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Original Research Reports

The Effects of Ice Massage
on Maximum Isokinetic-Torque Production
Jeffrey A. Borgmeyer, Bradley A. Scott, and Jerry L. Mayhew
Context: The effect of ice massage on muscle-strength performance is equivocal.
Objective: To determine the effects of ice massage on maximum isokinetic torque
produced during a 20-minute interval. Design: Participants performed a maximal
isokinetic contraction of the right arm at 30°/s every 2 minutes for 20 minutes, once
after a 10-minute ice massage over the right biceps brachii muscle belly and once
without ice treatment. Sessions were randomized. Participants: 11 college men.
Measurements: Torque was measured with a Cybex® II dynamometer. Biceps skinfold
was measured with a Harpenden caliper. Results: A repeated-measures ANCOVA
revealed no significant interaction between time and treatment condition when the
effect of skinfold thickness was held constant. A main effect for time indicated that
torque production was significantly higher at 4 and 8 minutes and declined thereafter. Conclusions: A 10-minute ice massage neither enhanced nor retarded muscleforce output and thus may be used for its pain-reducing effect to allow resistance
exercise during the rehabilitation process. Key Words: cryotherapy, pain reduction,
rehabilitation, muscle strength
Borgmeyer JA, Scott BA, Mayhew JL. The effects of ice massage on maximum isokinetic-torque production. J
Sport Rehabil. 2004;13:1-8. © 2004 Human Kinetics Publishers, Inc.

The main objective of physical rehabilitation is to return injured athletes to
the playing field as soon as possible. Before returning to their respective
sports, athletes should regain their preinjury levels of strength, power, range
of motion, and endurance.1 A major complicating factor in this process can
be the pain accompanying movement in the area being rehabilitated.2 Because of this pain, it is often difficult for the athlete to undertake a vigorous
resistance-training program, resulting in a slower than desired restoration
of strength. Consequently, therapists have used cryotherapy (treatment with
cold) early in the rehabilitation process in order to decrease the discomfort
associated with early active exercise.
Cryotherapy has been shown to increase vasoconstriction, prevent
edema, increase capillary permeability, enhance blood flow, reduce musclespindle activity, slow nerve-conduction velocity, and reduce muscle
spasm.2,3 One of the main benefits of cryotherapy is that it produces an
The authors are with the Exercise Science Dept, Truman State University, Kirksville,
MO 63501.

the chronic use of cold therapy before a daily isometric training program might produce larger strength gains during the training program than will thermotherapy.2 Borgmeyer. therapeutic exercise of the injured area can be completed during that brief interval. particularly ice massage. however. Early reports indicated that ice massage could generate surface analgesia after approximately 4. ice massage has been used as an adjunct in early intervention programs to allow overload resistance exercise to increase muscle strength. Scott. One element often overlooked when considering the effect of cold application on muscle function is the thickness of the subcutaneous fat layer covering the muscle. inexpensive. resulting in a higher threshold for pain receptors.13 and peak force and rate of force development14 decreased immediately after a cold treatment.7 In addition. have produced a force enhancement after cryotherapy treatment.5 minutes of application4 and would decrease muscle temperature quickly in the first 5 minutes. Not all studies.17 Although it might take longer to lower intramuscular temperature with greater subcutaneous adipose thickness. and easy to administer.9. which has been shown to be as effective as a cold bath.8. the purpose of this study was to determine the effects of a 10-minute ice massage to the anterior arm on the maximum isokinetic torque produced over a 20-minute interval.12 isokinetic strength.2.3 The limited empirical research concerning the effects of ice massage on force production appears equivocal.1.2 This reduced pain sensation is enough to allow movement of the affected areas during treatment.6 Because of these general effects of cold application.4 is valuable in the clinical setting because it is readily available. on force production as it might be used in a rehabilitation setting.18 it would be of additional interest to determine whether ice massage alters force output in this mode of exercise.7-10 These cryotherapy-induced increases can continue from approximately 5 minutes9 to 180 minutes after treatment.15 although this remains controversial. and Mayhew analgesic effect by decreasing sensory perception. This technique. Therefore.17 skinfold measurements might not be a major indicator of amount of temperature depression.4 One method commonly used to induce such an analgesic effect is ice massage. Fat tissue might act as an insulator and prevent the internal muscle temperature from dropping when cold is applied.16 Part of this controversy might revolve around the amount of adipose tissue present in the cooling area.11-14 More recent studies have shown that isometric force 10-minute ice massage.16 The confounding results of previous studies and lack of empirical evidence on the interactive effect of subcutaneous fat and cold application on muscle-force production would suggest the need for further investigation of the effect of cryotherapy.5 Although rapid superficial rewarming occurs immediately after a conventional 5. Early studies have noted an increase in strength after cold application. Because isokinetic resistance is a common technique used in rehabilitation.15.11. .

