Prolonged Icing for Muscle Strains – A Personal Hypothesis

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In my experience, icing a strained muscle for one to three hours at a time, rather than the usual 20 minutes, can dramatically speed its recovery. This article describes the protocol I use, why I think it might work, and what the research says for and against it.

Please read it for what it is: a hypothesis based on my own experience, not an established treatment. No study has tested prolonged icing of an injured human muscle. Some of the research is encouraging, some of it points the other way, and prolonged cold carries real risks. If you choose to try it, you do so at your own risk.

The main points are:

  • Only for mild strains of large muscles. I use it for a classic "pulled muscle" in the calf, quadriceps, hamstrings or glutes. I have not found ice useful for tendon or other connective tissue injuries, joints or delayed-onset muscle soreness (DOMS).
  • Use a bag of ice and water, never a gel pack. A mixture of ice and water stays at about 0°C, so it cannot freeze your skin. Gel packs, frozen vegetables and ice straight from the freezer start below freezing.
  • Build up gradually. Start with the conventional 20 minutes and increase by about half each day, to a maximum of three hours.
  • Keep your core warm, and don't use compression or elevation. The aim is to keep blood flowing to the muscle, not to shut it down.
  • Stop if the skin turns pale, white, waxy or blue. Redness is common, but it is not proof that blood flow has increased.
  • The rationale is plausible but unproven. Hours of icing cool deeper tissue than 20 minutes can, and continuous cooling reduced secondary damage in rats. My belief that prolonged cold increases blood flow to the muscle is the weakest part of the case.
  • The risks are real. Ice and water cannot cause frostbite, but prolonged cold can damage skin and nerves without freezing them, and injuries have been reported after prolonged cooling with ice and with ice water.
  • Ice baths are a different thing. A short ice bath cools only the outer layers of muscle and cools your core, the evidence for them is weak, and I think the effort is better spent on other recovery methods.

Disclosure: this article is the result of research and drafting with Claude, and my analysis/review. Any mistakes are mine alone.

Practical guide

Is this for you?

Suitable injuries. A classic "pulled muscle" (muscle strain) where only a limited number of muscle fibers are stretched or torn. The muscle is tender and painful, and you may lose some strength or function, but it keeps most of its normal strength. This is slightly broader than the formal definition of a grade I strain. I've found the protocol works best on large muscles such as the calves, quadriceps and hamstrings.

Small muscles. Small muscles, such as the intrinsic muscles of the foot, cool much faster, and the conventional 20-minute limit works well for them. This fits the research: under thin fat, cooling the muscle takes minutes, but under thicker fat it takes about an hour[1].

Not suitable. Tendon and other connective tissue injuries, joints, DOMS and more severe strains. If the muscle is clearly weak, you can't use it normally, or there is extensive bruising, get it assessed.

Who should not try it. Anyone with a condition that impairs circulation or the response to cold. Frostbite guidelines list peripheral vascular disease, Raynaud's disease, diabetes and smoking as risk factors for cold injury[2]. Reduced sensation in the area is another reason to avoid it, because you may not notice damage. There may be other contraindications I'm not aware of.

Where not to put the ice. Avoid prolonged icing where nerves run close to the surface, particularly the outside of the knee just below the joint, where the common peroneal (fibular) nerve wraps around the head of the fibula, and the inside of the elbow. Nerve injuries from icing are linked to the nerve's location, thin overlying fat, compression and the duration of cooling[3].

What you need

  • A bag of ice and water. Use a strong zip-lock bag, or two nested together, filled with ice cubes and enough cold water to make a slush.
  • A thin towel for the first few minutes.
  • Extra ice to top up during long sessions, so there is always ice in the water.
  • Warm clothing and a heating pad for your back or torso.
  • For areas you sit or lie on, such as the hamstrings and glutes, a hydration bladder works better than a bag. Put the ice in the bladder, remove the bite valve and run the hose into a bucket, so meltwater drains away instead of leaking (see Icing with a Camelbak).

