215 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 © Global Society of Scientific Research and Researchers http://asrjetsjournal.org/ Perception of Track and Field Athletes on the Use of Cryotherapy in Injury Management in Ashanti Region of Ghana Monday Omoniyi Mosesa*, Peter Akwasi Sarpongb, John Kwame Segedec, Eric Junior Appiahd, Francis Oseie, Lady Gwendoline Akwaf a,b,c,d,e.fDepartment of Sports and Exercise Science, Faculty of Allied Health Sciences, Kwame Nkrumah University Science and Technology, Kumasi,+233,Ghana aEmail: moniy152002@yahoo.com bEmail: Peter.bishop1@gmail.com cEmail: hopesego@ymail.com dEmail: loverisheric@gmail.com eEmail: oseifrancis7@gmail.com fEmail: akwalady@gmail.com Abstract The use of cryotherapy in injury management (IM) has been widely studied but report on track and field athletes’ (TFAs) perception in Ghana remains scarce. TFAs in Ashanti region of Ghana habitually sustained acute injuries due to competition stressors that typically affect peak performance like in other contact games. Despite been observed that sustained injuries accomplished cryotherapy treatment, TFAs’ visit to non-clinical therapy nonetheless remain prominent. This cross-sectional study therefore documents the perceptions of TFAs on the use cryotherapy in IM. Ninety five [mean age = 22.26±1.10years, 59 (62.1%) males, 36(37.9%) females] TFAs camped at the Babayara Sports stadium Kumasi in preparation for 11th African Games were purposively sampled. Self-structured and validated instrument on the use of cryotherapy in IM was administered to elicit TFAs perceptions. TFAs perceived the use of cryotherapy in IM as significant [F = 788.884, X2 = 404.192, df = 94, p = .000]. ------------------------------------------------------------------------ * Corresponding author. http://asrjetsjournal.org/ American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 216 Gender influence on TFAs perception of use of cryotherapy in IM was not significantly different. Mainstream significantly professed at least a good feeling (79.0%, X2 = 37.000, p = 000) after receiving cryotherapy treatment. As such, attachement of Physical Therapists to the TFAs training sessions in Ashanti region, provision of enabling environment and equipment to enhance effective IM processes through cryotherapy are strategic approaches advocated. Keywords: Perception; Uses of cryotherapy; Athletics; Injury management. 1. Introduction The use of cryotherapy in injury management (IM) has been extensively studied [1-4]. These studies have showed that cryotherapy is a low-cost and modest operative method to reprieve pains from acute sports injuries [5-8]. Since LaStayo and his colleagues [9] had earlier affirmed that mechanical stress imposed on active skeletal muscles during athletic events sometimes leads to high force of muscular contractions associated with muscle damage, then any direct competition stressor to sarcolemma, sarcomeres, excitation-contraction coupling system, and connective tissue would negatively affect optimal athletic performance [10- 12]. Water immersion, cold air, packaged crushed ice and evaporating spray are some of the common cold devices reported [13] and these devices are noticeably administered on injured athletes during sporting events in Ghana. Pains, edema, inflammation, tissue temperature, metabolism, muscle stiffness and nerve conduction velocity would decrease contingent on the cryotherapy procedure used [3, 13-15]. Nevertheless, the effectiveness of cryotherapy applications can only be measured through optimal performance of athletes after such treatment [16 – 18]. Regardless of the method applied, systematically reviewed literatures found that cryotherapy benefits athletes after both local and whole body therapy [4, 15, 19-21]. Ashanti, a developing region within a poorly resourced country like Ghana, would need a cost effective IM techniques like cryotherapy to rehabilitate injury sustained by most of the TFAs who bring honour to Ghana, besides soccer. TFAs in Ashanti region of Ghana habitually