The Influence of Circulating Cold Water Cryotherapy With or Without Intermittent Pneumatic Compression on Shoulder Joint Position Sense (JPS) in Recreationally Active Adults: a Randomized Crossover Trial

Objectives
Cryotherapy is a widely used intervention in sports settings to facilitate the return of injured athletes to competition, despite a lack of high-quality evidence. Given the possibility cryotherapy may increase the risk of injury, by reducing nerve conduction velocity, muscle force production, and proprioceptive afferent information, further research is needed to evaluate its effects on proprioception, particularly in the shoulder joint, which has the greatest range of motion of any joint in the body, where there is a dearth of studies.

Methods
We conducted a pre-registered, 1:1 block randomized, baseline controlled, double blind (outcome assessor and statistician), crossover trial of cryotherapy without compression and cryotherapy with compression.

Results
Analysis indicated there were no statistically significant changes in the accuracy of achieving the target angle because of either the cryotherapy or compression intervention. The small effect sizes observed between the groups indicate that cryotherapy is unlikely to have a clinically significant negative impact on shoulder joint position sense.

Conclusion
Consequently, returning athletes to the field of play after cryotherapy treatment is not expected to pose an increased risk of injury due to proprioceptive deficits. These findings align with the majority of studies investigating the effects of cryotherapy on proprioception.

Impact Statement
This pre-registered, randomized, crossover trial on the effects of cryotherapy on joint position sense (JPS) in physical therapy and rehabilitation provides valuable insights into a widely used treatment modality. The small effect sizes observed in our study suggest that cryotherapy is unlikely to have a clinically significant negative effect on shoulder JPS. Cryotherapy remains a viable therapeutic option, without concerns for adverse effects or further injury risk, in returning athletes to the field of play.