The protocol

  1. Start on the day you notice the injury.
  2. Warm up first and stay warm. Wear warm clothes and use a heating pad on your back, so your core temperature is normal or slightly raised. If your core cools, your body reduces blood flow to the limbs to protect it, which is the opposite of what you want (see Keeping blood flowing).
  3. Make the ice and water mix and let it stand until there is water around the ice, so the bag is at about 0°C rather than freezer temperature.
  4. Start with a thin towel between the bag and your skin for the first few minutes, so the initial cooling is gentler and less uncomfortable. Then remove the towel so the bag is in direct contact with the skin.
  5. Don't use compression or elevation. Both are standard advice, but I avoid them while icing because the goal is to keep blood flowing to the muscle. Avoiding compression also removes one of the risk factors for nerve injury[3].
  6. Keep ice in the bag. Top it up as the ice melts.
  7. Follow the build-up below, and stop at any warning sign.
  8. Repeat daily until the muscle feels normal.

Building up the time

Start with the conventional 20 minutes and increase the time by about half each day. While sessions are shorter than an hour, do two a day; once they reach an hour, one a day is enough. Don't go beyond three hours.

Day Session length Sessions per day
1 20 minutes 2
2 30 minutes 2
3 45 minutes 2
4 About 70 minutes 1
5 About 100 minutes 1
6 About 2½ hours 1
7 onwards 3 hours (maximum) 1

You don't have to reach three hours; stay at any length that is working. The build-up is a precaution, not a tested schedule. It lets you find out how your body reacts before committing to longer sessions, but no research shows that building up makes long sessions safer.

Warning signs

  • Stop immediately if the skin turns pale, white, waxy, grey or blue, or if redness fades while the ice is still on.
  • Stop and get medical advice if, after the skin has rewarmed, you have blisters, skin that stays discolored or hard, or numbness, tingling, burning pain or weakness that doesn't go away. Difficulty lifting the foot after icing the outside of the knee is a sign of nerve injury[4].
  • Never ice while asleep.
  • Expect numbness during icing, but sensation should return as the skin rewarms.
  • Take care afterwards. A cooled muscle has impaired control[5], so be careful before running or doing anything that needs quick reactions.

In my experience, the skin goes bright red fairly quickly. I used to take that as a sign of increased blood flow, but where skin blood flow has been measured directly under ice or cold pads, it falls[6][7]. Redness is therefore not reassurance that blood flow is up, but redness fading or giving way to pallor is a sensible signal to stop.

Why ice and water, not gel packs

A bag of ice and water stays at about 0°C until the ice has melted, because the ice absorbs heat as it melts[8]. Human tissue freezes at around −0.5 to −2°C[9], so an ice and water mix cannot cause frostbite. Gel packs, frozen vegetables, blocks of ice and ice cubes straight from the freezer all start well below 0°C and can freeze skin, particularly in the first few minutes. Gel packs then warm up steadily, because they don't change phase[10].

Ice is also the more effective coolant. In a comparison where all the packs were frozen at −20°C and applied through a damp towel, an ice pack cooled the skin significantly more than a gel pack or frozen peas throughout the 20 minutes[11]. Ice bags also cooled skin and muscle more than gel packs over 30 minutes[8], and ice that had already started to melt (wetted ice) cooled the skin better than dry cubed or crushed ice[12].

There is a catch. The property that makes ice and water effective, a steady 0°C for as long as the ice lasts, also keeps the skin cold for the whole session. That is why the risks of prolonged cold (see Safety in depth) matter more for this protocol than for a gel pack that warms up.

My experience

I've had the quickest and most dramatic recoveries from calf and quadriceps strains when using prolonged icing. It has also helped with hamstring and glute strains, though not as dramatically, and I once used it on a biceps tear. I've experimented with sessions of up to six hours without problems and have never had an adverse effect, but I've set the upper limit in this article at three hours.

I don't know how much of this is the ice. Muscle strains heal on their own, I have no comparable injuries without icing to compare with, and memories of past injuries are unreliable. That is why this article presents prolonged icing as a hypothesis rather than a recommendation.

Why it might work

I think three mechanisms could explain my experience. I've listed them from best to least supported.

1. Longer icing cools deeper tissue

The conventional 20 minutes barely cools muscle that lies under a layer of fat.

  • Cooling the muscle 1 cm below the fat by 7°C took about 8 minutes under 0–10 mm of fat, but about 60 minutes under 21–30 mm[1].
  • After 30 minutes of ice, muscle temperature 1–2 cm deep kept falling for 6–9 minutes after the ice was removed, suggesting that 30 minutes was not long enough to reach the lowest temperature[13].
  • With ice on the knee, the temperature inside the joint fell by a median of 3.3°C at 30 minutes, 12.8°C at 60 minutes and 15.2°C at 90 minutes[14].
  • A review concluded that muscle temperatures below 20°C have not been reported during conventional cryotherapy in humans. Even three hours of 15°C cooling packs only brought the vastus lateralis down to about 26°C at 1 cm and 28°C at 3 cm[10].

