The development of clinical interventions for knee injury management, using a novel cooling, heating, and compression device

Greenhalgh, Olivia (2023) The development of clinical interventions for knee injury management, using a novel cooling, heating, and compression device. Doctoral thesis (PhD), Manchester Metropolitan University in collaboration with the University of Central Lancashire.

Preview

Available under License Creative Commons Attribution Non-commercial No Derivatives. Download (5MB) | Preview

Abstract

Background: Cryotherapy and compression are advised within guidelines for injury management. However, optimum methods of applying cryotherapy have not been defined and authors have advocated a ‘personalised’ intervention approach. With a novel cooling, heating, and compression device (CHCD) offering control of temperature and compression, it is possible to explore the effect of a range of interventions for knee injury management. Methods & Results: Study 1 explored four 20-minute CHCD interventions on skin surface temperature (Tsk), oxygenation, thermal sensation/comfort, muscle strength, pressure pain threshold (PPT) and joint position sense (JPS), in a randomised crossover design on 26 healthy male subjects. The four interventions were: 1) 10 °C & 50 mmHg 2) 15 °C & 50 mmHg 3) 10 °C & 32 mmHg 4) alternating 10-40 °C & 25-50 mmHg. Interventions set at 10 °C achieved Tsk within the therapeutic range. Despite no significant differences in Tsk between the two compression settings, intervention 1 was perceived to be the coldest. Study 2 investigated the effects of two 20-minute interventions, A) wetted ice and B) CHCD (10 °C & 50 mmHg), on quadriceps strength, PPT, JPS and participant-perceived pain, in 10 healthy participants with experimentally induced knee pain. Complete pain relief (≥93% reduction) was achieved immediately post-cooling in 7 participants for the CHCD and in 4 participants for ice. Significant increases in PPT were found following the CHCD, up to 20-minutes post-cooling. Ice reduced strength by 13% immediately post-cooling, however the CHCD had a negligible effect on strength post-cooling (+0.3%). Significant increases were found in range of motion in the coronal plane following ice, indicating increased instability. Study 3 investigated the effects of A) wetted ice and B) CHCD (10 °C & 50 mmHg), on participant-reported pain, swelling and stability, through a series of 11 single-case experiments, using an alternating treatment design. The CHCD intervention achieved clinically important changes more frequently than the ice intervention for patient-reported pain (by 9%), swelling (by 21%) and patient-reported stability (by 3%). Conclusion: Compressive cryotherapy using the CHCD at 10 °C with 50 mmHg, appeared more beneficial for the majority (82%) of individuals with knee injuries, for reducing swelling and pain, compared to ice. Targeted compressive cryotherapy, using the novel CHCD, may contribute to greater clinical management of knee injuries.