The use of ice in the treatment of acute soft-tissue injury - A systematic review of randomized controlled trials

Background: There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis. Study Design: Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries. Methods: A computerized literature search, citation tracking, and hand searching were carried Out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale. Results: Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment. Conclusion: Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.