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Icing for injuries needs more study

PainSci » bibliography » Collins 2008
Tags: water, controversy, debunkery

Twelve articles on PainSci cite Collins 2008: 1. Contrast Hydrotherapy2. Icing for Injuries, Tendinitis, and Inflammation3. The Complete Guide to IT Band Syndrome4. The Complete Guide to Patellofemoral Pain Syndrome5. Complete Guide to Plantar Fasciitis6. Shin Splints Treatment, The Complete Guide7. Tennis Elbow Guide8. The Complete Guide to Muscle Strains9. Ice versus Heat for Pain and Injury10. Voltaren Gel: Does It Work?11. Guide to Repetitive Strain Injuries12. Whole Body Cryotherapy for Pain

PainSci commentary on Collins 2008: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

Bafflingly, therapeutic icing (cryotherapy) is one of really those basic things that you’d think modern medical science would have mastered by now, but no — not even close!

This is a 2008 review of the inadequate evidence: just six experiments, and only two of them any good, one with slightly positive results and the other showing nothing at all. So that’s two studies that showed little or no benefit, which is leaning towards bad news, but it’s not enough data to clinch it.

Four animal studies have showed that icing reduced swelling (and too much is harmful, duh!). That evidence is mildly encouraging, but of course we can’t take animal studies to the bank.

This really just isn’t enough data, and the bottom line is that we don’t know, which is what Collins concluded: “there is insufficient evidence.” A 2015 review (with a broader scope, see Malanga) had a similar non-conclusion, mostly confirming the absence of evidence.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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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This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:

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