Vol 37-1

35 Pages·2010·0.62 MB·English

by  Brenda Allum

New Zealand Journal of
SPORTS MEDICINE
Official Journal of Sports Medicine New Zealand Inc
Volume 37 • Number 1 • 2010
Photos kindly supplied by Wayne Hing (AUT)
and Jude Spiers (Warriors Rugby League)
The use of contrast therapy
recovery within the New
Zealand elite sports setting.

New Zealand Journal of
SPORTS MEDICINE
The opinions expressed throughout this Contents
journal are the contributors’ own and do
not necessarily relfect the view or policy
of Sports Medicine New Zealand (SMNZ).
Members and readers are advised that
Editorial
SMNZ cannot be held responsible for the
accuracy of statements made in RUGBY AND RODEO _____________________________________ 4
advertisements nor the quality of the goods Chris Milne
or services advertised. All materials
copyright. On acceptance of an article for
publication, copyright passes to the Best of British
publisher. No portion(s) of the work(s)
JANUARY TO JUNE 2010 __________________________________ 4
may be reproduced without written consent
Chris Milne
from the publisher.
PUBLISHER Original Research
SPORTS MEDICINE NEW ZEALAND THE USE OF CONTRAST THERAPY RECOVERY____________ 8
PO Box 6398 WITHIN THE NEW ZEALAND ELITE SPORTS
Dunedin SETTING
NEW ZEALAND Wayne Hing, Steven White, Peter Lee
Tel: [phone]
Fax: [phone]
CHANGES TO STRAIGHT-LINE SPRINTING FOOT _________ 12
Email: [email protected]
POSITIONS DURING A RUGBY UNION BASED
Web: www.sportsmedicine.co.nz
AGILITY TASK
Keane Wheeler and Mark Sayers
EDITOR
Dr Chris Milne
Articles
REVIEW CURRENT THINKING ON THE __________________20
INFORMATION FOR AUTHORS
MANAGEMENT OF RETROPATELLOR PAIN
Manuscripts are to be sent to:
Steven Lim
The Editor
NZ Journal of Sports Medicine
THE RELATIONSHIP BETWEEN PERSONALITY ___________ 23
Sports Medicine New Zealand
PO Box 6398 AND PERFORMANCE IN ENDURANCE SPORT
Dunedin Rod Corban
NEW ZEALAND
Email: [email protected]
Case Studies
Manuscripts may be submitted in
DE QUERVAIN’S TENOSYNOVITIS ________________________26
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Chris Lawrence, Hamish Osborne
details please contact the publisher.
INTERSECTION SYNDROME _____________________________ 28
Rachel Stewart, Hamish Osborne
Book Reviews
THE COMPLETE GUIDE TO FOOD FOR SPORTS __________ 30
PERFORMANCE 3rd Edition
OPEN - AN AUTOBIOGRAPHY____________________________ 31
Patient Information Sheet
ANTI-INFLAMMATORY DRUGS (NSAIDs) FOR _____________ 32
MUSCULOSKELETAL PAIN
EDITORIAL
Rugby and Rodeo
You may wonder what these two activities have in After what may well be a relatively limited history taking
common. The idea for this editorial arose out of a and focused examination, you should be in a position to
discussion I had with Winne Meeuwisse shortly after formulate a working diagnosis. You should also be aware
the opening ceremony of the Winter Olympics in of other diagnostic possibilities which may need
Vancouver. exclusion.
Winne works in Calgary, home of the famed Stampede. In my opinion, the role of investigations is often
He therefore sees a lot of rodeo riders. It seems like overemphasised in today’s healthcare environment. In
these riders have a similar mindset to plenty of our general, one should only order an investigation if the
football players; that is, they are relatively stoical laconic result will alter patient management. For most sporting
types. They tend to downplay their problems, which injuries we are generally talking radiology; start with
can make history taking a real challenge for the clinician. plain x-rays and use ultrasound only if there is a treatable
For example, a rodeo rider saying, “I fell off and hurt pathology likely to be identified by that modality. High-
my shoulder” is rather analogous to a rugby player technology imaging, (CT, MRI and bone scanning)
saying “he went through me in the back line and I hurt should be reserved for those few cases where a diagnosis
my shoulder”. This may be the only explanation given remains elusive despite standard modalities, or later down
for what turns out to be a glenohumeral dislocation. the track if the patient’s clinical course has not followed
expectations.
