Bicep and Rotator Cuff Tendinopathy Rehab

Bicep and Rotator Cuff Tendinopathy Rehab

By Kevin Masson MSc, CSCS, CPT, USAW, FMS

Rehabilitation for bicep and rotator cuff tendinopathy often involves several steps. These problems are most common in people who push themselves to the limits with lifting, either through powerlifting at the gym or lifting on the job.

Tendinopathy is most likely to occur when overloading them, either by using them too much injures the tendons or lifting too much weight with them. The tendon describes the connective fibers gathered together between your muscle and your bone. If you look at a picture of the musculoskeletal system, you will notice the muscles are made of red and white tissue. The red area is the meat of the muscle, and the white area is the tendon.

When an injury occurs, the body will work to heal the tendon. Sometimes, injuries will heal on their own. When a week or more passes, without definite signs of improvement, tendinopathy may be setting in.

Tendinopathy typically describes symptoms of tendon injury that are chronic, meaning they last long-term. The symptoms can be constant or occur intermittently. Once this happens, rest is not enough, and rehabilitative therapy becomes necessary to prevent surgical intervention. Traditional methods do not usually work with bicep and rotator cuff tendinopathy.

To encourage healing, one of the most effective methods of treatment is a combination of dry needling and corrective eccentric exercise. Dry needling describes the insertion of thin needles into the muscle and tendon to encourage relaxation that is necessary for healing. It is often used in conjunction with a stretching therapy. For tendinopathy, corrective eccentric exercise is one of the most effective techniques. It involves stretching and contracting the muscle and tendon to encourage blood flow to the area and allow healing.


What is Rehab Therapy for Bicep and Rotator Cuff Tendinopathy?

Rehab therapy is an intervention for an injury when the body does not seem to be fulfilling its natural healing process. This is a common problem with tendons when there is not enough blood flow to the area. Blood carries the nutrients, hormones, and growth factors to the injury so it can heal. Unfortunately, the traditional methods like rest, ice and heat therapy, inflammation treatment, and others do not work well for tendinopathy. This is when alternative options, like dry needling and eccentric exercise, may be used.

Symptoms of Tendinopathy

Repetitive motions with the shoulder can cause tendinopathy over time. It also commonly happens to powerlifters, which place heavy loads on their muscles. The symptoms associated with tendinopathy include:

    Thickening or mild swelling of the tendon, especially near the joint

    Tenderness or pain in the joint and surrounding shoulder area

    Restricted motion of the joint, difficulty performing certain motions with your arm

    Stiffness of the shoulder and upper arm

If you are experiencing these symptoms for more than 7-10 days, it is likely that chronic tendinopathy may become a problem in the future. Also, be wary of extreme pain or swelling and an inability to move the shoulder—this could be a ruptured tendon.

Problems with Traditional Methods of Treatment

Many of the traditional treatments for bicep and rotator cuff tendinopathy target stopping inflammation. The problem is that inflammation is common with tendinitis, not tendinopathy. Inflammation does not usually happen when the tendon is overloaded or overstretched like happens with tendinopathy.

However, though inflammation is common with tendinitis, it is not common with tendinopathy. In fact, slight swelling of the tendon is a good thing, since it indicates the body trying to heal itself. The reason that traditional methods do not work is because many of them target inflammation, not the tightening and thickening that happens with tendinopathy.

Rest is also frequently recommended in overuse cases, especially for muscles. The problem is that resting will not heal tendinopathy—it just temporarily settles the pain. Once you return to normal activities, it is likely your condition will flare up.

Other common approaches use passive techniques, including shockwave therapy, various types of massage, injections, and therapeutic ultrasound. These are rarely effective and repeated muscle injections can make tendinopathy harder to treat.

Stages of Tendinopathy

Tendinopathy is a condition that can get progressively worse the longer that it goes untreated, especially in instances where the muscle continues to be used. The first stage is known as reactive tendinopathy, which describes the time following the injury. If the tissue is working to heal itself as it should, then the disease may not progress past this point, and the patient may make a full recovery.

Following this stage is tendon disrepair, which happens when the muscle continues to be overused and overworked. This causes pain and tearing. The reason that the area does not always heal during this stage is because the rate that the injury is being worsened through use is greater than the rate the tendon is healing at. The tissue is attempting to heal in this stage, but it is not getting sufficient rest with proper exercise to encourage the process. Without proper treatment, it may progress to degenerative tendinopathy.

