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Cold Therapy

Cold therapy is an effective method for treating inflammation in muscles and joints. “Cold therapy, also known as cryotherapy, is the application of any substance or physical medium to the body that removes heat, decreasing the temperature of the contact area and adjacent tissues. Cold therapy is used in the management of acute injury/trauma, chronic pain, muscle spasm, DOMS, inflammation, and edema. Acute ankle sprains are a prototypic injury for which cold therapy is used, generally within the context of rest, ice, compression, and elevation (RICE) therapy. Many devices are available for application of cold therapy, including bags of crushed ice, commercially available ice and gel packs, ice massage, cold compression units, and cold whirlpool. The efficacy of each mode of cold therapy for lowering the temperature within deep and surface tissues may vary. For example, wetted ice is more effective than cubed ice or crushed ice in lowering skin surface temperature (17.0 C, 14.1 C, 15.0 C, respectively) and intramuscular temperatures (6.0 C, 4.8 C, 4.3 C, respectively) over a 20-minute application period.”1

This therapy reduces pain and acts as an anesthetic method when used correctly. The affected area chills, causing a reduction in nerve movement and the contraction of blood vessels. Also, the metabolic activity can be decreased, causing the swelling and rupture of tissue to lessen.

“Cryotherapy is commonly used to reduce tissue temperature, metabolism, inflammation, pain, circulation, tissue stiffness, muscle spasm, and symptoms of delayed-onset muscle soreness. Cryotherapy protocols, including ice application, water immersion, and commercially available cooling pads, are used by athletic trainers despite the lack of conclusive scientific research regarding the potential risks facing athletes or patients. Although the potential negative effects of cryotherapy itself and its possible influence on proprioception are unknown and despite equivocal evidence supporting its effectiveness, some clinicians continue to use cryotherapy in the treatment of acute soft tissue injury and to alleviate the symptoms of delayed-onset muscle soreness.”

Physiological effects of Cold Therapy

“Local and systemic cold therapies (cryotherapies) are widely used to relieve symptoms of various diseases including inflammation, pain, muscle spasms, and swelling, especially chronic inflammatory ones, injuries, and overuse symptoms. The beneficial effects of cold as a therapeutic agent have been known for a long time, with ancient population aware about the reinvigorating effects of cold water either taken orally or used for baths. The use of cold, mainly locally, still remains in our daily common activities. A still up-to-date survey of a sample of Irish emergency physicians highlighted the fact that 73% of consultants frequently ‘prescribe’ cold, 7% never suggest to use cryotherapy, and 30% is unsure about the benefits of using cold. Experience (47%) and common sense (27%) were the most frequently declared reasons for using ice, while only 17% referred to scientific reasoning.”

Currently, various products available for cold therapy can help alleviate inflammation or swelling, starting from a simple ice pack to a more sophisticated items, such as a localized therapy pump.

“Cold therapy has multiple physiological effects on injured tissue. Decreasing temperatures of skin and muscle reduces blood flow to the cooled tissues by activating a sympathetic vasoconstriction reflex. Cold Induced decreases in blood flow reduce edema and slow the delivery of inflammatory mediators (eg, leukocytes), reducing inflammation of the affected area. Decreasing tissue temperature also reduces the metabolic demand of hypoxic tissues, potentially preventing secondary hypoxic damage in injured tissue. Cold therapy induces a local anesthetic effect, referred to as cold-induced neurapraxia, by decreasing the activation threshold of tissue nociceptors and the conduction velocity of nerve signals conveying pain. Key receptors responsive to environmental cold include TRP cation channel subfamily M, member 8 (TRPM8), and, especially in the presence of other agonists, TRP cation channel subfamily A, member 1 (TRPA1), which has a role in cold hyperalgesia. Decreasing muscle temperature also reduces muscle spasm via inhibition of a spinal cord reflex loop. Sensory neurons express multiple TRP channels. The TRP cation channel subfamily V, members 1, 3, and 4 all respond to warming temperatures. Activation of any of these TRP cation channels can trigger action potentials in the sensory neuron. Some of these channels, such as TRPV1, are also expressed in the spinal cord, where they seem to have an important role in the central nervous system as well.”4

Potential Disadvantages and Consequences of Cold Therapy

“Cold therapy, if used inappropriately, can put patients at risk for local cold-induced injuries, such as frostbite. Commonly reported complications of cold therapy include allergic reactions, burns, and intolerance/pain. Cases of neuropathy of superficial nerves have been reported following ice application for muscle soreness and acute injury. This cryotherapy-related nerve palsy is temporary in almost all cases, but can last for hours, days, or months. Cold therapy should be used with caution in patients with hypertension, mental impairment, or decreased sensation. Cold therapy should not be used in patients with cold hypersensitivity, cold intolerance, or Raynaud’s disease, or over areas of vascular compromise. Cold therapy has also been associated with short-term adverse changes to joint position sense, muscle strength, and neuromuscular performance, which may adversely affect performance of athletes immediately post cooling.”5