The evidence that longer icing cools deeper tissue is strong. Whether deeper cooling helps healing is unknown.

2. Limiting secondary injury

After an injury, damage spreads to surrounding tissue over the following hours, and cooling is thought to slow this by reducing the tissue's metabolism[10].

Evidence for:

  • In rats, five hours of cryotherapy after a crush injury reduced the injured area[15], and six consecutive hours reduced macrophage infiltration, swelling and muscle necrosis[16][17]. Three 30-minute sessions two hours apart also reduced secondary injury[18].
  • In humans, prolonged cooling with 15°C phase change material (PCM) packs reduced strength loss and soreness after damaging eccentric exercise when applied for six hours[19], and sped recovery after soccer matches when applied for three hours[20][10]. This is the closest human evidence to my protocol, but it used 15°C rather than 0°C, and exercise-induced muscle damage rather than strains.
  • After knee replacement, cooling (often continuous, using devices) may reduce blood loss and pain slightly, but the certainty of the evidence is low[21].

Evidence against:

  • Inflammation is needed for repair. In mice, macrophages recruited during inflammation produce a growth factor (IGF-1) that is needed to repair injured muscle[22].
  • In rats, a single 20-minute icing after a crush injury delayed regeneration by about a day and led to excess collagen[23]. In mice, icing after eccentric damage delayed the arrival of macrophages and left smaller regenerated fibers two weeks later[24]. In rats, icing after a contusion delayed the inflammatory response and changes in blood vessels[25].
  • In humans, three hours of 15°C cooling after a marathon did not speed recovery on any measure[26]. After a simulated muscle injury, a daily 15-minute ice bath at 12°C for ten days did not improve muscle regeneration, while daily hot-water immersion did[27]. Cooling arm muscles to about 15°C for two hours did not speed recovery from fatiguing exercise in humans, and slowed it in mouse muscle[28][29].
  • A 2024 critical review found no human evidence that cryotherapy limits secondary injury or helps tissue regenerate. It recommended cryotherapy in the first six hours after an injury for pain, and caution beyond 12 hours, because animal studies suggest it may interfere with healing[30]. My protocol continues for days, so it falls in the period the review is cautious about.

The animal results are hard to apply to humans, because the muscle cooling in animal studies is far greater than icing can achieve in a human thigh[10].

3. Keeping blood flowing

My original rationale was cold-induced vasodilation (CIVD). When fingers or toes are held in cold water, blood flow first falls, then rises in cycles, a response first described in 1930[31][32]. I believed something similar happens in a large muscle during prolonged icing, and that keeping the core warm helps.

The cycling pattern of cold-induced vasodilation. This pattern is well documented in fingers and toes; whether anything similar happens in a large leg muscle under an ice bag is unknown.

Evidence for:

  • A warm body helps CIVD. A colder core makes the finger response smaller and later[33], and cooled forearm tissue impedes finger CIVD even when skin and core temperatures are normal[34]. These are finger studies, but they support keeping warm while icing.
  • Local cooling can cool the core. Three hours of 15°C packs on both quadriceps lowered core temperature by about 0.3°C at rest[10], so prolonged icing may cool your core unless you keep warm.
  • Some CIVD-like responses occur outside the fingers and toes. Fox and Wyatt (1962) found them occasionally in other skin, typically at pressure points such as the buttocks, kneecap and elbow. Cooling small patches of skin to 8°C increased skin blood flow on the chest to at least 70% above baseline; on the thigh it also rose, but not above baseline. These participants had spinal cord injuries, and the thigh was in a paralyzed area[35].
  • A study of forearms immersed in cold water reported cyclic fluctuations in muscle temperature[36]. I haven't been able to read it, so treat this as a lead rather than support.

Evidence against:

  • CIVD is mainly found in the fingers, toes, palms, soles, nose and ears, where specialized blood vessels (arteriovenous anastomoses) are abundant[35]. Most limb skin and muscle lack them.
  • Where blood flow has been measured under cold, it falls. Five minutes of ice over a knee replacement incision reduced skin blood flow by about 40%[6]. Commercial cooling devices on the knee reduced skin blood flow to 15–20% of baseline, and it stayed low for hours after cooling ended, even as the skin rewarmed[7][37]. A cold gel pack reduced blood volume at the ankle over 20 minutes[38].
  • These measurements are of skin, not muscle. I found no study that measured muscle blood flow during hours of icing.
  • If increased blood flow helps healing, heat is a more direct way to get it, and hot-water immersion did improve regeneration after a simulated muscle injury[27].