Degenerative tendinopathy of the bicep and rotator cuff begins with cell death in the area. This is primarily caused by the lack of healthy blood flow and critical healing factors to the area. This is the first of the ‘worse’ types of tendinopathy, because, at this point, the injury may not heal. If you experience cell death in the area, it may be one of the last chances that you have to find an effective treatment that encourages healing. Otherwise, it can cause a tendon rupture or tear.

Tendon rupture describes extreme tissue breakdown that is usually accompanied by an inability to use your shoulder. If tendinopathy progresses to this stage, surgery is usually the only thing that can fix it. For this reason, it is highly recommended that you attempt other forms of therapy, including the often-effective process of dry needling paired with corrective eccentric exercise.


Dry Needling

Dry needling is done to inactivate or release tense muscles and tendons, using myofascial trigger points in the body. Its name comes from its use of a needle without medicines, thus a needle that is ‘dry.’ Once the area has been effectively relaxed, rehabilitative therapy can begin to increase the range of motion and strengthen the area.

What is Dry Needling?

Dry needling involves the insertion of a thin, filament needle past the skin and into the muscular and connective tissues. This is done to stimulate myofascial trigger points, which are located in and around the muscle, beneath the skin’s surface.

Bicep and rotator cuff tendinopathy requires areas in the shoulder to be targeted for effectiveness. The goal is to insert the needle into the tight band of muscle, which is the tightened or thickened tendon, that is found in the shoulder muscle group. You should expect some pain when these are touched.

How Dry Needling Works

When you suffer an injury, such as overloading the tendon between the bicep and rotator cuff, the tissues of the body will try to heal themselves. Slight swelling and inflammation are often good signs, indicating the beginning of the healing process. Following this, the body starts to heal and reconstruct the injured tissue.

The problem is that because the tendons between the bicep and rotator cuff are so active, it can be hard for them to heal correctly. The contraction of tissue, inflammation, adhesions in the surrounding area, and scar development all play a role in improper healing—which may result in soft tissue dysfunction. When this happens, chronic tendinopathy may develop.

The problem is the soft tissue dysfunction inhibits further healing, which can make traditional massage methods and manual manipulation of the area ineffective. Additionally, the dysfunction decreases blood circulation, a common problem in the rotator cuff area. The decrease of blood flow and other fluids flowing into and out of the area discourages future healing. When the circulation is impeded completely, the injured area may also suffer from weakness and deformation, which can alter movement patterns, increase pain, and make it difficult or impossible to use the muscle.

The location of the bicep and rotator cuff tendon can cause it difficult receiving blood supply even before an injury. This can be corrected by dry needling. Dry needling techniques target the problem area with the filament needles, which penetrate where manual manipulation cannot. The small lesions that are created stimulate the body’s healing response, despite the low blood flow. This causes the body to secrete blood factors and proteins necessary for tissue healing. It is generally believed that there is little to no pain associated with dry needling.

Dry Needling vs. Acupuncture

Though the two practices seem similar, it is important to note that dry needling and acupuncture are very different processes. While each of these techniques involves insertion of a thin needle into a specific area of the body, this is where the similarities end.

Acupuncture has roots in Traditional Chinese Medicine. Though it is used to treat a variety of conditions, it focuses heavily on the flow of energy (called Qi) through the body. It is believed that stress, toxins, and other factors can affect the flow of Qi and cause pain, sickness, and ailments.

Dry needling is based on scientific studies conducted using principles of Western medicine. The goal is to cause the body to send healing elements like critical nutrients, growth factors, and cells to the area, which is necessary for healing to occur.

Corrective Eccentric Exercise

This type of therapy takes advantage of eccentric muscle action, which is a lengthening of a muscle from a position of contraction or tension. For example, imagine that you are standing on your toes and then coming back to a flat-footed stance. Standing up your toes contracts the calf muscles. When you return to the flat-footed position, the lowering motion causes the calf muscles to lengthen again—this is the eccentric muscle action.

