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Cold Therapy- Stefan Timms

Cold Therapy

Cryotherapy is defined as the use of cold temperature as a form of treatment for an injury. Although cryotherapy dates back to the ancient Greeks (Hippocrates), it is only recently (1940’s) that cold has been used extensively for the treatment of acute and subacute injuries, and rehabilitation.

Temperature alterations have four main effects on surface body tissues, including pain relief (analgesia), muscle relaxation, blood vessel alterations, and connective tissue effects. By reducing the speed of impulses conducted by nerve fibers, pain sensations are inhibited by cold. Target temperatures of 10-15 degrees C are recommended. Similarly, decreases in muscle spasm are seen with cold therapy, although the exact mechanisms for this are unclear. It is thought that this result may be mediated through reflex reduction in motor nerve activity secondary to response to increased activity in cold receptors.

With regard to the circulatory system, cold causes constriction of small arteries and veins, by direct stimulation of the smooth muscle lining these vessels. However, a curious reverse relaxing effect occurs with very low temperatures or prolonged cooling. The benefits of vasoconstriction include decreased hemorrhage and swelling within injured tissues.

The usual therapeutic techniques include direct application of ice or snow, the use of special cold packs or compression devices (using ice water or cooled water; 10-25 degrees C), cold water baths (hydrotherapy) or cooling topical sprays. These techniques utilize conduction and convection as means of cooling affected areas. General guidelines include the need to protect the skin from cold injury via a layer of intervening material, and limiting exposures to twenty minutes. A convenient schedule is alternating twenty minute periods of application and removal.

Skin and superficial fat is readily cooled by surface cryotherapy, but the effects on deep tissues like muscle and tendon, are somewhat debatable. There is agreement that cooling of underlying muscle requires prolonged exposure exceeding twenty minutes when using direct application of ice or cold packs, therefore cold water baths are the best way to ensure deep tissue results.

Typically, with application of ice, one will experience initial intense cold, then burning sensation, followed by aching and finally, pain relief or anaesthesia (loss of sensation).  Specific techniques useful to runners include direct application of ice to the elevated, injured part, often in combination with elastic wraps or compression devices. Ice massage is a very useful modality: paper or Styrofoam cups containing ice provide a convenient tool, making small overlapping circles of four to six inches for twenty minutes.

Problems with cryotherapy include hypersensitivity and allergic reactions (noted if cold and burning sensations last longer than several minutes), and cold injury, i.e.- frostnip and frostbite. Cryotherapy must be avoided in people with rheumatoid arthritic variants with cold sensitivity, those with skin sensation problems, Raynaud’s phenomenon, cryoglobulinemia, Buerger’s disease, and prior history of frostbite, etc. Caution is necessary when applying cold on or near superficial nerves, or when vigorous activity is expected soon after treatment, especially with prolonged treatment aimed at deeper tissues, such as muscle.

Time to chill.

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