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Do you Ice right?

People love a fancy name for something, and injury treatment is not different. Why have knee pain if you can have Patellofemoral Pain Syndrome? Why have a modest bruise if you can have a hematoma? And so I often – facetiously – tell people that if they want to jazz up their bag of frozen peas, why not tell your friends that you are partaking in a touch of cryotherapy?

Ice (I mean cryotherapy 😉 ) has always been seen as the go to treatment for decreasing tissue damage, inflammation/swelling and pain after injury. But what does current research say about the efficacy of this?

The application of ice does reduce tissue temperature, which decreases cell metabolism in the area surrounding the injury, and decreases the amount of secondary damage in the tissue surrounding the injury. However there is evidence that ice DOES NOT reduce swelling. The main effect of ice is actually to decrease nerve conduction speed (Ref 1), meaning a reduction in pain from soft tissues. A by product of this analgesic, pain relieving response, is that it allows you – the patient – to perform exercise/movement – and so muscle contraction – which in turn reduces swelling.

For this decrease in nerve conduction speed to take place, the tissue temperature needs to reach 10 degrees (Ref 1). Taking this in to account it seems that the best protocol for application of ice is directly on the skin, completely against the traditional method of wrapping the bag of crushed Ice, or bag of frozen peas in a towel. It goes without saying, that this is only applicable to those who have ruled out any contraindications such as open wounds, circulation issues, DVT etc. (contact me for more information on this; details below). And so because of this lack of insulation, our skin temperature can be reduced to our goal temperature within 5 minutes. There are many variables to this however, for example the depth of the target soft tissue and the build of the patient. There will be injuries at such a depth that no amount of ice will penetrate deep enough. As a rule of thumb, 10 minutes should suit for most.

Interestingly, this paper, Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury (Ref 2) says that “RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy”.

So heat or cold? Both have positive effect, it seems. Maybe it depends on what season you get injured – Heat in the Winter, Ice in the Summer? It seems you cant really go wrong…

…as long as you keep moving.


  1. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance.

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N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work

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