Full history taking may seem like dragging teeth but
one should attempt it. With such patients there is a From my 15 years in primary care, two things I learned
tendency to move more rapidly from the general to the that have remained are to be comfortable making a
specific, e.g. “did you feel a dead arm after the incident”. working diagnosis even without extensive investigations,
Usually by asking a few key questions the true severity and to use time as a diagnostic aid where appropriate.
of the condition can be ascertained; given that the history
supplies about 80% of our diagnostic information, time In summary, dealing with the laconic patient can have
spent on this aspect is seldom time wasted. its challenges but the rewards are many, as these patients
are usually the most grateful for any intervention which
In this context, the clinician will be more dependent on enables them to return to their sporting endeavours.
examination findings. Again, you should have a
practised routine and if signs are equivocal then do not Dr Chris Milne
be afraid to repeat a specific test later in the course of EDITOR
the examination.
BEST OF BRITISH
January The editorial by Steven Stovitz There is a useful article on heat
The January issue of the British outlined the pyramid of sports injury in young sportspeople.
Journal of Sports Medicine medicine and child health. This is Children are known to be at higher
concentrated on kids in sport. The built on a foundation of promotion risk for developing heat injury than
warm up article by Dennis Caine of physical activity, energy balance, adults. The article recommends
asks the question, are kids having a non-violence in sports and injury gradual acclimatisation of all
rough time of it in sports? He notes prevention. In the middle row he athletes to hot conditions and
that sport, recreational and exercise mentions advocacy plus a voice of reduction in activity during hot or
related injuries were the most reason pushing for more free play humid conditions. There is a further
common cause of paediatric injuries opportunities. Also, emotional and recommendation to use light
and that some of these may have long physical wellbeing are highlighted coloured clothing that absorbs heat
term consequences on the together with injury treatment. The less and careful monitoring of
musculoskeletal system. Articles pinnacle is the attainment of optimal athletes for signs of heat injury, plus
later in the same issue tackle specific child health. having resources available to
paediatric sports medicine issues. immediately and rapidly cool any
affected athletes. Lastly, there is a
4 NZJSM
BEST OF BRITISH
plea for better education of athletes, which children and adolescents Exercise Programme which involved
caregivers and coaches about heat regularly participate. a specific set of muscle strengthening
injury in young athletes. and balance retraining exercises
In my experience, in New Zealand a prescribed at home by three trained
Nicola Maffulli and colleagues large percentage of the children who nurses supervised by a
examined the long term health I have seen who have been physiotherapist. There were five
outcomes of young sports injuries. participating in resistance training home visits and monthly phone calls.
It is estimated that 8% of Australian programmes have been influenced A 30% reduction in falls was
adolescents drop out of recreational by people with a weight training observed.
