Is Ice Still the Right Answer? Rethinking Cryotherapy After Muscle and Tendon Injuries
For decades, ice has been one of the most commonly recommended treatments after a musculoskeletal injury. Many of us were taught some version of the RICE protocol (Rest, Ice, Compression, Elevation), later evolving into PRICE and POLICE. Ice became almost automatic—sprain an ankle, strain a muscle, grab an ice pack.
But is cryotherapy (ice or cold-based treatments) actually helping tissues heal?
A 2024 critical review published in the British Journal of Sports Medicine challenges long-held assumptions about icing after soft tissue injury. The authors examined decades of research and asked a simple but important question: What evidence do we actually have that cryotherapy improves healing?
Below is a clinician-friendly summary of what this paper means for patients, athletes, and rehab professionals.
Why Cryotherapy Became So Popular
Ice has traditionally been used with the goals of:
- Reducing pain
- Limiting swelling and hematoma
- Decreasing inflammation
- Preventing “secondary injury”
Because it can numb pain quickly, cryotherapy feels effective and that perception has helped cement its place in injury management. In fact, surveys show that the vast majority of athletes still use ice after injury, often multiple times per day for several days.
However, popularity does not equal evidence.
What the Research Actually Shows
1. There is no evidence that ice improves tissue healing in humans
One of the most striking findings of this review is that there are virtually no high-quality human studies showing that cryotherapy improves muscle, tendon, or ligament healing.
In other words, despite decades of routine use, we do not have human evidence that ice speeds recovery or improves tissue regeneration.
2. Pain relief? Yes. Enhanced healing? Not proven.
Cryotherapy does consistently reduce pain in the short term. This is its strongest and most reliable effect.
However:
- Pain relief does not automatically translate into better healing
- Reduced pain may mask symptoms without improving tissue recovery
There is also no evidence that icing allows for earlier or more effective rehabilitation.
3. Animal studies raise important concerns
Because human data are lacking, much of what we know comes from animal research. While these findings don’t translate perfectly to people, they raise red flags.
Animal studies suggest that cryotherapy may:
- Suppress the normal inflammatory response
- Delay removal of damaged tissue
- Disrupt macrophage activity (key immune cells for healing)
- Slow muscle regeneration
- Increase collagen deposition and fibrosis in some cases
Inflammation is not just something to “shut down”—it is a necessary part of tissue repair. Interfering with this process too aggressively may delay recovery rather than help it.
4. Severity of injury likely matters
The review highlights an important nuance:
- Large or severe injuries: Cryotherapy may delay healing
- Very mild injuries: Ice might limit excessive inflammation and injury expansion
However, these findings are based on animal models with controlled injuries and cooling protocols that often do not reflect real-world human use.
Translation to clinical practice remains uncertain.
5. What about tendons and ligaments?
Even less evidence exists for icing tendon and ligament injuries.
- No human studies demonstrate improved tendon or ligament healing with cryotherapy
- Animal studies suggest that suppressing early inflammation (similar to NSAIDs) may weaken long-term tendon structure and mechanical strength
Ice may help with postoperative pain, but there is no evidence it improves tissue integrity or long-term outcomes.
So… Should We Still Use Ice?
Based on current evidence, the authors conclude:
- Ice may be reasonable in the first few hours after injury
- Primarily for pain relief
- Possibly to limit early hematoma
- Ongoing or repeated icing beyond the acute phase should be used with caution
- Especially if the goal is “healing” rather than pain control
- Cryotherapy should not be assumed to be harmless or universally beneficial
Importantly, newer frameworks like PEACE & LOVE* have removed ice altogether, emphasizing education, optimal loading, movement, and circulation instead.
* (Protection, Elevation, Avoid anti-inflammatories, Compression, Education—for immediate care—then Load, Optimism, Vascularization and Exercise—for subsequent management)
What This Means for Patients and Athletes
If you’ve been injured:
- Using ice briefly for comfort is reasonable
- Relying on ice as a healing strategy is not supported by evidence
- Movement, progressive loading, and guided rehabilitation matter far more
If you’re a clinician:
- Ice should be framed as a pain-modulating tool, not a regenerative treatment
- Patient education is critical—pain relief does not equal tissue repair
The Bottom Line
Cryotherapy has been a cornerstone of injury care for decades but tradition has outpaced science.
There is currently no evidence that ice improves healing of muscles, tendons, or ligaments in humans. While it may help with short-term pain, prolonged or routine use may interfere with the body’s natural repair processes.
Until high-quality human research tells us otherwise, ice should be used thoughtfully, sparingly, and with clear intent—not by default.
If you’re unsure how to manage an injury or want an evidence-based rehabilitation plan, working with a clinician who understands tissue healing and load management is far more important than reaching for an ice pack.
Not sure what your injury actually needs?
A personalized evaluation can help determine whether pain relief, loading, or movement strategies are best for your recovery.
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Reference: , et al Cryotherapy for treating soft tissue injuries in sport medicine: a critical review
