CET Cryotherapy

Cryotherapy for acute ankle sprains:

A randomised controlled study of two different icing protocols.

BACKGROUND: The use of cryotherapy in the management of acute soft tissue injury is largely based on anecdotal evidence. Preliminary evidence suggests that intermittent cryotherapy applications are most effective at reducing tissue temperature to optimal therapeutic levels. However, its efficacy in treating injured human subjects is not yet known.

OBJECTIVE: To compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains.

SUBJECTS: Sportsmen (n = 44) and members of the general public (n = 45) with mild/moderate acute ankle sprains.

METHODS: Subjects were randomly allocated, under strictly controlled double blind conditions, to one of two treatment groups: standard ice application (n = 46) or intermittent ice application (n = 43). The mode of cryotherapy was standardised across groups and consisted of melting iced water (0 degrees C) in a standardised pack. Function, pain, and swelling were recorded at baseline and one, two, three, four, and six weeks after injury.

RESULTS: Subjects treated with the intermittent protocol had significantly (p<0.05) less ankle pain on activity than those using a standard 20 minute protocol; however, one week after ankle injury, there were no significant differences between groups in terms of function, swelling, or pain at rest.

CONCLUSION: Intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury.

Ankle injuries are one of the most common acute soft tissue injuries, incurring a significant cost to both the individual and society. Despite the high incidence, cost, and long term morbidity, however, the optimal method of managing acute ankle sprains remains controversial.

The application of ice after ankle sprain is accepted clinical practice even if the strength of evidence supporting the use of cryotherapy in management of acute soft tissue injury is generally poor.

Most randomised, controlled trials have focused on post-surgical patients, and have serious flaws in their study design and implementation. In addition, no study has rigorously compared the effectiveness of two different icing protocols; therefore there is no evidence to suggest an optimal mode, duration, or frequency of ice application.

In the absence of robust evidence from clinical studies, one systematic review made recommendations for an optimal treatment protocol, using evidence derived from investigations on animal models or healthy human volunteers.

The evidence suggested that intermittent 10 minute applications were most effective at reducing both skin and deep tissue temperature to optimal therapeutic levels, and melting iced water was deemed the safest and most efficient method of application. Although this provides preliminary evidence based recommendations for an optimal protocol, its efficacy in treating injured human subjects is not yet known.

The aim of this investigation was to study the effectiveness of cryotherapy in treating acute soft tissue injuries. The specific objective was to compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains.

Bleakley CM, McDonough SM, MacAuley DC, Bjordal J.

Health and Rehabilitation Sciences Research Institute, University of Ulster, Jordanstown BT37 0QB, County Antrim, Northern Ireland, UK.

Br J Sports Med. 2006 Aug;40(8):700-5; discussion 705. Epub 2006 Apr 12.

PMID: 16611722 [PubMed - indexed for MEDLINE]

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