07/10/2025
Published today 🔥
Effectiveness of cryotherapy on pain intensity, range of motion, swelling and function in the postoperative care of musculoskeletal disorders: a systematic review and meta-analysis of randomised controlled trials
❄️ Cryotherapy has long been used in the management of musculoskeletal injuries and postoperative rehabilitation. Its proposed mechanisms include reducing nerve conduction velocity and muscle spasms (Algafly & George, 2007), stimulating thermoreceptors that inhibit nociceptive signals (Komatsu & Nakajima, 2025), and decreasing metabolic demand to prevent secondary injury (Kwiecien & McHugh, 2021). Additionally, local vasoconstriction may reduce swelling and tissue necrosis (Ho et al., 1995; Shepherd et al., 1983).
❓ Despite its popularity in clinical practice, evidence regarding its effectiveness remains inconsistent. Previous systematic reviews found limited or low-certainty evidence for cryotherapy’s benefits, especially in postoperative contexts such as total knee arthroplasty and ligament reconstruction (Miranda et al., 2021; Aggarwal et al., 2023; Klintberg & Larsson, 2021).
📊 Given this uncertainty, a comprehensive synthesis of randomized controlled trials (RCTs) is required to clarify cryotherapy’s true clinical utility.
🥶 Miranda et al. (2025, https://bjsm.bmj.com/content/early/2025/10/05/bjsports-2024-109497) conducted a systematic review and meta-analysis of 28 RCTs evaluating cryotherapy’s effectiveness in postoperative care of musculoskeletal disorders. Outcomes included pain intensity, range of motion (ROM), swelling, and function.
✅ Pain intensity: Cryotherapy produced statistically significant short- to medium-term reductions in pain (immediate: MD −0.77; short-term: MD −0.84; medium-term: MD −0.41). However, these values fell below the minimum clinically important difference (MCID) of 2 points.
✅ Range of motion: Small to medium improvements in ROM were observed (immediate SMD 0.37; short-term SMD 0.51; medium-term SMD 0.61).
✅ Swelling: A small short-term effect was identified (SMD −0.35), though certainty of evidence was low.
✅ Function: Minimal short-term improvements were found (MD 3.45), but these did not reach the MCID of 11 points.
❎ The overall certainty of evidence ranged from very low to moderate, largely due to high risk of bias in included trials.
Conclusions 💡
The findings suggest that cryotherapy may provide minor short-term benefits for pain and ROM following musculoskeletal surgery. However, these effects are not clinically meaningful, and evidence for swelling and function remains weak. Clinical guidelines should therefore be cautious in recommending cryotherapy as a routine postoperative intervention. Future high-quality RCTs are needed to better establish its efficacy.
References 📚
Aggarwal A, Adie S, Harris IA, et al. (2023). Cryotherapy following total knee replacement. Cochrane Database Syst Rev, 9:CD007911.
Algafly AA, George KP. (2007). The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med, 41:365–9.
Ho SS, Illgen RL, Meyer RW, et al. (1995). Comparison of various icing times in decreasing bone metabolism and blood flow in the knee. Am J Sports Med, 23:74–6.
Klintberg IH, Larsson ME. (2021). Shall we use cryotherapy in the treatment in surgical procedures, acute pain, or long-term dysfunction? A systematic review. J Bodyw Mov Ther, 27:368–87.
Komatsu M, Nakajima M. (2025). Electromyographic study on inhibitory effects of local cold- and hot-water bathing on α-motor neuron activity. Cureus, 17:e84954.
Kwiecien SY, McHugh MP. (2021). The cold truth: role of cryotherapy in injury treatment and recovery. Eur J Appl Physiol, 121:2125–42.
Miranda JP, Silva WT, Silva HJ, et al. (2021). Effectiveness of cryotherapy on acute ankle sprain: systematic review. Phys Ther Sport, 49:243–9.
Miranda JP, Figueiredo RCC, Saragiotto B, Oliveira VC. (2025). Effectiveness of cryotherapy on pain intensity, range of motion, swelling and function in postoperative care of musculoskeletal disorders: a systematic review and meta-analysis of RCTs. Br J Sports Med, doi:10.1136/bjsports-2024-109497.
Shepherd JT, Rusch NJ, Vanhoutte PM. (1983). Effect of cold on the blood vessel wall. Gen Pharmacol, 14:61–4.
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