by Dr. Mitchell Abrahamsen
Suddenly, cold therapy is a hot topic.
The two most common questions we get from coaches and athletes about cold therapy are:
- Why not Ice?
- What is PCM and why is it better?
Here’s a short answer to both questions.
For decades, ice has been the “go to” therapy for on-the-field or post-exercise treatment to reduce swelling and provide immediate pain relief. But research now shows that extremely cold treatment modalities, like ice and other cryotherapies, can actually have negative implications for athletes. Since the human body, and your cells, are mostly comprised of water, subjecting your body to “freezing” temperatures (frozen water) has the potential to essentially turn off your physiological processes that are important for recovery from the aches and pains of muscle strain or injury.
ONYX COOL’s cool therapy devices utilize specially formulated Phase Change Material (or PCM) to pull heat away from the injured area at a temperature (58oF) that provides pain relief and still allows for the natural healing process to take place. Unlike ice therapy which has to be cycled on and off, our PCM cold therapy products deliver consistent therapeutic temperatures without the risk of severe skin damage (think ice burn or frost bite) or internal complications like vasoconstriction (when your blood vessels shrink and blood flow to the injury slows way down).
Recently, Men’s Health magazine published an article entitled The Cold Hard Truth About Icing Your Injuries (Berra L, 2020). This article nicely explains how our thought processes about the benefit and mechanisms of cold therapy have changed over time, and how difficult it is to change old habits in the absence of viable alternatives.
Following moderate or strenuous exercise, both trained and recreational athletes often experience exercise induced muscle damage (EMID) and muscle soreness as they attempt to recover to the pre-exercise state over the next few days (Enoka 1996; Howatson et al., 2008A; 2008B). For injured athletes, cold therapies have become popular as they have been found to alleviate physiological and functional deficits associated with exercise-induced muscle strain and soreness (Bastos et al., 2012; Brophy-Williams et al., 2011). For many decades, repeated rounds of short-duration treatment with ice have been typically recommended for the 48 hours after an injury or surgery to provide comfort and to reduce swelling of the affected area.
More recently, Cryotherapy, in the form of cold-water immersion (CWI), has become one of the most popular recovery modalities utilized by trained athletes for its ability to diminish perceptions of soreness (Bleakley and Davison 2012; Hohenauer et al. 2015; Leeder et al. 2011). The interest in using CWI instead of ice, has prompted a large the number of scientific studies focusing on the benefits and to optimize CWI treatment protocols. These studies have explored and confirmed the therapeutic benefit of cold therapy, and importantly have demonstrated that more moderate treatment temperatures [52 – 59oF] were more beneficial at delivering immediate and delayed therapeutic benefits that more severe cold temperatures [32 – 50oF] (reviewed in Machado et al., 2016).
These scientific studies and many others have provided the basis for a growing belief that ice therapy, although effective at pain relief, may actually delay the healing and recovery process. Simply put: ice may be just too cold. More moderate cool therapy temperatures, while still providing pain relief, may be more beneficial to the recovery process.
The Problem with Ice
Ice and gel packs are too cold and put you at risk for ice burn and frost bite. These ultra-cold methods cause your blood vessels to shrink, which reduces blood flow and inhibits your body’s natural ability to heal.
Why Not Cold Water Immersion (CWI)?
Although clearly beneficial for the treatment of EMID and muscle soreness, CWI has many significant drawbacks including:
- a central effect on core temperature and heart rate
- a requirement for large immersion tubs which require significant volumes of water
- patient discomfort which negatively impacts treatment duration
- a disruption to normal daily activities, therefore greatly limiting opportunities for treatment for the recreational athlete.
To address these limitations, Phase Change Materials (PCMs) have been investigated as a new cooling modality that can extend the duration of cryotherapy exposure while allowing the patient to continue with normal activities.
A Cool Alternative to Ice and CWI: ONYX COOL PCM
Unlike ice, Onyx Ortho PCM products are specially formulated for optimal cool therapy. These PCM products pull heat away from the injured area to reduce swelling, while providing safe and effective pain relief without the potential negative effects of ice therapy.
Cryotherapy with PCMs designed to provide cooling at the optimal 59oF temperature have achieved reductions in the magnitude of intramuscular temperature comparable to 15 minutes of CWI (Kwiecien et al. 2019) and can be safely and comfortably utilized for prolonged durations [3–6 hours] (Kwiecien et al. 2020).. Prolonged PCM cooling has been demonstrated to be effective at reducing soreness and strength loss on the days after eccentric quadriceps exercise in recreational athletes (Kwiecien et al. 2018) and after a professional soccer match (Clifford et al. 2018) when applied for 6 hours and 3 hours, respectively.
