Immediate Comparative Effects of Cryotherapy and Thermotherapy on Pain, Ankle Dorsiflexion Range of Motion And Swelling in Adults With Acute Grade I Lateral Ankle Sprain: A Randomized Controlled Trial

Abstract

Background: Acute ankle sprain is one of the most common musculoskeletal injuries, and cryotherapy and thermotherapy are both used as early conservative treatment despite their opposing physiological mechanisms and differing levels of evidentiary support.

Objective: To compare the immediate effects of cryotherapy and thermotherapy on pain, active ankle dorsiflexion range of motion, and swelling in adults with acute Grade I lateral ankle sprain.

Methods: A randomized controlled trial was conducted on 60 adults (age 18–43 years) presenting 24–72 hours after acute Grade I lateral ankle sprain, allocated into a Cryotherapy group (n = 30; single 15-minute cold pack application) and a Thermotherapy group (n = 30; single 15-minute moist hot pack application). Outcomes — Numerical Rating Scale (NRS), active dorsiflexion range of motion, and Figure-of-8 swelling — were recorded immediately pre- and post-intervention and analyzed using paired and independent t-tests (p < 0.05).

Results: Both groups showed significant within-group improvement in pain and dorsiflexion range of motion (p < 0.001). Swelling significantly decreased in the Cryotherapy group but significantly increased in the Thermotherapy group (p = 0.003). Intergroup comparison showed significantly greater pain reduction with cryotherapy (p = 0.003) and a highly significant divergence in swelling change between groups (p < 0.001), while dorsiflexion improvement was comparable between groups (p = 0.933).

Conclusion: Cryotherapy produced significantly greater immediate reduction in pain and swelling than thermotherapy, while both modalities produced comparable immediate gains in dorsiflexion range of motion. Cryotherapy should be preferred as the initial thermal modality in the first 24–72 hours after acute Grade I lateral ankle sprain, particularly for controlling pain and swelling.