Lasers in Medical Science

, Volume 31, Issue 9, pp 1925–1933 | Cite as

Photobiomodulation therapy (PBMT) and/or cryotherapy in skeletal muscle restitution, what is better? A randomized, double-blinded, placebo-controlled clinical trial

  • Paulo Roberto Vicente de Paiva
  • Shaiane Silva Tomazoni
  • Douglas Scott Johnson
  • Adriane Aver Vanin
  • Gianna Móes Albuquerque-Pontes
  • Caroline dos Santos Monteiro Machado
  • Heliodora Leão Casalechi
  • Paulo de Tarso Camillo de Carvalho
  • Ernesto Cesar Pinto Leal-JuniorEmail author
Original Article


Cryotherapy for post-exercise recovery remains widely used despite the lack of quality evidence. Photobiomodulation therapy (PBMT) studies (with both low-level laser therapy and light-emitting diode therapy) have demonstrated positive scientific evidence to suggest its use. The study aims to evaluate PBMT and cryotherapy as a single or combined treatment on skeletal muscle recovery after eccentric contractions of knee extensors. Fifty healthy male volunteers were recruited and randomized into five groups (PBMT, cryotherapy, cryotherapy + PBMT, PMBT + cryotherapy, or placebo) for a randomized, double-blinded, placebo-controlled trial that evaluated exercise performance (maximum voluntary contraction (MVC)), delayed onset muscle soreness (DOMS), and muscle damage (creatine kinase (CK)). Assessments were performed at baseline; immediately after; and at 1, 24, 48, 72, and 96 h. Comparator treatments was performed 3 min after exercise and repeated at 24, 48, and 72 h. PBMT was applied employing a cordless, portable GameDay device (combination of 905 nm super-pulsed laser and 875- and 640-nm light-emitting diodes (LEDs); manufactured by Multi Radiance Medical, Solon - OH, USA), and cryotherapy by flexible rubber ice packs. PBMT alone was optimal for post-exercise recovery with improved MVC, decreased DOMS, and CK activity (p < 0.05) from 24 to 96 h compared to placebo, cryotherapy, and cryotherapy + PBMT. In the PBMT + cryotherapy group, the effect of PBMT was decreased (p > 0.05) but demonstrated significant improvement in MVC, decreased DOMS, and CK activity (p < 0.05). Cryotherapy as single treatment and cryotherapy + PBMT were similar to placebo (p > 0.05). We conclude that PBMT used as single treatment is the best modality for enhancement of post-exercise restitution, leading to complete recovery to baseline levels from 24 h after high-intensity eccentric contractions.


Phototherapy Low-level laser therapy Light-emitting diodes Performance Exercise recovery 


Compliance with ethical standards


Professor Ernesto Cesar Pinto Leal-Junior would like to thank Sao Paulo Research Foundation—FAPESP (grant number 2010/52404-0) and Brazilian Council for Science and Technology Development—CNPq (grant numbers 472062/2013-1 and 307717/2014-3). Paulo Roberto Vicente de Paiva would like to thank Sao Paulo Research Foundation—FAPESP master degree scholarship (grant number 2014/04557-2).

Competing interests

Professor Ernesto Cesar Pinto Leal-Junior receives research support from Multi Radiance Medical (Solon, OH, USA), a laser device manufacturer. Douglas Scott Johnson is an employee and shareholder of Multi Radiance Medical (Solon, OH, USA). The remaining authors declare that they have no conflict of interests.


