Ankle sprain is a condition with a high incidence in the general population and athletes and can cause direct costs (expenses with medical appointments and medication) and indirect costs (absence from work and loss of productivity). Cryotherapy is often recommended for the management of this condition, however current evidence supporting cryotherapy is still uncertain. A systematic review is needed to inform clinicians and patients about the current quality of evidence for the effectiveness of cryotherapy after an episode of an acute ankle sprain.

The aim of this systematic review was to investigate the effectiveness of cryotherapy on pain, edema, range of motion, function, and recurrence after acute ankle sprains.

This systematic review of randomized controlled trials was reported following the PRISMA checklist and some stages were conducted according to the Cochrane recommendations. Protocol was prospectively registered in PROSPERO (CRD42020166411) and Open Science Framework (https://osf.io/x6p23). Searches for randomized controlled trials evaluating the effectiveness of cryotherapy on pain, swelling, range of motion, function, and recurrence outcomes in people with acute ankle sprains were performed in six databases (MEDLINE, COCHRANE, EMBASE, AMED, PSYCINFO and PEDRO, without language or date restriction, until January 2021). Study selection, data extraction, and assessment of the methodological quality of included studies were conducted independently by two reviewers, with discrepancies resolved by a third reviewer. Estimates were presented as Difference of Means (MDs) with 95% confidence intervals (CIs). The quality of evidence was assessed using the GRADE approach.

Two randomized controlled trials with a high risk of bias (methodological quality < 6 on the 0-10 PEDro scale) were included. There were no studies investigating the effectiveness of cryotherapy alone on our outcomes of interest. Both studies evaluated the additional effects of cryotherapy, comparing cryotherapy as an adjunct to another active intervention with the active intervention alone. Evidence with a high level of uncertainty shows that cryotherapy does not increase the effects of the other intervention for the outcomes edema (MD = 6.0; 95% CI: -0.5 to 12.5), pain (MD = -0.03; 95% CI: -0.34 to 0.28) and range of motion (p > 0.05).

The results of this study conclude that the current literature lacks evidence supporting the use of cryotherapy in the management of acute ankle sprains. There is an urgent call for higher quality RCTs to clarify the evidence on the effectiveness of cryotherapy in this condition.

Clinical guidelines should reassess recommendations regarding the use of cryotherapy in the management of acute ankle sprains. Clinicians should look for therapies with more robust scientific evidence as a first-line treatment for this condition.