Summary

Mechanism Supported by Against My confidence
Longer icing cools deeper tissue Several human temperature studies No contrary evidence on temperature High for temperature; unknown whether it helps healing
Limiting secondary injury Continuous cooling in rats; prolonged 15°C cooling after exercise damage Icing delays regeneration in rodents; no human evidence of better healing; a review advises caution beyond 12 hours Low to moderate
Increased blood flow (CIVD) Finger studies; some responses in other skin; a warm core helps CIVD Measured skin blood flow falls under cold; muscle blood flow never measured Low

Safety in depth

Freezing and non-freezing injury

Frostbite requires tissue to freeze, which happens at about −0.5 to −2°C[9]. Skin under an ice pack typically sits at about 5°C[39], so ice and water cannot cause frostbite.

Prolonged cold can cause injury without freezing. Non-freezing cold injury occurs at temperatures from 0 to 15°C and does not involve tissue freezing[40]. The US military describes these injuries as developing over hours to days, at temperatures as high as 60°F (16°C)[41]. Classic examples such as trench foot develop over days, and one expert has suggested a minimum exposure of about three hours, and about 12 hours for a serious injury[42]. Those figures are expert opinion, and they come from feet in cold, wet conditions, not skin held against a bag at 0°C. Skin under ice sits in the middle of the range where non-freezing injury occurs, so these figures are not a safety margin for this protocol.

Blood flow can stay low after the ice comes off

In studies of cooling devices on the knee, skin blood flow stayed low for hours after cooling stopped, and its recovery did not follow skin temperature back up[7][37]. The authors suggest this could contribute to non-freezing cold injury. It also means that monitoring skin temperature protects against freezing but not against reduced blood flow.

Reported injuries

Injuries after prolonged cooling are rarely reported, but they include cases close to this protocol:

  • A man used continuous cryotherapy, with pads circulating cold water from an ice cooler, in hospital and then at home after surgery on both knees. Four weeks after surgery he had full-thickness skin damage over both knees[43]. Water circulating from an ice cooler cannot be below 0°C, so this was almost certainly a non-freezing injury, though the paper calls it frostbite.
  • A woman applied a homemade bag of ice through a thin cloth for six hours after a breast biopsy, replacing the ice to keep it cold, and developed a second-degree cold injury[44].
  • Six athletes developed temporary nerve injuries from cryotherapy, all of which resolved[3]. A 19-year-old footballer who iced the outside of his knee for 45 minutes after a blow developed foot drop the next day and took 30 weeks to return to play, although the blow itself may have contributed[4].

I haven't had any problems, but nobody knows how many people have used prolonged icing without harm, so I can't say how common these injuries are.

Areas and people with limited blood flow

The risk is likely to be higher wherever blood supply or sensation is poor:

  • Hands and feet, where non-freezing cold injury classically occurs[40]. The small muscles here cool quickly, so the conventional 20 minutes is enough.
  • Places where nerves are near the surface, such as the outside of the knee and the inside of the elbow, especially if you're lean[3].
  • Anywhere under compression, which is a risk factor for nerve injury[3].
  • People with impaired circulation or sensation, including those with peripheral vascular disease, Raynaud's disease or diabetes, and smokers[2].

Ice and DOMS

I've had DOMS many times, and ice has never helped, or at least not enough to be worthwhile. The research on ice packs largely agrees:

  • After eccentric arm exercise in 11 men, icing was followed by higher blood markers of muscle damage and no better recovery of strength[45].
  • Ice massage did not reduce the symptoms of DOMS[46].
  • In a 2026 trial of 48 adults, neither immediate nor delayed repeated cold packs gave a meaningful benefit over no cooling for soreness, strength or inflammatory markers[47].

Two other forms of cooling have more positive evidence. Ice baths reduced soreness 24 hours after high-intensity exercise in a meta-analysis[48] (see Ice baths). And six hours of 15°C cooling reduced soreness and strength loss after eccentric exercise[19]. This is the one area where research on prolonged cooling is more positive than my own experience. See also Delayed Onset Muscle Soreness.

