Cold therapy is used to reduce pain, swelling, and inflammation to soft tissues usually caused by an acute injury or a medical procedure. Cold therapy is often recommended by orthopedic surgeons and family doctors as part of what is commonly called R.I.C.E. therapy, which is an acronym rest, ice, compression, and elevation. In cold therapy, ice is applied to the injured tissue for the first 48 to 72 hours after the injury. If cold is not applied immediately, then increased pain, redness, swelling, and possibly stiffness and loss of mobility are much more likely.
The cold temperature of the ice helps to reduce swelling of the damaged area. For instance, cold therapy is often used with an acute injury, which is any sudden, traumatic injury that causes pain, tenderness, redness, and swelling immediately, or within a few hours of, the damaging event. Most acute injuries are the result of trauma or impact such as a sprain in a sporting activity, a fall down the stairs, or a car accident. After an acute injury or surgical procedure, a cold pack is often applied to the affected area to reduce pain, swelling, and inflammation. Cold therapy is one of the most widely used remedies for treating acute sport injuries.
In one form or another, cold therapy has been performed for as long as humans could take a piece of ice and place it on a swollen or bruised body part to feel better and heal more quickly.
Ligaments and tendons are tissues that connect bones and muscles to each other. Ligaments, tendons, and muscles all contain collagen, which gives them the ability to stretch. That ability is limited, however, and when the limit is exceeded, the collagen tears. The tearing bursts blood vessels that pour out blood cells and fluids; this often creates a swollen, bruised area above the tear. When this happens, cold therapy can be used to treat the injury.
With cold therapy, a cold pack is applied to the problematic site because the coldness helps to lower the temperature of the injured tissue. Such a decrease in temperature reduces the metabolic rate of the tissue, which helps the tissue heal faster. Ice wrapped in a thin, moist towel is applied to the damaged area for 10 to 15 minutes. Then the ice is removed to let the area return to a normal body temperature. Ice can be reapplied two or three more times. This procedure can be repeated several times each day for up to three days.
It is important to always rest the injured area while treating it with cold therapy. Individuals should not use the afflicted body part to bear weight, such as carrying a backpack on an injured shoulder or walking on an injured knee. The amount of time that the injury takes to respond to cold therapy depends on many factors. A deep muscle injury will respond more slowly than one near the surface. Most injuries will benefit from cold therapy within ten minutes, but that may be slower depending on the amount of fat surrounding the affected area.
Besides treating acute injuries, cold therapy is also helpful for overuse injuries, such as back pain after a day of heavy lifting. Cold therapy can also help with a chronic injury that flares up with exercise. Applying ice after the activity can help to reduce the chances of inflammation recurring. For instance, long-distance runners or football players may ice down a knee or elbow after participating in their sporting events. Quarterbacks in football and pitchers in baseball often ice down the elbows of their throwing arms.
Many different forms of cold therapy are available. Simply filling a plastic bag or water bottle with ice and placing a moist towel over the affected area before applying the ice will produce the results of cold therapy. Even a bag of small frozen vegetables (such as peas or corn) can be used to apply cold therapy to a problem area. Ice should never be applied directly to the skin. When applied over a moist towel, the ice should be kept on the area for no more than 20 minutes. Once the skin feels numb or if it becomes blistered, bright red, or blotchy, the ice must be removed immediately.
A block of ice can also be used to massage the cold into the skin. Sometimes water added to a paper cup and frozen can be used by tearing away the top of the cup and using the remaining paper as a holder for the ice while massaging the skin. A constant circular motion of the ice on the affected skin should be performed, so that the ice is not in any one area for more than three minutes at a time. Longer than three minutes could produce frostbite. This procedure can be repeated for several hours to help reduce the pain of the injury. An ice massage is often used to treat golfer's elbow or tennis elbow.
Refreezable ice or gel packs within a cold wrap (also called an ice wrap or ice pack) are often used in cold therapy. Branded examples of such wraps are Cool Relief, Pro Ice, and Icy Cools. These wraps are often made specifically for different areas of the body, such as the knee, wrist, lower back, or shoulder, and are made to hold a constant temperature for a certain amount of time to provide the maximum amount of relief to the sore or injured site. For instance, the Pro Ice website ( http://proice.net/ ) states that its products will maintain an even temperature of 27°F (-2.8°C) for up to one hour.
When an injury has occurred, cold therapy is effective at reducing swelling and pain when used in the first 48 to 72 hours after the event. For a surgical procedure, the amount of treatment time is likely longer. Patients should ask the attending surgeon about the recommended amount of time to use cold therapy.
Cold therapy should be used with caution in some cases. It is not recommended for anyone who has circulation problems, such as in the legs and feet; is unable to communicate or cannot feel the application of the cold therapy, such as a stroke victim or one who has neuropathy or a paralyzed limb; or is allergic to cold, such as those who develop blisters or a rash as a result of cold therapy. In addition, cold therapy should not be used for chronic injuries or acute injuries that typically do not involve inflammation or swelling, or to relax tight muscles or muscle spasms. Sore or stiff muscles or joint pain should be treated with heat therapy rather than with cold therapy.
Important cautions include:
When a temperature that is much less than the body temperature is applied to an injured area, the coldness helps to decrease the flow of blood and fluids into the damaged tissue (internal bleeding). An excessive amount of internal bleeding can lead to the death of cells from oxygen deprivation, which is called a secondary hypoxic injury. The cold also slows down the release of chemicals that cause inflammation. In addition, cold applied to an injured area also decreases the sensation of pain by numbing the nerve endings that conduct impulses to the brain. In all, cold therapy is a recommended way to reduce pain, swelling, and stiffness of injured areas.
See also Heat therapy .
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American Association of Orthopaedic Surgeons, 9400 W. Higgins Rd., Rosemont, IL, 60018, (847) 823-7186, Fax: (847) 823-8125, http://www.aaos.org/ .
American College of Sports Medicine (ACSM), 401 W. Michigan St., Indianapolis, IN, 46202-3233, (317) 6379200, Fax: (317) 634-7817, http://www.acsm.org .
American Pain Society, 8735 W. Higgins Rd., Ste. 300, Chicago, IL, 60031, (847) 375-4715, info@american painsociety.org, http://americanpainsociety.org .
William A. Atkins,, BB, BS, MBA