sports injury, physiotherapy

Welsh rugby captain Sam Warburton faces a race against time to recover from injury to face Ireland in the Six Nations on Saturday.

In a bid to speed up the healing process he has been on an intensive ice machine to get rid of inflammation. This new High Tech bit of kit ” The Game Ready”  has also been endorsed by Rory McIlroy.


But what is the difference  between this and a bag of frozen peas from your freezer?

And what ultimately are we trying to achieve?


What these athletes are following is the PRICE regime for an acute injury:

Protection – Aim to prevent further injury e.g. using crutches

Rest – Allow healing by preventing further aggravating activities

Ice – Reduces pain, swelling and inflammation

Compression – A pressure strap such as tubi-grip to limit the swelling

Elevation – By raising the injured area above the level of the heart excessive swelling can allow swelling to drain away.


When we look at the outcome of an injury  we need inflammation to occur to facilitate the body healing itself, it is the excessive inflammation which as therapists we aim to minimise as this ultimately slows the recovery process.

This has led to an extensive array of treatment options using ice/cryo therapy all claiming to speed up the reduction of swelling and ultimately the recovery of injury.

So what are the options available????

Hyperbarbic Gaseous Cryotherapy

This technique consists in applying for a short time on the skin up to the painful area, carbon dioxide at −78 °C with a pressure of 50 bars and a frequency of 400 Hz. Sessions can be repeated at will. Unlike ice packs, the usage of carbon dioxide does not produce pain. Even if not as dangerous as liquid nitrogen used in cryosurgery, the low temperature could cause burns.

The Ice Bath

The theory behind ice baths is related the fact that intense exercise actually causes microtrauma, or tiny tears in muscle fibers. This muscle damage not only stimulates muscle cell activity and helps repair the damage and strengthen the muscles ( muscle hypertrophy ), but it is also linked with delayed onset muscle pain and soreness (DOMS) , which occurs between 24 and 72 hours after exercise.

The ice bath is thought to:

  • Constrict blood vessels and flush waste products, like lactic acid, out of the affected tissues
  • Decrease metabolic activity and slow down physiological processes
  • Reduce swelling and tissue breakdown

Then, with rewarming, the increased blood flow speeds circulation, and in turn, improves the healing process. Although there is no current protocol regarding the ideal time and temperature for cold immersion routines, most athletes or trainers who use them recommend a water temperature between 12 to 15 degrees Celsius and immersion times of 5 to 10 and sometimes up to 20 minutes.

The Game Ready

As modelled by Rory McIlroy below the Game Ready System continuously circulates cold water from the control unit’s ice reservoir, via a connector hose, through an inner chamber of the anatomical wrap  (this chamber is located closest to the body) before returning to the ice reservoir.

As a complete loop, the cold water is refreshed through the ice before returning through the anatomical wrap, thus delivering continuous cold therapy to the body part, allowing heat to be removed from the treatment site.

Simultaneously, the control unit pumps air into the separate, outer chamber of the anatomical wrap, intermittently inflating and deflating according to the pressure setting that is selected.

The compression not only assists in preventing/ limiting swelling, but also conforms the Anatomical Wrap to the contours of the body.  This increases the surface contact and aids the delivery of the circumferential cold therapy.

rory game ready

The Ice Pack 

Ice packs can be made from ice cubes in a plastic bag or wet tea towel. A packet of frozen peas may also be used as they mould nicely and can go in and out of the freezer. Purpose-made cold packs can also be bought which are reusable.  They can be applied for 15-20minutes and repeated every 2 hours. However care should be taken to protect the skin to prevent an ice burn.


Within our clinic we see trends towards a new type of ice therapy on a regular basis, with half a football team heading to cold baths in County Meath, or to an ice chamber in Portadown. Ultimately if the time spent travelling to these places was spent focusing on the PRICE regime with rest and ice packing maintained religiously, the same outcome would be achieved almost all of the time. So hold onto those peas for a little longer !!