Does the Latest Research Support the Use of Ice After Surgery?

Posted by Grant Frost, Physiotherapist

If you’ve had surgery for a sore knee, shoulder, or ankle, you’ve likely been told to ice it. It’s one of the most common pieces of post-operative advice. But how much does it actually help with pain, swelling, and getting you back to function? A major systematic review published in the British Journal of Sports Medicine set out to answer this exact question by analysing the available evidence. The findings might challenge some long-held beliefs and help us make more informed choices in recovery.

As a physio who has previously questioned the routine use of ice for acute injuries, I find this new review on post-surgical care particularly relevant. It moves the conversation from theory to harder data. Let’s break down what this robust research found, what it means for your recovery, and how we can apply these insights practically.

What Did the Researchers Do?

This was a systematic review and meta-analysis, which is considered one of the highest levels of evidence in healthcare. The authors didn't run a new experiment; instead, they rigorously searched for, combined, and analysed the results from 28 existing Randomised Controlled Trials (RCTs).

• Focus: People recovering from musculoskeletal surgeries (like ACL reconstruction, rotator cuff repair, joint replacements).
• Comparison: They looked at studies comparing the use of cryotherapy (ice packs, cold compression units, cold therapy) against no cryotherapy during post-operative rehab.
• Outcomes Measured: Pain, range of motion (ROM), swelling, and functional recovery.
• Key Strength: They didn't just ask if results were statistically significant; they checked if the effects were large enough to be clinically important to a patient. For example, a pain reduction needs to be more than about 2 points on a standard 0-10 scale for a person to genuinely feel better.

The Findings: A Closer Look at the Evidence

Here’s a summary of what the analysis of thousands of patient outcomes revealed. The table below breaks down the results for each key recovery metric.

Strengths, Limitations, and What It Means for Your Recovery

This was a well-conducted review using robust methods. However, applying its findings requires understanding its context.

Strengths of the Evidence

• High-Quality Methodology: Systematic reviews of RCTs form the cornerstone of evidence-based practice.
• Focus on Patient-Centred Outcomes: By using Minimum Clinically Important Difference (MCID) values, they prioritised what matters to patients, not just p-values.
• Transparency: The authors clearly rated the certainty of evidence as "very low to moderate," which is an honest reflection of the limitations in the underlying studies.

Important Limitations to Consider

• Variability in Ice Protocols: The included studies used different types of cryotherapy (gel packs vs. cold compression devices), durations, and frequencies. A one-size-fits-all conclusion is tricky.
• It's Not an Individual Response: While the average benefit was small, some individuals might find ice more helpful for pain relief than others. The research can't identify who those people are.
• Focus on Post-Surgery Only: These findings are specific to the controlled inflammation and healing environment after an operation. They don't directly apply to acute injuries, which was the topic of my previous article.

Practical Guidance: How to Use This Information

So, should you throw your ice packs away after surgery? Not necessarily. But you might want to change how and why you use them.

1. Reposition Ice as a Pain Modulator, Not a Healer: If ice makes your post-op knee or shoulder feel more comfortable, especially in the first few days, using it for short periods may be reasonable. However, don't rely on it to significantly reduce swelling or accelerate your functional milestones.
2. Don't Let Ice Interfere with Active Rehab: The core of your recovery is guided movement, strengthening, and mobility work prescribed by your physio. Never skip or delay these exercises because you're icing. Ice can be used after a session for comfort if needed.
3. Follow Safety Guidelines: Always use a cloth barrier, limit applications to 15-20 minutes, and allow the skin to return to normal temperature between sessions to avoid ice burns or nerve damage.
4. Focus on What the Evidence Does Support: Channel your energy into the strategies with stronger evidence for post-surgical recovery: graded exercise, progressive loading, patient education, and nutrition.

Need Personalised Guidance?

If you're navigating post-surgical recovery and want help building a rehab plan that focuses on high-value strategies, consider a consultation. We can move beyond one-size-fits-all advice and tailor an approach for your specific goals.

Book a Telehealth Consultation

Final Thoughts

This comprehensive review provides a data-driven perspective that can help us use ice more wisely after surgery. It suggests that while cryotherapy is not harmful when used correctly, its benefits for meaningful recovery outcomes are potentially modest at best. The real progress comes from an active rehabilitation program.

As physiotherapy evolves, it’s important to regularly examine common practices like icing. This allows us to prioritise the most effective elements of your care, ensuring your effort and time are invested in what truly helps you regain function and return to the activities you love.