Does icing really help with an ankle sprain?

Does icing really help with an ankle sprain?

An ankle sprain typically causes pain and may result in a decrease in functional performance in the ankle. It is among the most common injuries incurred during sports participation,[1] and it is not uncommon is obstacle course racing. Running in different terrain, jumping off walls, landing after clearing an obstacle, all this will challenge the stability of the joint.

The ICE (Ice, Compress, Elevate) treatment protocol is widely accepted by many coaches, trainers, and therapists for acute treatment to soft-tissue injury like an ankle sprain. Despite widespread use, there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries.[4] The use of cryotherapy (cold therapy) in the management of acute soft tissue injury is largely based on anecdotal evidence.[5]

Though cryotherapy has been shown to reduce pain, it may negatively affect the long-term recovery of the tissue.[6] Moreover, this temporary pain relieves may facilitate continue participation in events and training which may aggravate the injury further.

Research has shown that pain may rapidly decrease during the first 2 weeks after injury, up to 33% continued to experience pain after 1 year, and as much as 34% reported at least 1 re-sprain.[2]

Many have reported that the ankle feels “unstable” or it feels like it’s “giving way”, this is a sign of chronic ankle instability.[3]

This emphasises the need for specific training to strengthen the ankle to reduce the risk of relapse from happening.

Soft-tissue injuries simply need PEACE and LOVE

A new treatment acronyms guideline was proposed that addresses the importance of education and psychosocial factors to enhance recovery. This guideline encompasses immediate care (PEACE) to subsequent management (LOVE). In addition, while anti-inflammatories show benefits on pain and function, it flags potential harmful effects on optimal tissue repair. Hence, it is not be included in the standard management of soft tissue injuries.[4]


  1. Hertel, J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of athletic training, 37(4), 364.
  2. van Rijn, R. M., Van Os, A. G., Bernsen, R. M., Luijsterburg, P. A., Koes, B. W., & Bierma-Zeinstra, S. M. (2008). What is the clinical course of acute ankle sprains? A systematic literature review. The American journal of medicine, 121(4), 324-331.
  3. Delahunt, E., Coughlan, G. F., Caulfield, B., Nightingale, E. J., Lin, C. W. C., & Hiller, C. E. (2010). Inclusion criteria when investigating insufficiencies in chronic ankle instability. Medicine & Science in Sports & Exercise, 42(11), 2106-2121.
  4. Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE.
  5. Bleakley, C. M., McDonough, S. M., & MacAuley, D. C. (2006). Cryotherapy for acute ankle sprains: a randomised controlled study of two different icing protocols. British journal of sports medicine, 40(8), 700-705.
  6. Singh, D. P., Barani Lonbani, Z., Woodruff, M. A., Parker, T. J., Steck, R., & Peake, J. M. (2017). Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in physiology, 8, 93.

Coach Justin

- Certified Personal Trainer | Obstacle Racing Specialist | Sports Science <3

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