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

The body's reaction to an injury

An injury means tissues will have either been stretched or blood vessels damaged, and the extent of bleeding will depend on the vascularity of the tissues involved. It is important 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 the release of histamine 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 permeable with Protein and inflammatory substances pushed into the area causing swelling.

Muscle spasm 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 level of swelling and amount of 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 therefore exacerbating the swelling. Do not apply ice directly to the skin. Use a wet flannel
  • Compression - After ice, apply a compression bandage to help minimise the swelling in the tissues
  • Elevation - Elevate the injured part to help limit blood flow and prevent the use of muscles to the injured 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 properly managed, it may create long-term problems for the athlete.

Use of Ice

When applying ice never apply directly onto the skin as this may result in ice burns to the skin, instead wrap the ice in a damp cloth (a dry cloth will not transmit cold effectively).

There is on-going 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, 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 so 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 and American Football and with endurance athletes. For contact sports whole body ice baths can be considered and for sports that predominantly stress the legs, such as football, field hockey, running etc. immersion of the lower limbs only can be considered. Initially start with one-minute sessions and progressing to a maximum of 10 minutes over a period of 10 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 reaction in the muscles, 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 problems such as nerve impingement. In such instances ice would only serve to mask this and complicate the problem
  • Do not apply cold to someone with high blood pressure as vasoconstriction will increase the pressure within the vessels


It is important to educate anyone managing injuries including athletes themselves on at least the basic use of Ice on soft tissue injuries - early treatment is essential.

Related References

The following references provide additional information on this topic:

  • HIGGINS, T. R. et al. (2011) A random control trial of contrast baths and ice baths for recovery during competition in U/20 rugby union. The Journal of Strength & Conditioning Research, 25 (4), p. 1046-1051

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

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