The application of ice to an ankle sprain is one of the most common methods for reducing pain, swelling, and inflammation associated with an ankle sprain. There are many different ways to apply ice, ranging from a pack of frozen peas, to ice baths, to a fancy cryocuff that actively circulates cold water through the cuff system.
In this article, we will review the use of an ice bath for an ankle sprain, including the general method, some more specific information related to safety, and some of the evidence behind this method of cryotherapy.
Types of Ice Baths for a Sprained Ankle
There are two main types of ice baths that typically come to mind when attempting to reduce pain and swelling in a sprained ankle or other ankle injuries.
The first type is an ankle submersion ice bath where you simply place your injured foot and ankle in a container that contains a mix of cold water and ice. This is the type of ice bath we will focus on for this article.
The second type is a whole-body ice bath, which is more commonly used for post-exercise recovery, but can also help address symptoms associated with a sprained ankle.
How do you make an ice bath for a sprained ankle?
Putting together an ice bath for a sprained ankle is actually pretty simple. The only things you will need are an appropriate sized container, a towel, water, ice, and ideally a thermometer that can confirm the temperature of the ice bath.
In terms of the type of ice used, cubed and crushed ice are the most common. Cubed ice can usually last longer without melting, but may take a little while to reach the appropriate temperature. Given that crushed ice has a larger surface area, it will bring the water temperature down quite quickly, but may melt a bit faster.
Simply fill a clean container with the cleanest cold water and ice that you have available (if you don’t trust the source of the water and ice, just use a different method of cryotherapy, such as an ice pack). You want it high enough to completely cover the foot and ankle joint, potentially up to about 1/3 to 1/2 of the way up the shin.
What is the best temperature for an ankle ice bath?
There are a couple considerations here. First, safety needs to be considered, as very low temperatures can be harmful to soft tissue, and second, you must be able to tolerate the low temperature long enough for there to be an effect.
Typical ice bath temperatures range between 10-15 degrees C, or 50-60 degrees F, and this is usually a safe zone for ankle immersion.
Colder temperatures can work as well, but may elicit more pain at first, and if the temperature is approaching freezing (0-5 degrees C, or 32-41 degrees F) there is a much higher risk of reducing blood flow to the point where you can sustain damage to the soft tissue around the foot and ankle.
These numbers may change a little bit based on your tolerance to cold, as well as any precautions or contraindications to cold therapy. For example, if you have an underlying condition that makes cold therapy more risky, then you probably don’t want to start with a very low temperature on your first attempt, even if the underlying condition isn’t specifically to do with the ankle joint.
For those who want to push the limits, it’s very important to first perform a safety screen that includes understanding your medical history, as well as a hot/cold sensation test to ensure adequate feedback throughout the treatment.
In a study conducted in 2006, it was shown that lower temperatures created high levels of pain throughout ice therapy for ankle injuries. In this case, it was found that pain ratings were 40% higher for temperatures of 1 degree C (34 degrees F) compared to 10 degrees C (50 degrees F), and 70% higher when compared to 15 degrees C (59 degrees F). Additionally, there was a wide variety of how patients responded to different temperatures (Galvan et al, 2006).
Therefore, if this is your first time setting up an ice bath for your sprained ankle, start a little warmer than you may think to ensure a safe and tolerable experience, as you can always continue to cool the water with more ice should you feel that’s necessary.
How long do you leave your ankle in an ice bath?
You can leave your injured ankle in an ice bath for 10-15 minutes, so long as you are able to visually check the ankle throughout this time. If you aren’t adding ice throughout and the water is slowly starting to warm up over time, then you may be able to leave your ankle in safely for a bit longer.
Remember that the body typically doesn’t function at such low internal temperatures. That’s part of the reason why you don’t want to leave your ankle in for too long.
It usually takes the body about 30 minutes to reach a state whereby the blood vessels actually expand to allow more blood flow, which is a sign that the tissue is becoming dangerously cold and blood flow is too restricted, so the body is trying to bring more to the area.
Therefore, both in terms of safety and effectiveness, it’s recommended to keep any form of cold therapy to a treatment time of under 20 minutes to ensure adequate blood flow throughout the process unless otherwise indicated by a healthcare professional who has assessed your specific condition and injury in person.
