CoolingPaper

Original effects on performance elite football DOI: https://doi.org/10.5114/biolsport.2022.102866

Effects of contemporary cryo-compression on post-training

performance in elite academy footballers
AUTHORS: Jill Alexander1, Jane Keegan1, Antony Reedy2, David Rhodes3 Corresponding author:
Jill Alexander
1 University of Central Lancashire
Sport, Nutrition and Clinical Sciences, School of Sport and Health Sciences University of Central Lancashire, School of Sport&Health Sciences
Preston, United Kingdom Preston, Lancashire, UK
2 E-mail: JAlexander3@uclan.ac.uk
Burnley Football Club, Gawthorpe Park, Burnley, Lancashire, United Kingdom
3
Institute of Coaching and Performance (ICaP), School of Sport and Health Sciences, University of Central
Lancashire, Preston, United Kingdom ORCID:
Jill Alexander
0000-0002-6492-1621
ABSTRACT: Fatigue is a predisposing risk factor for injury commonly investigated in elite football populations.
Little evidence advocates the most beneficial recovery strategies including contemporary cooling applications. David Rhodes
The aim of the study was to examine immediate effects of the Game Ready® on physiological and biomechanical 0000-0002-4224-1959
measures in a population of elite male academy footballers, following a fatiguing training session mid-competitive
season. Twenty, elite male footballers took part (180.2 ± 8.7cm, 75.0 ± 11.4kg, 18 ± 0.5years). Following
a normal fatiguing training session, players were randomly assigned to receive either cryotherapy (Game Ready®)
(20-minutes at medium compression (5–55 mm Hg)) or passive recovery (PAS). Data was collected at match-
day+1, immediately post-training and immediately post-intervention. Performance measures included
countermovement jump (CMJ), isometric adductor strength (IAS), hamstring flexibility (HF), and skin surface
temperature (Tsk). Significant main effects for group for CMJ data following exposure to cooling were displayed
(p = < 0.05). Individual group analysis displayed a significant reduction in CMJ performance in the group
exposed to cryotherapy (p = < 0.05) immediately post, but not for PAS. No main effects were identified for
cryotherapy or PAS group for IAS or HF (p = > 0.05). Tsk reduced significantly (p = < 0.05) in the cryotherapy
group, meeting therapeutic Tsk range. Reductions in performance immediately following exposure to pneumatic
cryo-compressive devices may negate the justification of this recovery strategy if neuromuscular mechanisms
are required in immediate short term. Application of such recovery strategies however are dependent on the
type of recovery demand and should be adapted individually to suit the needs of the athlete to optimise
readiness to train/play.
Key words:
Performance
CITATION: Jill Alexander, Jane Keegan, Antony Reedy, David Rhodes. Effects of contemporary cryo-compression Cryotherapy
on post-training performance in elite academy footballers. Biol Sport. 2022;39(1):11–17. Soccer
Football
Received: 2020-08-06; Reviewed: 2021-01-14; Re-submitted: 2021-01-14; Accepted: 2021-01-14; Published: 2021-02-18. Muscle Strength

INTRODUCTION
To optimise post-training recovery response to fatigue is desirable of reduced performance levels or perceptual indices of recovery in
and several strategies are proposed within the literature to prepare elite football/soccer. Equivocal evidence however fails to consolidate
athletes for in-season training demands [1, 2]. Perceptions and prac- understanding around the effects of cryotherapy on muscular function
tices used in the practical setting however are not always supported in relation to optimal recovery through performance markers.
by validated recommendations from research and vice versa [1]. A large proportion of practitioners administer CWI post daily train-
Without appropriate recovery strategies optimal competition perfor- ing and base the choice of modality on practicality and accessibili-
mance may be hindered or result in an increased risk of injury [3, 4]. ty [2]. Inappropriate periodisation or choice of cryotherapy modality
Between bouts of fatiguing exercise through competitive season train- however has the potential to impact negatively the adaptations in-
ing cycles, the maintenance of muscular performance and function tended from training [9, 10], despite known physiological benefits.
is required, and choice of recovery strategy or modality to achieve Dose-response in terms of duration of application presents further
this is important [3, 5]. The effects of cryotherapy as an acute re- disparities thus failing to present agreement on optimal recovery
covery strategy, measurable by performance parameters in sport, are protocols using cryotherapy. Many studies report on the use of
debated in terms of periodisation and impact following training [2, 6]. CWI [2, 11] on pertinent football performance parameters however
Typically, the application of cooling is often utilised with the aim to the same cannot be reported for many contemporary cryo-compres-
reduce the symptoms of fatigue [7, 8], mitigating the consequence sive devices, such as the Game Ready® (CoolSystems, Inc). A con-

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 Jill Alexander et al.

sensus on optimal protocols in terms of periodisation of cooling in the CRYO group consisted of the Game Ready® pneumatic-cooling
applications using cryo-compressive devices is also absent. device applied to both lower limbs (circumferentially wrapped around
To further the understanding on current recovery practices in elite the thigh) for a 20-minute dose with medium intermittent compres-
sport settings with the aim to develop cryotherapy protocols for sion (5–55 mm Hg). One Game Ready® base unit was used and
within-season post training recovery, the effects of contemporary two lower limb cuffs connected with a splitter device allowing for the
cryotherapeutic cooling devices on common performance parameters crushed ice and water contents to circulate both limb cuffs. Indi-
requires investigation. Conjecture in the current literature recommends viduals remained in a supine semi-recumbent position on a plinth
the investigation of cooling recovery modalities with the target of during application.
informing evidenced-based prescription around professional team
sport schedules [2]. The aim of the current study was to examine Physiological Measure
the immediate physiological and biomechanical performance effects Thermal images were taken of the hamstring and quadriceps of both
®
of the Game Ready as a recovery strategy in a population of male limbs before and after either intervention. Skin surface temperature
elite academy footballers, following a fatiguing training session dur- (Tsk) collected using Infrared Thermal Imaging (ThermoVision A40M,
ing mid-competitive season. Flir Systems, Danderyd, Sweden) followed standard protocol set up
of the TISEM guidelines [13] capturing three images per region of
MATERIALS AND METHODS interest (ROI) with analysis taking the mean average Tsk. Emissivity
Subjects settings were 0.97–0.98 following normal clinical approaches with
Twenty, elite male academy footballers volunteered to take part in the thermal imaging camera situated at 134cm from the ground
the study (height: 180.2 ± 8.7cm, weight: 75.0 ± 11.4kg, age: perpendicular to the lower limb [14]. Images of the anterior thigh
18 ± 0.5years). The purpose of the study was presented to each were taken initially, followed by the posterior thigh turning from
participant with an information sheet outlining the protocol. All play- a supine to prone position on the plinth. Over the anterior thigh a ROI
ers provided written and verbal consent to take part. All players met was determined by placing thermally inert markers providing a frame-
the inclusion criteria (academy age group footballer, healthy, male, work to quantify Tsk [15]. Location of markers included superiorly
no current injury to the lower limbs). Players were excluded from the (one-third way between anterior superior iliac spine (ASIS) and base
study if they presented with; current / history of lower limb injury/ of the patella) and inferiorly (two thirds way between ASIS and base
surgery in the last six months; female; outside academy age range, of the patella) with central anterior thigh determined by measure of
known neurological compromise to cold, such as Raynauds [12]. thigh circumference, 50% between ASIS and base of patella [14].
Ethical approval for the study was approved by the host university Posterior markers were applied in a similar fashion, applied superi-
and adhered to the Declaration of Helsinki (2013), data collected orly one-third from the ischial tuberosity to the lateral epicondyle of
was permitted for publication via the host football club. The same the femur and inferiorly two-thirds from the lateral epicondyle of the
researchers collected each data from the physiological and biome- femur to ischial tuberosity. Centre of the posterior thigh determined
chanical assessments throughout the study. by thigh circumference in the same approach as the anterior thigh
marker placement. Markers were then placed at 10% medially and
Testing Protocol laterally from these marker locations to complete a ROI for the pos-
Data collection took place in a rehabilitation testing suite at the terior thigh. To complete the ROI, markers were applied at 10% of
football club, mid-competitive academy season. Players were ran- the distance in lateral and medial directions from the centre of the
domly allocated to receive either passive recovery (PAS) (Group 1) thigh for both anterior and posterior regions.
or cryotherapy intervention (CRYO) (Group 2) post fatiguing exercise Ambient room temperature monitored at the point of testing for
coinciding with normal weekly training schedules (Table 1). Famil- each participant was measured to ensure consistency throughout
iarisation of the biomechanical and psychological assessments were testing and to monitor any fluctuations (21.8 ± 0.7°C).
not required as these tests are regularly performed by the squad and
participants therefore conversant of each outcome measure. Baseline Performance measures protocols
measures were collected at match day+1 consisting of hamstring CMJ height as a form of quantifying neuromuscular function was
flexibility (HF) via sit and reach test (SRT) (Apollo Sit & Reach Box), performed. Excellent test-retest reliability (ICC 0.982–0.989) has
neuromuscular function (NMF) through a countermovement-jump been demonstrated for the Optojump system [16] for field-based
(CMJ) (OptoJump System, Microgate, Bolzano, Italy) and isometric assessment of CMJ with acknowledgement in contemporary literature
adductor strength (IAS) quantified by a Sphygmomanometer (Disytest; as being the most accurate when comparing to other portable de-
Welch Allyn, Skaneateles, NY). Intervention of either PAS or CRYO vices used to measure neuromuscular parameters [17]. To perform
commenced on match day+3 following a fatiguing training session the CMJ participants positioned themselves in-between the infrared
(Table 1). PAS group consisted of 20-minutes laying still in a semi- platform (OptoJump System, Microgate, Bolzano, Italy) with both
recumbent position on a plinth. The cryotherapy intervention utilised feet (wearing trainers) on the ground, shoulder width apart with their

