For decades we have been applying icepacks to ankle sprains and recently following RICER protocols for up to 72 hours after a sprain, strain, or fracture. More recently adding localised cryotherapy in place of using icepacks has taken off in a number of allied health practices. Personally, I’m a big fan of localised cryotherapy and have invested in it at my Performance Recovery and Strength & Conditioning Centre. It's less messy than ice, it can stay at a constant temperature for the whole time of the treatment, it’s not wet and messy, and doesn’t leave any opportunity for ice burn. All my clients love it, but is there any research to back using localised cryotherapy for an ankle sprain over ice?
Studies by Hocutt et al (1982) found that patients using localised cryotherapy within the first 36 hours who were diagnosed with grade four sprains (unable to bear weight because of pain) reached full activity in 13.2 days compared to 30.4 days in a group using cryotherapy initiated 36 hours after injury. This was also compared with using heat therapy which took 33.3 days for a full recovery. This procedure entailed 3 sessions a day of approximately 15min sessions in the first 72-hour window (1). Therefore, early use of cryotherapy was found to be an effective treatment of ankle sprains yielding earlier complete recovery than later application of cryotherapy or heat therapy. Furthermore, this study concluded that the early use of cryotherapy in acute ankle sprains along with the continued use of compression was an effective treatment protocol for ankle sprains (4). This allowed for patients to have complete recovery earlier than those patients who started cryotherapy outside the 36-hour window or heat therapy.
How often should I do localised cryotherapy for an ankle sprain?
According to the Department of Family Medicine, Cryotherapy should be applied for the first three to seven days after injury to reduce pain and improve recovery time in patients with an ankle sprain (5). This involves sessions of around 15 minutes, one to three times per day for best results in decreasing pain and inflammation (4). In my own centre, we have been treating clients within the first 72 hours and then every day or 2nd day for approximately 7 days. The early anecdotal evidence has shown great results in terms of reduction in swelling, reduced pain, and better movement to be able to do rehab perscriptions. This has resulted in more health professionals such as Physiotherapists referring more clients to our centre due to these anecdotal positives and great client feedback.
(1) Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury? J Athl Train. 2004;39(3):278–279.
(2) Hubbard TJ, Aronson SL, Denegar CR. Does cryotherapy hasten return to participation? A systematic review. J Athl Train. 2004;39(1):88–94.
(3) Duggan, William MD; Tyler, Carl MD, MSc Is cryotherapy effective for acute management of ankle sprain?, Evidence-Based Practice: March 2014 - Volume 17 - Issue 3 - p 1-2
(4) Hocutt JE Jr, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. Am J Sports Med. 1982 Sep-Oct;10(5):316-9.
(5) JEFFREY D. TIEMSTRA, MD, Department of Family Medicine, University of Illinois College of Medicine, Chicago, Illinois, Am Fam Physician. 2012 Jun 15;85(12):1170-1176.