20 Aug Cryotherapy

The role of Cryotherapy

Cryotherapy—and specifically its effectiveness in managing knee osteoarthritis—is a field in which Mr. Pavlidis has both clinical and research experience. It was also the focus of his postgraduate dissertation in the MSc program in Trauma and Orthopaedics at the University of Salford.
Cryotherapy, or simply the application of ice, is one of the most widely used treatments for both acute injuries and chronic conditions.
But is it truly effective? What does it help with, how does it work, and when should it be used?

What is Cryotherapy?

Cryotherapy has been used for centuries, with references dating back to Hippocrates, who applied cold for pain, inflammation, and swelling. Today, it is commonly used in both acute and chronic cases. It can be applied in various ways, including ice packs, crushed ice, cold water immersion, or cooling sprays. All these methods share the same goal: to reduce tissue temperature.

How Does It Work?

Cryotherapy is believed to work by lowering the skin temperature, leading to blood vessel constriction (vasoconstriction) and a reduction in local blood flow and swelling. It also helps reduce pain by temporarily slowing down nerve signal transmission (a phenomenon known as cold-induced neuropraxia).
Additionally, it can reduce inflammation by suppressing the activity of enzymes (such as matrix metalloproteinases) and chemical mediators involved in the inflammatory process, producing an anti-inflammatory effect.

Cryotherapy in Sports Injuries

Using ice for sports injuries is a well-established practice. We’ve all seen medical teams rushing to apply ice or spray to injured athletes. However, the effectiveness of cryotherapy in acute sports injuries has come under debate in recent years, largely due to a lack of solid research.

In 2014, ice was removed from official treatment guidelines for sports injuries. The reason? Suppressing the natural inflammatory response might actually delay healing.
As a result, the RICE protocol (Rest, Ice, Compression, Elevation) has been replaced by the PEACE & LOVE approach for managing soft tissue injuries, which does not include ice.
A study from the University of Otago in New Zealand (Mackie, 2015) showed that while cryotherapy has a short-term pain-relieving effect in acute muscle injuries, it may also impair muscle healing and delay recovery and return to sport.
For ankle sprains, clinical guidelines state that ice alone does not improve function or accelerate healing. However, due to its pain-relieving effects, when combined with therapeutic exercise, cryotherapy may improve short-term ankle function—allowing patients to perform exercises correctly and potentially recover faster (Vuurberg et al., 2018).

So, what’s the bottom line?

Ice alone has limited value in acute injuries and may even slow recovery. But when used in combination with exercises, it can play a valuable role in rehabilitation by reducing pain and enhancing short-term function.

Cryotherapy and Osteoarthritis

Osteoarthritis (OA), particularly of the knee, is a chronic degenerative condition and one of the most common causes of pain and disability worldwide. It significantly impacts patients’ quality of life and daily function.
In fact, knee OA accounts for 98% of all knee joint replacement surgeries.
Common symptoms include pain, swelling, and stiffness, which can severely limit mobility and daily activities.
Inflammation also plays a role in OA, though it’s quite different from inflammation in acute injuries. In acute injuries, inflammation is part of the body’s natural healing response. Suppressing it too early can delay recovery.
In contrast, OA involves chronic, low-grade inflammation—often due to joint stress or degeneration—which contributes to long-term damage. In this case, managing inflammation is crucial, making cryotherapy a justified treatment option for OA.

What Did Our Research Find?

We aimed to answer a simple question:
Is cryotherapy effective in improving clinical outcomes in patients with knee osteoarthritis? And what role does it play in managing these cases?

Key findings:
Pain: All studies showed significant pain relief with cryotherapy. However, the effect tends to be short-term.
Range of motion & stiffness: When used alone, cryotherapy is not very effective. But when combined with therapeutic exercise, it significantly improves flexibility and joint function.
Muscle strength & functionality: Both cryotherapy alone and in combination with exercise showed improvements in strength and physical performance.

How to Apply Cryotherapy

How often and for how long should ice be used?
As with any therapy, cryotherapy should follow specific guidelines for frequency and duration. Unfortunately, due to limited comparative research, the optimal parameters are not yet clearly defined.
However, based on current evidence and clinical experience, the following is recommended:

Apply ice for 10–15 minutes per session (no more than 20 minutes to avoid reactive vasodilation).
3–5 sessions per day over a six-week period, alongside an individualized treatment plan that emphasizes therapeutic exercise.
So, What’s the Role of Cryotherapy in Chronic Conditions like Knee Osteoarthritis?
Cryotherapy is a safe and effective treatment for patients with knee osteoarthritis.
It serves as a powerful pain reliever that gives patients a “window of opportunity” to perform their exercises, follow their treatment plan, and remain physically active—factors that can lead to long-term improvements in function and quality of life.
Disclamer!
This article is intended for informational purposes only and should not be used to diagnose or treat any medical condition. Always consult a qualified healthcare professional for personalized advice based on your symptoms.

References:
Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. British journal of sports medicine 2007;41(6):365-9. doi:10.1136/bjsm.2006.031237
Bangkokpost (2019). Brazil’s Neymar out of Copa America after tearing ankle ligament. IMAGE. https://www.bangkokpost.com/world/1690432/brazils-neymar-out-of-copa-america-after-tearing-ankle-ligament
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. The American journal of sports medicine 2004;32(1), 251-261. doi:10.1177/0363546503260757
Brosseau L, Yonge K, Welch V, et al. Thermotherapy for treatment of osteoarthritis. Cochrane Database of Systematic Reviews 2003;(4). doi:10.1002/14651858.CD004522
Demoulin C, Vanderthommen M. Cryotherapy in rheumatic diseases. Joint Bone Spine 2012;2(79), 117-118. doi:10.1016/j.jbspin.2011.09.016
Dubois B., and Esculier J., (2020). Soft-tissue injuries simply need PEACE and LOVE. IMAGE. British Journal of Sports Medicine 2020;54:72-73. https://bjsm.bmj.com/content/54/2/72.citation-tools
Farion KJ, Splinter KL, Newhook K. The effect of vapocoolant spray on pain due to intravenous cannulation in children: a randomized controlled trial. Canadian Medical Association Journal 2008;179(1), 31-36. doi:10.1503/cmaj.070874
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Galiuto L. The use of cryotherapy in acute sports injuries. Annals of Sports Medicine and Research 2016;3(2), 1060.
Mackie E. To Cool or not to Cool, that is the Question: A narrative synthesis of the Literature for the use of Cryotherapy for the Management of Acute Soft Tissue Injury [Master]. University of Otago, Dunedin New Zealand 2015.
Marty M, Hilliquin P, Rozenberg S, et al. Validation of the KOFUS (knee osteoarthritis flare-ups score). Joint Bone Spine 2009;76(3), 268-272. doi:10.1016/j.jbspin.2008.07.018
Mirkin G. Dr. Gabe Mirkin on Health, Fitness and Nutrition. | Why Ice Delays Recovery 2014. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
Vuurberg, G., Hoorntje, A., Wink, L. M., Van Der Doelen, B. F., Van Den Bekerom, M. P., Dekker, R., … & Kerkhoffs, G. M. (2018). Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline. British journal of sports medicine, 52(15), 956-956.