Recently, people have been challenging the traditional use of ice. Some argue that it is no longer the miracle cure to musculoskeletal pain, but in fact it may be detrimental to performance or recovery. Others however argue that cryotherapy aids in recovery and reduces delayed onset muscle soreness (DOMS). In the Athletic Training setting, cryotherapy is utilized on a daily basis. Cryotherapy is applied to acute musculoskeletal injuries to prevent secondary injury caused by swelling and to decrease pain. While it makes sense that we would want to prevent further swelling in an acute care situation, are we handing our patients ice for every ache and pain after practice? Check out the article, Top 10 Reasons Not to Ice, in “The Athletic Trainers News Feed” Click here
Cryotherapy is commonly used by athletes to prevent DOMS and is often recommended by Athletic Trainers. While the literature does demonstrate reduction of inflammatory markers that are known to cause DOMS, research is still lacking on whether the decrease in inflammatory markers actually leads to decreased recovery time. Cryotherapy seems to “blunt inflammation through reducing local metabolism and inducing vasoconstriction.” Click here The question then becomes, do we want to slow down metabolism and decrease blood flow?
I don’t recommend CWI because I believe that the inflammatory markers and blood flow in sore muscles is necessary to a certain extent to allow for muscle repair. Cryotherapy, whether it is cold water immersion or an ice bag, seems counterintuitive to the healing process. While I do think that it is important to prevent excessive inflammation and supplemental DOMS, I do not think cryotherapy is the answer. It may be detrimental to decrease the temperature and affect the cellular changes following exercise. Why are we so afraid on inflammation? The body knows how to regulate itself, instead of slowing down a natural process, why not promote it with movement? On the other hand, there is no research to show that cryotherapy has a negative impact and many athletes believe that it helps. Should we recommend other options or support their decision?
As Athletic Trainers we want to do all we can to help. We want to decrease their pain so we give them ice. However, the literature does not fully support the use of cryotherapy for recovery. Much of the literature involving cryotherapy uses different exercise protocols to induce DOMS, therefore the effects cannot be generalized to all types of exercise. There also exists a lack of functional outcomes in the cryotherapy literature, making the results subjective in nature and/or involving a placebo effect.
So what do we do as Athletic Trainers? Do we continue to support or recommend the use of cryotherapy? In my clinical practice, I recommend a different approach to recovery. When my athletes come to me after practice reporting muscle soreness, I don’t usually recommend ice. Instead, I recommend active recovery, foam rolling, and stretching. Active recovery (10 mins of light biking or running) and foam rolling have been shown to reduce blood lactate concentration, therefore preventing the resulting DOMS. (click here, click here, click here)
I would love to hear from fellow Athletic Trainers on their common practice pertaining to cryotherapy. Feel free to comment below.
Check out this video for some more insight: http://youtu.be/0UmJVgEWZu4
Michael Neal LAT, ATC