Cold therapy or cryotherapy is a common and useful therapeutic modality often used by physiotherapists in treating a wide range of conditions. It is easy to apply and if care is taken over cautions and contraindications it is very safe and patients can be instructed to self treat to manage their conditions independently. Cryotherapy is most commonly used in sports and acute injury treatment and is cheap and simple to use. Cold can be applied in several different ways including cold packs, crushed ice, cubed ice or cold water devices.
Ice therapy cools the local tissues by carrying away heat from the body as the ice melts or the cold water warms. The main physiological effects of cold therapy include decreasing the local metabolism, vasoconstriction, circulation increase in reaction to cold, reduction in oedema and swelling, decrease of any haemorrhage, reduction in muscle efficiency and analgesia secondary to sedation of nerve transmission from the cold. Muscle spasm and spasticity are also reduced as a side effect of pain reduction from the cold application.
There are many tissue based effects which are promoted by the application of cold therapy and these include post-injury reduction of swelling and oedema, a time-related reduction in spasticity once the cold has been applied for some time, an increase in the local circulation, lowering of the acute inflammation which follows tissue damage, muscle spasm reduction, and pain inhibition. Muscle contraction can be facilitated by a physiotherapist using cold therapy and this can be used to improve muscle contraction to increase joint ranges of motion after injury.
An injury to an area with tissue damage increases the metabolism of the area and thereby brings more circulation in, causing a rise in temperature and oedema to the local tissues. For this kind of condition cold is much preferable as heat will increase all the unwanted tissue responses. Cold application causes a reduction in the inflammatory reaction, lowers the metabolic rate of the tissues, allows pain reduction and inhibits oedema, limiting the inflammatory response and allowing speedier recovery. Compression and cold should be applied to the damaged area as soon as possible after the event and while cold is an important treatment compression may be more critical.
It is important to understand the risks to skin integrity which potentially come with using cold therapy. Contraindications to cold are understood by physiotherapists and they will examine the skin for normal sensibility and good colour with lack of broken or abnormal areas. To protect the skin integrity oil can be applied to the area before cold application. A common treatment is performed using an ice pack, made by packing crushed ice into a towel bag and applied closely to the part to be treated. Thorough wetting of the towel and eliminating any pockets of air between the pack and the skin ensure a good cooling effect.
Convenient and cheap home cold application is often performed using a pack of frozen peas but these should be used with caution as they come out from the freezer at -18 degrees centigrade and this could result in skin injury. This temperature is too low for direct skin application and a wet cloth should always be interposed between the skin and the pack to avoid the chance of frostbite which is cold-mediated local skin damage. From five to twenty minutes is the typical application time used and the skin should be checked after five or ten minutes to make sure skin reaction is normal. Small white spots appearing on the skin indicate overcooling and treatment should stop.
Pain after operative intervention or acute injuries are good subjects for cold therapy in the first two days after onset to control inflammation and pain. Areas of altered skin sensibility should be avoided as they may react abnormally and other contraindications are arterial insufficiency, cold allergy, Reynauds syndrome and lower limb ischaemia. Physiotherapists use various techniques including cold packs, water immersion, contrast baths, spray and stretch and massage with ice. Myofascial pain syndrome trigger points are treated with spray and stretch. - 23802
Ice therapy cools the local tissues by carrying away heat from the body as the ice melts or the cold water warms. The main physiological effects of cold therapy include decreasing the local metabolism, vasoconstriction, circulation increase in reaction to cold, reduction in oedema and swelling, decrease of any haemorrhage, reduction in muscle efficiency and analgesia secondary to sedation of nerve transmission from the cold. Muscle spasm and spasticity are also reduced as a side effect of pain reduction from the cold application.
There are many tissue based effects which are promoted by the application of cold therapy and these include post-injury reduction of swelling and oedema, a time-related reduction in spasticity once the cold has been applied for some time, an increase in the local circulation, lowering of the acute inflammation which follows tissue damage, muscle spasm reduction, and pain inhibition. Muscle contraction can be facilitated by a physiotherapist using cold therapy and this can be used to improve muscle contraction to increase joint ranges of motion after injury.
An injury to an area with tissue damage increases the metabolism of the area and thereby brings more circulation in, causing a rise in temperature and oedema to the local tissues. For this kind of condition cold is much preferable as heat will increase all the unwanted tissue responses. Cold application causes a reduction in the inflammatory reaction, lowers the metabolic rate of the tissues, allows pain reduction and inhibits oedema, limiting the inflammatory response and allowing speedier recovery. Compression and cold should be applied to the damaged area as soon as possible after the event and while cold is an important treatment compression may be more critical.
It is important to understand the risks to skin integrity which potentially come with using cold therapy. Contraindications to cold are understood by physiotherapists and they will examine the skin for normal sensibility and good colour with lack of broken or abnormal areas. To protect the skin integrity oil can be applied to the area before cold application. A common treatment is performed using an ice pack, made by packing crushed ice into a towel bag and applied closely to the part to be treated. Thorough wetting of the towel and eliminating any pockets of air between the pack and the skin ensure a good cooling effect.
Convenient and cheap home cold application is often performed using a pack of frozen peas but these should be used with caution as they come out from the freezer at -18 degrees centigrade and this could result in skin injury. This temperature is too low for direct skin application and a wet cloth should always be interposed between the skin and the pack to avoid the chance of frostbite which is cold-mediated local skin damage. From five to twenty minutes is the typical application time used and the skin should be checked after five or ten minutes to make sure skin reaction is normal. Small white spots appearing on the skin indicate overcooling and treatment should stop.
Pain after operative intervention or acute injuries are good subjects for cold therapy in the first two days after onset to control inflammation and pain. Areas of altered skin sensibility should be avoided as they may react abnormally and other contraindications are arterial insufficiency, cold allergy, Reynauds syndrome and lower limb ischaemia. Physiotherapists use various techniques including cold packs, water immersion, contrast baths, spray and stretch and massage with ice. Myofascial pain syndrome trigger points are treated with spray and stretch. - 23802
About the Author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Edinburgh. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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