Why Eccentric Exercises Work

Muscles have two parts—the red, meaty part that makes up the main area of the muscle also called “the belly” of the muscle and the white area, which represents the tissue of the tendons. When you perform an action, the red muscle is strengthened through muscle shortening. By contrast, active muscle lengthening stresses and strengthens the tendon. Since bicep and rotator cuff tendinopathy affects the tendon, targeting this area is more effective than other methods of stretching that have been studied for treatment.

The goal of corrective exercise for tendinopathy is to encourage blood flow and healing of the tissue. This is done by:

    Relaxing the Tissue- Relaxation is incredibly essential for corrective exercise. When the tendon is already suffering pain and tightness, working it without relaxation can worsen the injury.

    Stretching the Tissue- When the tendon is stretched, it must be done gently. Anything greater than a gentle stretching can tear the area and cause worse problems.

    Strengthening the Tissue- Once the tissue has been stretched, it must be strengthened. The strengthening process works as it would with any muscle—it is broken down through physical activity. Then, the body sends healing factors and nutrients to rebuild the muscle, stronger than it was before.

A Note About Eccentric Corrective Exercise and Pain

If you are already struggling with bicep and rotator cuff tendinopathy, then pain may be a familiar feeling. When you are doing exercises, you should expect some pain. This should be muscle pain and feel like soreness or burning from exertion. What you should not feel is pinching or pain in the joints. This could indicate irritation of the problem or impingement of a joint or nerve, which can cause irreversible damage.

Dry Needling and Eccentric Corrective Exercise in Practice

When using dry needling and corrective eccentric exercise, there is one primary focus—healing. As the bicep and rotator cuff tendon is encouraged to heal, it will eliminate the symptoms used in the techniques, including pain, stiffness, and limited motion.

What to Expect: Dry Needling

Sessions of dry needling are usually spaced 5-7 days apart. During the session, the specialist inserts very thin needles into designated areas of the muscle. It is left in until the muscle starts to relax. The process is continued, targeting different areas until the muscle relaxes completely.

You should expect the muscles and tendons in your problem area to be sore following dry needling therapy. This will feel similar to the soreness from overworking the area like you would when lifting at the gym or at work. The pain can last as little as a few hours or as much as two days. Moist heat or ice is recommended for this pain.

It is highly advised that you follow your physical therapist’s instructions after the dry needling to improve your tendinopathy. An exercise regimen is prescribed following the treatment—some PTs will recommend you start working it as soon as it is no longer sore, while others will do 2-3 courses of dry needling (to see its effectiveness) before recommending exercise. The next section will go over one of the most effective exercise regimens for bicep and rotator cuff tendinopathy rehab—eccentric corrective exercise.

What to Expect: Eccentric Corrective Exercise

Exercise is something that should be done under the watchful eye of a physical therapist (PT) when you are experiencing a condition like a tendinopathy, which can become worse if the tendon is exercised the wrong way. Usually, a 3-part process of relaxation, stretching, and strengthening will be used for rehabilitation of the tendon.

For the relaxation, a technique called Trap Release may be used. Here, the PT will stand behind you and place their hand on your shoulder. They will instruct you move your shoulders in a slow, rolling motion. As you go around and into the lowest position, the PT will press down with 3-5 pounds of pressure on your shoulder.

A stretching exercise that may be used involves stretching the pectoral muscles. This will gently stretch the rotator cuff and bicep as well. Start by placing your hands on the back of your head, either laying your hands on top of one another or interlacing your fingers. Spread your elbows out to the sides of your head, feeling the stretch in your chest and shoulders. The PT will touch the backside of your elbow and gently pull it backward, deepening the stretch in your pectoral muscles. Then, they may ask you to try and press your elbows forward while they resist your movement. This creates a contraction, which is the goal of eccentric stretching.

Once you have finished stretching, strengthening is done. The strengthening exercises prescribed vary, but generally, they involve slightly increasing the weight that the bicep and rotator cuff tendon can support. Weight resistance exercises are more common that lifting for this during early treatment since they have a lower likelihood of injury.

For many patients, dry needling coupled with eccentric corrective exercise provides adequate pain relief and healing for bicep and rotator cuff tendinopathy rehab. Dry needling helps relieve pain and relax the tendon, while the exercise helps relax, stretch, and strengthen the area. The problem with traditional methods is that they may not target the tendon appropriately. By trying this method, you may encourage healing and avoid surgical intervention.



