DOI: 10.1097/01.jsm.0000277813.25356.fe
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PMID: 17620801
Issn Print: 1050-642X
Publication Date: 2007/07/01
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Excerpt
Objective: To compare the effectiveness of intermittent cryotherapy with standard cryotherapy in the management of acute ankle sprains.
Design: Randomized controlled trial stratified by sport/nonsport causes of injury, with investigator-blinded outcome assessment. Multiple statistical comparisons were corrected by the method of Bonferroni.
Setting: Community study that commenced in January 2002 in Northern Ireland.
Participants: The inclusion criterion was a mild/moderate ankle sprain sustained within the preceding 48 hours. Exclusion criteria were a positive anterior drawer or talar tilt test, <16 years of age, a bony injury (excluded by the application of the Ottawa ankle rules), multiple injuries, and the presence of any cold-related condition.
Intervention: Participants (n = 89; mean age, 30 y; sport-related cause of injury, 49%; men, 65%) were assigned to intermittent cryotherapy or a standard protocol. Both groups were instructed to apply a melting icepack wrapped in a damp towel every 2 hours for the first 72 hours after the injury, according to verbal and written instructions. The standard cryotherapy group applied the icepack continuously for 20 minutes. The intermittent cryotherapy group applied the icepack for 10 minutes, rested the ankle for 10 minutes, and then reapplied the pack for a further 10 minutes. Patients were asked to keep a compliance diary. Both groups were instructed in exercises for ankle mobility, calf stretching, and improving proprioception, which were to be done once a day for the first week.
Main outcome measures: The primary measure was subjective ankle function at 1, 2, 3, 4, and 6 weeks after injury using Binkley's scale. Patients also reported pain at rest and during activity on 10-cm visual analog scales (VAS). Ankle swelling was measured. The intention-to-treat analysis included 79% of patients.
Main results: After adjustment for baseline differences the groups did not differ in improvement of function or lessening of swelling or pain at rest at any of the measurement points. Pain on activity decreased more between baseline and week 1 in the intermittent protocol group than in the standard protocol group (P = 0.017). Baseline VAS pain scores on activity were ~4 for the intermittent group and ~4.7 for the standard group, which decreased to ~0.7 for each group by week 6. At 6 weeks both groups had improved on all measures (P < 0.05). No adverse effects of treatment were reported.
Conclusion: The intermittent cryotherapy protocol was more successful in lessening pain on activity during the first week than the standard protocol, but after 6 weeks both cryotherapy methods produced similarly good results for patients with ankle sprains.