Ice and tendons

I've found ice ineffective for tendon and other connective tissue injuries. A 2026 systematic review concluded that current evidence does not support cryotherapy as a standalone or standard treatment for tendinopathy, though it may help as an adjunct for short-term pain relief[49]. No human study has tested whether cryotherapy helps tendons or ligaments heal[49]. There may be a case for brief icing in the first few hours after an acute injury, to reduce pain and possibly bleeding into the tissues[30], but that's outside my experience. See Tendon Injuries.

Ice baths

Ice baths are falling out of fashion, and the evidence suggests they do little. The short-term benefits are modest: an ice bath reduces soreness the next day[48], with the best results at 11–15°C for 11–15 minutes[50], but a placebo was as effective as an ice bath for recovery of strength[51]. Used regularly after strength training, ice baths reduce gains in strength[52] and probably in muscle size[53], although they don't appear to affect gains from aerobic training[52]. After a simulated muscle injury, daily ice baths did not improve regeneration[27].

So why might prolonged icing work when ice baths don't seem to? I think there are three differences, though this is reasoning rather than evidence:

  • Depth. A 10-minute bath at 10°C cooled the quadriceps by up to about 6.4°C at 1 cm, but only 1.6°C at 3 cm, a change that was not significant[54]. Hours of ice reach deeper tissue (see above).
  • Core temperature. Immersing much of the body lowers core temperature, by about 0.84°C on average after exercise in a pooled analysis[10]. That makes the body reduce blood flow to the limbs, the opposite of my approach of icing one area while keeping the core warm.
  • Purpose. Ice baths are mostly used after normal training, where the inflammation that cold suppresses is part of how the body adapts. My protocol is for an injury.

In my opinion there is also a practical cost. An ice bath is unpleasant and takes mental effort, and for most people that effort would be better spent on other recovery methods.

Unresolved questions

  • No trial has compared prolonged icing with conventional icing or no icing for muscle strains in humans.
  • Blood flow in muscle during hours of icing, with the core kept warm, has never been measured.
  • The safe upper limit for continuous icing is unknown, as is how much the risk varies between people.
  • Heat may be a better way to increase blood flow to an injured muscle, and the two have not been compared.

