrees from level. An increase in number indicate wide motion, which indicates a problem with balance 24 . The participants ability to control the platforms angle of tilt was measured by the system and noted as a stability index. The data on the balance of the tried and true participants were supplied to the system. These data included anteroposterior stability index (APSI), mediolateral stability index (MLSI), and overall stability index (OSI). The little the amo unt of sway, the lower the numerical appreciate of these indexes 24.OSI represented the variance of initiation platform displacement in degrees, from level, in all motions during the test. A high number was indicative of considerable movement during this test.APSI represented the variance of foot platform displacement, in degrees, from level, for motion in the sagittal monotone.MLSI represented the variance of foot platform displacement, in degrees from level, for motion in the frontal plane 24 .Therapeutic instrumentationreclaimable cold gel pack 25.4 x 48.1 cm. 5 +/- degree C 25 was frozen and wrapped with a wipe and supported with elastic strap around the ankle joint of dominant lower extremity.ProcedureEach participant received a vocal explanation about the test steps. When the system was on, the first displayed suppress was the main menu. It allowed us to choose entering testing, training, or system utilities. Choosing to enter testing showed the bordering entomb, which allowed determination of the test parameters such as test duration and the stability level chosen. The weight and height of the participant were recorded and the next screen was used for the refering process. The next screen was the stability test screen, where the start key was pressed to lock or unlock the platform and begin the test. A cursor appeared during the test tracing the movement of the platform while the clock counted till the time of the test ends. The next screen showed a menu. The examiner chooses the numeric report option on this screen to allow the participants numeric screen appear. Pressing start while on this screen initiates printing of the report, which includes the numeric appreciate of the APSI, MLSI, and OSI (operation and service manual).Step 1 balance assessmentthe participants were tested without footwear and asked to perform two test trials before a specific test condition for the purpose of instrument familiarity before data collection. Then, the par ticipant was first asked to assume the test position (standing on dominant foot) with arms held at the sides, eye closed and to attempt to control his/her balance as much as possible. Each participant was asked to center him/herself on the foot platform before head start the test.The test parameters introduced into the device wereParticipants age , weight and height perceptual constancy level all participants were tested on stability level 0 for 15 s.Then, the start key was pressed in the control panel (which took 5 s) with an auditory warning device just before the beginning of the test. The participant was instructed that the test was started just after the alarm. Each participant was instructed to maintain his/her balance for the period of the test. Three trials were execute prior to the measurement.There was report obtained at the end of each test include information on OSI, APSI, and MLSI.Step 2 cryotherapy applicationReusable cold gel pack 25.4 x 48.1 cm. 5 +/- degree C was employed as the cryotherapy modality in this study. Application duration leave be 15 minutes. Wrapping of pack by towel give applied all around ankle joint of domain extremity with towel in between .Two elastic straps will used to ascertain the ice pack. The subject will asked to relax during cryotherapy application to limit activity of muscle and lessen any change in temperature of tissue.Step 3 balance reassessmentthe participant was asked to repeat the same balance testing procedures directly after cryotherapy application, 30 minutes later and 60 minutes later to measure post OSI, MLSI, and APSI.Statistical analysisAll statistical analysis were carried out by using SPSS,version 23 for windows SPSS Inc., Chicago,Illinois,USA.the normality of data distribution was tested through the Shapiro-wilk test.Descriptive data for participants, characteristics was calculated as the smashed, standard deviation and range minimum maximum of measured variables, ANOVA tests used to compare between pretest and posttest. Unpaired test used to compare between male and female. take aim of significant will set at ResultsGeneral characteristics of the subjectsIn this study, thirty subjects were assigned randomly, the range of the ages is between 18 to 40 years overall. There was no statistically significant differences between the groups in their ages as the p- set are 0.412. The range of the weight is between 50 to 105 kg. There was no statistically significant differences between the groups in their weight as the p- abide by are 0.214. The range of the Height is between 156 to 195 cm. There was no statistically significant differences between the groups in their weight as the p- re take to be are 0.366. submit (1) Demographics statistical distributionItemsMaleFemaleComparisonSignificantMeanSDMeanSDT- regard asP-value board (years)26.4 6.0825.533 5.410.4120.682No SignificantWeight (Kg)70.89 14.5777.2 5.41-1.2700.214No SignificantHeight (cm)165.27 4.57166.66 6.41-0.4 110.366No SignificantFigure. (1) Demographics DistributionAs for the gender distribution, 15 subjects (50%) were male and 15 subjects (50%) were females. In addition, 26 subjects (86.7%) had their dominant right leg tested, and 4 subjects (13.3%) had their dominant left leg tested. atmospherics BalancePre-testThe results are shown using the following table (2) and illustrated in figure (2).1) Overall stableness force supreme t-test was used to show difference between pretest for females and males. The female imagine value of overall stability index (3.471.42) was significantly diametrical from (5.042.31) with t test = -2.242 and p value = 0.033*.2) A/P constancy business leader nonsymbiotic t-test was used to show difference between pretest for females and males. The female squiffy value of A/P perceptual constancy index (2.41 0.85) was significantly distinguishable from (3.3931.65) with t test = -2.157 and p value = 0.043.3) M/L Stability magnate single-handed t-test was used to show difference between pretest for females and males. The female loaded value of M/L Stability index (2.01 1.08) was insignificantly various from (2.991.72) with t test = -1.887 and p value = 0.072.Table (2) The pre-test results for the Stability Indices electrostaticStability big businessmanOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test for Females3.671.412.4070.852.011.08Pre-test for Males5.042.33.391.652.991.72 item-by-item t-valuep value-2.4920.033*Significant-2.1570.045*Significant-1.8840.072 insignificant information are evince as average SD.P 0.05= insignificant.*PFigure (2) The pre-test results for the Stability Indices nonmovingB) Within Group (Females)The results are shown using the following table (3) and illustrated in figure (3).ANOVA F-test was used to show difference between pre and post-test in the stability indices.Overall Stability IndexThe misbegotten value was pretest (3.471.42) when compared with its corresponding no s ignificant difference after assessment immediately (3.781.868), after 30 minutes (3.41 2.27), and after 60 minutes (4.29 2.86) with f test = 0.521 and p value = 0.66.A/P Stability IndexThe mean value was pretest (2.41 0.85) when compared with its corresponding no significant difference after assessment immediately (2.47 1.52), after 30 minutes (2.14 1.27), and after 60 minutes (3.27 1.43) with f test = 1.616 and p value = 0.196.M/L Stability IndexThe mean value was pretest (2.01 1.08) when compared with its corresponding no significant difference after assessment immediately (2.2 1.07), after 30 minutes (2.12 1.84), and after 60 minutes (2.13 1.98) with f test = 0.04 and p value = 0.989.Table (3) The mean value and S.D of Stability Indices before starting and after the test for Females StaticData of evaluationsOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test3.47 1.422.41 0.852.01 1.08 mooring-Immediate3.73 1.8682.47 1.522.2 1.07Post-30 minutes3.41 2.272.141.272.12 1.84Post-60 minutes4.29 2.863.27 1.432.13 1.98F-value ANOVA0.5211.6160.04p value0.669Insignificant exit0.196Insignificant Difference0.989Insignificant DifferenceData are expressed as mean SD.P 0.05= insignificant.*PFigure (3) The mean values and S.D of Stability Indices before starting and after the test for Females StaticD) Within groups (Males)The results are shown using the following table (4) and illustrated in figure (4). ANOVA F-test was used to show the difference between post-test in the stability indices.Overall Stability IndexThe mean value was pretest (5.042.3) when compared with its corresponding no significant difference after assessment immediately (5.01 1.765), after 30 minutes (4.422.22), and after 60 minutes (3.951.56) with f test = 1.039and p value = 0.382.A/P Stability IndexThe mean value was pretest (3.391.69) when compared with its corresponding no significant difference after assessment immediately (3.41.42), after 30 minutes (3.11 1.78), a nd after 60 minutes (2.67 1.416) with f test = 0.707and p value = 0.525.M/L Stability IndexThe mean value was pretest (2.99 1.72) when compared with its corresponding no significant difference after assessment immediately (3.021.28), after 30 minutes (2.52 1.55), and after 60 minutes (2.33 1.02) with f test = 0.874and p value = 0.46.Table (4) The mean values and S.D of Stability Indices before starting and after the test for Males StaticData of evaluationsOverall Stability IndexA/P Stability IndexM/L Stability IndexPre-test5.042.313.391.652.99 1.72Post-Immediate5.01 1.7653.4 1.423.02 1.28Post-30 minutes4.42 2.2293.11 1.782.52 1.55Post-60 minutes3.951.562.67 1.422.33 1.02F-value ANOVA1.0390.7070.874p value0.382Insignificant Difference0.552Insignificant Difference0.46Insignificant DifferenceData are expressed as mean SD.P 0.05= insignificant.