Article Text

Download PDFPDF

Cryotherapy duration is critical in short-term recovery of athletes: a systematic review
  1. Alexander H Jinnah1,
  2. Tianyi David Luo1,
  3. Christopher Mendias2,
  4. Michael Freehill3
  1. 1 Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  2. 2 Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
  3. 3 Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Alexander H Jinnah; ajinnah{at}


Importance Cryotherapy is one of the simplest and oldest therapeutic methods used to alleviate acute soft tissue trauma and muscle soreness. However, inconsistent outcomes have been reported due to inconsistent protocols.

Objective To determine if various cryotherapy methods lead to enhanced recovery in athletes and identify optimal methods and protocol for short-term recovery in athletes.

Evidence review PubMed/MEDLINE and SPORTDiscus databases were searched from 1 April 1950 to 31 December 2018. The search algorithm used was: (Icing OR Ice Therapy OR Cryotherapy) AND (Athlete OR Sports) NOT (Case Reports). Inclusion criteria was human clinical studies with level 1–4 evidence, a cohort of at least 20 athletes, who were followed to determine the effect cryotherapy had on performance, pain and/or recovery were included. Abstracts, reviews, case reports and conference proceedings were excluded. Seven studies investigating the effect cryotherapy recovery were included. Manual extraction and compilation of demographic, methodology, functional and biochemical outcomes from the studies were completed. Non-randomised trials were assessed using the Methodological Index for Non-Randomised Studies and the randomised were assessed using Oxford quality scoring system.

Findings Decreased pain or muscle soreness was seen with cold water immersion(CWI) when compared with passive recovery. Other outcome variables assessed (biomarkers, functional tests) did not reveal consistent findings. Longer icing times (>10 min) were associated with detrimental effects in muscle power and activity.

Conclusions and relevance Duration is the critical variable in conventional cryotherapy, with prolonged icing leading to immediate detriment in muscle power and activity. Thus, we recommend using ice cryotherapy following exercise for no longer than 10 min for pure hypoalgesia. CWI had a greater benefit on recovery than passive recovery. Furthermore, CWI has a more beneficial effect on recovery in the first 24 hours following exercise versus immediately postrecovery. We recommend using a protocol to include immersion times of 11–15 min in 11°C–15°C (52°F–59°F) water.

Level of evidence Level III.

  • exercise physiology
  • sport specific injuries
  • basic science
View Full Text

Statistics from


  • Contributors MF and CM significantly contributed to the study conception and design. AHJ and TDL performed data extraction, analysis and interpretation. AHJ and TDL drafted the original manuscript that then underwent critical revisions by MF and CM. All authors gave final approval of this version of the manuscript to be submitted for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.