Researchers throw cold water over the 'extraordinary' amounts of ice being used to treat Olympians

Using ice can be counter-productive

About 22 tons of ice were delivered to the competition venues of the Tokyo 2020 Summer Olympic Games for medical purposes. Another 42 tons were provided to the residences of the Olympic Village, via ice-dispensing machines and other outlets. But how much was used and how much was wasted remains obscure, explain the editorialists.

But the requirement for Paris 2023 vastly exceeds those figures, say lead author Sebastien Racinais from Montpellier University and his colleagues. ‘The first estimation done by Paris 2024 based on the initial requests presented by the International Federations was 1,624 tons of ice, at a cost of €2.5 million. No independent vendors were able to fulfil the public tender. Subsequently, this estimate has been reduced to 650 tons (450 for the Olympics and 200 for the Paralympics),’ Dr Racinais and colleagues note.

Ice usage at the Summer Olympics has reached extraordinary levels, potentially stressing local and regional resources [Sebastien Racinais et al]

Cryotherapy (ice treatment) in the form of ice packs, compression pumps, ice baths, and cold water immersion is widely used by athletes and their support teams to manage injury and illness and speed up recovery, note the authors.

But Dr Racinais and colleagues point out: ‘Apart from logistical challenges related to production, transportation, and storage, ice is often used to obtain benefits which are not evidence-based. More importantly, ice could have the opposite effect to that expected, such as delayed tissue regeneration or impaired recovery.’ 

For example, pooled data analyses show that cold water immersion is better for muscle power and perception of recovery than active recovery, massage, or contrast baths (hot water followed by cold), they explain. But recently published studies report that cooling decreases long-term strength adaptations and may impair performance after exercise.

Pros and cons

Cold water immersion is good for fast relief of heat exhaustion after exercising in hot temperatures, the relief of muscle soreness after prolonged exercise in normal temperatures, and helpful if muscle soreness is anticipated after several days of training, Dr Racinais and colleagues note.

But it shouldn’t be used for recovery between consecutive bouts of high intensity training, nor immediate or long-term recovery after resistance exercise, they say.

Apart from logistical challenges related to production, transportation, and storage, ice is often used to obtain benefits which are not evidence-based. More importantly, ice could have the opposite effect to that expected, such as delayed tissue regeneration or impaired recovery [Sebastien Racinais et al]

Physios using more cold water-based treatments

Cold water immersion accounted for around 10 per cent of treatments prescribed by physiotherapists at the Olympic polyclinics in Athens 2004 and London 2012, rising to 44 per cent by Rio 2016 – mainly for recovery purposes (98 per cent), with the rest for injury.

Ice is also commonly recommended for the treatment of injuries, particularly soft tissue injuries. But there is a paucity of current evidence to support that approach, note the editorialists.

Dr Racinais and colleagues conclude: ‘Ice usage at the Summer Olympics has reached extraordinary levels, potentially stressing local and regional resources. The sport and exercise medicine community needs better data on the actual amount of ice consumed at major sporting events, for what purposes, and at what financial and environmental costs.'  

They conclude by issuing a challenge to the Games' organisers: ‘When planning for the provision of ice, organisers should aim to minimise the use of non-evidence-based practices and promote better sustainability. Ice should, however, remain available for certain situations, including acute pain relief, specific recovery needs, and management of exertional heat stroke.’

About Marie-Elaine Grant

According to Dr Grant’s LinkedIn listing, she was the first physiotherapist in Ireland to be awarded an honorary doctorate from University College Dublin, the institution from which she originally graduated in physiotherapy in 1981. The honorary doctorate was awarded in 2013 in recognition of her achievements in and contribution to the field of sports physiotherapy.

In 1997, Dr Grant gained a PhD at the University of Limerick in physiotherapy and exercise science. Dr Grant was Ireland's Olympic Team lead physiotherapist from 1990 to 2010 and she was appointed to the International Olympic Committee's Medical Commission (Games Group) from 2010 onwards.

To access the full version of the article – titled Ice challenge in recent summer olympic games Doi 10.1136/bjsports-2024-108664 – click