To ice, or not to ice? If you ice, how long should you, and with what? Historically, the use of cryotherapy has been highly debated, yet insufficiently researched. With miles of myths and over-hyped opinions, it’s hard to know what is right and what is wrong when it comes to the efficacy of ice.
In January, Dr. Jeremy Hawkins and Shawn Hawkins were curious about how athletic trainers were using ice and how it stacked up against the little research that currently exists. They sent out an anonymous, cryotherapy-centered survey to collegiate athletic trainers across the country. “The first purpose of this study was to determine the cryotherapy methods most often selected by collegiate athletic trainers to treat an acute and subacute ankle sprain… The second purpose was to compare the use of cryotherapy to available research” (Hawkins, Hawkins, 2016).
Responders completed two scenarios, choosing how they would treat each patient in the given situation. Then, the researchers compared the results to the available supporting research.
Scenario #1: Acute ankle sprain
“The center on the men’s basketball team went up for a rebound and landed awkwardly during practice. An initial evaluation was performed and it was determined that he suffered a grade II lateral ankle sprain. He was pulled from practice to begin treatment. Which treatment do you perform?” (Hawkins, Hawkins, 2016)
The treatment options for scenario one included:
- Ice packs
- Ice immersion
- Game Ready
How did the some of the responses stand up to the current research available?
49% chose Game Ready as the modality of choice.
- Game Ready and similar devices claim to be a comparable or better method of cryotherapy than the classic ice pack and elastic wrap because of the added benefit of sporadic compression. However, Hawkins et al. (2012) observed that “the traditional cooling methods of an ice pack with an elastic wrap and ice immersion both cooled to a greater extent than a Game Ready machine on medium setting, and maintained that cooling longer,” making traditional methods more effective.
43% chose to treat the patient for 16-20 minutes.
- Hawkins and Hawkins (2016) note that, generally speaking, it is still unknown how to best apply cryotherapy in an acute situation. “However, based on the work of Otte et al., both groups treated the acute ankle sprain for a sufficient amount of time to see a 7 °C decrease in temperature, or twelve minutes. This is supported by more recent work by Jutte et al..”
81% of those who chose to use an icepack would do so without a barrier.
- It is universally known and accepted that ice packs made from crushed ice are safe to be applied directly to the skin. The researchers supported this notion, stating “applying an ice pack made of crushed ice directly to the skin is the best practice since including a barrier will insulate the treatment area, decreasing the effectiveness of the treatment“ (Hawkins, Hawkins, 2016).
40% of those who chose to use an icepack would do so with elastic wrap, while 38% would use plastic wrap.
- Research has shown that compressing ice to the skin with elastic wrap performs better than plastic wrap. Tomchuk et al. found that, although both held the ice pack in place, “elastic wrap facilitated a decrease in temperature that the plastic wrap did not. As such, if the goal is to decrease tissue temperature, applying the ice pack under an elastic wrap is optimal.”
Check in next week for the second scenario!
Hawkins, Hawkins 2016. Clinical applications of cryotherapy among sports physical therapists. Int J Sports Phys Ther. Feb;11(1):141-8.
Hawkins JR, Shurtz J, Spears C. Traditional cryotherapy treatments are more effective than Game Ready© on medium setting at decreasing sinus tarsi tissue temperatures in uninjured subjects. J Athl Enhanc. 2012;1:2. doi:10.4172/2324-9080.1000101
Jutte LS, Hawkins JR, Miller KC, Long BC, Knight KL. Skinfold Thickness at 8 Common Cryotherapy Sites in Various Athletic Populations. J Athl Train. 2012;47:170–177. PubMed
Otte JW, Merrick MA, Ingersoll CD, Cordova ML. Subcutaneous adi- pose tissue thickness alters cooling time during cryotherapy. Arch Phys Med Rehabil. 2002;83(11):1501–1505. PubMed doi:10.1053/ apmr.2002.34833
Tomchuk D, Rubley MD, Holcomb WR, Giadagmoli M, Tarno JM. The magnitude of tissue cooling during cryotherapy with varied types of compression. J Athl Train. 2010;45(3):230–237. PubMed doi:10.4085/1062-6050-45.3.230