sporting activities each year because background. I remain unconvinced
of injury recurrence. Growth plate that it is necessary for athletes to Later in the same issue Bell, Cusi and
injuries are associated with growth undergo significant weight training colleagues in Sydney examined the
disturbance in about 15% of cases. prior to attaining skeletal maturity use of prolotherapy in the sacroiliac
Most of these appear to involve and believe that the same gains can joint. They studied a group of 25
American football. MRI scan studies be accrued by waiting until such patients with SI joint pain, diagnosed
of athletes with back pain have maturity has occurred. by validated clinical tests, who had
shown some correlation with disc not had satisfactory improvement
degeneration, but this is not borne The January issue concludes with following a previous exercise
out by all studies. About 50% of part 5 of the reviews of nutritional programme. They were given an
young athletes who undergo supplements on an A to Z basis. This injection of 0.8ml of a solution
meniscal surgery will have later issue covers sodium bicarbonate and containing 50% glucose,
development of knee osteoarthritis. sodium citrate, where there is Bupivacaine 1% and radioactive
These figures are in accord with the undoubted evidence of efficacy at an contrast material. Their subjects
data in adults. ACL reconstruction optimal dose of 0.3g/kg bodyweight. were reviewed at three months, 12
in children is a complex issue. Both substances function as buffers, months and two years, and both
Studies have indicated that children reducing the acidosis associated with clinical and functional questionnaire
managed non-operatively frequently high level exercise. The main scores using the Quebec Back Pain
develop poor function compared limitation to their use is GI upset, and Disability Score and Roland
with those undergoing individual tolerances vary so users Multiform Questionnaire showed
reconstruction. There are still need to test their own response to significant improvement. This is a
potential issues with growth plate buffer ingestion. Beta alanine and small intervention trial and the
disturbance and detailed discussion carnosine both function as authors suggested further research in
by the surgeon, athlete and their intracellular buffers. The authors this area. The data is consistent with
caregivers is advised. quote two studies indicating the other interventional trials where the
ability to undertake strenuous more specific the diagnosis is in the
Weight training among young bicycle exercise increases with low back, the more likely a targeted
athletes is another controversial area. carnosine supplementation and a injection is to achieve a desirable
Faigenbaum and Myer evaluate this further study indicated that beta outcome.
issue and conclude that resistance alanine supplementation limits the
(weight) training can be a fall in blood pH during high intensity Later in the same issue, George
worthwhile and beneficial activity exercise without affecting blood Murrell and colleagues evaluated
for children and adolescents. They lactate or bicarbonate concentration. shoulder pain in elite swimmers and
conclude that most injuries relating Therefore, it is not surprising that concluded that most of this arose
to youth weight training are as a these substances have become used from the supraspinatus tendon. They
result of inadequate professional by international level athletes. found features of tendinopathy and
supervision, with associated poor Further studies are necessary to this seemed most strongly correlated
exercise techniques and clarify their true roles. by the volume of swimming training.
inappropriate training loads. They They found that shoulder laxity per
therefore advocate supervision by February se had only a minimal association
appropriately qualified professionals The February issue included a with shoulder impingement in elite
and, in this context, have not systematic review of home based swimmers. They therefore proposed
observed any increased risk of strength and balance programmes in that the intensity and duration of load
musculoskeletal injury resulting people aged over 80 to prevent falls. to tendon fibre results in
from age appropriate weight Nine studies were evaluated and tendinopathy, impingement and
training, weight lifting and three of these showed cost saving in therefore shoulder pain. This is
plyometrics. This is when compared these older adults. The best value somewhat different from the
with other recreational activities in for money came from the Otago
Vol 37 No 1 2010 5
BEST OF BRITISH
prevailing hypothesis that myeloperoxidase and salivary backs were more prone to tackling
glenohumeral joint instability is the interleukin 6 in the Difflam group; injuries than other players. Video
major cause of shoulder pain in the significance of this remains to be analysis showed that only 17% of
swimmers. This study included 80 determined. The authors conclude players who had sustained an injury
young elite swimmers aged between that anti-inflammatory based relating to a tackle above the line of
13 and 25 years, of whom 73 had interventions may be useful in the shoulder had that tackle penalised
reported shoulder pain. alleviating the severity of post-race by the referee. The authors made
upper respiratory symptoms in mention of New Zealand’s Rugby
It has long been observed that rural athlete populations. Smart injury prevention programme
Africans have low rates of coronary plus also the Shark Smart injury
heart disease despite a diet high in Exostoses in the external auditory prevention programme from South
saturated fat, and genetic protection canal are common in those athletes Africa.