sustained acute injuries due to competition stressors (physical, physiological and environmental) that typically affect peak performance like in other contact games. In the event of injury induced disruptions, TFAs supposed to look forward to medics for professional feat to ensure immediate management and rehabilitation. TFAs in Ashanti region run contrary to this expectation perhaps previous experiences yielded negative results. Despite authors’ personal observation that sustained injuries accomplished cryotherapy treatment, phenomenal issues appeal for resolution. “How would TFAs describe their knowledge about cryotherapy? Which components form the source of their knowledge? Have they been treated with cryotherapy more than once? Which types of cryotherapy devices are in used? Who applied cryotherapy devices on the injury sustained? How long was cryotherapy applied? How would TFAs describe their feelings during and after treatment with cryotherapy? How would they describe their performance after cryotherapy treatment?” Could it possibly be for the anecdote reason that Ghana authorities are just not doing enough or give minimum attention to motivate TFAs? The aforementioned issues need to be well addressed based on qualitative perception of the athletes concerned. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 217 Few of the perceptional [22] and cryotherapy [23] related studies in Ghana, not even in Ashanti region, have not previously reveal TFAs perception on the use of cryotherapy in IM. Hence, the needs to elucidate the perception of TFAs to the use of this cost effective IM technique become imperative. 2. Materials and Methods 2.1 Participants This descriptive cross-sectional design survey is meant to qualitatively describe the perception of TFAs on the use of cryotherapy in IM. The Ashanti regional camp of Ghana for the 11th African Games was initially opened to all TFAs in the region at Babayara Sports stadium Kumasi where screening and assessment for fitness were carried out. After the screening and assessment exercises, ninety five [59, 62.1% males and 36, 37.9% females] TFAs who met the final selection list of the coaches purposively served as study participants. The participants included 32 (33.7%) sprinters, 18(18.9%) middle distance runners, 22 (23.2%) long distance runners, 14 (14.7%) throwers and 9 (9.5%) jumpers. Authors had initial visit and verbal discussions with the athletes and their coaches on the importance of the study. Informed consent form was given to the athletes to sign and date of instrument administration was agreed upon after signed consent form retrieved. 2.2 Instrument Self-structured close ended instrument, “Use of Cryotherapy Perception Questionnaire (UCPEQ)”, was administered. UCPEQ has 9 items, apart from demographic information of age, marital status and length of play, which focused on the perception of TFAs on the broad use of cryotherapy in IM with emphasis on general knowledge on cryotherapy (items 1 and 2), frequency of cryotherapy usage (item 3), type of cryotherapy devices in use (items 4-6), feelings during (item), after cryotherapy administration (item 8) and post therapy sport performance (items 9). Responses to each question items differ based on the nature of anticipated inquiry. UCPEQ items were exposed to factor analysis (Table 1) to identify highly correlated and latent relationship between them. Kaiser-Meyer-Olkin and Bartlett’s Test showed item sampling adequacy = .624, Chi-Square = 102.014, df = 36, p=.000. To further ensure reliability, UCPEQ was subjected to strict parallel reliability test which gave unbiased reliability scale value of 0.76. UCPEQ was administered to TFAs at the Babayara Sports stadium in Kumasi, the Ashanti regional capital, after a morning training sessions and independent responses ensured through direct monitoring. 