No Evidence to Support the Use of Cryotherapy for the Treatment of Acute Ankle Sprain

women leg ankle injury/painful, women touch the pain ankle leg
The potential effectiveness of cryotherapy in the treatment of acute ankle sprain pain, swelling, and range of motion was evaluated in a systematic review of randomized controlled trials.

A systematic review found no evidence to support the use of cryotherapy for the management of acute ankle sprain. These findings were published in Physical Therapy in Sport.

Researchers from the Universidade Federal dos Vales do Jequitinhonha e Mucuri in Diamantina, Brazil, searched publication databases through January of 2021 for randomized controlled trials of cryotherapy within 7 days of an ankle sprain. A total of 2 studies published in 1989 with 143 and 30 participants met the criteria for inclusion.

Neither study compared cryotherapy with placebo or sham treatments. Both assessed cryotherapy efficacy for the treatment of pain intensity and swelling and 1 of the studies also assessed range of motion. Cryotherapy was defined as 20 to 30 minutes with an ice pack with nonsteroidal pain medication, standardized exercise, and elevation and rest or ultrasound therapy.

Cryotherapy with other active therapy was not found to decrease swelling compared with active therapy alone (mean difference [MD]=6.95% CI, 0.5-12.5; P =.07). Participants in both groups exhibited up to 10% improvement regardless of treatment assignment.

Pain intensity was not found to be significantly reduced by cryotherapy with other active therapy compared with active therapy alone, as measured on a 5-point scale (MD=-0.03, 95% CI, 0.34-0.28; P =.84).

There was no evidence that range of motion was improved by cryotherapy (P >.05). No raw data on range of motion were provided in the original publication.

This study was limited in that the researchers only included 2 studies, each of which had a high risk for bias. In addition, some data that had been collected more than 30 years ago was determined to be unavailable.

The study authors concluded that the available evidence does not indicate cryotherapy as an efficacious treatment for ankle sprain. Additional placebo or sham studies are needed.


Miranda J P, Silva W T, Silva H J, Mascarenhas R O, Oliveira V C. Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: a systematic review of randomized controlled trials. Phys Ther Sport. 2021;49:243-249. doi:10.1016/j.ptsp.2021.03.011