has been postulated as the reason for who exercise in or on water. A Welsh
this. Mbalilaki and colleagues group studied 92 kayakers and Shoulder padding is being worn
performed a cross-sectional study of compared their findings with 65 increasingly by today’s players but
985 Tanzanian men and women; 130 control volunteers. They found that there is relatively little evidence for
were rural Masai, 371 rural Bantu 69.5% of the kayaker ears and 1.7% its benefit. Harris and colleagues
and 484 urban Bantu with a mean of the ears in the control group were from Middlesborough in the UK
age of 46 years. The most significant found to have exostoses in the analysed the impact attenuation
finding for the rural Masai, who were external auditory canal. Severity of properties of four commercially
eating a high fat-low carbohydrate these exostoses was significantly available shoulder pads in the
diet, was their extremely high energy associated with the duration and laboratory. They found that all pads
expenditure and low bodyweight. frequency of kayaking. Once reduced peak impact force and the
The Masai would expend some 2565 kayakers had been active in their best performing pad was the thickest
kilocalories per day over vasal sport for more than 10 years, over one, which is hardly surprising.
requirements on average, compared 90% of them had such exostoses. It However, the pads were less
with 1500 kilocalories per day in the is thought that the exostoses arise effective at higher loads and the
rural Bantu and 891 kilocalories per from hyperaemia after cold water authors expressed disappointment in
day for the urban Bantu. This high exposure of the external auditory the overall performance of pads,
energy expenditure resulted in canal. This, in turn, stimulates stating that they appeared to bottom
reduced body mass index among the osteoblastic activity which results in out under higher impact loads. My
Masai. In other words, they were so narrowing of the canal. The authors interpretation of this would be that
active that they burnt off any excess found some evidence that earplugs they may well induce a false sense
calories, whether these were in the may prevent the formation and of security for players.
form of fat or carbohydrate. recurrence of exostoses, but advised
further study in the area. Cervical spine injuries are amongst
Respiratory symptoms are common the most catastrophic in rugby. A
in endurance athletes. A group from March French-based study, with Peter
the Australian Institute of Sport The IOC-sponsored special edition Milburn and Ken Quarry as New
evaluated the use of Difflam throat of BJSM in March focused on rugby Zealand-based co-authors, examined
spray in a group of 45 well-trained injuries. Several articles within this static and dynamic MRI protocols in
half marathon runners in an effort to issue will be of interest to New the assessment of cervical spine
evaluate its efficacy. This study was Zealand readers. abnormalities in asymptomatic adult
prompted by the observation that not professional rugby union players.
all bouts of upper respiratory The first of these assessed the injury The most frequent anatomical
symptoms in athletes have an risks associated with tackling in abnormality was degenerative disc
infectious cause. Therefore, rugby union. Simon Kemp and disease and, not surprisingly, this
alternative treatments may well be colleagues studied 645 players from was seen in players aged over 21
helpful. They found symptom 13 English premiership clubs years. Those players with a high
severity scores were approximately through two professional seasons. medulla to canal ratio were at highest
29% lower in those subjects They found that high speed going risk. Interestingly, most medullary
undergoing Difflam treatment, but into the tackle in association with canal ratios that were initially
post-exercise responses in plasma high impact forces and contact with assessed as intermediate on static
inflammatory markers showed no a player’s head or neck were MRI were subsequently assessed as
significant variation. There was a significant risk factors for both the abnormal with dynamic MR
subtle rise in salivary ball carrier and the tackler. Midfield imaging. However, the big unknown
6 NZJSM
BEST OF BRITISH
is predicting which players with any see if the results are replicated in from 1980 to 2003, when it was
MR abnormalities would go on to other studies before rushing out to removed because it was found that
sustain permanent functional embark on this intervention. the best ergogenic effects come from
impairment. In the absence of such small to moderate doses of caffeine
predictors, clinical evaluation Also in the March issue was a study (2-3mg/kg). These doses are well
remains the mainstay of athlete by the Lincoln University group on within the normal daily caffeine
screening. health and fitness parameters in New intake of the general population.
