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Cryotherapy is the use of cooling to treat injuries. The effects of cooling on damaged soft tissues have been researched. Although the benefits are accepted, there are varying opinions on the cooling process's duration to gain maximum benefit.

The body's reaction to an injury

An injury means tissues have been stretched or blood vessels damaged, and the extent of bleeding will depend on the vascularity of the tissues involved. It is essential to stop bleeding as it will increase inflammation which must be cleared before the healing can start.

Cells starved of nourishment due to injury will soon die. These dying cells stimulate histamine release, causing the blood vessels to dilate, which increases blood supply and extra nutrients to help repair the damaged tissues. With an increase in blood supply, the capillary walls become much more porous with Protein and inflammatory substances pushed into the area, causing swelling.

Muscle spasms may also occur, causing the muscle to contract, helping prevent further movement. This may restrict blood flow and place more pressure on nerve endings, leading to increased pain.


By applying ice immediately after a soft tissue injury, the amount of swelling and blood allowed to leak out may be substantially limited. This can also be assisted by compression, elevation and rest, hence "ICER", (or more commonly "RICE)

  • Ice - Apply ice for up to 10 minutes as soon after the injury as possible - do not wait for the swelling to start. This may be repeated every 2 hours during the first two days after injury. It is important not to keep the ice on any longer than 10 minutes as the body then reacts by increasing blood flow to warm the area and exacerbate the swelling. Do not apply ice directly to the skin. Use a wet flannel.
  • Compression - After ice, apply a compression bandage to help minimise tissues swelling.
  • Elevation - Elevate the injured part to help limit blood flow and prevent the muscles' use of the damaged part.
  • Rest - the injured part as much as possible to allow the healing of damaged tissues.

Failure to follow the RICE protocol will increase the period of recovery from injury. If the injury is severe and not adequately managed, it may create long-term problems for the athlete.

Use of Ice

When applying ice, never use it directly onto the skin. Ice burns the skin. Instead, wrap the ice in a damp cloth (a dry cloth will not transmit cold effectively).

There is an ongoing debate over how long to apply ice. Current research suggests that during the first 24-48 hours after injury, ice should be applied for 10 minutes and repeated every 2 hours.

If the ice pack is left on for more than 10 minutes, a reflex reaction occurs (Hunting effect) where the blood vessels dilate, and blood is again pumped into the injured area, causing further bleeding and swelling.

Ice will have an analgesic effect on the injured part by limiting the pain and swelling, and muscle spasm may also be reduced. Whilst this has obvious benefits, be cautious about reducing the pain, as this may mask the seriousness of the injury.

During the first 24 to 72 hours after an injury, be sure to avoid any form of heat at the injury site (e.g. heat lamps, heat creams, spa's, Jacuzzi's and sauna's), avoid movement and do not massage the injured area as these will increase the bleeding, swelling and pain.

After the initial healing period of up to 72 hours (depending on the severity of the injury), ice massage may be incorporated into treatments. By applying stroking movements with an ice pack, the blood vessels will dilate and constrict alternately bringing an increased supply of blood and nutrients to the area and increasing the rate of healing. This may be done for more than 10 minutes to increase circulation.

Ice Baths

Ice baths have become popular in contact sports like rugby, American Football, and endurance athletes. Full-body ice baths can be considered for contact sports, and for sports that predominantly stress the legs, such as football, field hockey, running, etc., the immersion of the lower limbs can only be considered. Initially, start with one-minute sessions and progress to a maximum of 10 minutes over ten weeks.

Contra indications of using ice

  • Check a person's general sensitivity to ice - some people find the application of cold immediately painful.
  • Do not use ice on injuries in the chest region, as in some instances, this may cause a muscle reaction, bringing about angina pain, possibly from the constriction of coronary arteries.
  • Always check skin sensitivity before applying ice - if a person cannot feel touch before applying ice, it may indicate other nerve impingement problems. In such instances, ice would only mask this and complicate the situation.
  • Do not apply cold to someone with high blood pressure as vasoconstriction will increase the vessels' pressure


It is important to educate anyone managing injuries, including athletes, on at least the primary use of ice on soft tissue injuries - early treatment is essential.

Page Reference

If you quote information from this page in your work, then the reference for this page is:

  • MACKENZIE, B. (2000) Cryotheraphy [WWW] Available from: [Accessed