In summary:
- Doctors and coaches recommend cold therapy for post-exercise recovery and injuries.
- Cold therapies are well-accepted and popular with recreational and trained athletes.
- A growing body of evidence has identified the risk and limitations of severe cold therapies.
- Phase Change Materials are a safe and effective method to achieve the benefits of cold therapy.
- Phase Change Materials can be used for long duration treatments directly on the skin without risk of injury.
Onyx Ortho’s devices are designed to deliver optimal cold therapy and can be worn while playing the game or during rest and recovery. The adjustable sizing conforms naturally to your body and does not limit daily activities. Athletes can stay active and recover faster with ONYX COOL.
For more research and data on the benefits of 58oF (15oC) versus ice, here are the research citations to cool your curiousness.
Anderson D, Nunn J, Tyler CJ (2018). Effect of cold (14oC) vs. Ice (5oC) water immersion on recovery from intermittent running exercise. J Strength Cond Res 32:764-711. https://journals.lww.com/nsca-jscr/Abstract/2018/03000/Effect_of_Cold__14__C__vs__Ice__5__C__Water.21.aspx
Bastos FN, Vanderlei LCM, Nakamura FY, et al. (2012) Effects of cold-water immersion and active recovery on post-exercise heart rate variability. Int J Sports Med;33(11):873–9. https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0032-1301905
Berra L. (2020). The cold, hard truth about ice. Mens Health Magazine. March:90-93
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW (2012) Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Data- base Syst Rev 2:CD008262. https://doi.org/10.1002/14651858. cd008262.pub2
Brophy-Williams N, Landers G, Wallman K. Effect of immediate and delayed cold-water immersion after a high intensity exercise session on subsequent run performance. J Sports Sci Med. 2011:665–670. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761518/
Clifford T, Abbott W, Kwiecien SY, Howatson G, McHugh MP (2018) Cryotherapy reinvented: application of phase change material for recovery in elite soccer. Int J Sports Physiol Perform 13(5):584– 589. https://doi.org/10.1123/ijspp.2017-0334
Enoka RM (1996) Eccentric contractions require unique activation strategies by the nervous system. J Appl Physiol 81(6):2339–2346. https://doi.org/10.1152/jappl.1996.81.6.2339
Hohenauer E, Taeymans J, Baeyens JP, Clarys P, Clijsen R (2015) The effect of post-exercise cryotherapy on recovery characteristics: a systematic review and meta-analysis. PLoS ONE 10(9):e0139028. https://doi.org/10.1371/journal.pone.0139028
Howatson G, van Someren KA (2008A) The prevention and treatment of exercise-induced muscle damage. Sports Med 38(6):483–503. https://doi.org/10.2165/00007256-200838060-00004
Howatson G, Goodall S, van Someren KA (2008B) The influence of cold water immersions on adaptation following a single bout of damaging exercise. Eur J Appl Physiol 105(4):615–621. https:// doi.org/10.1007/s00421-008-0941-1
Kwiecien SY, McHugh MP, Howatson G (2018) The efficacy of cooling with phase change material for the treatment of exercise- induced muscle damage: pilot study. J Sports Sci 36(4):407–413. https://doi.org/10.1080/02640414.2017.1312492
Kwiecien SY, McHugh MP, Goodall S, Hicks KM, Hunter AM, Howat- son G (2019) Exploring the efficacy of a safe cryotherapy alterna- tive: physiological temperature changes from cold water immer- sion vs prolonged phase change material cooling. Int J Sports Physiol Perform 14(9):1288–1296. https://doi.org/10.1123/ijspp .2018-0763
Kwiecien SY, O’Hara DJ, McHugh MP, Howatson G (2020) Prolonged cooling with phase change materials enhances recovery and does not affect the subsequent repeated bout effect following exercise. Eur J of App Physiol 120:413-423. https://link.springer.com/article/10.1007%2Fs00421-019-04285-5
Leeder J, Gissane C, van Someren K, Gregson W, Howatson G (2011) Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med 46(4):233–240. https://doi. org/10.1136/bjsports-2011-090061
Machado AF, Ferreira PH, Micheletti JK, de Almeida AC, Lemes ÍR, Vanderlei FM, Netto Junior J, Pastre CM (2016) Can water tem- perature and immersion time influence the effect of cold water immersion on muscle soreness? A systematic review and meta- analysis. Sports Med 46(4):503–514. https://doi.org/10.1007/ s40279-015-0431-7