Zealand children aged 10 to 14 years. Traditionally, caffeine was believed
The issue also contained an article Comparisons were made between a to enhance endurance performance
regarding ethical dilemmas and the group study in 1991 and a by increased utilisation of fat as an
sports team doctor. This arose out comparator group in 2003. Over that exercise fuel and relative sparing of
of the controversy following the use 12 year period the average weight of glycogen. However, this glycogen
of a fake blood capsule by a boys increased by 4.5kg and girls by sparing effect is now known to be
Harlequins rugby player during a 3.9kg. The 550 metre run short-lived and inconsistent.
match versus Leinster in 2009. The performance declined by 1.5% per Furthermore, caffeine drinkers were
doctor was involved as she is alleged year for boys and 1.7% per year for warned about the diuretic effect but
to have cut the inside of the player’s girls. Most worryingly, children in small to moderate doses of caffeine
mouth in order to fabricate a the poorest performing and fattest have only minor effects on urine
laceration. The ethical issues are percentiles showed substantially losses and the authors conclude that
examined in depth and the most worse results in 2003 than in 1991. the diuretic risk had been previously
important guideline is “do not Results obtained in this study overemphasised. All in all, a very
abdicate your responsibility to the confirm the worrying trend seen in good update about this controversial
individual player”. other countries. The major worry is substance.
health problems that these children
The routine March issue of BJSM will face later in life and the As Sports Medicine New Zealand is
included an article on oral associated healthcare costs that no longer maintaining a collective
administration of the probiotic society and these individuals will subscription to BJSM, these
Lactobacillus fermentum VRI-003 have to bear. The study provides summaries have been expanded to
and mucosal immunity in endurance compelling evidence for trying to get provide our members with greater
athletes. Twenty healthy elite male our least active children to be more detail on the current contents of the
distance runners were studied at the active. Journal.
Australian Institute of Sport. A
double blind placebo-controlled Whole body vibration exercise has Chris Milne
cross over trial was conducted over become popular in recent years. Is Sports Physician
a four month period of winter there any evidence that it may Hamilton
training. The active ingredient was reverse age-related loss of muscle
a freeze-dried powder and gelatine mass and strength? Is seems there
capsules, with placebo capsules for could be, based on a UK study of 20
the other group. Subjects reported individuals with an average age of
30 days of respiratory symptoms 70 years. They used a randomised
during probiotic treatment compared cross over trial design with five
with 72 days during placebo minutes of vibration exercise
treatment. Also illness severity was characterised by static squat with a
lower. There were no significant frequency of 30Hz. There was an
differences in the mean change in acute increase in the circulating
salivary IgA and IgA1 levels, or in levels of IgF1 and cortisol but no
interleukin 4 or 12 levels between change in growth hormone and
treatments, however the probiotic testosterone. It remains to be seen
treatment doubled the gamma whether these hormonal changes are
interferon levels compared with sufficient to slow the rate of
placebo. These are impressive functional decline in older people.
results and may offer some avenue
of future prophylaxis for those The regular review of dietary
athletes who are prone to recurrent supplements in the March issue
illness, especially over the winter considered the role of caffeine. This
period. It would be worthwhile to was on the list of banned substances
Vol 37 No 1 2010 7
ORIGINAL RESEARCH
The use of contrast therapy
recovery within the New
Zealand elite sports setting
Wayne Hing
PhD1
Steven G White
MSc(Hons)1
Peter Lee
MHPrac (Hons) (Musculo), PGCert (West Acup), PGDHSc (Musculo), BHSc(Phty)2
Anousith Boouaphone
PGDHSc (Musculo), BHSc(Phty)3
1 AUT University, School of Rehabilitation & Occupation Studies
2 Mark Plummer Physiotherapy, Manukau City, Auckland
3 Health Zone, Millennium Institute of Sport and Health, Albany, Auckland
Correspondence to
Dr Wayne Hing, Associate Professor
AUT University, School of Rehabilitation & Occupation Studies
Health & Rehabilitation Research Centre, Discipline of Physiotherapy
Private Bag 92006
Auckland 1142, New Zealand.