12
 Cooling effects on performance elite football

hands on their hips throughout the full CMJ [18]. To execute the main effects across all timepoints and interventions for biomechan-
jump players flexed their knees to their preferred starting push-off ical and physiological measures. Post-hoc analysis with a Bonfer-
position [19]. The decision to keep hands-on-hips was based upon onni correction for performance parameters explored any significant
the approach that suggests hands-on-hips isolates lower extremity main effects. To assess residual normality for each dependant vari-
force production and eliminating potential arm-swing and postural able, q-q plots were generated using stacked standardised residuals.
variations [18, 20]. Taking off from this position the participant was Scatterplots of the stacked unstandardized and standardised residu-
instructed to jump as high as they possibly could and landed back als were utilised to assess error of variance associated with the re-
on both feet. Trials were validated by the researcher through visual siduals. The assumptions associated with the statistical model were
inspection to ensure satisfactory landing and participants performed assessed to ensure model adequacy. Mauchly’s test of sphericity were
three trials, separated by 45 seconds of passive recovery [21]. Jump completed for all dependent variables, with a Greenhouse Geisser
height of each player was calculated by flight time (cm) and best correction applied if the test was significant. Partial eta squared (η2)
jump used for analysis [21]. values were calculated to estimate effect sizes for all significant main
effects and interactions. Partial eta squared was classified as small
Isometric Adductor Strength (IAS) (0.01–0.059), moderate (0.06–0.137), and large (> 0.138).
For IAS measures, participants lay in a semi-supine position, hips
flexed at 45°, with the sphygmomanometer placed in-between both RESULTS
legs at the medial aspect of the knees [22]. The sphygmomanom- Physiological Measures (Tsk)
eter was set to 10 mm Hg tension prior to each session [22]. When Overall analysis identified a significant main effect of group and time-
relaxed participants then squeezed the cuff in between their legs as point for quadriceps (Group: F = 93.38, p = < 0.00, ɳ2 = 0.940;
forcefully as they could for 3 seconds and a score was recorded. Timepoint: F = 84.69, p = < 0.00, ɳ2 = 0.966); and hamstrings
Tsk (Group: F = 2136.41, p = < 0.00, ɳ2 = 0.997; Timepoint:
Hamstring Flexibility (HF) F = 2060.27, p = < 0.00, ɳ2 = 0.999). Significant interaction
HF was quantified via the SRT (Apollo Sit & Reach Box). Participants was displayed for group x timepoint for quadriceps (F = 91.08,
removed their trainers to perform the SRT, in a half-sitting position p = < 0.00, ɳ2 = 0.968) and hamstrings Tsk (F = 1993.0,
with knees in full extension, and both feet flat against the SRT box. p = < 0.00, ɳ2 = 0.998). Statistically significant decreases in Tsk
The bar was slowly pushed as far as possible with palms facing down over the quadriceps and hamstrings ROI’s immediately post-inter-
and tips of fingers moving forwards [23]. To the nearest cm the range vention, compared to immediately post-training and baseline tem-
was calculated. Participants repeated the test once for analysis per peratures for the Cryo group were displayed (p = < 0.05). No sig-
each timepoint. nificant differences in Tsk were reported for the PAS group across any
timepoint (Table 2).
Statistical Analysis
Statistical analysis was performed using SPSS (Version 26.0) (SPSS Biomechanical Measures (CMJ, IAS, HF)
Inc, Chicago, IL). The statistical significance was set at p = ≤ 0.05 with Overall analysis for the biomechanical data set displayed significant
all data presented as mean ± (SD) with 95% confidence limits. main effects group (F = 5.005, p = 0.029, ɳ2 = 0.85), but not
A univariate repeated-measures general linear model quantified the timepoint (F = 1.028, p = 0.365, ɳ2 = 0.037) for CMJ. No