  1. 1.
    Enoka RM, Duchateau J (2008) Muscle fatigue: what, why and how it influences muscle function. J Physiol 586:11–23CrossRefPubMedGoogle Scholar
  2. 2.
    Lightfoot JT, Char D, McDermott J, Goya C (1997) Immediate postexercise massage does not attenuate delayed onset muscle soreness. J Strength Cond Res 11:119–124Google Scholar
  3. 3.
    Halson Shona L, Bartram J, West N, Stephens J, Argus CK, Driller MW, Sargent C, Lastella M, Hopkins WG, Martin DT (2014) Does hydrotherapy help or hinder adaptation to training in competitive cyclists. Med Sci Sports Exerc 46:1631–1639CrossRefPubMedGoogle Scholar
  4. 4.
    Cochrane DJ (2004) Alternating hot and cold water immersion for athlete recovery: a review. Phys Ther Sport 5:26–32CrossRefGoogle Scholar
  5. 5.
    Nelson AG, Driscoll NM, Landin DK, Young MA, Schexnayder IC (2005) Acute effects of passive muscle stretching on sprint performance. J Sports Sci 23:449–454CrossRefPubMedGoogle Scholar
  6. 6.
    Isabell WK, Durrant E, Myrer W, Anderson S (1992) The effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness. J Athl Train 27:208–217PubMedPubMedCentralGoogle Scholar
  7. 7.
    Hohenauer E, Taeymans J, Baeyens JP, Clarys P, Clijsen R (2015) The effect of post-exercise cryotherapy on recovery characteristics: a systematic review and meta-analysis. PLoS ONE 10, e0139028CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW (2012) Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev 2, CD008262Google Scholar
  9. 9.
    Leal-Junior EC, Vanin AA, Miranda EF, de Carvalho PT, Dal Corso S, Bjordal JM (2015) Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis. Lasers Med Sci 30:925–939CrossRefPubMedGoogle Scholar
  10. 10.
    Borsa PA, Larkin KA, True JM (2013) Does phototherapy enhance skeletal muscle contractile function and postexercise recovery? A systematic review. J Athl Train 48:57–67PubMedPubMedCentralGoogle Scholar
  11. 11.
    Miranda EF, de Oliveira LV, Antonialli FC, Vanin AA, de Carvalho PT, Leal-Junior EC (2015) Phototherapy with combination of super-pulsed laser and light-emitting diodes is beneficial in improvement of muscular performance (strength and muscular endurance), dyspnea, and fatigue sensation in patients with chronic obstructive pulmonary disease. Lasers Med Sci 30:437–443CrossRefPubMedGoogle Scholar
  12. 12.
    Antonialli FC, De Marchi T, Tomazoni SS, Vanin AA, dos Santos GV, de Paiva PR, Pinto HD, Miranda EF, de Tarso Camillo de Carvalho P, Leal-Junior EC (2014) Phototherapy in skeletal muscle performance and recovery after exercise: effect of combination of super-pulsed laser and light-emitting diodes. Lasers Med Sci 29:1967–1976CrossRefPubMedGoogle Scholar
  13. 13.
    Miranda EF, Vanin AA, Tomazoni SS, Grandinetti Vdos S, de Paiva PR, Machado Cdos S, Monteiro KK, Casalechi HL, de Tarso P, de Carvalho C, Leal-Junior EC (2016) Using pre-exercise photobiomodulation therapy combining super-pulsed lasers and light-emitting diodes to improve performance in progressive cardiopulmonary exercise tests. J Athl Train 51:129–135CrossRefPubMedGoogle Scholar
  14. 14.
    Pinto HD, Vanin AA, Miranda EF, Tomazoni SS, Johnson DS, Albuquerque-Pontes GM, Aleixo Junior IO, Grandinetti VD, Casalechi HL, de Carvalho PT, Leal-Junior EC (2016) Photobiomodulation therapy (PBMT) improves performance and accelerates recovery of high-level rugby players in field test: a randomized, crossover, double-blind, placebo-controlled clinical study. J Strength Cond ResGoogle Scholar
  15. 15.
