Which interval-icing rationales are tool-bound vs. physiological?

Pulling this out of the Dose-Controlled paper for discussion. The paper argues the on/off interval is largely an artifact of ice being an uncontrollable, overly-cold source — we dose-limit by time because we can’t dial the rate. But some of the interval rationale is genuinely physiological (inflammation is part of repair; reactive hyperemia; skin-vs-deep-tissue gradients). Where exactly is the line? What would you want the dose–response study to hold constant first?

My read: the “20 minutes” ceiling is almost entirely the safety fuse — nerve palsy / frostbite guidance, not an optimum. The genuinely physiological piece is the rebound/hyperemia question. I’d hold target tissue temperature constant across arms and vary duration, rather than the reverse.

From the field: adherence collapses with the off intervals. If a held setpoint lets us run a milder continuous dose, that alone changes real-world delivery. Worth capturing adherence as an endpoint, not just pain/ROM.

On the instrument side — we can report heat removed (W, kJ) and the tissue-temp achieved continuously, so “dose delivered” is auditable per session. Suggest the instrumented subset logs the steady-vs-hunting variability so we can separate device behaviour from physiology in the analysis.