Telephone: [phone] extension 7800
e-mail: [email protected]
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
ABSTRACT
Background; Contrast therapy is a recovery modality that is widely used by many athletes despite the lack of scientific
evidence for its use.
Aim; The purpose of this paper is to firstly survey and analyse the current utilisation of contrast therapy within the elite
sports of New Zealand (NZ) and secondly, to compare the findings with current scientific research.
Method; A questionnaire was developed to survey elite NZ sports teams on their use of contrast therapy. The majority of
respondents (79%) utilised contrast therapy as a recovery modality.
Results; The results indicated that contrast therapy is used immediately post exercise, utilising bins (cold cycle) and showers/
spas (hot cycle). The temperatures of each cycle ranged from 4-15°C (cold) and 23-40°C(hot) with 1:1-3 minutes (cold : hot)
ratio over 3 repetitions.
Conclusions; This study demonstrates that contrast therapy is widely used amongst the elite athletes of NZ. There appears
to be little consensus in regard to contrast therapy and this is also reflected in the literature which does not currently report
optimal contrast therapy parameters.
INTRODUCTION in sport.1 Contrast therapy may therefore (including changes in blood flow,
C
ontrast therapy consists of be an athlete’s preferred choice of post decreased creatine kinase levels, increased
immersion in hot/warm and cold exercise recovery compared to other range of motion, decreased muscle
water baths in an alternating recovery modalities. soreness and faster recovery of power) the
sequence. The strategy was initially used quality of the studies included in the
for injury management but has being An earlier paper9 reported the findings of review were of limited methodological
utilised for post-exercise recovery in more a systemic review of the literature that quality. Therefore this paper reports the
recent times.1 There are a number of investigated the physiological and findings of a survey that investigated
anecdotal reports from athletes and functional effects of contrast therapy in current utilisation of contrast therapy
coaches that suggest that contrast therapy the experimental setting. The review within elite sports of New Zealand (NZ).
has a positive effect on both recovery post concluded that although a number of The purpose of the research was to
exercise and on subsequent performance physiological changes were reported determine if contrast therapy was being
8 NZJSM
ORIGINAL RESEARCH
widely used and if so, to establish what Statistical Analysis This information is incomplete however
the normal practice in terms of protocols Analytical reports and tables were as 14 of the respondents (45%) did not
was amongst this cohort. This paper also generated from Microsoft access and also answer this question.
compares how current practice relates to from SPSS. For this paper, analysis and
the research evaluated in the earlier paper9 data presented is specific to the ‘water Temperature
with the intent of helping to provide a immersion’ section of the questionnaire, Eleven teams (35% of respondents) gave
guide to the clinical application of contrast in particular the contrast therapy section. details about the temperature of the hot
therapy. or cold water they used. The temperature
RESULTS of the cold water ranged from 4 to 15°C
METHODS Response Rate and between 23 and 40°C for the hot
Questionnaire A total of 39 out of 41 completed and component. The addition of ice to cold
A questionnaire was developed by the returned the questionnaire providing a water was the usual method of achieving
researchers to collect data concerning a response rate of 95%. Fifteen teams were the desired temperature. Three teams did
number of sports recovery strategies in NZ domestic (Interprovincial) not state how the water was chilled.
including: active recovery (light jogging, competitions and 16 teams were Twenty one teams (67% of respondents)
cycling), water immersions (ice baths, spa, international teams or NZ based used showers as the warm/hot component
contrast therapy), pool recovery, massage, professional teams playing in overseas of their contrast therapy. One team used a
stretching and nutrition. The data was competitions. Of the 39 responses, 31 bin full of hot water and 7 teams used a
collected over the period. Key themes (79%) indicated that they utilised contrast spa pool.