TABLE 1. Data collection protocol.

Weekly Post Match Day Training Schedule
Match Day +1 Match Day +2 Match Day +3 Scheduled Training
2. Post Training
1. Baseline Data Collected * No data collected
Time Point (1–3) 3. Immediately Post Intervention
Post training data collected *
Group 1 (PAS) Baseline Data Collected * No data collected
Immediately post (PAS) data collected *
GROUP
Post training data collected *
Group 2 (Cryo) Baseline Data Collected * No data collected
Immediately post (Cryo) data collected *

*Data collection at all timepoints consisted of; Performance measures = Countermovement Jump (CMJ); Isometric Adductor Strength
(IAS), Hamstring Flexibility (HF); Skin Surface Temperature (Tsk) of hamstring and adductors.

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 Jill Alexander et al.

TABLE 2. Descriptive (mean ± SD) for hamstring and quadriceps ROI, for both PAS and Cryo groups across all time points.
Time Point
Group ROI** Immediately Post Immediately post
Limb Baseline (Tsk) (°C)
Training (Tsk) (°C) intervention (Tsk) (°C)
LEFT 30.7 ± 1.5 30.2 ± 0.2 31.1 ± 0.8
Quadriceps*
RIGHT 30.1 ± 1.2 29.9 ± 0.5 30.0 ± 0.5
LEFT 30.9 ± 1.2 30.1 ± 0.9 30.2 ± 0.5
PAS Hamstrings*
RIGHT 30.5 ± 0.8 29.8 ± 0.8 30.1 ± 0.4
Average Tsk
30.5 ± 1.2 30.0 ± 0.6 30.2 ± 0.6
(quadriceps and hamstrings both limbs) (°C)
LEFT 30.1 ± 1.2 29.9 ± 1.1 10.8 ± 1.1
Quadriceps*
RIGHT 30.5 ± 1.3 30.1 ± 1.2 14.3 ± 1.2
LEFT 29.8 ± 1.3 30.6 ± 1.1 11.3 ± 1.3
Cryo Hamstrings*
RIGHT 29.5 ± 0.9 30.5 ± 1.2 12.8 ± 1.4
Average Tsk
29.8 ± 1.2 30.3 ± 1.2 12.3 ± 1.3
(quadriceps and hamstrings both limbs) (°C)

