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. Ice is routinely used in the management of soft tissue injuries, from sprains to strains and contusions. A recent personal survey of Irish emergency physician practice indicated that 73% of consultants "always or frequently" advocate the use of ice while only 7% "never" use cryotherapy; 30% were "unsure" if ice therapy is beneficial. Experience (47%) and common sense (27%) were the reasons most frequently cited for using ice, while 17% used scientific reasoning. Two-thirds (66%) of the consultants surveyed occasionally questioned the medical evidence for ice, 17% never questioned it and 17% frequently questioned the evidence. Almost a quarter (23%) had read literature supporting an improved clinical outcome following ice, 17% had not read supporting literature and 60% were unsure. The frequency with which Irish physicians advocate the use of ice echoes the findings of a UK study stating that 80% of emergency department consultants recommend ice in the management of ankle sprains.1 The use of ice in the management of acute soft tissue injuries is firmly established, but is there evidence to support this practice? A comprehensive review of published scientific literature was undertaken to investigate if ice improves outcome when used in the management of acute soft tissue injuries. Outcome was defined as (1) a reduction in pain, (2) a reduction in swelling/oedema, (3) improved function and (4) reduced time to return to participation in normal activity.
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