Kylie Palermo, Kate Wiens, Rick Hill
Searching for evidence on cold whirlpools and ankle sprains was difficult. There was very little research on the subject and whirlpool treatment in general. In order to fully understand the effect a cold whirlpool treatment will have on a sprained ankle, more research must be conducted.
Articles in support of cold whirlpool
An article I found in favor of cold whirlpool treatment for the treating of ankle injury was a narrative review (“The physiological basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner.” PMID: 16858479). This article discussed a study that showed that cold whirlpool resulted in a greater decrease in swelling than an ice pack did. The study stated cold whirlpool was more effective both one day and four days into treatment.
One article I found in favor of using a cold whirlpool treatment for treating ankle sprains was a study that compared using a cold whirlpool to an ice pack (“Temperature changes in the human leg during and after two methods of cryotherapy.” PMID: 16558480) To interpret this article as providing support, you have to already be on board with using cryotherapy of some kind as a modality to treat ankle sprains. Given that, this study found that a cold whirlpool was better than an ice pack in producing sustained temperature declines in tissue, which would give a therapist more time to work with a patient after applying the modality.
The article: “Comparison of three treatment procedures for minimizing ankle sprain swelling” Physical Therapy July 1988 vol. 68 no. 7 1072-1076 concluded that cold immersion therapy is a better option than heat or contrast baths. It should be noted that with all 3 treatment modalities, there was still an increase in edema. However, cryotherapy is the best option for minimizing edema before exercising.
Articles against cold whirlpools
The article: “Localized whirlpool folliculitis in a football player.” Cutis. 2000 Jun;65(6):359-62 PMID:10879303 described the poor sanitation of whirlpools. Pseudomonas aeruginosa folliculitis is an infection associated with whirlpools. Coaches and trainers should use new water for each player and washing the foot prior to the tub. In reality, these precautions are not very feasible due to time constraints, resources, and the size of a football team. In conclusion, whirlpools are not the best cryotherapy modality due to the high presence of bacteria.
An article that suggests cold whirlpool treatment would not be good for the treatment of ankle injuries discusses the gravity-dependent position (“Volume decreases after elevation and intermittent compression of post acute ankle sprains are negated by gravity-dependent positioning.” PMID: 14737214). This article discussed both previous experiments and the performed experiment. Although it stated the effects of elevation may not be sustainable for a long period of time, it had multiple resources stating that a gravity-dependent position will inhibit a reduction in lower extremity swelling. This suggests that the gravity-dependent position of a cold whirlpool for an ankle sprain would be counterproductive. Instead, a form of cryotherapy combined with elevation would be more effective in reducing swelling.
One article I found against using a cold whirlpool treatment for treating ankle sprains was a systematic review (“Managing ankle sprains in primary care: what is best practice? A systematic review of the last 10 years of evidence” http://bmb.oxfordjournals.org.proxy.kumc.edu:2048/content/97/1/105.full) which didn’t mention cold whirlpools, or cryotherapy of any kind, at all. This could suggest that when it comes to best practices, there isn’t any evidence to support the use of cryotherapy generally, or cold whirlpools in particular, to manage ankle sprains.
This article looked at the effectiveness of different modalities that heat tissue on PROM of the hip flexors vs. active exercise. The study used a stationary bike for active exercise, and then used warm whirlpool and moist heat pack for thermotherapy modalities. The study revealed a significant difference in the hip flexion PROM gains between the active exercise groups and the thermotherapy modality groups. Each group gained PROM, but the active exercise group gained a significantly higher amount of PROM in the hip flexors. Therefore, this study refutes the use of warm whirlpool if the therapist has to decide between using warm whirl pool or active exercise in order to gain PROM.
ReplyDeleteHanson, M., & Day , J. (n.d.). Effects of different heating modalities on hip flexion passive range of motion. (2012). International Journal of Athletic Therapy & Training, 17(6), 27-30. doi: NLM UID: 101558270
I found a systematic review that discusses the effects of local cooling agents on functional performance. Most of the studies involved the use of cold water immersion/whirlpool for 20 minutes or longer. Functional tests were measured either before and after cold application or with a control group vs. cold treatment group. Decreased muscle strength was reported in the majority of studies, and there is also evidence of adverse effects on speed, power, and agility-based activities. So, athletes may have limited performance when returning to activity immediately after a cooling treatment greater than 20 minutes. The review did indicate that there was significant heterogeneity among studies, and hardly any controlled for bias. There is also current research that suggests applying/ingesting cooling agents prior to competition in a hot environment has a positive effect on endurance/aerobic performance. So, more research in this area would be beneficial to therapists treating athletic injuries.
ReplyDeleteThe article referenced above:
ReplyDeleteBleakley, C., Costello, J. & Glasgow, P. Should athletes return to sport after applying ice? (2012). Sports Medicine 42(1), 69-87. PMID: 22121908