In one session. One researcher performed all of the ice-massage treatments to an area approximately 10 cm long by 6 cm wide at a rate of 2 strokes per second. participants rested for 10 minutes and received no treatment before performing the MIF.1 years.7 N · m. Because the ice treatment was applied for a constant time. with force output recorded on a strip-chart recorder at a paper speed of 25 cm/s on a torque scale of 40. no measure of surface numbness was determined. The participants had had no arm injuries within the preceding year and had no contraindications to the use of ice massage.Ice Massage and Torque 3 Methods Research Design A randomized.9 ± 5. and all participants signed informed-consent documents before testing. crossover design was used to assess the effect of the ice massage on forearm-flexor force production. Instrument Testing was completed on a Cybex® II isokinetic dynamometer (division of Lumex Inc. performed once every 2 minutes for 20 minutes. height 179. NY) at a dampening setting of 2. The study was approved by the Institutional Review Board for the Protection of Human Subjects.9 ± 1. participants were instructed to look straight ahead and were given verbal encouragement throughout the exercise.0 cm. For the other session. Test Procedures Each participant performed 2 randomly ordered exercise sessions 1 week apart. Participants were secured in a seated position using Velcro® straps to eliminate extraneous movement and to isolate right-arm flexion through a full range of motion. The measurement of maximum isokinetic arm-flexor torque (dependent variables) was performed after application of ice massage or a no-ice control condition (independent variable). weight 82.4 ± 8. Each exercise session consisted of 10 maximum isokinetic flexions (MIF) of the right arm at 30°/s. All flexion torque values were measured by the same investigator from the recorder output using a vernier caliper to enhance the precision of measurement. the participants received a 10-minute ice massage over the anterior surface of the belly of the biceps brachii using an ice cup before performing the MIF. During the flexion movement.6 kg) volunteered to participate. The same investigator determined all biceps skinfold thicknesses over the midpoint of the muscle on the . Participants Eleven male college students (mean ± SD: age 20.

The level of significance for all tests was set at P < . and the average was used to represent the site. with post hoc analysis indicating that torque values at 4 and 8 minutes were significantly higher than at any other time.05) when the effect of skinfold thickness was removed (F10. Results The repeated-measures ANCOVA revealed no significant interaction between time and treatment condition (F10. The torque values versus time followed a third-order polynomial for both the no-ice (R2 = . Statistical Analysis A repeated-measures analysis of covariance (ANCOVA) was used to examine the differences in maximum torque produced between the treatment conditions throughout the 20-minute test interval while removing the influence of biceps skinfold thickness. Scott.001). There was a significant main effect for time (F10. 190 = 6.4 Borgmeyer. Figure 1 Average maximum isokinetic arm-flexion torque values (± 2 SE) every 2 minutes over a 20-minute interval with and without ice-massage treatment.74) conditions (Figure 1). 190 = 2.85) and ice-massage (R2 = . P < .05. . Three measurements were made. Tukey’s honestly significant difference post hoc test was used to identify differences when significance was noted.05). P > . A thirdorder polynomial was used to depict the trend lines.41. and Mayhew anterior side using a Harpenden skinfold caliper.00. P < . 190 = 1. The torque values at all other times were not significantly different from each other.94.