* PFigure (4) The mean values and S.D of Stability Indices before starting and after the test for Males StaticD) Post test results StaticThe results are shown using the following table (5) and illustrated in figure (5). individual t-test was used to show difference between post-test in the stability indices.1) Overall Stability IndexIndependent t-test was used to show difference between immediately post-test for females and males. The female mean value of overall stability index (3.73 1.868) was insignificantly different from (5.01 1.765) with t test = -1.913and p value = 0.063.Independent t-test was used to show difference between 30 minutes post-test for females and males. The female mean value of overall stability index (3.41 2.27) was insignificantly different from (4.42 2.229) with t test = -1.227and p value = 0.23.Independent t-test was used to show difference between 60 minutes post-test for females and males. The female mean value of overall stability index (4.29 2.86) was insignificantly different from (3.95 1.56) with t test = 0.415 and p value = 0.682.Stability IndexImmediate30 transactions60 MinutesOv erall Stability IndexPost-test for Females3.73 1.8683.41 2.274.29 2.86Post-test for Males5.01 1.7654.42 2.2293.95 1.56Independent t-valuep value-1.9130.063Insignificant-1.2270.23Insignificant0.4150.682InsignificantTable (5.a) The mean values and S.D of Overall Stability Index post-test for both Females and Males-StaticData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.a) The mean values and S.D of Overall Stability Index post-test for both Females and Males-Static2) A/P Stability IndexIndependent t-test was used to show difference between immediate post-test for females and males. The female mean value of A/P Stability index (2.47 1.52) was insignificantly different from (3.4 1.42) with t test = -1.699and p value = 0.1.Independent t-test was used to show difference between 30 minutes post-test for females and males. The female mean value of A/P stability index (2.14 1.27) was insignificantly different from (3.11 1.78) with t test = -1.723and p value = 0.096.A /P Stability IndexImmediate30 Minutes60 MinutesA/P Stability IndexPost-test for Females2.47 1.522.14 1.273.27 1.43Post-test for Males3.4 1.423.11 1.782.67 1.42Independent t-valuep value-1.6990.1Insignificant-1.7230.096Insignificant-0.9250.363InsignificantIndependent t-test was used to show difference between 60 Minutes post-test for females and males. The female mean value of A/P stability index (3.27 1.43) was insignificantly different from (2.67 1.42) with t test = -0.925 and p value = 0.363.Table (5.b) The mean values and S.D of A/P Stability Index post-test for both Females and Males-StaticData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.b) The mean values and S.D of A/P Stability Index post-test for both Females and Males-Static3) M/L Stability IndexIndependent t-test was used to show difference between immediate post-test for females and males. The female mean value of M/L Stability index (2.21.07) was insignificantly different from (3.02 1.28) with t test = -1.898and p value = 0.068.Independent t-test was used to show difference between 30 Minutes post-test for females and males. The female mean value of M/L stability index (2.12 1.84) was insignificantly different from (2.52 1.55) with t test = -0.656and p value = 0.518.Independent t-test was used to show difference between 60 Minutes post-test for females and males. The female mean value of M/L stability index (2.13 1.98) was insignificantly different from (2.33 1.02) with t test =0.097and p value = 0.729.Table (5.c) The mean values and S.D of M/L Stability Index post-test for both Females and Males-StaticM/L Stability IndexImmediate30 Minutes60 MinutesM/L Stability IndexPost-test for Females2.2 1.072.12 1.842.13 1.98Post-test for Males3.02 1.282.52 1.552.33 1.02Independent t-valuep value-1.8980.068Insignificant-0.6560.518Insignificant0.0970.729InsignificantData are expressed as mean SD.P 0.05= insignificant.* PFigure (5.c) The mean values and S.D of M/L Stability In dex post-test for both Females and Males-StaticDiscussionThe purposes of the study were To determine the immediate and late effect of cryotherapy on the dominant ankle joint on static balance and To determine the difference in static balance changes between both sexes.Our result revealed that the females have significant difference in static balance than male when measured before application of cold gel pack to ankle dominant extremity with p value of overall stability index = 0.033 , p value of A/P stability index=0.043 and not for ML stability index with p value of =0.072.Our result revealed that after using cold gel pack to ankle dominant extremity for 15 minutes has no statistically significant difference on all aspect of static balance in female group. In over stability index at that place was no statistically significant difference after assessment immediately, after 30 minutes and after 60 minutes with p value =0.66. In over A/P stability index there was no statistically sig nificant difference after assessment immediately, after 30 minutes and after 60 minutes with p value =0.196. and In over M/L stability index there was no statistically significant difference after assessment immediately,