I would like to comment on the editorial published in the May/June 2020 issue entitled “21st Century Attacks on Cryotherapy in Sports Health Care—Clinician Beware,” written by Long and Jutte.¹ I have an interest in cryotherapy, especially on its effect, if any, on return to play following athletic injuries. I agree with the authors that online posts and discussion boards are not the places for clinicians to receive information, but the bigger issue might be that they have nowhere else to go on this clinical topic.

There is a lack of support for cryotherapy from peer-reviewed literature that in my opinion justifiably questions the effectiveness of cryotherapy except for pain management.² In a 2004 systematic review, Hubbard et al³ reported that there were only 2 studies that reported cryotherapy enhanced recovery following ankle sprains, but both had significant methodological concerns. More than 16 years later, little has changed and, using principles of evidence-based practice, the Strength of Recommendation Taxonomy (SORT) grade of cryotherapy is consistently graded as a “C” defined as based on consensus, usual practice, and opininon.⁴

When asked what is the clinical benefit of cryotherapy as it relates to sports injury management, I simply state, pain management, as referenced in your editorial. Anything beyond that, including “secondary injury” from my experience, is speculation.⁵

Thank you for your editorial. I hope that it will stimulate clinicians and researchers to seek answers to these important and still unanswered questions. I agree with your final sentence that “Clinicians should beware of false and inaccurate claims about cryotherapy,” but they should also be wary of claims and suggestions of benefits that are not supported by patient-focused outcomes.

Michael G. Dolan, MA, ATC, CSCS
Buffalo, New York