See also

References

  1. ↑ 1.0 1.1 Otte JW, Merrick MA, Ingersoll CD, Cordova ML. Subcutaneous adipose tissue thickness alters cooling time during cryotherapy. Archives of Physical Medicine and Rehabilitation, 2002, 83(11):1501–1505. PMID:12422316
  2. ↑ 2.0 2.1 McIntosh SE, et al. Wilderness Medical Society clinical practice guidelines for the prevention and treatment of frostbite: 2024 update. Wilderness & Environmental Medicine, 2024. doi:10.1177/10806032231222359
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Malone TR, Engelhardt DL, Kirkpatrick JS, Bassett FH 3rd. Nerve injury in athletes caused by cryotherapy. Journal of Athletic Training, 1992, 27(3):235–237. Link
  4. ↑ 4.0 4.1 Cryotherapy associated common peroneal nerve lesion in a soccer player. Medicina dello Sport, 2012. Link
  5. ↑ Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Medicine, 1986, 3(6):398–414. PMID:3538270
  6. ↑ 6.0 6.1 Foster D, Williams J, Forte AJ, Lesser ER, Heckman MG, Shi GG, Whalen JL, Wilke BK. Application of ice for postoperative total knee incisions – does this make sense? A pilot evaluation of blood flow using fluorescence angiography. Cureus, 2019, 11(7):e5126. doi:10.7759/cureus.5126
  7. ↑ 7.0 7.1 7.2 Khoshnevis S, Craik NK, Diller KR. Cold-induced vasoconstriction may persist long after cooling ends: an evaluation of multiple cryotherapy units. Knee Surgery, Sports Traumatology, Arthroscopy, 2015, 23(9):2475–2483. doi:10.1007/s00167-014-2911-y (Supported by the US National Institutes of Health. Diller has served as an expert witness for both plaintiffs and defendants in cases about cryotherapy devices, and the authors have filed related patent applications; see Diller et al. 2016.)
  8. ↑ 8.0 8.1 Merrick MA, Jutte LS, Smith ME. Cold modalities with different thermodynamic properties produce different surface and intramuscular temperatures. Journal of Athletic Training, 2003, 38(1):28–33. PMID:12937469
  9. ↑ 9.0 9.1 Therapeutic recommendations for frostbite: a narrative overview. Health Promotion and Physical Activity, 2025, 31(2):28–34. doi:10.55225/hppa.691
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 Kwiecien SY, McHugh MP, Howatson G. Don't lose your cool with cryotherapy: the application of phase change material for prolonged cooling in athletic recovery and beyond. Frontiers in Sports and Active Living, 2020, 2:118. doi:10.3389/fspor.2020.00118 (The authors declare no conflicts of interest; the studies reviewed used Glacier Tek PCM packs.)
  11. ↑ Kanlayanaphotporn R, Janwantanakul P. Comparison of skin surface temperature during the application of various cryotherapy modalities. Archives of Physical Medicine and Rehabilitation, 2005, 86(7):1411–1415. doi:10.1016/j.apmr.2004.11.034
  12. ↑ Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. Journal of Athletic Training, 2009, 44(2):136–141. doi:10.4085/1062-6050-44.2.136
  13. ↑ Zemke JE, Andersen JC, Guion WK, McMillan J, Joyner AB. Intramuscular temperature responses in the human leg to two forms of cryotherapy: ice massage and ice bag. Journal of Orthopaedic & Sports Physical Therapy, 1998, 27(4):301–307. doi:10.2519/jospt.1998.27.4.301
  14. ↑ Warren TA, McCarty EC, Richardson AL, Michener T, Spindler KP. Intra-articular knee temperature changes: ice versus cryotherapy device. American Journal of Sports Medicine, 2004, 32(2):441–445. doi:10.1177/0363546503258864
  15. ↑ Merrick MA, Rankin JM, Andres FA, Hinman CL. A preliminary examination of cryotherapy and secondary injury in skeletal muscle. Medicine & Science in Sports & Exercise, 1999, 31(11):1516–1521.
  16. ↑ Schaser KD, Disch AC, Stover JF, Lauffer A, Bail HJ, Mittlmeier T. Prolonged superficial local cryotherapy attenuates microcirculatory impairment, regional inflammation, and muscle necrosis after closed soft tissue injury in rats. American Journal of Sports Medicine, 2007, 35(1):93–102.
  17. ↑ Vieira Ramos G, Pinheiro CM, Messa SP, Delfino GB, Marqueti RC, Salvini TF, Durigan JLQ. Cryotherapy reduces inflammatory response without altering muscle regeneration process and extracellular matrix remodeling of rat muscle. Scientific Reports, 2016, 6:18525. doi:10.1038/srep18525
  18. ↑ Oliveira NML, Rainero EP, Salvini TF. Three intermittent sessions of cryotherapy reduce the secondary muscle injury in skeletal muscle of rat. Journal of Sports Science and Medicine, 2006, 5(2):228–234. Link