*Bilateral limb Tsk measures (mean ± SD). **ROI = Region of Interest. ***Significance at p = < 0.001

Table 3. Descriptive (mean ± SD) for biomechanical measures of CMJ, IAS and HF for both PAS and Cryo groups across all time
points.
TIMEPOINT
Percentage change
PERFORMANCE Immediately Post Immediately Post
GROUP Baseline (%) from IPT to IPI
PARAMETER Training (IPT) Intervention (IPI)
(match day+1) time point
(match day +3) (match day +3)
CMJ
35.1 ± 5.1 34.7 ± 5.5 35.2 ± 5.1 +1.43%
(Jump Height – cm)
PAS
HF (cm) 24.0 ± 5.5 22.4 ± 5.3 22.6 ± 4.7 +0.88%
IAS (mm Hg) 224.0 ± 41.9 231.9 ± 51.9 235.0 ± 55.8 +1.33%
CMJ
33.2 ± 4.7 33.8 ± 5.1 29.3 ± 4.2* -13.3%
(Jump Height – cm)
Cryo
HF (cm) 24.5 ± 5.6 24.1 ± 5.9 24.2 ± 5.9 +0.41%
IAS (mm Hg) 215.0 ± 41.9 215.0 ± 51.9 220.0 ± 71.3 +2.2%

CMJ = Countermovement Jump; IAS = Isometric Adductor Strength; HF = Hamstring Flexibility; *Significance at p = < 0.05 data
compared to baseline.

significant main effects were displayed for group or timepoint for IAS Collapse of the data into physiological and biomechanical data
(Group: F = 0.977, p = 0.327, ɳ = 0.018; Timepoint: F = 0.112,
2
for Cryo group displayed no significant effects for HF (F = 0.016,
p = 0.894, ɳ2 = 0.004) or HF (Group: F = 0.918, p = 0.342, p = 0.984, ɳ2 = 0.001), CMJ (F = 2.674, p = 0.87, ɳ2 = 0.165),
ɳ2 = 0.017; Timepoint: F = 0.68, p = 0.935, ɳ2 = 0.003). No or IAS (F = 0.026, p = 0.944, ɳ2 = 0.002). For the PAS group no
significant interactions were displayed between group x timepoint significant effects for HF (F = 0.281, p = 0.758, ɳ2 = 0.020), CMJ
for CMJ, IAS or HF (CMJ: F = 1.345, p = 0.269, ɳ2 = 0.047; IAS: (F = 0.018, p = 0.982, ɳ2 = 0.001), or IAS (F = 0.127, p = 0.881,
F = 0.030, p = 0.971, ɳ2 = 0.001, HF: F = 0.199, p = 0.820, ɳ2 = 0.009). A significant difference is displayed between Cryo and
ɳ = 0.007).
2
PAS groups for CMJ (p = 0.02) regardless of timepoint. Significant

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 Cooling effects on performance elite football