What is a Tendinopathy?. (2018). Physioworks.com.au. Retrieved 1 May 2018, from https://physioworks.com.au/FAQRetrieve.aspx?ID=38256

Gabriella Ode, M. (2018). What Is the Difference Between Tendonitis, Tendinosis, and Tendinopathy?Sports-health. Retrieved 1 May 2018, from https://www.sports-health.com/sports-injuries/general-injuries/what-difference-between-tendonitis-tendinosis-and-tendinopathy

Andres, B., & Murrell, G. (2008). Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon. Clinical Orthopaedics And Related Research466(7), 1539-1554. https://dx.doi.org/10.1007/s11999-008-0260-1

Krey, D., Borchers, J., & McCamey, K. (2015). Tendon needling for treatment of tendinopathy: A systematic review. The Physician And Sportsmedicine43(1), 80-86. https://dx.doi.org/10.1080/00913847.2015.1004296

Dry Needling Is The Next Big Thing In Physical Therapy. (2018). Dr. John Rusin – Exercise Science & Injury Prevention. Retrieved 1 May 2018, from https://drjohnrusin.com/dry-needling-physical-therapy/

Why is Semi-Private Coaching Catching Heat?

Why is Semi-Private Coaching Catching Heat?

By Kevin Masson MSc, CSCS, CPT, USAW, FMS

When it comes to the fitness industry, a lot of people are opting for semi-private training as opposed to personal training programs. So, what exactly is the difference between the two? Semi-private training programs include a qualified trainer along with a couple, or a trainer along with 3 – 5 friends who share the same fitness goals. In such scenarios, they share their training programs, exercise schedules and divide the program cost between them.

These cost-effective sessions not only offer you top-notch training but also give you the necessary kick to get through your workout. Moreover, you start to see the results within a few weeks of following this program diligently. There are numerous reasons why these semi-private coaching sessions are becoming increasingly popular among people. Some of these reasons are listed below.

  • Customized fitness programs as per individual’s needs
  • At least eight training sessions per month
  • Creative team training
  • Cost-effective

One of the highlights of this type of training session is that helps in keeping the monotony at bay. Also, if you don’t like working out alone, you will get the much-needed encouragement from your workout buddies. This program is also ideal for people who wish to attain optimal results without having to plan it out on their own. Since the semi-private sessions are completely dedicated to helping people make some serious progress towards their goals while making their fitness journey enjoyable, their increasing popularity comes as a no surprise.

Benefits of semi-private training sessions

Most clients who attend semi-private group sessions have similar goals, like wanting to look and feel fitter, reduce body fat by a certain percentage, enhance their endurance and lead a healthy lifestyle. If you have any of these goals, then it is essential that your training program covers things such as flexibility, strength exercises that involve your core muscles, some aerobic as well as anaerobic exercises along with some hypertrophy work. Now, this sounds perfect for a lot of people, but when it comes to applying this training regime, they often feel overwhelmed or lost. Most people start off with a bang and then start getting discouraged when their training plan isn’t as supportive as they thought. Some people just join a gym and feel completely lost within the first few days or when their plan gets completely thrown off, as the equipment they need is not available owing to a busy gym floor.

This is where semi-private training can help you. There are so many advantages to going down this route that you will wonder why you didn’t think of it before. Under a semi-private training group, typically about 3-6 clients work together towards a similar program along with a couple of trainers. Mentioned below are some of the many advantages people list when they start semi-private training:

Coaching/ Learning 

All certified trainers aim at assisting their clients as much as possible to achieve their desired goals. They also make sure not to overwhelm you with intense training sessions during the initial days. So, if you are a newbie, don’t worry about being thrown into the deep end.  All good trainers will want to put you at ease first and then work toward the basics and posture before moving on to strenuous exercises. A good trainer will carefully assess where you stand with regards to your end goals and set up a training plan accordingly. These trainers will start with teaching you basic body movements like lunges, squats, hinge, etc. followed by a recovery session. Mobility can help in assessing the areas that you need to work on first before moving on to better things. BioFit Performance system periodize programs months in advance based on strength and conditioning for three different levels, (Beginner- white), (Intermediate – Green) and (Advance- Black), so everyone can participate safely and efficiently. While using the data from your Functional movement assessment, we are able to customize those programs to YOUR needs while you are in a group environment.

Constant variation

“Insanity is doing the same thing over and over again and expecting different results.”