This greater increase in torque output in the ice-massage condition could be explained by a greater change in muscle temperature than in the control condition. the area of ice-cup application was approximately 30 cm2. the methods of measuring intramuscular temperatures differ so greatly among studies as to make comparisons of the effects practically impossible. which would have covered about half of the treatment area every second.0%) might have been the result of a general warm-up effect. Jutte et al16 found that intramuscular temperature continued to fall for several minutes after removal of the ice treatment. .Ice Massage and Torque 5 Discussion Cryotherapy is a therapeutic modality commonly used early in the rehabilitation process to expedite recovery from injury.⫻ 4-cm-square area (16 cm2). Zemke et al20 intimated that the area covered during ice massage should be a 4. What might be lacking from many of these reports of muscle-temperature changes is the duration of the effect after the ice application is removed.8% increase in torque production observed during the first 4 minutes of the ice-massage condition (no-ice condition increased only 1.4. The 6. The area covered in the current study was approximately 60 cm2. Missing from their report. we can assume that a treatment as short as 10 minutes can have a marked cooling effect over a small area. Because the internal temperature probe used by Zemke et al20 indicated that muscle temperature dropped about 3 °C in the first 10 minutes at a depth of 1. In the current study. because of its analgesic effects. The 9.16 however. there were some noteworthy variations between the 2 curves (Figure 1).5% lower torque output at time 0 for the ice-massage condition in the current study agreed with the 10% lower quadriceps-extension torque at 30 °/s noted by Howard et al19 and the 15% lower isometric arm-flexion strength noted by Cornwall.14 Thus. it appears that even a short-duration ice massage can be expected to slightly reduce force output in a muscle.6.21 The muscle might have a greater warmup effect and hence a slightly greater ability to produce force when the internal temperature has been depressed slightly. which could explain the lower torque production at time 0 in the ice-massage condition (Figure 1). because participants were not allowed any submaximal contractions before the MIF of the testing phase. were the area of the ice cup and the application rate. Although the general trends in torque output between the ice-massage and control conditions were not significantly different. however.7 cm.2 Our results indicated that a short-term ice massage did not significantly enhance or retard force output during a follow-up rehabilitation period. Although ice massage has been shown to produce a faster drop in deepmuscle temperature than an ice bag does. As pointed out by Jutte et al. is particularly useful because it can reduce pain quickly and allow greater range of movement in an injured area. Ice massage.

4 ± 2.6 thus allowing pain-free movement while the athlete receives maximum benefit from the exercise bout. however.6 Borgmeyer. it might be advisable to complete cryotherapeutic exercise within this time frame. Indeed. Analgesia would still be present in the injured area. and Mayhew The decline in torque output in both conditions from minutes 10 through 20 might represent a fatigue effect. Because torque output peaks at 4–8 minutes after an ice massage. the recovering athlete is unlikely to exceed the normal workload of a noncooled muscle. Although the present study found no significant torque changes as a result of ice massage for healthy individuals. whereas the no-ice condition had only a 4.15-17. but certainly a rough approximation of the skinfold layer could be used as a guideline for ice-massage duration. it is probably impractical to attempt to predict intramuscular temperature. which appeared to be slightly more pronounced after the ice massage (Figure 1).19 There is no clear explanation. the changes observed in a therapeutic setting might be sufficient to undermine the strengthening program. skinfold alone might not be the major determinant of the extent of temperature depression in muscle with ice application.20 Nonetheless. Because the interaction between time and treatment condition was not significant. Such a trend would agree with previous findings using isokinetic quadriceps-extension torque.22 Change in muscle temperature during cryotherapy treatments has been shown to be inversely related to skinfold thickness. for the sudden increase in torque in the final minute of exercise in the current study. it can be speculated that those with a thicker skinfold might be affected to a lesser degree by the constant-time ice-massage treatment because their muscle was more insulated from the cold. although there is some support for increased muscle endurance after cold treatment. 15-17 Myrer et al15 found the greatest decrease in muscle temperature to occur in individuals with skinfold values less than 8 mm. the biceps skinfold was a significant covariable contributing to explaining the differences in torque output. The average biceps skinfold in the current study (5. it is important that rehabilitation clinicians be aware of any alterations in strength associated with cryotherapy. if the trend established in the final few minutes of MIF had continued. these differences might be artifactual. there could have been a significant reduction in torque after ice massage. In any event. The ice-massage condition had a 12. precooling strength should not be compared with postcooling strength .17. Accordingly. Nevertheless. Thus.16 As Jutte et al16 point out. especially at higher velocities.0% decrease.20 Despite the small variability in skinfold values.23 implying that ice massage should be used only for its analgesic effects and not as a means of facilitating superior strength gains.5. The current research might have important implications for the applied rehabilitation setting.9% decrease in torque during this period.0 mm) would suggest that the 10-minute ice massage would be sufficient to decrease the internal muscle-tissue temperature by approximately 3–4 °C over small areas with minimal skinfold thickness. Scott.

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