  19. ↑ 19.0 19.1 Kwiecien SY, McHugh MP, Howatson G. The efficacy of cooling with phase change material for the treatment of exercise-induced muscle damage: pilot study. Journal of Sports Sciences, 2018, 36(4):407–413. doi:10.1080/02640414.2017.1312492
  20. ↑ Clifford T, Abbott W, Kwiecien SY, Howatson G, McHugh MP. Cryotherapy reinvented: application of phase change material for recovery in elite soccer. International Journal of Sports Physiology and Performance, 2018, 13(5):584–589. doi:10.1123/ijspp.2017-0334 (Glacier Tek PCM packs, worn inside compression shorts.)
  21. ↑ Aggarwal A, Adie S, Harris IA, Naylor J. Cryotherapy following total knee replacement. Cochrane Database of Systematic Reviews, 2023, CD007911. doi:10.1002/14651858.CD007911.pub3
  22. ↑ Lu H, Huang D, Saederup N, Charo IF, Ransohoff RM, Zhou L. Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury. FASEB Journal, 2011, 25(1):358–369. doi:10.1096/fj.10-171579
  23. ↑ Takagi R, Fujita N, Arakawa T, Kawada S, Ishii N, Miki A. Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. Journal of Applied Physiology, 2011, 110(2):382–388. doi:10.1152/japplphysiol.01187.2010
  24. ↑ Kawashima M, Kawanishi N, Tominaga T, Suzuki K, Miyazaki A, Nagata I, Miyoshi M, Miyakawa M, Sakuraya T, Sonomura T, Arakawa T. Icing after eccentric contraction-induced muscle damage perturbs the disappearance of necrotic muscle fibers and phenotypic dynamics of macrophages in mice. Journal of Applied Physiology, 2021. doi:10.1152/japplphysiol.01069.2020
  25. ↑ Singh DP, Barani Lonbani Z, Woodruff MA, Parker TJ, Steck R, Peake JM. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Frontiers in Physiology, 2017, 8:93. doi:10.3389/fphys.2017.00093
  26. ↑ Kwiecien SY, McHugh MP, Hicks KM, Keane KM, Howatson G. Prolonging the duration of cooling does not enhance recovery following a marathon. Scandinavian Journal of Medicine & Science in Sports, 2021, 31(1):21–29. doi:10.1111/sms.13822
  27. ↑ 27.0 27.1 27.2 Dablainville V, Mornas A, Normand-Gravier T, et al. Muscle regeneration is improved by hot water immersion but unchanged by cold following a simulated musculoskeletal injury in humans. Journal of Physiology, 2025, 603(23):7603–7625. doi:10.1113/JP287777
  28. ↑ Cheng AJ, Willis SJ, Zinner C, Chaillou T, Ivarsson N, Ørtenblad N, Lanner JT, Holmberg HC, Westerblad H. Post-exercise recovery of contractile function and endurance in humans and mice is accelerated by heating and slowed by cooling skeletal muscle. Journal of Physiology, 2017, 595(24):7413–7426. doi:10.1113/JP274870
  29. ↑ Allen DG. Cooling muscles following exercise. Journal of Physiology, 2017, 595(24):7269. doi:10.1113/JP275370
  30. ↑ 30.0 30.1 Racinais S, Dablainville V, Rousse Y, Ihsan M, Grant ME, Schobersberger W, Budgett R, Engebretsen L. Cryotherapy for treating soft tissue injuries in sport medicine: a critical review. British Journal of Sports Medicine, 2024, 58(20):1215–1223. doi:10.1136/bjsports-2024-108304
  31. ↑ Lewis T. Observations upon the reactions of the vessels of the human skin to cold. Heart, 1930, 15:177–208.
  32. ↑ Daanen HA. Finger cold-induced vasodilation: a review. European Journal of Applied Physiology, 2003, 89(5):411–426. doi:10.1007/s00421-003-0818-2
  33. ↑ Daanen HA, Van de Linde FJ, Romet TT, Ducharme MB. The effect of body temperature on the hunting response of the middle finger skin temperature. European Journal of Applied Physiology and Occupational Physiology, 1997, 76(6):538–543. doi:10.1007/s004210050287
  34. ↑ Ducharme MB, Sessler DI, Doufas A, Greif R. Effect of the forearm tissue temperature on the cold induced vasodilation. In: Prevention of Cold Injuries, NATO RTO-MP-HFM-126, 2005, paper 14 (conference paper). Link
  35. ↑ 35.0 35.1 Fujita Y, Kamijo Y, Kinoshita T, Hashizaki T, Murai K, Yoshikawa T, Umemoto Y, Kaminaka C, Shibasaki M, Tajima F, Nishimura Y. Observations of cold-induced vasodilation in persons with spinal cord injuries. Spinal Cord, 2024, 62(4):170–177. doi:10.1038/s41393-024-00960-3
  36. ↑ Ducharme MB, VanHelder WP, Radomski MW. Cyclic intramuscular temperature fluctuations in the human forearm during cold-water immersion. European Journal of Applied Physiology and Occupational Physiology, 1991, 63:188–193. (Not read; cited from its title.)
