Avoiding Cryotherapy is Beneficial in the Treatment of Many Musculoskeletal Injuries

Categories: Athletic Performance, Musculoskeletal Health Tags: Cryotherapy, Inflammation, Muscle Recovery, Performance Medicine, RICE Protocol Posted on: 11-Aug-2025

For decades, ice packs were a cornerstone of injury management. Coaches and clinicians routinely prescribed “RICE” (Rest, Ice, Compression, Elevation) for everything from sprains to muscle soreness. But in recent years, our understanding of muscle physiology and tissue repair has evolved, and so has our use of cryotherapy.

Cryotherapy is no longer a blanket treatment. It is one tool among many, used selectively and strategically. Our protocols are built around the biology of tissue healing, not just symptom relief.

Why Cryotherapy Fell Out of Favor

The original RICE protocol was based on reducing pain and swelling. While these are important goals, modern sports medicine recognizes that some inflammatory activity is essential for proper healing. Inhibiting this response too aggressively, especially in the early post-injury phase, may slow down the repair process.

Cold exposure can:

Suppress the inflammatory signaling necessary for satellite cell activation
Reduce local blood flow and delay immune cell infiltration
Blunt anabolic responses to resistance training
Alter mitochondrial function and cellular metabolism

When Cryotherapy Still Makes Sense

Despite its limitations, cryotherapy still has clinical value—especially in specific use cases where the goals are pain reduction or temporary neuromuscular inhibition. We continue to use local cryotherapy for:

Acute muscle strains with significant pain
Nerve-related pain syndromes (e.g., pudendal neuralgia)
Post-exercise soreness in individuals with limited recovery capacity
Short-duration exposures to complement other therapies

Importantly, these sessions are brief, targeted, and always part of a broader recovery plan. We avoid prolonged ice baths, daily cold exposure routines, or any protocol that may interfere with inflammation-driven remodeling.

What Replaces RICE?

The new gold standard in tissue recovery emphasizes active movement, circulation, and load progression. Depending on the injury and goals, the following strategies are prioritized:

MEAT protocol: Movement, Exercise, Analgesia, and Treatment
Blood flow optimization: gentle mobility, compression sleeves, TECAR, or PEMF
Tissue support: anti-catabolic strategies, mitochondrial support, and nutrition
Neuromuscular retraining: tools like Neubie, electrical stimulation, or manual therapy
Regenerative therapies: PRP, BMAC, shockwave, or Class IV laser to enhance cellular repair

These approaches work with the body’s biology rather than against it. The goal is to restore structure and function, not just to suppress symptoms.

Our Approach

At the Performance Medicine Institute, we assess the phase of injury, tissue type, and recovery goals before selecting cryotherapy. If used, it is always limited to a defined purpose, usually to reduce acute pain or calm overactive neural input. From there, we shift rapidly toward revascularization, movement, and functional rehab.

This is particularly important for athletic patients or individuals undergoing regenerative treatments, where inflammation is not the enemy but a necessary partner in recovery.

Conclusion

Cryotherapy still has a role in musculoskeletal care, but its widespread use as a first-line treatment has been replaced by a more targeted, evidence-based approach. Rather than reflexively reaching for ice, today’s recovery strategies focus on circulation, activation, and cellular support. Contact Us today to learn how we personalize injury recovery for better long-term outcomes.

References

Sarver, D. C., Sugg, K. B., Disser, N. P., Enselman, E. R. S., Awan, T. M., & Mendias, C. L. (2017). Local cryotherapy minimally impacts the metabolome and transcriptome of human skeletal muscle. Scientific Reports, 7(1), 2423.

Bleakley, C. M., Glasgow, P., & Webb, M. J. (2012). Is it time to Rethink RICE? British Journal of Sports Medicine, 46(4), 220–221.

Chan, R. W., & Lee, C. Y. (2018). Revisiting the use of cryotherapy in musculoskeletal injury management. Journal of Physical Therapy Science, 30(7), 1005–1010.

Vella, L., & Cameron-Smith, D. (2010). Cold water immersion and recovery from strenuous exercise: a meta-analysis. British Journal of Sports Medicine, 44(3), 179–187.