-Albert Einstein

This statement couldn’t be more accurate when it comes to fitness goals. You don’t want your body to get used to a routine. Once that happens, the results start slowing down. Most people fall off track with their gym schedules because they start to get boring. With a semi-private coaching program, the training sessions are so varied that you have no chance to get bored. The general layout, however, includes Release, Warm-up, Mobility/Correctives, Reactive (power), Strength, Conditioning, Recovery. 
The release part, where you will get on a foam roll and start targeting tight areas in your body. We can’t expect your body to move optimally if you are tight in some areas. Followed by a general warm-up to get the core temperature up start getting some blood flow to those muscles and get your nervous system ready for the session. Mobility/Correctives are also part of the warm-up where we target some of your personal problems and try to correct these deficiencies. We then transition onto the first part of the workout, the reactive movements, which are power exercises this will target your central nervous system and get your fired up and ready for the next part. Depending on which class you are in the main workout is either Strength or Conditioning and finally end the session with some recovery tools.
There is science behind the reason why we write each of our sessions this way but one of the main aim of bringing versatility into your training sessions is to keep you motivated and achieve result towards your goal.

They measure progress

No, not literally with the scales! And no one should evaluate their progress using these because the scales are perpetually fluctuating and aren’t important anyway. When you work with a particular trainer consistently, she/he can figure out what you can or can’t do. They can evaluate your progress based on your mobility and fitness to body composition. This is far more vital and something that counts rather than merely looking down at some numbers on a measuring scale. As your performance starts to improve, your image and bodyweight will begin to show signs of improvements too.  Once you combine your workouts with proper nutrition, there’s absolutely no reason why you shouldn’t hit your training goals.

Customized workouts

Although it’s a group workout, pretty much everything in the training session is designed to cater to your fitness needs. A good trainer, after assessing your strengths and weaknesses, will quickly develop a training program that will enhance your growth.  It’s almost like having a personal trainer without having to shell out an extra chunk of cash. The perfect trainer will conduct a fitness session, which works out great for every individual. For instance, if you have a weaker upper body and find it challenging to do pull-ups, your trainer will add some variations like ring rows. If you aren’t feeling up to it, then he/she will map out a different workout for you. Regardless of your fitness levels, rest assured that your trainer will always have a workout to make your life easy.

Finding new workout buddies and being responsible for your fitness

If you are a fitness freak like me, you are going to find it annoying to attend those boring social gatherings that circle the same alcohol-induced nonsense talks. Now I am not saying alcohol is bad but, after a while, such mediocre gatherings do get boring.  Instead, why not get together with a few mates and participate in a session that revolves around fitness. You know what they say, “You are only good as the company you keep.” If you are perpetually surrounded by people who have no interest in keeping their bodies fit, you will slowly become like one of them. Unless that’s what you want. Also, the fact that you are going to be accountable for your progress certainly helps you in the long run to achieve your goal. We love some friendly competition.

100% mapped out schedules

One of the most beneficial things about taking up a semi-private training session is that you are almost never going to feel lost. The layout session will be there for you to see much before you start your workouts. Isn’t that relieving? I mean, who has the time to plan out your work out session amidst other essential issues that take up our time like family, commitments, spouse, kids, etc.? So, having all of your 60-minute sessions mapped out by your trainer comes as a great relief. All you have to do is show up at the class. It’s far better than having to sit around in a gym, not knowing what to do next or merely relaxing in the sauna and then just heading back home. And mind you all this comes at a hefty cost too. What a waste of your valuable money and time. Instead of doing this, just take out about 60 minutes a day for your semi-private training sessions and let us take care of everything else.


Let’s face it. Not all of us have a lot of money to spare when it comes to fitness training. And personal training can be extremely pricey. Most personal fitness trainers charge about $100 per session. Even if you take up three sessions a week, that comes to about $1200. If you have that kind of cash, by all means, go ahead and hire yourself a personal trainer.  Now some of you may argue that you can join a local gym that may offer the same for as little as $10 a month. But think about it. Even though the fees are cheap, what’s the point if you don’t show up every day or have no clue what kind of workouts you should be doing? Like a lot of people, you are going to go straight to the treadmill for an hour and wonder why you are no achieving the goals?
Semi-private training sessions, on the other hand, cost approximately $30 per session, per person. For some people, that’s still not cheap enough, but you will end up getting the same benefits that you would get from hiring a personal trainer. Now considering that, you may re-evaluate your priorities and find the price to be very reasonable.