Important Safety Considerations
It may seem a little silly to talk about safety given how common it is to apply ice to an ankle injury; however, adverse responses to heat and ice are some of the most common adverse effects we see in physical therapy settings in general, so problems can arise.
By having a good understanding of your own medical history and performing a very simple safety screen, you can be more confident in your ability to safely apply ice to your ankle sprain.
When to NOT use an Ice Bath for a Sprained Ankle
The following is a list of conditions or situations when you would want to avoid applying ice to your ankle injury. This is includes some of the more common contraindications to cold therapy, but is not exhaustive, so when in doubt, we highly recommend consulting with your local doctor or physical therapist.
- Open wounds
- Deep vein thrombosis (DVT) or thrombophlebitis
- Current or very recent history of infection or tuberculosis
- Impaired sensation
- Hypertension (Many people have hypertension that is controlled with medication. In this case, discontinue the ice bath if blood pressure becomes elevated)
- Impaired circulation
- Impaired cognition
- Reynaud’s disease or history of vasospasm (fingers or toes that are hypersensitive to cold and quickly become pale)
- Cryoglobulinemia (protein disorder that can affect properties of blood when exposed to cold)
- Cold urticaria and/or hypersensitivity (a history of abnormal or allergic reactions to cold)
- A superficial nerve that has been injured in the area that is still regenerating
Sensation Testing for Cold Therapy
To ensure you can receive proper feedback about how your skin and other soft tissue is responding to ice, you can simply trial applying heat and ice in a random order and test your ability to differentiate the two.
For example, in the clinic, we have little vials of water that we fill with cold and warm water. We will usually have the patient to close their eyes and tell us if they feel cold or warm as we touch a single vial of water to their skin in and around the area of intended application.
We do this about 10 times with a random order of hot vs. cold. If the patient is able to correctly identify 9 or 10 of the vial temperatures (at least a 90% success rate), then we can be confident they have intact protective sensation.
Reduced Balance Following Cryotherapy?
While an ice bath won’t physically shorten muscles to the point where you may reduce any improvements made when working on ankle range of motion, many people report feeling a little stiff after applying any form of ice. Therefore, it’s important to plan the timing of your ice bath accordingly.
For example, a study in 2013 showed that side-to-side single leg stability was reduced immediately following a foot and ankle ice bath, particularly dynamic balance (Douglas et al, 2013). This is, in part, likely due to a temporary reduction in nerve conduction velocity, but there are likely other factor at play as well.
Therefore, it could be a good idea to plan your ice bath during a time when you won’t be needing to challenge the affected limb immediately after. For example, leaving the ice bath until the end of the day when you can relax after may be preferable relative to doing the ice bath and immediately having to walk on uneven terrain after.
Summary
While evidence for the use of cold therapy to reduce swelling in acute ankle sprains and other ankle injuries isn’t as clear as many people think (Miranda et al, 2021), clinical experience suggests it can be a safe and effective method to reduce pain, reduce swelling, and reduce inflammation secondary to an ankle sprain.
It is very important to consider the safety when applying ice to ankle injuries, especially if you are doing this unsupervised or for the first time.
In order to have the most confidence in your approach to cold therapy, we highly recommend consulting with a doctor or physical therapist first, which may save you from some problems in the long run while also ensuring you are effective in your ice application.
References
Douglas, M., Bivens, S., Pesterfield, J., Clemson, N., Castle, W., Sole, G., & Wassinger, C. A. (2013). Immediate effects of cryotherapy on static and dynamic balance. International journal of sports physical therapy, 8(1), 9.
Galvan, H. G., Tritsch, A. J., Tandy, R., & Rubley, M. D. (2006). Pain perception during repeated ice-bath immersion of the ankle at varied temperatures. Journal of Sport Rehabilitation, 15(2), 105-115.
Miranda, J. P., Silva, W. T., Silva, H. J., Mascarenhas, R. O., & Oliveira, V. C. (2021). Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: a systematic review of randomized controlled trials. Physical Therapy in Sport, 49, 243-249.
Disclaimer:
The content here is designed for information & education purposes only and is not intended for medical advice.
