Cryotherapy added to PEACE & LOVE rehabilitation for acute lateral ankle sprain in physically active adults: A randomized controlled trial in sports rehabilitation.

OBJECTIVES

To evaluate whether adding cryotherapy during the first 72 h to a standardized PEACE & LOVE rehabilitation program improves early recovery after acute lateral ankle sprain compared with a room-temperature gel-pack control.

DESIGN

Randomized, parallel-group controlled trial.

METHODS

Sixty physically active adults with Grade I-II acute lateral ankle sprain within 48 h of injury were randomized 1:1 to PEACE & LOVE rehabilitation plus either active cryotherapy or room-temperature gel-pack control. Cryotherapy was delivered using a 0-4 °C gel pack for 20 min, three times daily for 72 h. Both groups received identical progressive rehabilitation for four weeks. The primary outcome was average ankle pain during the previous 24 h measured using the Numeric Pain Rating Scale at Day 7. Secondary outcomes were swelling, Lower Extremity Functional Scale score, Weight-Bearing Lunge Test, paracetamol use, and re-injury. Outcomes were analyzed using linear mixed-effects models.

RESULTS

All randomized participants completed follow-up. Pain decreased in both groups, with a statistically greater Day 7 reduction in cryotherapy than control (adjusted difference -1.10, 95% confidence interval -1.85 to -0.35; p = 0.004). However, this did not reach the pre-specified 2-point minimal clinically important difference. Swelling also decreased more with cryotherapy (-1.78 cm, 95% confidence interval -3.26 to -0.30; p = 0.019). Functional recovery, dorsiflexion, paracetamol use, and re-injury were comparable. Responder analysis produced a number needed to treat estimate with confidence intervals crossing infinity.

CONCLUSIONS

Cryotherapy provided statistically greater short-term pain and swelling reductions, but its added clinical value beyond progressive rehabilitation remains uncertain within four weeks.