    Vanin AA, Miranda EF, Machado CS, de Paiva PR, Albuquerque-Pontes GM, Casalechi HL, de Tarso Camillo de Carvalho P, Leal-Junior EC (2016) What is the best moment to apply phototherapy when associated to a strength training program? A randomized, double-blinded, placebo-controlled trial: phototherapy in association to strength training. Lasers Med SciGoogle Scholar
  16. 16.
    Núñez SC, Garcez AS, Suzuki SS, Ribeiro MS (2006) Management of mouth opening in patients with temporomandibular disorders through low-level laser therapy and transcutaneous electrical neural stimulation. Photomed Laser Surg 24:45–49CrossRefPubMedGoogle Scholar
  17. 17.
    Oliveira P, Sperandio E, Fernandes KR, Pastor FA, Nonaka KO, Renno AC (2011) Comparison of the effects of low-level laser therapy and low-intensity pulsed ultrasound on the process of bone repair in the rat tibia. Rev Bras Fisioter 15:200–205CrossRefPubMedGoogle Scholar
  18. 18.
    da Costa Santos VB, de Paula RS, Milanez VF, Corrêa JC, de Andrade Alves RI, Dias IF, Nakamura FY (2014) LED therapy or cryotherapy between exercise intervals in Wistar rats: anti-inflammatory and ergogenic effects. Lasers Med Sci 29:599–605CrossRefPubMedGoogle Scholar
  19. 19.
    Camargo MZ, Siqueira CP, Preti MC, Nakamura FY, de Lima FM, Dias IF, Toginho Filho D de O, Ramos S de P (2012) Effects of light emitting diode (LED) therapy and cold water immersion therapy on exercise-induced muscle damage in rats. Lasers Med Sci 27:1051–1058Google Scholar
  20. 20.
    Leal Junior EC, de Godoi V, Mancalossi JL, Rossi RP, De Marchi T, Parente M, Grosselli D, Generosi RA, Basso M, Frigo L, Tomazoni SS, Bjordal JM, Lopes-Martins RA (2011) Comparison between cold water immersion therapy (CWIT) and light emitting diode therapy (LEDT) in short-term skeletal muscle recovery after high-intensity exercise in athletes—preliminary results. Lasers Med Sci 26:493–501CrossRefPubMedGoogle Scholar
  21. 21.
    Grandinétti Vdos S, Miranda EF, Johnson DS, De Paiva PR, Tomazoni SS, Vanin AA, Albuquerque-Pontes GM, Frigo L, Marcos RL, de Carvalho PT, Leal-Junior EC (2015) The thermal impact of phototherapy with concurrent super-pulsed laser and red and infrared LEDs on human skin. Lasers Med Sci 30:1575–1581CrossRefPubMedGoogle Scholar
  22. 22.
    Lau WY, Muthalib M, Nosaka K (2013) Visual analog scale and pressure pain threshold for delayed onset muscle soreness assessment. J Musculoskelet Pain 21:320–326CrossRefGoogle Scholar
  23. 23.
    Lau WY, Blazevich AJ, Newton MJ, Wu SS, Nosaka K (2015) Assessment of muscle pain induced by elbow-flexor eccentric exercise. J Athl Train 50:1140–1148CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Dannecker EA, Koltyn KF (2014) Pain during and within hours after exercise in healthy adults. Sports Med 44:921–942CrossRefPubMedGoogle Scholar
  25. 25.
    Baroni BM, Leal Junior EC, De Marchi T, Lopes AL, Salvador M, Vaz MA (2010) Low level laser therapy before eccentric exercise reduces muscle damage markers in humans. Eur J Appl Physiol 110:789–796CrossRefPubMedGoogle Scholar
  26. 26.
    Graham CA, Stevenson J (2000) Frozen chips: an unusual cause of severe frostbite injuy. Br J Sports Med 34:382–383CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Moeller JL, Monroe J, McKeag DB (1997) Cryotherapy-induced common peroneal nerve palsy. Clin J Sport Med 7:212–216CrossRefPubMedGoogle Scholar
  28. 28.
    Bassett FH 3rd, Kirkpatrick JS, Engelhardt DL, Malone TR (1992) Cryotherapy-induced nerve injury. Am J Sports Med 20:516–518CrossRefPubMedGoogle Scholar
  29. 29.
    Pournot H, Bieuzen F, Duffield R, Lepretre PM, Cozzolino C, Hausswirth C (2011) Short term effects of various water immersions on recovery from exhaustive intermittent exercise. Eur J Appl Physiol 111:1287–1295CrossRefPubMedGoogle Scholar