Now that you have read all of the above benefits, I am sure there is no speck of doubt in your mind that semi-private training sessions make more sense.

Contrast Bath Therapy

Contrast Bath Therapy

By Kevin Masson MSc, CSCS, CPT, USAW, FMS

What is contrast wet therapy and how will it benefit my recovery?

Contrast wet therapy also known as “hot/cold immersion therapy”, is a form of treatment where a limb or the entire body is immersed in warm water followed by the immediate immersion of the limb or body in ice water. This procedure is repeated several times, alternating hot and cold. The goals for a Contrast Bath include:

  • Decreasing pain
  • Decreasing swelling
  • Decreasing/controlling inflammation
  • Improving mobility
  • Improve muscle recovery after exercising

The cold water causes blood vessels to constrict or tighten, thereby reducing inflammation and flushing out the waste products that were accumulated during exercise. Combine this with hot water immersion which rapidly causes dilation or opening of the blood vessels that were constricted during the cold-water therapy.

This contrast in temperature immersion facilitates rapid constriction and dilation of the blood vessels. Typically, in a contrast wet therapy session you would cycle through several cycles of cold followed by warm to create a muscle pump effect via the effect it has on blood vessels.

Contrast wet therapy assist in recovery by alterations in tissue temperature and blood flow; reduced muscle spasm and inflammation; and improved range of motion. In comparison to passive recovery, contrast wet therapy is by far the superior, with studies proving results of significantly greater improvements in muscle soreness (DOMS) and reduced muscle strength loss (Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis, 2013).

Not only is contrast wet therapy proven to help with muscle soreness from exercise and everyday life it can also help with alleviating pain associated with arthritis and people with poor circulation.

Can I just have a bath of ice and then a warm shower with the same effect?

Yes, you can and it would still be effective in helping reduce muscle fatigue and soreness, however full body water immersion is far greater and will have an impact on the whole body and the added benefits of emotional wellbeing that goes along with it. At BioFit Performance we recommend that you use the contrast bath therapy and infra sauna to ultimately improve recovery.

So, the really important question is, do you finish off with warm or cold?

“There is no evidence to suggest that ending with either heat or cold is more effective” National Athletic Trainers’ Association. The choice is all yours, you can leave feeling warm and fuzzy or cool and invigorated.  I would advise, it all depends on when you are doing the therapy. If you are the type of person that like to workout in the morning and want to have a quick relaxing moment in the bath before work then probably end with a cold bath, that way you will feel sharp and ready to deal with your day. On the other end if you want to relax after a long day at the office or a hard workout, end with a nice relaxing hot bath or even warm sauna will leave you a cozy relaxing mood ready for you to go home and relax.

Conditions to watch for:

If you suffer from rheumatoid Arthritis then consider ending with the hot and make sure to dry thoroughly.
Another condition is if you have an acute injury or suffer from a swollen joint, only use the cold immersion on that joint.


DO NOT do Contrast Baths for any of the following problems:

  • Local malignancies
  • Peripheral vascular disease (PVD)
  • Impaired sensation
  • Bleeding and acute inflammation.
  • Diabetes and neuropathy
  • If there is a good pulse in the extremities, diabetics and those with neuropathies can benefit from a contrast bath, but it needs to be under the supervision of a physical therapy.

Again, you should consult your physician or physical therapist if you are unsure if this treatment is right for you.

What is the procedure for contrast bath?

  • Sit in the hot water (98 -110 degrees Fahrenheit) for 3-4 mins. (If swelling is present around the joint use only cold bath.)
  • Once you had a good 3 mins in the hot bath switch to the cold water (45 – 70 degrees Fahrenheit) for 1 minute or until you cannot tolerate it anymore.
  • Repeat the above steps three to four more times (about 20 minutes)


US National Library of Medicine National Institutes of Health. 2013. Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633882/. [Accessed 21 February 2017].

National Athletic Trainers’ Association. 1998. Contrast Therapy Does Not Cause Fluctuations in Human Gastrocnemius Intramuscular Temperature. [ONLINE] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320584/pdf/jathtrain00012-0042.pdf. [Accessed 21 February 2017].