reductions in CMJ were reported between immediately-post training thigh region in this population. We can only presume intra-muscular
and immediately-post cooling timepoints (p = 0.04) for the Cryo response as this was not quantified in this study however, we con-
group (Table 3). No other significant differences at any other timepoint sider the significant reduction in CMJ in the CRYO group occurred
for Cryo group for CMJ data were reported (p = > 0.05). For the due to physiological changes in deeper structures required for feed-
PAS group no significant differences were displayed for CMJ, HF or back, altering neuromuscular biomechanical output, resulting in
IAS data when comparing between each timepoint (p = > 0.05). a reduced jump height. The effectiveness of recovery protocols is
The Cryo group displayed no significant differences between timepoint often quantified by neuromuscular function through various assess-
for IAS or HF (p = > 0.05). ment of contractile properties. Definitive conclusions as to the effects
of cryotherapy on neuromuscular performance however are problem-
DISCUSSION atic to draw based on available literature [26]. Previous studies
The study aimed to investigate the effects of a contemporary cryo- typically quantify the effects of CWI for recovery, using CMJ as
compressive cooling device compared to passive recovery on physi- a means of measuring neuromuscular performance [29, 30], this is
ological and biomechanical measures following a fatiguing training the first study to our knowledge that explores the Game Ready® quan-
session within an elite male academy football population. With tified in a comparable fashion. Results from the current study appear
physical performance known to decline following competitive match to represent similar findings by Hohenauer et al, (2016) [30], in
play in football [24, 25], optimal recovery strategies are therefore terms of time-course recovery at immediately post cold exposure,
paramount for readiness to train / play performance. Furthermore, although direct comparisons are limited due to differences in cold
the effects of congested schedules on performance and injury risk modality applied. Perceptual indices were not determined in the
may be heighted due to accumulative fatigue and literature encour- current study, which may, as [30] Hohenauer et al (2016) suggests,
ages the need for optimal recovery strategies [24]. Cryotherapy in influence objective performance measures. Quantification of wellbe-
many forms is used for recovery and is common practice within elite ing parameters should be considered in future study designs of
performance settings despite limited evidence for its efficacy or a similar nature to fully elucidate the impact and effects of recovery
use [26]. The current study observed several parameters, both phys- parameters.
iological and biomechanical in nature, representing typical monitor- Non-significant changes were displayed for IAS / HF for both
ing techniques used during a competitive football season with results groups, and only marginal trends suggesting better increases in
demonstrating significant main effects for group, for CMJ data fol- IAS measures following cooling compared to PAS depicted by small
®
lowing exposure to cooling (Game Ready ). Further analysis displayed percentage change from IPT to IPI (Table 3). It was considered,
significant reductions in CMJ performance (jump height) in the group compared to CMJ response however, that players felt more able to
exposed to cryotherapy (CRYO) (p = < 0.05) immediately post better perform isometric contraction following cooling due to an-
exposure following a fatiguing training session, the same was not algesic influence on muscle soreness levels, although perceptual
demonstrated in the PAS group. No main effects were identified for responses were not quantified in this study. The choice of perfor-
the CRYO or PAS group for IAS or HF (p = > 0.05). Results have mance measure, such as IAS is identified as a useful outcome
implications of decision-making for the use of the Game Ready® de- measure that sports medicine or performance practitioners may
vice to optimise its application as a recovery strategy compared to implement during a congested season for the assessment of play-
passive recovery in an elite football setting. Findings support the ers readiness to compete [31]. That said, eccentric contraction as
multifaceted approach of athlete monitoring in practice; replicated a damaging exercise and functional assessment of strength may
in research this helps determine response to common strategies ap- provide better representation of fatigue related to injury risk factors
plied in elite performance settings through relevant applied markers. in football and should be considered in future investigations of this
Tsk reduced significantly (p = < 0.05) in the CRYO group across nature as a relevant performance measure. Hohenauer et al,
both ROI’s (hamstring and quadriceps), compared to IPT timepoint, (2015) [7] concluded that evidence suggests after muscle damag-
meeting therapeutic Tsk range for physiological changes to ensue, ing exercise, compared to passive strategies, cooling is a superior
according to previous literature [27]. Similar Tsk responses after Game for recovery, although this conclusion was based on subjective
®
Ready applications are reported in recent literature [28] albeit vary- responses alone. Assessment of wellbeing through perceptual re-
ing slightly thought to be due to levels of compression adjunct between sponses to fatigue and recovery interventions may be beneficial in
the available protocols offered by the device and differences in meth- future studies to consider alongside physiological and biomechan-
odological approaches between studies. The Game Ready® protocol ical indices. In agreement with Ihsan et al (2020) [32] the sug-
chosen in the current study represented a typical application of con- gestion of CWI is contextual, and so should the application of
temporary cryo-compression method used in the club where data cryo-compressive devices in the same setting. A multifaceted ap-
was collected. Although Tsk was not consistent bilaterally (Table 2), proach to research design and parameters of measures is key to
results support this protocol if the target aim is to successfully reduce fully elucidate the influences on performance both positive and
Tsk to within therapeutic range circumferentially over the bilateral negative that cryotherapy modalities have. The trend of a small