2.3 Statistical Analysis Qualitative statistical analyses were carried out using IBM SPSS software for windows 20.0 version, USA. Mean, standard deviation, distribution differences in age, marital status, length of play and significance of TFAs perception were analysed using Chi-square test. Score differences among UCPEQ items was analysed using Friedman ANOVA test because response were based on ordinal scale [24] while gender differences was measured using independent t-test reported at 95% level of significance. American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 218 Table 1: Factor Matrix Analysis on UCPEQ S/N Items Factor 1 2 3 4 1 How will you describe your knowledge about cryotherapy? .562 .091 .228 -.126 2 Which of the following form the source of your knowledge? -.303 .428 .005 -.033 3 Have you being on cryotherapy more than once? .393 -.208 .000 .134 4 Which of these form your basis of using cryotherapy? .708 .014 -.342 -.002 5 Who applied cryotherapy on you when injured? -.417 -.246 .404 .569 6 How long is cryotherapy applied? .232 .029 -.122 .026 7 How will you describe your feeling during cryotherapy? .164 .200 -.038 .278 8 After treatment with cryotherapy how did you feel? .401 -.097 .037 -.098 9 How will you describe your performance after cryotherapy treatment? .539 .534 .420 -.034 3. Results Complete 28 (29.5%) were aged 15-19years, 32(33.7%) aged 20 – 24years, 19(20.0%) fell between 25 – 29yrs, 14(14.7%) were aged 30 – 34yrs while 2.1 %( 2/95) were aged 35yrs and above. Although 60(63.2%) of the TFAs were single, 35(36.8%) have experience of below 5yrs, 31(32.6%) between 5 – 9yrs, 12(12.6%) between 10 – 14yrs, 11(11.6%) between 15 – 19yrs, as against only 1(1.1%) with experience of 35yrs and more (Table 2). Table 2: Distributions of the Participants Demographic Data Variables Categorizations Freq. (%) Chi-Square P-value Age 15yrs-19yrs 28(29.5) 29.684 .000* 20yrs-24yrs 32(33.7) 25yrs-29yrs 19(20.0) 30yrs-34yrs 14(14.7) 35yrs+ 2(2.1) Marital Status Single 60(63.2) 53.200 .000* Married 33 (34.7) Divorced 2 (2.1) Length of Play Below 5yrs 35(36.8) 86.632 .000* 5yrs-9yrs 31(32.6) 10yrs-14yrs 12(12.6) 15yrs-19yrs 11(11.6) 20yrs-24yrs 3(3.2) 25yrs-29yrs 2 (2.1) 35yrs+ 1 (1.1) *Significant at 0.05 There was significance differences in age (X2 = 29.684, p = .000), marital status (X2 = 53.200, p = .000) and length of play (X2 = 86.632, p = .000) distributions (Table 2). American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 219 Table 3: Chi-Square analysis on TFAs Perception on the use of Cryotherapy in IM S/N Categorization Freq. (%) X2 P-value 1. Poor 2(2.1) 43.263 (df=4) .000* Weak 7(7.4) Average 26(27.4) Good 37(38.9) Excellent 23(24.2) 2. Ice water immersion 7(7.4) 72.779 (df=6) .000* Refreezable chemical gel packs 26(27.4) Ice massage 35(36.8) Aerosol sprays 5(5.3) Crushed ice in a plastic bag 17(17.9) Salicylic acid 2(2.1) Not sure 3(3.2) 3. Yes 50(52.6) 0.263 (df=1) .608 No 45(47.4) 4. Active swelling 38(40.0) 49.663 (df=2) .000* Inflammatory reaction 56(58.9) Continuous bleeding 1(1.1) 5. Coach 23(24.2) 42.211(df=4) .000* Athletic trainer 42(44.2) Team doctor 11(11.6) Physiotherapist 7(7.4) Friends 12(12.6) 6. Below 10days 77(81.1) 164.326(df=3) .000* 11-20days 15(15.8) 21-30days 2(2.1) 31days+ 1(1.1) 7. Painful 32(33.7) 118.916(df=5) .000* Chilly 48(50.5) Burning sensation 5(5.3) Blistering 3(3.2) Scarring 3(3.2) Others 4(4.2) 8. Very unhappy 3(3.2) 59.474 (df=4) .000* Unhappy 2(2.1) Indifferent 19(20.0) Happy 40(42.1) Very happy 31(32.6) 9. Poor 3(3.2) 37.000(df=3) .000* Average 17(17.9) Good 41(43.2) Excellent 34(35.8) *Significant at 0.05 Table 4: Friedman ANOVA Test on TFAs Perception on the use of Cryotherapy in IM Sources Sum of Squares df Mean Square Friedman's Chi-Square P-value Between Subject 101.467 94 1.079 404.192 .000* Within Subject 788.884a 8 98.611 Residual 694.449 752 .923 Total 1483.333 760 1.952 1584.800 854 1.856 *Significant at 0.05 American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 220 Score differences on TFAs Perception of the use of Cryotherapy in IM were statistically significant [F = 788.884, X2 = 404.192, df= 94, p = .000] (Table 4). Perceptions of TFAs on the use of cryotherapy in IM were statistically significant (p = .000) as shown in Table 3. Table 5: Gender comparison on TFAs Perception on the use of Cryotherapy in IM Question items’ S/N Gender Mean ±SD Std. Error Mean t-value P 95%CI 1. Male 3.56±1.02 .133 -2.618 .010* -.921, -.148 Female 4.08±.81 .134 2. Male 3.32±1.49 .194 1.260 .211 -.218, .973 Female 2.94±1.29 .214 3. Male 1.50±.50 .066 .864 .390 -.119, .303 Female 1.41±.50 .083 4. Male 1.64±.52 .067 .817 .416 -.127, .304 Female 1.56±.50 .084 5. Male 2.49±1.37 .178 .889 .376 -.298, .781 Female 2.25±1.13 .188 6. Male 1.17±.46 .059 -1.457 .149 -.387, .059 Female 1.33±.63 .105 7. Male 2.12±1.42 .184 .781 .437 -.311, .715 Female 1.92±.81 .134 8. Male 3.95±.97 .127 -.527 .599 -.507, .294 Female 4.06±.92 .154 9. Male 3.01±.78 .102 -.737 .463 -.468, .215 Female 3.19±.86 .143 *Significant at 0.05 4. Discussion This study documents the perception of track and field athletes (TFAs) in Ashanti region of Ghana on the use of cryotherapy in injury management (IM). All the TFAs had experienced using cryotherapy at least once (Table 3). This endorses the popularity, widely acceptance and utilization of cryotherapy in injury management as earlier established [4, 8]. Based on average level of cognizance and above, 80.5% (86) of the study sample are knowledgeable of the use of cryotherapy in IM. This percentage indicates good awareness level which support previous findings on cryotherapy as a common treatment modality for post-acute soft tissue injury [6-8, 25]. Realising the values of a given medication (cryotherapy) would create a level of leverage for effective professional practices. Although ice water immersion maybe unpopular, our results show that 7.4% (7) of the TFAs had personal experienced with its application. Personal experience with circumstances is one of the best scientific strategies to imbibe culture of usage in human endeavours. 58.9% (56) of the population sample acceded to inflammatory reaction as their cryotherapy utilisation indicator. Chronic inflammatory reactions are common injury conditions adjudged to be detrimental to athletic performance at any level of competition. Its prominent in this study is in American Scientific Research Journal for Engineering, Technology, and Sciences (ASRJETS) (2017) Volume 28, No 1, pp 215-224 221 agreement with Pournot and his colleagues [26] and Ramos and his colleagues [27] reports that strenuous exercises encourages upsurge in the pro-inflammatory cytokines Tumor Necrosis Factor alpha (TNF-α) and interleukin 1 Beta (IL-1β) and a dramatic increase in the inflammation responsive cytokine interleukin 6 (IL-6). Quantitative analysis of the responses in this study sample reveals that Athletic Trainers (42, 44.2%) and Coaches (23, 24.2%) top the list of professionals administering cryotherapy respectively ahead of team doctor and physiotherapist. This could reflect the issue surrounding availability or accessibility of few experts (medics) in Ghana. This calls for concerns about the effectiveness of treatment that will not be counterproductive. Although there are few experts, our results reveal that 77(81.1%) and 15(15.8%) of the TFAs admitted cryotherapy treatment on their injuries lasted for less than 10days and 11-20days respectively which concord with previous studies [21, 26-30] that frequent cryotherapy treatment each day over 5 days lessen IL-2, IL-8, CK, prostaglandin E2 (PGE2) activity, and display augmented condensation of anti-inflammatory cytokines (IL- 10) in peripheral blood. Relating to the issues of disposition after cryotherapy treatment, 40(17.9%) of the study sample were happy and 31(32.7%) very happy which indicate that 74.7% satisfaction were achieved. Also 96.9% of the TFAs describe their performances after cryotherapy treatment as average (17, 17.9%), good (41, 43.2%) and excellent (34, 35.8%). The TFAs in this study perceived cryotherapy as effective in the treatment of painful and chilly symptoms in sustained injury (Table 4). This affirmed the results of previous research works [8, 15, 31-32]. 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