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.
1

Borgmeyer, Scott, and Mayhew

analgesic effect by decreasing sensory perception, resulting in a higher

threshold for pain receptors.2 This reduced pain sensation is enough to
allow movement of the affected areas during treatment.4
One method commonly used to induce such an analgesic effect is ice
massage. This technique, which has been shown to be as effective as a cold
bath,4 is valuable in the clinical setting because it is readily available, inexpensive, and easy to administer. Early reports indicated that ice massage
could generate surface analgesia after approximately 4.5 minutes of application4 and would decrease muscle temperature quickly in the first 5 minutes.5 Although rapid superficial rewarming occurs immediately after a
conventional 5- to 10-minute ice massage, therapeutic exercise of the injured area can be completed during that brief interval.6 Because of these
general effects of cold application, ice massage has been used as an adjunct
in early intervention programs to allow overload resistance exercise to increase muscle strength.3
The limited empirical research concerning the effects of ice massage on
force production appears equivocal. Early studies have noted an increase
in strength after cold application.1,2,7-10 These cryotherapy-induced increases
can continue from approximately 5 minutes9 to 180 minutes after treatment.7 In addition, the chronic use of cold therapy before a daily isometric
training program might produce larger strength gains during the training
program than will thermotherapy. Not all studies, however, have produced
a force enhancement after cryotherapy treatment.8,9,11-14 More recent studies have shown that isometric force production,11,12 isokinetic strength,13
and peak force and rate of force development14 decreased immediately after a cold treatment.
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. Fat tissue might act as an insulator and prevent the
internal muscle temperature from dropping when cold is applied,15 although
this remains controversial.16 Part of this controversy might revolve around
the amount of adipose tissue present in the cooling area.17 Although it might
take longer to lower intramuscular temperature with greater subcutaneous adipose thickness,15,17 skinfold measurements might not be a major indicator of amount of temperature depression.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, particularly ice massage, on force production
as it might be used in a rehabilitation setting. Because isokinetic resistance
is a common technique used in rehabilitation,18 it would be of additional
interest to determine whether ice massage alters force output in this mode
of exercise. Therefore, 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.

Ice Massage and Torque 3

Methods
Research Design
A randomized, crossover design was used to assess the effect of the ice
massage on forearm-flexor force production. 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).

Participants
Eleven male college students (mean SD: age 20.9 1.1 years, height
179.9 5.0 cm, weight 82.4 8.6 kg) volunteered to participate. The participants had had no arm injuries within the preceding year and had no contraindications to the use of ice massage. The study was approved by the
Institutional Review Board for the Protection of Human Subjects, and all
participants signed informed-consent documents before testing.

Test Procedures
Each participant performed 2 randomly ordered exercise sessions 1 week
apart. Each exercise session consisted of 10 maximum isokinetic flexions
(MIF) of the right arm at 30/s, performed once every 2 minutes for 20
minutes. In one session, 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. 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. Because the ice treatment was applied for a constant time, no measure of surface numbness was determined. For the other
session, participants rested for 10 minutes and received no treatment before performing the MIF.

Instrument
Testing was completed on a Cybex II isokinetic dynamometer (division
of Lumex Inc, NY) at a dampening setting of 2, with force output recorded
on a strip-chart recorder at a paper speed of 25 cm/s on a torque scale of
40.7 N m. 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. During the flexion movement, participants
were instructed to look straight ahead and were given verbal encouragement throughout the exercise. 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 same investigator determined
all biceps skinfold thicknesses over the midpoint of the muscle on the

Borgmeyer, Scott, and Mayhew

anterior side using a Harpenden skinfold caliper. Three measurements were

made, and the average was used to represent the site.

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. Tukeys honestly significant difference post hoc test was used to identify differences when significance was
noted. The level of significance for all tests was set at P < .05.

Results
The repeated-measures ANCOVA revealed no significant interaction between time and treatment condition (F10, 190 = 1.41, P > .05) when the effect
of skinfold thickness was removed (F10, 190 = 2.94, P < .05). There was a significant main effect for time (F10, 190 = 6.00, P < .001), with post hoc analysis
indicating that torque values at 4 and 8 minutes were significantly higher
than at any other time. The torque values at all other times were not significantly different from each other. The torque values versus time followed
a third-order polynomial for both the no-ice (R2 = .85) and ice-massage
(R2 = .74) conditions (Figure 1).

