Does ice improve the outcome of soft tissue injuries?

NewsBot · Jun 21, 2008

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Is ice right? Does cryotherapy improve outcome for acute soft tissue injury?
Collins NC.
Emerg Med J. 2008 Feb;25(2):65-8.

AIMS: The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practised. This review was conducted to examine the medical literature to investigate if there is evidence to support an improvement in clinical outcome following the use of ice or cryotherapy.

METHODS: A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were (1) a reduction in pain; (2) a reduction in swelling or oedema; (3) improved function; or (4) return to participation in normal activity.

RESULTS: Six relevant trials in humans were identified, four of which lacked randomisation and blinding. There were two well conducted randomised controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced oedema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation.

CONCLUSION: There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries
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NewsBot · Jun 22, 2008

There was this older review on the same topic

The Use of Ice in the Treatment of Acute Soft-Tissue Injury
A Systematic Review of Randomized Controlled Trials
Chris Bleakley, Suzanne McDonough and Domhnall MacAuley
The American Journal of Sports Medicine 32:251-261 (2004)

Background: There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis.

Study Design: Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries.

Methods: A computerized literature search, citation tracking, and hand searching were carried out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale.

Results: Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.

Conclusion: Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries
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NewsBot · Sep 30, 2014

Effects of cold water immersion on lower extremity joint biomechanics during running
Claudiane Arakaki Fukuchi, Emmanuel Souza da Roch & Darren John Stefanyshyn
Journal of Sports Sciences; Published online: 26 Sep 2014

The purpose of this study was to identify the influence of cryotherapy on lower extremity running biomechanics. Twenty-six healthy male volunteers were randomised into two intervention groups: cold water (cold water at ~11°C) or tepid water (tepid water at ~26°C). They were required to run at 4.0 ± 0.2 m · s−1 before and after they underwent water immersion for 20 min. Differences between pre- and post-intervention were used to compare the influence of water intervention during running. Peak joint angles, peak joint moments, peak ground reaction forces (GRF) and contact time (CT) were calculated using three-dimensional gait analysis. Independent t-tests were applied with a significant alpha level set at 0.05. Decreased peak propulsive and vertical GRF, decreased plantarflexion moments, increased hip flexion angle and longer CT were observed following cold water immersion. Although cold water immersion (cryotherapy) affected the running movement, none of the alterations have been related to running biomechanical patterns associated with injuries. Therefore, our results indicated that cold water immersion appears safe prior to running activities.
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David Smith · Oct 1, 2014

Yes it does

NewsBot · Oct 6, 2014

Why ice doesn’t help an injury

New research shows that icing an injury may even make it worse
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David Smith · Oct 6, 2014

My Experience, over many years of treating sprain injuries and severe brusing in full contact fighting sports, is - ice it and get better qucikly - don't ice it and stay off injured for much longer. One exception is this, with minor sprains ignore the p[ain and just work thru it, you'll often find that bt the end of training it wont hurt anymmore. But if it does then ice it.

My theory after reading contrary research is this: Ice relieves the p[ain and swelling enough so that you can quickly get back to mobilising and strengthening the muscles and ligaments that stabilise the joint. So while icing, in itself, may be detrimental the much greater positive effect of the folowing rehab treatment that can occurr earlier results in faster rehabilitation. Thats why minor sprains that are iced post immediately injury (and therefore rested) can take longer to heal than if you just work thru it.

I see many patients who did not ice their sprained ankle (but also didnt do or recieve any other therapy) who spend months nursing a painful joint.

There has to be a planned rehab that IMO is ice, immobilisation of the joint (or rest i.e. non w/b) for a short time, then mobilisation then strengthening and all th etime maintaining strapping or support till the joint is stable enough and increasing activity as the joint becomes painfree and stronger. The timing of these event is tailored to the person and the type and severity of the injury so no fixed paradigms in those terms. This is nothing new of course but it is a course of action that works regularly and reliably.

I wouldn't drop icing without very strong evidence, which one might assume would be easy to gather i.e. just do a treat and not treat with ice experiment with all other variables the same and see who returns to their chosen activity first.

regards Dave

NewsBot · May 17, 2019

Negative Impact of Icing Treatment on Qualitative
Recovery of Injured Soleus Muscle in Rats
Tsubasa Shibaguchi et al
ACSM ANNUAL MEETING
May 28 – June 1, 2019 – Orlando, Florida

PURPOSE: Although the RICE (Rest, Ice, Compression, and Elevation) treatment
has been recognized as the gold standard of first aid treatment for sports injuries, we
and the others previously demonstrated that a transient icing treatment immediately
after skeletal muscle injury impaired muscle regeneration. However, the information
about the influence of icing treatment following skeletal muscle injury remains limited.
This study was, therefore, to investigate the impact of icing as a first-aid treatment on
qualitative recovery of damaged muscle in terms of fibrosis and myosin heavy chain
(MyHC) profile.
METHODS: Male Wistar rats (9-10 weeks of age) were randomly assigned to control
(Con), injured, and injured with icing groups (Ice). Bupivacaine (BPVC) was injected
into slow soleus muscles bilaterally in order to induce muscle injury in the two injury
groups. Application of icing treatment (ice pack, 0°C for 20 min) to the icing group
was carried out immediately after the BPVC injection. At 3 days-4 weeks after BPVC
injection, soleus muscles were removed and analyzed.
RESULTS: Compared with the Con group, a significant increase in fibrotic area
was observed after 2 weeks following injury in the injured groups, but after 1 week
following injury in the Ice group (P < 0.05). This area was also tended to be higher
in Ice than in injured animals during 1-4 weeks of recovery period. In addition, the
number of Tcf4-positive nuclei, a fibroblast marker, located in interstitial spaces in
both injured groups markedly increased 1 week after BPVC injection. The numbers
were tended to be more magnified in the Ice group than in the injured group, then their
number in both injured groups gradually degreased thereafter. Injury-related de novo
appearance of embryonic, neonatal, IId/x, and IIb MyHC isoforms was noted in both
injured groups 1 week after BPVC injection. These MyHC isoforms were significantly
decreased toward the undetectable level thereafter. However, the embryonic MyHC
isoform was still detectable in icing, but not in injured, animals 4 weeks after BPVC
injection.
CONCLUSIONS: Our results suggested that icing treatment following skeletal muscle
injury will have a negative impact on recovery process (fibrosis and normalization of
MyHC profile) of regenerating muscle.
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David Smith Well-Known Member

NewsBot The Admin that posts the news.

David Smith Well-Known Member

NewsBot The Admin that posts the news.

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