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Should Athletes Return to Sport After Applying Ice?

A Systematic Review of the Effect of Local Cooling on Functional Performance

  • Review Article
  • Effect of Tissue Cooling on Functional Performance
  • Published:
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Abstract

Applying ice or other forms of topical cooling is a popular method of treating sports injuries. It is commonplace for athletes to return to competitive activity, shortly or immediately after the application of a cold treatment.

In this article, we examine the effect of local tissue cooling on outcomes relating to functional performance and to discuss their relevance to the sporting environment. A computerized literature search, citation tracking and hand search was performed up to April, 2011. Eligible studies were trials involving healthy human participants, describing the effects of cooling on outcomes relating to functional performance. Two reviewers independently assessed the validity of included trials and calculated effect sizes. Thirty five trials met the inclusion criteria; all had a high risk of bias. The mean sample size was 19. Meta-analyses were not undertaken due to clinical heterogeneity. The majority of studies used cooling durations >20 minutes. Strength (peak torque/force) was reported by 25 studies with approximately 75% recording a decrease in strength immediately following cooling. There was evidence from six studies that cooling adversely affected speed, power and agility-based running tasks; two studies found this was negated with a short rewarming period. There was conflicting evidence on the effect of cooling on isolated muscular endurance. A small number of studies found that cooling decreased upper limb dexterity and accuracy. The current evidence base suggests that athletes will probably be at a performance disadvantage if they return to activity immediately after cooling. This is based on cooling for longer than 20 minutes, which may exceed the durations employed in some sporting environments. In addition, some of the reported changes were clinically small and may only be relevant in elite sport. Until better evidence is available, practitioners should use short cooling applications and/or undertake a progressive warm up prior to returning to play.

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Acknowledgements

Part of this project was funded by the Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSM). The authors declare no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Health and Rehabilitation Sciences Research Institute, Faculty of Life and Health Sciences, University of Ulster, Newtownabbey, County Antrim, BT370QB, Northern Ireland

    Chris M. Bleakley

  2. Centre for Physical Activity and Health Research, Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland

    Joseph T. Costello

  3. Sports Institute Northern Ireland, University of Ulster, Newtownabbey, County Antrim, Northern Ireland

    Philip D. Glasgow

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  1. Chris M. Bleakley
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  2. Joseph T. Costello
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  3. Philip D. Glasgow
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Correspondence to Chris M. Bleakley.

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Bleakley, C.M., Costello, J.T. & Glasgow, P.D. Should Athletes Return to Sport After Applying Ice?. Sports Med 42, 69–87 (2012). https://doi.org/10.2165/11595970-000000000-00000

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