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Ankle injuries are one of the most common acute soft tissue injuries, 1 incurring a significant cost to both the individual and society. 2 Despite the high incidence, cost, and long term morbidity, however, the optimal method of managing acute ankle sprains remains controversial. 2, 3
The application of ice after ankle sprain is accepted clinical practice even if the strength of evidence supporting the use of cryotherapy in management of acute soft tissue injury is generally poor. 4, 5 Most randomised, controlled trials have focused on post-surgical patients, and have serious flaws in their study design and implementation. In addition, no study has rigorously compared the effectiveness of two different icing protocols; therefore there is no evidence to suggest an optimal mode, duration, or frequency of ice application.
In the absence of robust evidence from clinical studies, one systematic review 6 made recommendations for an optimal treatment protocol, using evidence derived from investigations on animal models or healthy human volunteers. The evidence suggested that intermittent 10 minute applications were most effective at reducing both skin and deep tissue temperature to optimal therapeutic levels, and melting iced water was deemed the safest and most efficient method of application. 6 Although this provides preliminary evidence based recommendations for an optimal protocol, its efficacy in treating injured human subjects is not yet known.
The aim of this investigation was to study the effectiveness of cryotherapy in treating acute soft tissue injuries. The specific objective was to compare the efficacy of an intermittent cryotherapy treatment protocol with a standard cryotherapy treatment protocol in the management of acute ankle sprains.
METHODS
Participants and recruitment
Recruitment began in the University of Ulster in January 2002 and was extended to the Royal Victoria Hospital, Belfast in March 2002. To be eligible for inclusion in the study, subjects had to have sustained a mild/moderate ankle sprain within the preceding 48 hours. A three point grading scale 7 was used to determine the severity of the sprain. Subjects testing positive on the anterior drawer test or talar tilt test were automatically excluded from the trial.
Delayed physical examination for the presence or absence of a ligament lesion gives diagnostic quality equal to that of arthroscopy. 8 Other exclusion criteria were subjects <16...