Cold/Ice Therapy: When & when not to use it

Cold therapy. In my experience this an underused self management tool for people suffering from pain, especially of musculoskeletal origin. People often tend to use heat straight away as its feels more relaxing but realistically heat shouldn’t be used for acute injuries. So this blog is about how to use ice, when to use ice and most importantly when not to use ice.

How to use cold/ice therapy:

The application of cold should not exceed 30 minutes and should not be placed directly on the skin. Cold is usually applied in ice packs with towels layered over the pack to protect the skin. As with heat the application of ice will mainly affect the skin however after 20 minutes, tissues 2 cm deep can be cooled by around 5 degrees celsius.

The application of cold has many effects including:

  • Vasoconstriction (decreased blood flow)
  • Decreased local metabolic activity
  • Decreased oxygen demand
  • Reduced nerve conduction
  • Decreased activity of the muscle spindles and golgi tendon organs
  • Reduce oedema
  • Analgesia (Pain reduction)

When to use cold therapy:

  • Acute trauma
  • Oedema (swelling)
  • Haemorrhage
  • Pain
  • Muscle Spasm
  • Spasticity
  • Reduction of metabolic activit

When not to use cold therapy:

  • Ischemia
  • Raynaud’s disease
  • Insensitivity
  • Inability to report pain

There are varying opinions and research on the effectiveness of cold therapy, the general rule is that you should never use one therapy on its own; use with exercise, manual therapy and/or in conjunction with heat therapy to achieve greatest benefits.

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