Icing for injuries needs more study
PainSci summary of Collins 2008?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focussed 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 at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
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.
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.
- “Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury,” an article in Postgrad Med, 2015.
These eleven articles on PainScience.com cite Collins 2008 as a source:
- PS Contrast Hydrotherapy — Exercising tissues with quick temperature changes for injury recovery, especially repetitive strain injuries
- PS Icing for Injuries, Tendinitis, and Inflammation — Become a cryotherapy master
- PS Save Yourself from IT Band Syndrome! — All your treatment options for Iliotibial Band Syndrome reviewed in great detail, with clear explanations of recent scientific research supporting every key point
- PS Save Yourself from Patellofemoral Pain Syndrome! — Patellofemoral pain syndrome (aka runner’s knee) explained and discussed in great detail, including every imaginable self-treatment option and all the available scientific evidence
- PS Save Yourself from Plantar Fasciitis! — Plantar fasciitis explained in great detail, including every possible treatment option, and all supported by recent scientific research
- PS Save Yourself from Shin Splints! — Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture
- PS Save Yourself from Tennis Elbow! — Not just for tennis players, straight-talking advice on healing from this common tendinitis (lateral epicondylitis)
- PS Save Yourself from Muscle Strain! — Muscle strain (pulled muscle) and muscle pain explained and discussed in great detail, plus every imaginable treatment option
- PS The Great Ice vs. Heat Confusion Debacle — A quick guide that explains when to ice, when to heat, when not to, and why
- PS Voltaren® Gel — A useful rub-on anti-inflammatory medication
- PS Repetitive Strain Injuries Tutorial — Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome