Is your Instagram feed filled with people spruiking the benefits of ice baths and ocean swims in winter? Welcome to the world of cryotherapy.
Cryotherapy sounds fancy but if we break the word down, it simply translates to cold treatment. “Cryo” comes from the Greek word “krýos” and means icy cold or frost.
Cryotherapy can refer to athletes taking an ice bath after their game, or immersing themselves in a cryotherapy chamber. Popping ice on a sporting injury is also technically a form of cryotherapy.
What is cryotherapy?
The use of cold in medicine dates back to the ancient Egyptians and later Hippocrates, who used cold to treat pain and inflammation. More recently, it’s been used to treat skin conditions like warts and skin tags, and even some cancers.
Dr Gabe Mirkin coined the concept of RICE in the 1970s – that is, Rest, Ice, Compression and Elevation – to treat athletic injuries. Since then, it’s been standard practice to apply ice straight after an acute injury such as strains, sprains and fractures.
Cryotherapy has seen a recent surge in popularity, with many people advocating the benefits of whole body treatments, where you stand in a freezing tank for several minutes. Proponents swear by whole body cryotherapy (WBC) for everything from weight loss to better sleep to improved athletic performance.
How does cryotherapy work?
According to Clinical Edge, there are two main benefits for applying ice straight after an acute sports injury:
- First, it reduces the tissue temperature around the injury, which decreases the cell metabolism in that area. The result? You’re less likely to have secondary damage in the surrounding tissue.
- Secondly, ice decreases the pain of the acute injury. There’s evidence that ice doesn’t reduce swelling on its own, but it works by decreasing nerve conduction velocity – namely, the signals between the injury and the brain. This means you experience less pain and can get the area moving again. By performing exercises, you’ll reduce swelling, making this a byproduct of ice application rather than a direct outcome.
Researchers say that cryotherapy also decreases edema (swelling caused by too much fluid trapped in the tissue) and muscle spasms.
Is RICE outdated?
Some people suggest that icing interferes with natural healing, based on a 2015 article from Dr Mirkin, which asserts that healing requires inflammation. In this website post, Dr Mirkin says that because ice reduces blood flow to the injury site, it also cuts off the healing cells of inflammation. In short, “ice delays recovery”.
But, as Pain Medicine points out, Dr Mirkin wrote his article to counter the claim that ice promotes healing. Most people don’t apply ice to promote healing – they do it for immediate pain relief.
Dr Mirkin also concludes his article by re-confirming that ice reduces pain, and saying it’s ok to ice an injury for short periods right after the injury occurs. Many proponents of “no ice” seem to focus on the headline and gloss over this fact.
When and how to ice
What sorts of injuries should you ice? Pain Science suggests using ice for any injuries where superficial tissues have been recently inflamed, such as:
- sprains
- strains
- bruises
- tendinitis
By icing the injury immediately, we reduce the degree of tissue damage. To achieve this outcome, we need to decrease the tissue temperature as quickly as possible to around 5 to 15 degrees celsius. Clinical Edge suggests the best way to do this is with crushed ice, as conventional gel packs and frozen peas don't get the tissue temperature below 13 ℃.
The outlier to this rule of thumb is RE3. We’ve engineered and chamber-tested our ice compression packs to ensure they maintain a temperature below 10℃ and retains it's temperature for longer periods of time.
This means an RE3 ice compression pack is more effective than crushed ice, which only gets the tissue temperature down , it cannot maintain it.
Ice can also be used in the rehab stage. At this point in your recovery, ice primarily helps with pain relief. This allows you to get back to exercise earlier, and with more intensity.
How long should you ice your injury?
The recommended time for applying ice depends on how fast you can reduce your tissue temperature. Like most things, this depends on a few variables:
- Location of injury: Joints can be cooled much more easily, so you’ll be able to reduce the temperature of your hands and feet much faster than other areas of the body.
- How deep the injury is: The deeper the injury, the longer you should ice the sore area. But we suggest when first starting out with icing to check the site regularly (every 5 minutes or so) and build up to the desired time prescribed by your healthcare team.
- The amount of fatty tissue: Some areas of the body naturally have subcutaneous layers, just as some athletes naturally carry more body fat. A lean athlete with an injury close to the surface (such as an ankle) will need to ice their injury for a shorter time than an athlete with an injury to a deeper muscle (such as a hamstring).
When not to use ice
So, ice reduces pain, gets you back to exercise faster, and sets you on the path to recovery. What’s not to love? Well, there are a few instances where you shouldn’t use cryotherapy. Don’t apply ice if you have impaired circulation, an open wound, local infection, cold hypersensitivity, or active deep vein thrombosis. If in doubt, check with your doctor or read our FAQs.
The verdict
Some people assert that Dr Mirkin has debunked his own RICE theory, but this doesn’t capture the nuances of his 2015 article. There’s no doubt that ice allows you to perform exercises with reduced (or no) pain – and this only has a positive effect on your mobility, recovery, and function.