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. A thirdorder polynomial was used to depict the trend lines.

Ice Massage and Torque 5

Discussion
Cryotherapy is a therapeutic modality commonly used early in the rehabilitation process to expedite recovery from injury. Ice massage, because of
its analgesic effects, is particularly useful because it can reduce pain quickly
and allow greater range of movement in an injured area.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 the general trends in torque output between the ice-massage and control conditions were not significantly different, there were some noteworthy variations between the 2 curves (Figure 1). The 6.5% 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.
Although ice massage has been shown to produce a faster drop in deepmuscle temperature than an ice bag does, Zemke et al20 intimated that the
area covered during ice massage should be a 4- 4-cm-square area (16
cm2). The area covered in the current study was approximately 60 cm2.
Missing from their report, however, were the area of the ice cup and the
application rate. In the current study, the area of ice-cup application was
approximately 30 cm2, which would have covered about half of the treatment area every second. 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 1.7 cm, we can assume that a treatment as
short as 10 minutes can have a marked cooling effect over a small area.
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.
Jutte et al16 found that intramuscular temperature continued to fall for several minutes after removal of the ice treatment, which could explain the
lower torque production at time 0 in the ice-massage condition (Figure 1).
The 9.8% increase in torque production observed during the first 4 minutes of the ice-massage condition (no-ice condition increased only 1.0%)
might have been the result of a general warm-up effect, because participants were not allowed any submaximal contractions before the MIF of
the testing phase. 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.4,6,21 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. As pointed out by Jutte
et al,16 however, the methods of measuring intramuscular temperatures
differ so greatly among studies as to make comparisons of the effects practically impossible.

Borgmeyer, Scott, and Mayhew

The decline in torque output in both conditions from minutes 10 through

20 might represent a fatigue effect, which appeared to be slightly more
pronounced after the ice massage (Figure 1). The ice-massage condition
had a 12.9% decrease in torque during this period, whereas the no-ice condition had only a 4.0% decrease. Because the interaction between time and
treatment condition was not significant, these differences might be artifactual. Indeed, if the trend established in the final few minutes of MIF had
continued, there could have been a significant reduction in torque after ice
massage. Such a trend would agree with previous findings using isokinetic
quadriceps-extension torque, especially at higher velocities.19 There is no
clear explanation, however, for the sudden increase in torque in the final
minute of exercise in the current study, although there is some support for
increased muscle endurance after cold treatment.22
Change in muscle temperature during cryotherapy treatments has been
shown to be inversely related to skinfold thickness.5, 15-17 Myrer et al15 found
the greatest decrease in muscle temperature to occur in individuals with
skinfold values less than 8 mm. The average biceps skinfold in the current
study (5.4 2.0 mm) would suggest that the 10-minute ice massage would
be sufficient to decrease the internal muscle-tissue temperature by approximately 34 C over small areas with minimal skinfold thickness.17,20 Despite the small variability in skinfold values, the biceps skinfold was a significant covariable contributing to explaining the differences in torque
output. Thus, 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.15-17,20 Nonetheless,
skinfold alone might not be the major determinant of the extent of temperature depression in muscle with ice application.16 As Jutte et al16 point
out, it is probably impractical to attempt to predict intramuscular temperature, but certainly a rough approximation of the skinfold layer could be
used as a guideline for ice-massage duration.
The current research might have important implications for the applied
rehabilitation setting. Because torque output peaks at 48 minutes after an
ice massage, it might be advisable to complete cryotherapeutic exercise
within this time frame. Analgesia would still be present in the injured area,6
thus allowing pain-free movement while the athlete receives maximum
benefit from the exercise bout. Nevertheless, the recovering athlete is unlikely to exceed the normal workload of a noncooled muscle,23 implying
that ice massage should be used only for its analgesic effects and not as a
means of facilitating superior strength gains.
In any event, it is important that rehabilitation clinicians be aware of
any alterations in strength associated with cryotherapy. Although the
present study found no significant torque changes as a result of ice massage for healthy individuals, the changes observed in a therapeutic setting
might be sufficient to undermine the strengthening program. Accordingly,
precooling strength should not be compared with postcooling strength

Ice Massage and Torque 7

when assessing patient progress because of possible alteration in forceoutput capacity. Moreover, the numbness produced by the ice massage
might mask the pain associated with the injury.

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