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Should We Still Use Ice in the Initial Stages of Rehabilitation and Injury Recovery?

Updated: Jun 19

Fellow therapists, it's time we had an honest conversation about cryotherapy or icing. This long-standing modality has been a cornerstone of acute injury management and post-operative care for as long as most of us can remember. Slapping an ice pack on a swollen ankle or surgical site has become such a reflexive part of our practice, one could argue it's muscle memory at this point.

But recently, some compelling evidence has emerged that's challenging conventional wisdom around cryotherapy's widespread use, particularly in those early, critical stages of rehabilitation. As evidence-based practitioners, we have an obligation to examine these findings objectively.

Let's start with the benefits we're all familiar with – cryotherapy or icing is extremely effective at reducing pain, inflammation and swelling acutely. The vasoconstriction helps put the brakes on runaway inflammatory processes that could otherwise exacerbate tissue damage. Decreased metabolic demand also minimizes secondary cell death. For years, these were justifications enough to make cryotherapy a go-to part of our protocols.

However, emerging research indicates excessive or prolonged icing of an injury may actually impair healing long-term by suppressing inflammation too much. We know inflammation is a crucial part of the repair process, bringing vital cells and nutrients to the injury site. Could we be doing our patients a disservice by putting that mechanism on ice for too long?

There are also the more tangible side effects with icing that we've likely observed – increased muscle stiffness, reduced flexibility, and potential skin issues with improper application. As mobility specialists, these consequences run counter to our rehab goals of restoring full range of motion and function.

lady icing her injured knee

Now, this isn't to say we should abandon cryotherapy altogether. It still has an important role to play, particularly in the immediate aftermath of acute injuries when managing pain and hemostasis is the priority. The key may be striking the right balance and knowing when to pull back on the cold therapy in favor of other modalities.

Heat, for example, can improve blood flow and tissue extensibility later in recovery. Compression helps control swelling while providing support. Electrical stimulation can disrupt pain signals without the potential drawbacks of cryotherapy. Even simple elevation can effectively limit edema.

As therapists, we're fortunate to have an arsenal of techniques to pull from. By taking a judicious, multi-modal approach customized to each patient's needs and phase of healing, we can maximize therapeutic benefit while mitigating unintended consequences.

The rehab realm is ever-evolving, and we'd be doing our patients a disservice by not evolving along with it. Perhaps it's time to step back and critically examine our reliance on cryotherapy, approaching it with the same evidence-based lens we apply to other interventions. Our clients are counting on us to provide the most effective and responsible care possible. Staying abreast of the latest research is key to upholding that responsibility.

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