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 Jill Alexander et al.

incremental increase in HF depicted by percentage change from Although not demonstrated in this exploratory study, individual
IPT to IPI in the PAS group, although non-significant, may be ex- analysis of response is important to establish. Average group analy-
plained by the impact cooling has on muscle mechanical properties sis as portrayed in the current study provides an approach too broad
through reduced stretch in muscle tissue [33]. The combination to provide crucial understanding within an applied sports performance
of objective and psychological measures for overall athlete response setting for individualisation of recovery protocols. In accumulation
to cryotherapy recovery strategies may provide further explanation these considerations in future research would benefit decision mak-
of biomechanical performances after exposure to such modalities. ing around not only periodisation of cooling modalities within normal
In addition to this, and a potential limitation in the current study training and playing schedules but the individual responses within
is the period of observation. It would be beneficial to consider elite populations. Baseline measures were taken at match day+1,
further assessment of performance measures again at 24-hours not pre-training, additional data at this timepoint may be more ben-
post training/intervention for example given the known temporal eficial as a comparison due to the expected reductions in objective
patterns of fatigue reported in football [25]. Future study design performance parameters so soon following a competitive fixture.
is recommended over a longer period of investigation, considering Table 3 therefore depicts percentage differences from IPT-IPI time-
multiple micro-cycles to determine cumulative effects of multiple points as an indication of the meaningful effects of the recovery
bouts of cryotherapy on several performance measures. Compari- strategies employed in the current study. These observations have
son of this protocol using methods such as CWI may be beneficial implications on future study design considering at what point data
in future investigations through the additional exploration of indi- is collected to optimally reflect key markers of athlete recovery with-
vidual athlete response. in mid-season micro-cycles.
Beneficial physiological responses to cooling following fatigue are
generally focused around the symptom reduction of delayed onset CONCLUSIONS
muscle soreness (DOMS) [34] or perceived fatigue [7]. Several Variable responses following exposure to the Game Ready® (20-min-
mechanisms explain the benefits of across many modes of cryo- utes, medium compression (5–55 mm Hg) bilateral (thigh)) compared
therapeutic exposures, including minimising muscle damage, inflam- to passive recovery across several performance measures suggest
mation [32] and soreness [35]. Optimal recovery may be determined individualisation of recovery strategies is important. Significant reduc-
by complex training load, fatigue and adaptation interactions [10]. tions in neuromuscular performance immediately following exposure
Modulated recovery therefore is complex and the effect on perfor- to pneumatic cryo-compressive devices may negate the justification
mance is contradictory in supporting the benefits for recovery [36]. of this recovery strategy if neuromuscular mechanisms are required
The outcomes of the current study suggest cryo-compression may in the short term. Application of such recovery strategies however
negate the potential to perform optimal neuromuscular function im- are dependent on the type of recovery demand and should be adapt-
mediately post exposure. Despite the physiological benefits high- ed to suit the needs of the athlete to optimise readiness to train/play.
lighted in literature, findings suggest biomechanical function is re- Future investigation into periodisation of contemporary cryo-com-
duced through the effect on neuromuscular response to cold. pressive modalities within training micro-cycles for recovery is required
Consequently, this may be detrimental to the athlete, emphasising over longer periods to fully elucidate temporal patterns. Multifacto-
the need for correct periodisation of cryo-compression for maximum rial measures generate better understanding to support or refute the
benefits of this modality. Although the current study supplements application of such methods currently practiced widely in elite foot-
current debate, it only observes the acute effects and a temporal ball performance settings. Future studies should consider individual
pattern of response is required to examine the effects of cryo-com- data analysis to establish optimal cry-compressive applications which
pressive recovery strategies over time (during a typical weekly micro- may be advantageous for the athlete in terms of individualisation of
cycle) or multiple dosages. Safer periods of rewarming prior to func- recovery programmes.
tional movements requiring optimal neuromuscular performance
following cryo-compression requires further investigation to optimise Conflict of Interest
understanding and periodisation. There are no conflicts of interest to declare.

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