addressed in the questionnaire included therapy as a recovery strategy. The
the type of equipment, application numbers of responses from the various Application Time
protocols, rationale and the personnel teams and sports are presented in Table 1 The time spent in the cold varied from 20
involved with the prescription and the and the individual protocols of each team seconds to 120 seconds each cycle. The
implementation of the recovery strategy. are presented in Table 2. most common was 30 seconds and used
This paper reports the findings specific to by 19 teams (61% of respondents). The
the use of contrast therapy. Method of Delivery time spent in the hot component varied
A range of equipment is used in from 30 to 180 seconds. The most
Questionnaires were coded to correspond application of contrast therapy including common was 60 seconds and used by 15
to a particular sporting code/team to large bins, showers, plunge pools, spa teams (48% of respondents).
provide the tracking of responses and baths and pools, bath tubs and swimming
subsequent follow up of the non- pools. Large bins were the most Cycle Ratio / Repetitions
respondents. Participants were asked to commonly used equipment for the cold The ratio of the cycle between cold and
respond to questions for each of the component, while showers or spas were hot ranged from 1:1 to 1:4. The most
recovery strategies they used. The the most common for the hot component. commonly used ratios were 1:2 (13 teams/
questioning consisted of a mixture of open There was significant variation in the time 41% of respondents) and 1:1 (10 teams/
and closed ended questions. The closed of application following activity/ 32% of respondents). However, one team
ended questions required the participant competition. This ranged from appeared to spend more time in the cold
to answer yes/no questions or tick boxes immediately up to 30 minutes post event. cycle than hot with a ratio of 2:1. Three
from a list of available choices. Open teams indicated multiple options in the
ended questions were used in relation to
the rationale for the use of a particular TABLE 1: The sports and number of teams the questionnaires were sent to
recovery strategy. Questionnaires were with the response rate and number of teams that utilise contrast therapy.
returned (either by a pre-paid envelope,
email or fax). On receipt of the completed
Sporting Number of Number Contrast National Professional/
questionnaire, information was entered Code Teams Returned Therapy Teams International
into a Microsoft Access data base and Teams
Excel spreadsheet. Basketball 3 2 2 2
Cricket 2 2 2 2
Participants Hockey 2 2 2 2
Netball 9 9 9 8 1
Identification of elite national and
Rowing 1 1 1 1
international sporting teams within NZ
Rugby 14 13 8 6 2
that potentially used recovery strategies
Rugby League 2 2 2 2
was undertaken. The nature, purpose, and
Soccer 3 3 3 1 2
procedures of the study were conveyed to Squash 1 1 1 1
the participant via telephone and a Tennis 1 1 1 1
covering letter attached to the Triathlon 1 1 0
questionnaire. Informed consent was Softball 1 1 0
gained in accordance with the AUT Swimming 1 1 0
University Ethics Committee guidelines.
