If you missed the state of cryotherapy today and the acute ankle sprain scenario results, catch up on part one before continuing!

How would you use cryotherapy for subacute sprains… or would you at all? A few weeks ago, we took a look at a study done to analyze the efficacy of cryotherapy and its use in the athletic training field. Scenario one broke down the responses of collegiate athletic trainers in an acute ankle sprain scenario. Expanding on this hypothetical, these qualified athletic trainers were asked how they would respond in a subacute situation. Unfortunately, the lack of supporting research surrounding cryotherapy was especially evident in scenario two.

Scenario #2: Subacute ankle sprain

“The basketball player with a grade II lateral ankle sprain has moved past the acute care phase (0–4 days) and is now moving into the sub- acute phase (4–14 days). You begin a before-practice rehabilitation protocol to remove any swelling that is left over from the injury and to facilitate range of motion exercises. The athlete is full weight bearing and is able to walk unassisted. Which cryotherapy modality would you choose for the rehab? “

The treatment options for scenario two included:

  • Ice pack
  • Ice pack + cryokinetics
  • Ice immersion
  • Ice immersion + cryokinetics
  • Game Ready
  • Game Ready + cryokinetics
  • Other
  • None of the above

How did the responses stand up to the current research available?

Courtesy of Hawkins, Hawkins 2016.

Courtesy of Hawkins, Hawkins 2016.

The “Other” option revealed a wide variety of treatment preferences.

  • Athletic trainers that said they would choose another form of treatment shed light on a variety of other methods that are being practiced in the athletic training room. Most notably, their diverse opinions included manual therapy (massage and instrument assisted soft tissue mobilization) (Hawkins, Hawkins, 2016).

34% (the highest percentage) chose ice immersion + cryokinetics

  • Pairing immersion techniques with cryokinetics has been historically used to “achieve numbness, and the addition of motion is necessary to move the swelling out” (Hawkins, Hawkins, 2016). With this knowledge, it is easy to assume that this would be what most athletic trainers would chose to treat a patient with a sub-acute ankle sprain.

However, it is not enough to site a groundbreaking majority

  • With the highest chosen method at 34% and the remaining responses spread out through the other choices, it is clear that there is an extreme lack of research and evidence surrounding this scenario. “Once a patient moves out of the acute phase where a decrease in temperature may help with pain and secondary injury, the approach one takes to get their patient cold to facilitate exercise may be less important than the fact the patient is cold to facilitate exercise… there is no evidence to support the use of one treatment approach over the other” (Hawkins, Hawkins, 2016).

What does this mean for the future of cryotherapy and its efficacy in athletic training? Subscribe to our blog and our social media feeds to make sure you catch part three next week!


Hawkins, Hawkins 2016. Clinical applications of cryotherapy among sports physical therapists. Int J Sports Phys Ther. Feb;11(1):141-8.

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