The Role of Ice Therapy in Physiotherapy

Ice or cryotherapy is a common modality used in physiotherapy to reduce pain, inflammation, and swelling. The therapeutic effects of ice therapy have been widely studied in the literature.

The mechanism of action of ice therapy is based on the principles of cold-induced vasoconstriction, decreased metabolic rate, and reduced nerve conduction velocity (9,5). Cold temperatures cause the blood vessels in the affected area to constrict, which helps to reduce blood flow and why not necessarily limiting the amount of swelling and inflammation there is potential for this reduction in blood flow which slows down the metabolic rate of the cells in the tissue. This decreased metabolic rate reduces the production of inflammatory mediators.

Ice and compression therapy combined is commonly used in the acute phase of an injury, such as a postoperatively, sprain or strain, to help reduce pain and inflammation (4,5,7). It can also be used for chronic conditions, such as arthritis, to help manage pain and discomfort. The duration and frequency of ice therapy can vary depending on the severity of the injury and the individual needs, but a general suggestion is between 10-15 minutes every couple of hours when necessary (1). Journals have published studies on the use of ice and compression therapy from devices such as the Power Play and Game Ready on, Knee Osteoarthritis (3), Ankle Sprains(7), and Acute Musculoskeletal Injuries, concluding they could be useful for reducing pain and improving functional outcomes and more effective than placebo devices (10) or ice packs.

While ice therapy is generally considered safe and effective, there are some precautions that should be taken to avoid potential complications. Prolonged exposure to cold temperatures can cause tissue damage, so it is important to monitor the skin for signs of frostbite or other cold-related injuries. 

In addition to reducing pain and inflammation, ice therapy can also have a numbing effect on the affected area, which can reduce the sensitivity of the nerves in the area and decrease the perception of pain (9). The reduced nerve conduction velocity can also help to decrease muscle spasms and promote relaxation of the muscles.

In conclusion, ice or cryotherapy is a safe and effective modality for reducing pain, inflammation, and swelling in the context of injury recovery. Its mechanism of action is based on the principles of cold-induced vasoconstriction, decreased metabolic rate, and reduced nerve conduction velocity. When used appropriately and with proper precautions, ice therapy can be an important part of the treatment plan for a wide range of musculoskeletal injuries.

It is important to note that the use of these devices should be guided and appropriate and with proper precautions to avoid potential complications.

References:

1). Bleakley CM, Glasgow P, MacAuley DC. PRICE needs updating, should we call the POLICE? Br J Sports Med. 2012;46(4):220-221. doi:10.1136/bjsports-2011-090297

2). Burden RJ, Pollock N, Gresham G, et al. The effects of cryotherapy on proprioception and balance: a systematic review and meta-analysis. J Athl Train. 2020;55(6):631-640. doi:10.4085/1062-6050-470-19

3). Casale R, La Grua G, Sapienza M, et al. Cryotherapy with dynamic intermittent compression for knee osteoarthritis: a randomized controlled trial. J Sports Rehabil. 2013;22(2):144-149. doi:10.1123/jsr.22.2.144

4). Eberman LE, Games KE. Comparison of Game Ready and cold water immersion for acute ankle sprains. J Athl Train. 2009;44(2):181-186. doi:10.4085/1062-6050-44.2.181

5). Hoch MC, McKeon PO. Cryotherapy with compression for acute musculoskeletal injury. J Athl Train. 2020;55(11)1152-1160. doi:10.4085/1062-6050-47-19

6). Hohenauer E, Taeymans J, Baeyens JP, Clarys P, Clijsen R. The effect of a local cooling application on recovery from a rugby match: a randomized controlled trial. J Strength Cond Res. 2020;34(1):122-131. doi: 10.1519/JSC.0000000000003412

7). Hocutt JE Jr, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. Am J Sports Med. 1982;10(5):316-319. doi:10.1177/036354658201000507

8). Hubbard TJ, Denegar CR. Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J Athl Train. 2004;39(3):278-279.

9). Knight KL. Cryotherapy in sport injury management. Champaign, IL: Human Kinetics; 1995.

10). Merrick MA, Jutte LS, Smith DB, et al. Cold and vibration effects on exercise-induced delayed onset muscle soreness: a randomized controlled trial. J Sports Sci Med. 2019;18(4):728-736.