title: Changes of Achilles midportion tendon microcirculation after repetitive simultaneous cryotherapy and compression using a Cryo/Cuff.
abstract: BACKGROUND
  Cryotherapy and compression have been shown to decrease pain and improve function. The dosage and timing of these options remain unclear.
  
  
  OBJECTIVE
  To examine the effects of a standardized compression and cryotherapy device (Cryo/Cuff) on midportion Achilles tendon microcirculation during intermittent administration.
  
  
  METHODS
  Descriptive laboratory study.
  
  
  METHODS
  Twenty-six subjects were included (13 men and 13 women; age, 32.3 +/- 12 years; body mass index, 25.4 +/- 5 kg/m(2)). Each underwent three 10-minute applications of the device, followed by a 10-minute recovery period. A continuous real-time assessment of parameters of Achilles tendon midportion microcirculation was performed with a laser Doppler spectrophotometry system.
  
  
  RESULTS
  Superficial tendon oxygen saturation dropped significantly from 35.9 +/- 21 arbitrary units (AU) to 13.5 +/- 15, 15.9 +/- 16, and 11.1 +/- 11 AU (P = .0001) during each period of cryo-compression, respectively. There was significant increase during the recovery period (55.4 +/- 29, 65.2 +/- 26, and 65.7 +/- 27 AU; P = .003), up to +83% of the baseline level. At 8-mm tendon depth, cryo-compression preserved local oxygen with -4% (P = .001) of the baseline level and small but significant increased oxygen saturation of up to +13% (P = .0001). Relative postcapillary venous tendon filling pressures were favorably reduced both superficially (57% +/- 34%, 67% +/- 27%, and 64% +/- 38%, respectively; P = .0004) and deep (76% +/- 13%, 79% +/- 11%, and 78% +/- 18%, respectively; P = .0002). Superficial capillary blood flow was reduced from 48.4 +/- 48 to 5 +/- 7, 4 +/- 5, and 3 +/- 4 AU at each period, respectively (-94%, P = .0003), with increased flow during recovery periods of up to 58 +/- 64, 58 +/- 79, and 47 +/- 71 AU, respectively (+20%, P = .265). Deep flow was reduced from 197 +/- 147 to 66.7 +/- 64, 55 +/- 46, and 43 +/- 39 AU, respectively (-78%, P = .0002) without increase during recovery periods.
  
  
  CONCLUSIONS
  Cryo/Cuff exerts beneficial effects on the microcirculatory level of the midportion Achilles tendon with decreased capillary blood flow, preserved deep tendon oxygen saturation, and facilitated venous capillary outflow.
authors.affiliation: Trauma Department, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. kknobi@yahoo.com
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
authors.forename: Ruth
authors.initials: R
authors.lastname: Grasemann
authors.forename: Michael
authors.initials: M
authors.lastname: Jagodzinski
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
authors.forename: Johannes
authors.initials: J
authors.lastname: Zeichen
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
mesh_terms: D000125:Achilles Tendon / Q000098:blood supply*; D000328:Adult; D003131:Combined Modality Therapy; D017679:Cryotherapy; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008833:Microcirculation; D010100:Oxygen / Q000097:blood; D011312:Pressure; D011446:Prospective Studies; D019233:Retreatment; D013053:Spectrophotometry
chemical_list: D010100:Oxygen