top of page

Cold Therapy

 

Where heat brought energy to the body to create a therapeutic effect, cryotherapy uses conduction and evaporation to take energy away from the body in order to create a cooling therapeutic effect. Cryotherapy can be used in the immediate care of an injury as part of first aid to reduce inflammation and prevent secondary injuries and in post immediate care to cool tissue as an adjunct to exercise or other threapy during rehabilitation of various pathways. 

Cooling agents are used to reduce inflammation, edema and spasticity, to manage osteoarthritis and rheumatoid arthritis, for pain and facilitated movement through muscle contraction, and/or to facilitate another intervention such as cross friction massage for plantar fasciitis. This is accomplished by the general effects of decreasing temperature that include:

  • Decreased cell metabolism

  • Decreased circulation

  • Decreased muscle spasm

  • Decreased sensory NCV

  • Decreased arhtrogenic inhibition

  • Increased or decreased inflammation

  • Increased or decreased pain

    • "cold pain" vs anesthetic effect

  • Increased tissue stiffness

  • Possible vasodilation

Metabolic effects - Cold decreases the metabolic rate of all metabolic reactions. One of the metabolic reactions is inflammation. This can be good or bad as inflammation is an important proccess of healing. However, reducing metabolism may prevent secondary hypoxic injury. If ice is applied less than 5 minutes after trauma, it may slow the metabolic imbalance due to the acute injury and prevent further injury of non-injured cells. Cold also inhibits cartilage degrading enzymes, which may be useful in the treatment of osteoarthritis and rheumatoid arthritis. 

 

Hemodynamic effects - Cold increases blood viscosity which decreases flow rate. Cold caues cutaneous vasoconstruction by both direct an dindirect mechanisms. Activating cold receptors directly stimulates the smooth muscle so the blood vessel wall contracts. Cold decreases he release of vasodilators, however, there is a possiblity that blood flow will increase with a processes known as Cold Induced Vasodilation. It has been theorized that this occurs to bring an adequate blood flow to an anrea in response to severe cold (exposure to <1˚C for >15 min). 

 

Neuromotor effects - Cold can decrease MSR (DTR) in about 5 minutes and decrease the frequency of clonus with longer applications. This may be caused initially by a decrease in gamma motorneuron activity and later by a decrease in afferent spindle and golgi tendon activity due to direct muscle cooling. 
 
Inflammation control - The rate of chemicial reactions slows down, decreasing the heat, redness, edema, pain and loss of funciton in the inflammation stage of healing. Decreased blood flow to the area of injury as a result of the hemodynamics of cold will impede the movement of fluid to the interstitial tissue. To be most effective in this area, cryotherapy should be applied immediately after an injury. 
 
Pain Control - This is thought to be the result of blocking conduction in A delta fibers and gating pain transmission by cutaneous thermal receptors. It may also reduce muscle spasms by breaking the pain-spasm-pain cycle.

The following are methods of heat transfer that can draw energy away from the body to create a cooling effect:

 

Conduction: Heat transfer occuring by direct contact when there is a tempearture gradient between the two contacting surfaces (i.e. direct contact, immersion)
Evaporation: Absorption of energy away from the body, creating a cooling effect (i.e. vapocoolant spray, sweat)
 
Consider precautions and contraindications before introducing a patient to thermotherapy
 
 

Methods of cryotherapy include:

 

  • Ice or Gel Packs

    • Packs maintained in a freezer kept at from 0 to -5˚C for a minimum of 30 minutes before use

    • Should be deformable to be able to mold around the area to be treated

    • A crushed ice pack will have higher specific heat and may require a layer of insulation to prevent adverse effects

    • Allternatively, using a damp cloth may increase the energy exchange to produce the cooling effect as water has a higher specific heat than air

    • Elevate the area to be treated

    • Remove jewelry and clothing from the area to be treated

    • Secure the cold pack

    • Treat for 10-30 minutes

    • Inspect for adverse effects 

 

  • Ice Massage

    • Frequently used prior to friction massage to anesthetize the area as this can be a painful intervention

    • Remove jewelry and clothing from the area to be treated

    • Place a towel under the treatment area to catch drips from the melting ice

    • Treat a small area by rubbing the ice in a circular motion

    • Treat for 5-10 minutes (10-15 minutes for muscle)

    • Inspect for adverse effects

 

  • Cold Compression 

    • Popular products for cold compression include the Cryocuff, Autochill, and Game Ready machines

    • These products include a compressive component in addition to providing cold

    • Can be effective in lowering both superficial and deep tissue temperatures

    • Use water that is 10-15˚F

    • Treatment time can range from 10-30 minutes

    • Inspect for adverse effects

 

  • Vapocoolant Spray 

    • Believed to incativate local trigger points more effectively and with less patient discomfort than by injection or ischemic compression

    • Pentafluropropane and tetraflouroethane are newer products that are neither flammable nor toxic as oppose to earlier developed sprays

    • Use this to spray approximately 10 times in succession on the skin overlying a muscle that is put in stretch

    • Inspect for adverse effects

 

  • Cold Whirlpool 

    • A great method for treating extremities, a cold whirlpool should be

    • Use for 10-20 minutes at a temperature of 55-65˚F

      • Note that 55˚F will become very uncomfortable 

    • Be cautious of having the extremity in a dependent positio

    •  

      Inspect for adverse effects

       

  • Cryokinetics 

    • Alternating cold with active exercise

 

  • Cryostretch 

    • Alternating cold with muscle stretching

 

The effects of cryotherapy can be monitored via girth or volumetric measurements for edema, a visual analoug scale for pain, goniometric measurements for range of motion, and ROM and flexibility measures to reflect the presence of muscle guarding. 

 

Always monitor adverse effects that may result from excessive cooling:

  • Tissue Death

  • Frost bite (-4˚C - -10˚C)

  • Nerve damage

  • Possible vasodilation

Want more information?

 

CONTACT US!

​

 

Email:      kjames13@su.edu


Address:  Shenandoah University - Health Professions Building

              N Sector Court

              Winchester, VA 22601

© 2023 by Business Solutions. Proudly created with Wix.com

bottom of page