  37. ↑ 37.0 37.1 Khoshnevis S, Craik NK, Brothers RM, Diller KR. Cryotherapy-induced persistent vasoconstriction after cutaneous cooling: hysteresis between skin temperature and blood perfusion. Journal of Biomechanical Engineering, 2016, 138(3). PMID:26632263 (Same authors' disclosures as Khoshnevis 2015.)
  38. ↑ Taber C, Contryman K, Fahrenbruch J, LaCount K, Cornwall MW. Measurement of reactive vasodilation during cold gel pack application to nontraumatized ankles. Physical Therapy, 1992, 72(4):294–299. Link
  39. ↑ Janwantanakul P. The effect of quantity of ice and size of contact area on ice pack/skin interface temperature. Physiotherapy, 2009, 95(2):120–125. doi:10.1016/j.physio.2009.01.004
  40. ↑ 40.0 40.1 Imray CHE, Castellani JW. Nonfreezing cold-induced injuries. In: Wilderness Medicine, 2012 (book chapter). Link
  41. ↑ Armed Forces Health Surveillance Division. Cold weather injuries – non-freezing peripheral injuries. 2022 Armed Forces Reportable Medical Events Guidelines and Case Definitions. Link
  42. ↑ Schimelpfenig T. Non-freezing cold injury – immersion foot. Wilderness Medicine Institute of NOLS, 2005. Link (Not peer-reviewed; quotes Murray Hamlet.)
  43. ↑ Lee CK, Pardun J, Buntic R, Kiehn M, Brooks D, Buncke HJ. Severe frostbite of the knees after cryotherapy. Orthopedics, 2007, 30(1):63–64.
  44. ↑ Öksüz S, Eren F, Sever C, Ülkür E. Frostbite injury of the breast: a case report. Annals of Burns and Fire Disasters, 2014, 27(2):105–106. Link
  45. ↑ Tseng CY, Lee JP, Tsai YS, Lee SD, Kao CL, Liu TC, Lai CS, Harris MB, Kuo CH. Topical cooling (icing) delays recovery from eccentric exercise-induced muscle damage. Journal of Strength and Conditioning Research, 2013, 27(5):1354–1361. doi:10.1519/JSC.0b013e318267a22c
  46. ↑ Isabell WK, Durrant E, Myrer W, Anderson S. The effects of ice massage, ice massage with exercise, and exercise on the prevention and treatment of delayed onset muscle soreness. Journal of Athletic Training, 1992, 27(3):208–217. Link
  47. ↑ Buehler C, Romitti R, Wellauer V, Clijsen R, Hohenauer E. Effects of immediate and delayed repeated cold exposure after physical exertion: a randomized controlled trial. International Journal of Environmental Research and Public Health, 2026, 23(7):887. doi:10.3390/ijerph23070887
  48. ↑ 48.0 48.1 Moore E, Fuller JT, Buckley JD, Saunders S, Halson SL, Broatch JR, Bellenger CR. Impact of cold-water immersion compared with passive recovery following a single bout of strenuous exercise on athletic performance in physically active participants: a systematic review with meta-analysis and meta-regression. Sports Medicine, 2022, 52(7):1667–1688. doi:10.1007/s40279-022-01644-9
  49. ↑ 49.0 49.1 Lima TA, Rocha TS, Bezerra MA, Oliveira RR. Is cryotherapy effective for tendon health? A systematic review of evidence and methodological limitations. Journal of Bodywork & Movement Therapies, 2026, 46:346–355. doi:10.1016/j.jbmt.2025.11.015
  50. ↑ Machado AF, Ferreira PH, Micheletti JK, de Almeida AC, Lemes ÍR, Vanderlei FM, Netto Junior J, Pastre CM. Can water temperature and immersion time influence the effect of cold water immersion on muscle soreness? A systematic review and meta-analysis. Sports Medicine, 2016, 46(4):503–514. Link
  51. ↑ Broatch JR, Petersen A, Bishop DJ. Postexercise cold water immersion benefits are not greater than the placebo effect. Medicine & Science in Sports & Exercise, 2014, 46(11):2139–2147. doi:10.1249/MSS.0000000000000348
  52. ↑ 52.0 52.1 Malta ES, Dutra YM, Broatch JR, Bishop DJ, Zagatto AM. The effects of regular cold-water immersion use on training-induced changes in strength and endurance performance: a systematic review with meta-analysis. Sports Medicine, 2021, 51(1):161–174. doi:10.1007/s40279-020-01362-0
  53. ↑ Piñero A, Burke R, Augustin F, Mohan AE, DeJesus K, Sapuppo M, Weisenthal M, Coleman M, Androulakis-Korakakis P, Grgic J, Swinton PA, Schoenfeld BJ. Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy. European Journal of Sport Science, 2024, 24(2):177–189. doi:10.1002/ejsc.12074
  54. ↑ Freitag L, Clijsen R, Deflorin C, Taube W, Taeymans J, Hohenauer E. Intramuscular temperature changes in the quadriceps femoris muscle after post-exercise cold-water immersion (10°C for 10 min): a systematic review with meta-analysis. Frontiers in Sports and Active Living, 2021, 3:660092. doi:10.3389/fspor.2021.660092
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