TOTAL 41 39 31 15 16
Vol 37 No 1 2010 9
ORIGINAL RESEARCH
ratio of the hot and cold cycle depending survey respondents provided detail about individual to determine how hot they had
on the intensity of the workout. the temperature of the water they used. the water. This is reflected in the responses
to the survey where the majority of
The number of contrast therapy cycles The temperatures for the cold cycle varied respondents either stated that they could
ranged between 1-5 repetitions. The most between 4 to 15˚C from the survey which not give a temperature or left this question
common was 3 repetitions (20 teams / appear similar to the 8-15˚ used in the blank. Ten teams (32%) used
64% or respondents). Total time spent research environment.9 Interestingly, the thermostatically controlled plunge or spa
performing contrast therapy ranged from majority of the studies recently reviewed pools and could therefore give definitive
2.5- 20 minutes. by Hing et al (2008) used temperatures values (38-40˚C). The hot water
over 10˚C indicating that the temperature temperatures used by these teams were
DISCUSSION of the cold cycle appears to be at the very similar to those used in the research
This study has demonstrated that the higher end of the range. based studies apart from one study that
majority of teams (79%) and elite sporting used hot packs heated in water at 75˚C.9
codes in NZ use contrast therapy. In addition, it is clear that temperatures
However, there appears to be little are not monitored or strictly controlled as It is common for the surveyed athletes to
consensus with respect to a number of they are in the research environment. spend less than 1 minute immersed for
parameters relevant to this form of With the repeated cycles between cold and each cold cycle. This reflects the timing
therapy. Similarly, there are significant hot water, it is likely that with subsequent of 1 minute employed in all but one of
differences in the method of application use of the ice bath there would be a the research studies12 identified in our
of contrast therapy ‘in the field’ compared progressive increase in the temperature of recent literature review.9 There is more
to that used by those who have the water. The size of the bins used and variation in the duration of the hot cycle,
investigated the physiological and the relative amounts of water and ice with surveyed athletes spending between
functional effects of this form of therapy. added are also likely to affect the water 1-3 minutes and the subjects in the
One of the treatment parameters that could temperature. research studies spending between 3 and
be considered likely to have a significant 10 minutes.
effect on the effects of contrast therapy is With respect to the hot cycles, whilst the The total duration of application of
the temperature of the water used, shower was the most common method of contrast therapy also varied between the
however, only 11 teams (35%) of the application, it is largely up to the athletes represented by the survey and the
TABLE 2: Contrast therapy protocols for each sports code and individual team.
SPORT TEAM TEMPERATURE/APPLICATION CYCLE RATIO REPETITIONS WHEN
COLD HOT (Cold:Hot) (secs)
Basketball Team 1 option A ice Shower 30 : 60 3 straight after
Team 1 option B ice nil 300 in cold 1 straight after
Team 2 4-10 o C shower/spa 60: 180 not stated not stated
Cricket Team 1 ice shower 30 : 60 3 10 - 30 mins post match
Team 2 10 - 15 o C shower 30 : 30 3 not stated
Hockey Team 1 ice shower not stated 3 15 - 20 mins post match
Team 2 ice shower 30 : 60 3 not stated
Netball Team 1 ice shower 30 : 60 not stated not stated
Team 2 ice shower 30 : 60 3 straight after
Team 3 not stated shower 20 : 40 OR 30 : 60 5 not stated
Team 4 ice shower 30 : 60 OR 30 : 120 3 not stated
Team 5 10 o C shower 30 : 30 3 straight after
Team 6 ice shower 30 : 60 3 straight after
Team 7 ice shower not stated 2 OR 3 straight after
Team 8 ice shower 30 : 60 3 straight after
Team 9 10 - 12 o C shower 60 : 180 not stated straight after
Rowing Team 1 ice hot water bin 30 : 30 3 straight after
Rugby Team 1 10 o C 23 o C 30 : 30fOR 60 : 180 5 straight after
Team 2 8 o C 40 o C spa 45 : 45 4 not stated
Team 3 not stated 39 - 40 o C spa 60 : 60 3 not stated
Team 4 ice shower 60 : 120 2 straight after
Team 5 ice 38 o C spa 30 : 120 1 straight after
Team 6 not stated 39 - 40 o C spa 60 : 60 3 not stated
Team 7 8 o C 40 o C spa 45 : 45 4 straight after
Team 8 ice 38 o C spa 30 : 120 1 straight after
Rugby League Team 1 ice thermostat controlled spa 30 : 60 3 straight after
Team 2 ice thermostat controlled spa 30 : 60 3 not stated
Soccer Team 1 3 - 4 bags ice shower 30 : 30 4 OR 5 straight after
Team 2 ice shower not stated 3 not stated
Team 3 ice shower 45 : 45 3 not stated
Squash Team 1 ice shower 120 : 60 3 not stated
Tennis Team 1 option A ice nil 600 in cold 1 straight after
Team 1 option B ice shower 30 : 60 3 not stated
10 NZJSM