Cryotherapy has the primary effect of cooling tissue. Depending upon the
application method and duration, the basic effects include the
following:
Decreased local metabolism
Vasoconstriction
Reactive hyperemia
Reduced swelling/edema
Decreased hemorrhage
Reduced muscle efficiency
Analgesia secondary to impaired neuromuscular transmission
Pain reduction associated with application of cold relaxes muscle spasm and
minimizes upper motor neuron spasticity. The most common indications and uses
for local application of therapeutic cold modalities include the following:
To decrease swelling/edema following trauma (cooling in water at 8°C for 30
minutes decreases edema)
To treat burns
To inhibit spasticity (in spasticity, the muscle must be cooled; this process
takes 10 minutes in thin patients and up to 60 minutes in more obese persons)
To reduce muscle spasm
To reduce acute inflammatory reaction
To reduce pain
To reduce limb metabolism (prior to amputation)
To produce reactive hyperemia
To facilitate muscular contraction for various forms of neurogenic weakness
and for muscle re-education
Immediate application of ice or cold packs for superficial burns and burns of
less than 20% total body surface area decreases pain, edema, erythema, and
blistering. For optimal results in cases of trauma, cold should be applied
before significant edema and hemorrhage occur.
Ways to apply cold therapy
The most common methods of cold application include cold packs, cold
immersion, ice massage, and cooling during exercise (cryokinetics).
Spray and
stretch is an application of cryotherapy with a vapocoolant spray, which then is
followed by stretching of the involved muscles. This technique sometimes is used
in the management of myofascial pain syndromes, as described by Travell and
Simons.
Therapeutic cold is applied for 5-20 minutes, followed by a rest period of 30
minutes. For treatment of acute sprains/strains and postoperative care,
application of cold is recommended for the first 24-48 hours.
For treatment of deeper tissues or for prolonged periods of cold application,
physician evaluation/prescription is essential to avoid complications.
The following are conditions for which local cold treatment is not
recommended:
Hypertension (due to secondary vasoconstriction)
Raynaud disease
Rheumatoid arthritis
Local limb ischemia
History of vascular impairment, such as frostbite or arteriosclerosis
Cold allergy (cold urticaria)
Paroxysmal cold hemoglobinuria
Cryoglobulinemia or any disease that produces a marked cold pressor response
Cold packs applied to the abdomen cause increased gastrointestinal motility and
gastric acid secretion; therefore, this treatment is contraindicated in those
with known peptic ulcer disease. Interestingly, application of hot packs to the
abdomen produces the opposite effect.
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When not to use a heating pad
Local application of heat is not advised in patients with decreased sensation
or circulatory impairment. It is also contraindicated over areas of malignancy
and not advisable in acute injury. Generally cold therapy is preferred in an
recent injury. Keep one of our packs in the freezer for cold therapy. Some
conditions respond best to an alternating treatment of cold therapy and a
heating pad. Usual application is about 20 minutes, not more than 30
minutes.
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Information and products provided on this site are not designed to
diagnose, prescribe, or treat any illness, or injury and is
provided for general informational purposes only and should not be
used as a substitute for professional advice. The information on
this site has not been evaluated by the Food and Drug
Administration. "
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