Cryotherapy: Soft Tissue

Healing/Parameters

Anna Lamb, Marissa Rescott,

Charlotte Thurnauer, and Christy
Adams

Effectiveness and safety of cryotherapy after

arthroscopic anterior cruciate ligament reconstruction:
A systematic review of the literature
Purpose: to update and appraise literature since 2005 on the
effectiveness/safety of cryotherapy post ACLR (10 studies, 573
participants; RCT/quasiRCT)
Sample: skeletally mature patients post arthroscopic ACLR
Outcome measures: VAS, edema, adverse events (AE), function,
ROM, medication use, blood loss, QOL, hospital stay
Main findings: Cryotherapy produced short term (48h) pain reduction
and did not increase risk of AE; Evidence is too limited to evaluate
other outcomes, but pain reduction might accelerate RTADLs
Discussion: Acute care ACLR/prehab pt education: use
cryotherapy/cold compression devices
Literature is lacking in high quality evidence for functional outcomes of cryotherapy
Does decreased pain improve pts early stage tolerance to mobility?

Cryotherapy for acute ankle sprains: a randomized

controlled study of two different icing protocols

Purpose: to study the effectiveness of ice in

treating acute soft tissue injury
Specifically: compare intermittent protocol to a
standard protocol

Subjects: 44 athletes and 45 gen. population

with acute ankle sprains
Methods: Standard Ice Application (20 min) vs.
Intermittent Ice Application (10 on, 10 off, 10 on)
Outcome Measures:
Binkleys Lower Extremity Functional Scale
Visual Analog Scale
Figure Eight Measurement

Cryotherapy for acute ankle sprains

Results
Findings:
Function/swelling/pain at rest had significant
improvement in both groups
Intermittent protocol has less pain during
activity at week 1

Clinical Relevance:
Intermittent protocol produces greater pain
relief in the early stage of rehab
The use of an intermittent protocol may provide
more opportunities for pain-free exercise

The Use of Ice in the Treatment of Acute

Soft-Tissue Injury
Purpose: Explore the clinical evidence for cryotherapy and
make conclusions about the strength of the evidence
supporting its use in treating acute soft-tissue injuries and
make recommendations for future research.
Sample: systematic review of 22 RCT studies with human
subjects post acute soft-tissue injury utilizing cryotherapy in
isolation or in combination with other therapies.
Outcome measures: Function (subjective or objective), pain
(visual analogue scale and/or analgesic consumption) ,
swelling, or range of movement.

The Use of Ice in the Treatment of Acute

Soft-Tissue InjuryResults
Main findings
Continuous cryotherapy had a greater decrease in pain and wrist
circumference (post CTR) than intermittent
A single application of ice and compression was as effective as no
treatment in reducing pain, swelling, and ROM after an ankle sprain
There was no significant difference in the time of restricted activity
after an ankle sprain using ice and compression

Discussion/clinical relevance
Single applications seem to be as effective as no treatment
ice and compression is no more effective than compression alone
(limited conclusion)
Optimal protocol recommendations cannot be made (limited evidence)
Overall: More high-quality studies are needed for strong evidence

Changes of Achilles Midportion Tendon

Microcirculation After Repetitive Simultaneous
Cryotherapy and Compression Using a Cryo/Cuff

Purpose/Hypothesis: Examine the effects of Cryo/Cuff device on midportion Achilles

tendon microcirculation during intermittent administration (10 on, 10 off for 60 min)
expecting reversible microcirulation changes
Methods: 13 males, 13 females with no acute Achilles tendon or ankle disorder/injury
Outcomes: Foot and Ankle Outcome Score (FAOS), sensibility to cold
Findings:
O2 Saturation At 2 mm, drops significantly after 1st application and begins to
increase 40-60 seconds after removal. At 8 mm, significant drop after 20
seconds with increase to greater than resting during recovery.
Post Capillary Venous Filling Significant drops observed at both 2 mm and 8
mm.
Discussion:
Capillary blood flow is regulated within 20 seconds. Combined Cryo/Cuff have
immediate effects after initiation and after termination.
Blood flow is restored quickly after removing ice and compression.
Post capillary venous filling pressures diminished during Cryo/Cuff, favoring
venous outflow.
Manages swelling and clears out capillaries to help prevent blockage.

Synthesis of Evidence
Take Aways:
Ice after an acute injury is a very common practice,
even though the evidence supporting cryotherapy to
manage acute soft tissue injury is poor
Cryotherapy is effective for the reduction of pain in the
acute phase of injury

Future Research:
Studies comparing ice alone vs. compression alone
vs. ice and compression
Studies looking at exercise during the off-time of an
intermittent protocol

References

Martimbianco ALC, da Silva, Brenda Nazar Gomes, de Carvalho, Alan

Pedrosa Viegas, Silva V, Torloni MR, Peccin MS. Effectiveness and safety of
cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A
systematic review of the literature. Physical Therapy in Sport.
2014;15(4):261-268.
Bleakley CM, McDonough SM, MacAuley DC. Cryotherapy for acute ankle
sprains: a randomized controlled study of two different icing protocols. Br J
Sports Med. 2006;40:700-705.
Bleakley C, Mcdonough S, MacAuley D. The use of ice in the treatment of
acute soft-tissue injury: a systematic review of randomized controlled trials.
Am J Sports Med. 2004;32(1):251-61.
Knobloch K, Grasemann R, Jagodzinski M, Richter M, Zeichen J, Krettek C.
Changes of Achilles Midportion Tendon Microcirculation After Repetitive
Simultaneous Cryotherapy and Compression Using a Cryo/Cuff. Am J
Sports Med. 2006;34(12):1953-1959.

Reference Links
http://bjsm.bmj.com/content/40/8/700.full.pdf+html
http://ajs.sagepub.com/content/32/1/251.full.pdf+h
tml
http://ajs.sagepub.com/content/34/12/1953.full.pdf
+html
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