  30. 30.
    Elias GP, Varley MC, Wyckelsma VL, McKenna MJ, Minahan CL, Aughey RJ (2012) Effects of water immersion on posttraining recovery in Australian footballers. J Sports Physiol Perform 7:357–366Google Scholar
  31. 31.
    Yamane M, Teruya H, Nakano M, Ogai R, Ohnishi N, Kosaka M (2006) Post-exercise leg and forearm flexor muscle cooling in humans attenuates endurance and resistance training effects on muscle performance and on circulatory adaptation. Eur J Appl Physiol 96:572–580CrossRefPubMedGoogle Scholar
  32. 32.
    Leal Junior EC, Lopes-Martins RA, Baroni BM, De Marchi T, Rossi RP, Grosselli D, Generosi RA, de Godoi V, Basso M, Mancalossi JL, Bjordal JM (2009) Comparison between single diode low-level laser therapy (LLLT) and LED multi-diode (cluster) therapy (LEDT) applications before high-intensity exercise. Photomed Laser Surg 27:617–623CrossRefPubMedGoogle Scholar
  33. 33.
    Leal Junior EC, Lopes-Martins RA, Rossi RP, De Marchi T, Baroni BM, de Godoi V, Marcos RL, Ramos L, Bjordal JM (2009) Effect of cluster multi-diode light emitting diode therapy (LEDT) on exercise-induced skeletal muscle fatigue and skeletal muscle recovery in humans. Lasers Surg Med 41:572–577CrossRefPubMedGoogle Scholar
  34. 34.
    Sellwood KL, Brukner P, Williams D, Nicol A, Hinman R (2007) Ice-water immersion and delayed-onset muscle soreness: a randomised controlled trial. Br J Sports Med 41:392–397CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Hayworth CR, Rojas JC, Padilla E, Holmes GM, Sheridan EC, Gonzalez-Lima F (2010) In vivo low-level light therapy increases cytochrome oxidase in skeletal muscle. Photochem Photobiol 86:673–680CrossRefPubMedGoogle Scholar
  36. 36.
    Albuquerque-Pontes GM, Vieira Rde P, Tomazoni SS, Caires CO, Nemeth V, Vanin AA, Santos LA, Pinto HD, Marcos RL, Bjordal JM, de Carvalho PT, Leal-Junior EC (2015) Effect of pre-irradiation with different doses, wavelengths, and application intervals of low-level laser therapy on cytochrome c oxidase activity in intact skeletal muscle of rats. Lasers Med Sci 30:59–66CrossRefPubMedGoogle Scholar
  37. 37.
    Santos LA, Marcos RL, Tomazoni SS, Vanin AA, Antonialli FC, Grandinetti Vdos S, Albuquerque-Pontes GM, de Paiva PR, Lopes-Martins RÁ, de Carvalho Pde T, Bjordal JM, Leal-Junior EC (2014) Effects of pre-irradiation of low-level laser therapy with different doses and wavelengths in skeletal muscle performance, fatigue, and skeletal muscle damage induced by tetanic contractions in rats. Lasers Med Sci 29:1617–1626CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Paulo Roberto Vicente de Paiva
    • 1
    • 2
  • Shaiane Silva Tomazoni
    • 3
  • Douglas Scott Johnson
    • 4
  • Adriane Aver Vanin
    • 1
    • 5
  • Gianna Móes Albuquerque-Pontes
    • 1
    • 2
  • Caroline dos Santos Monteiro Machado
    • 1
  • Heliodora Leão Casalechi
    • 1
  • Paulo de Tarso Camillo de Carvalho
    • 1
    • 2
    • 5
  • Ernesto Cesar Pinto Leal-Junior
    • 1
    • 2
    • 5
    Email author
  1. 1.Laboratory of Phototherapy in Sports and ExerciseUniversidade Nove de Julho (UNINOVE)São PauloBrazil
  2. 2.Postgraduate Program in Biophotonics Applied to Health SciencesUniversidade Nove de Julho (UNINOVE)São PauloBrazil
  3. 3.Department of PharmacologyUniversity of São PauloSão PauloBrazil
  4. 4.Multi Radiance MedicalSolonUSA
  5. 5.Postgraduate Program in Rehabilitation SciencesUniversidade Nove de Julho (UNINOVE)São PauloBrazil

Personalised recommendations