When patients accept Cold Therapy, they also face its drawbacks. “One of the most obvious consequences of ice applied to the body surface is vasoconstriction of the skin blood vessels. This reflex is aimed at minimizing heat loss of the body and is mediated via both the autonomic nervous system and local hormonal autonomic nervous system and local hormonal control. Vasoconstriction is followed by vasodilation, usually lasting about 15 minutes and further vasoconstriction. This sequence of events may also be demonstrated on the untreated collateral side of the body. […]

“It is not clear which of these immediate sequelae of skin cooling might contribute to the analgesic effect (if any) of cryotherapy. Other mechanisms are also possible. For example, vasoconstriction could lead to minimization of edema production after traumas and may also decrease the release of pain-producing substances locally. It is also tempting to speculate that the thermal receptors of the skin interfere with the gate control mechanisms. They might provide a strong sensory input to partly ‘close the gate’, which consequently reduces the transmission of painful stimuli. By the same mechanism, cold might also release endorphins and thereby influence opioid receptors in the central nervous system.”6

Recommendations

  • “Cryotherapy is a relatively simple outpatient procedure that is easy to learn and requires no electricity to perform. This ease of use, combined with its level of effectiveness, safety, and acceptability, make cryotherapy a feasible treatment technology appropriate for use in low-resource settings.
  • Health providers should give women clear messages about the relative safety of cryotherapy and information on when to return for additional medical care if symptoms such as fever or severe pain, with or without malodorous discharge, develop.
  • Pretreatment counseling can help alleviate anxiety about pain and discomfort during and after the treatment and will prepare women for anticipated side effects.
  • Health providers should provide counseling that addresses women’s questions about long-term sequelae associated with cryotherapy and alleviates fears about impaired fertility or obstetrical problems.”7

Cold Therapy Products Available

  • Chilling units
  • Cold packs
  • Cold socks
  • Cold therapy systems
  • Cold wraps
  • Cooler boxes
  • Eye masks
  • Face masks
  • Hot cold packs
  • Hot cold wraps
  • Ice bags
  • Ice packs
  • Ice hot patches
  • Pain relief creams
  • Pain relief gels
  • Pain relief roll-ons
  • Pain relief sprays

“Ice is one of the simplest, safest, and most effective self-care techniques for injury, pain, or discomfort in muscles and joints. Ice will decrease muscle spasms, pain, and inflammation to bone and soft tissue. You can use ice initially at the site of discomfort, pain, or injury. You can also apply ice in later stages for the rehabilitation of injuries or chronic (long-term) problems. During an initial injury, tissue damage can cause uncontrolled swelling. This swelling can increase the damage of the initial injury and delay the healing time. If you use ice immediately, you will reduce the amount of swelling. Ice decreases all of these: swelling, tissue damage, blood clot formation, inflammation, muscle spasms, and pain. At the same time, the ice enhances the flow of nutrients into the area, aids in the removal of metabolites (waste products), increases strength, and promotes healing. This ‘ice effect’ is not related to age, sex, or circumference of the injured area.”8

Cold therapy certainly provides several health benefits. It relieves injured muscles, joints, and tissues; it helps users recover from surgery; reduces spasms; decreases metabolic rate, and more. Consult with your physician before using cold therapy for your particular case.

References:

(1, 4, 5) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Malanga, G.A., Yan, N. & Stark, J. Postgraduate Medicine. 2015. https://www.researchgate.net/publication/269767537_Mechanisms_and_efficacy_of_heat_and_cold_therapies_for_musculoskeletal_injury

(2) Cryotherapy and Joint Position Sense in Healthy Participants: A Systematic Review.  Costello, J.T., and Donnelly, A.L. Cryotherapy and Joint Position Sense in Healthy Participants: A Systematic Review. Journal of Athletic Training. 2010. https://www.natajournals.org/doi/full/10.4085/1062-6050-45.3.306

(3) Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. An Updated Review of the Literature. Lombardi,G., Ziemann, E. & Banfi, G. Frontiers in Physiology. 2017. https://www.frontiersin.org/articles/10.3389/fphys.2017.00258/full

(6) Ice Freezes Pain? A Review of the Clinical Effectiveness of Analgesic Cold Therapy. Ernst, E., & Fialka, V. Journal of Pain and Symptom Management.1994. https://cryosense.de/wp-content/Articulos/articulos-cientificos-analgesia/Ice%20Freezes%20pain%20-%20A%20review%20of%20the%20clinical%20effectiveness%20of%20analgesic%20cold%20therapy.pdf

(7) Effectiveness, Safety, and Acceptability of Cryotherapy: A Systematic Literature Review. Castro, W., Gage, J., Gaffikin, L., Ferreccio, C., Sellors, J., Sherris, J., & Blumenthal, P.  Cervical Cancer Prevention Issues in Depth #1. 2003. http://www.rho.org/files/ACCP_cryo_white_paper.pdf

(8) Ice Therapy. L. J., Freeman. FootNotes. 1995. http://www.rnrmassagetherapy.com/articles/ice_therapy.pdf

María Laura Márquez
13 October, 2018

Written by

María Laura Márquez, general doctor graduated from The University of Oriente in 2018, Venezuela. My interests in the world of medicine and science, are focused on surgery and its breakthroughs. Nowadays I practice my profession...read more:

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