Ice Therapy: How Good is the Evidence?

Abstract

Ice, compression and elevation are the basic principles of acute soft tissue injury. Few clinicians, however, can give specific evidence based guidance on the appropriate duration of each individual treatment session, the frequency of application, or the length of the treatment program. The purpose of this systematic review is to identify the original literature on cryotherapy in acute soft tissue injury and produce evidence based guidance on treatment. A systematic literature search was performed using Medline, Embase, SportDiscus and the database of the National Sports Medicine Institute (UK) using the key words ice, injury, sport, exercise. Temperature change within the muscle depends on the method of application, duration of application, initial temperature, and depth of subcutaneous fat. The evidence from this systematic review suggests that melting iced water applied through a wet towel for repeated periods of 10 minutes is most effective. The target temperature is reduction of 10-15 degrees C. Using repeated, rather than continuous, ice applications helps sustain reduced muscle temperature without compromising the skin and allows the superficial skin temperature to return to normal while deeper muscle temperature remains low. Reflex activity and motor function are impaired following ice treatment so patients may be more susceptible to injury for up to 30 minutes following treatment. It is concluded that ice is effective, but should be applied in repeated application of 10 minutes to be most effective, avoid side effects, and prevent possible further injury.

Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs

“…25 Intermittent pneumatic compression decreases venous stasis and increases arterial blood flow during the treatment period. [33][34][35] Cryotherapy also decreases edema and hemorrhage by decreasing capillary permeability and increasing blood flow in the treated area via a mechanism known as the hunting reflex, 36 which is a physiologic response intended to protect the body from cold damage and that results in periodic bursts of vasodilation following the local application of ice. These factors, in combination with intermittent pneumatic compression, are the probable mechanisms through which CCT alleviates pain and inflammation.…”

Ankle Cryotherapy Facilitates Soleus Function

“…However, cryotherapy could be equally useful prior to athletic competition and rehabilitation of patients with joint injuries. Several authors 5,21,28 have reported that ice should not be used prior to activity because it impairs motor function and therefore increases the susceptibility of injury. Our data indicate that motor function is not impaired; rather, it is enhanced following joint cooling on normal subjects.…”

Current Concepts for Rehabilitation and Return to Sport After Knee Articular Cartilage Repair in the Athlete

“…The application of cryotherapy (FIGURE 1), compression, and elevation is important to lower tissue temperature, slow metabolism, decrease secondary hypoxic injury, and reduce edema formation. 102 A meta-analysis by Raynor et al 146 demonstrated that patients who received cryotherapy had less postoperative pain but no improvement in early ROM after anterior cruciate ligament reconstruction. The use of compression wraps or a sleeve may also assist in the reduction of effusion.…”