Introduction:
Musculoskeletal injuries are very common and can be associated with mild to severe pain and disability. Back pain is the most common musculoskeletal pain affecting a large number of people, from young to old age. Musculoskeletal pains are managed in two ways. These include pharmacological and non-pharmacological techniques. Painkillers, anti-inflammatories, and muscle relaxants are included in the pharmacological approach. The non-pharmacological approach mainly aims to reduce pain and swelling.
What Is Cold Therapy?
Cold therapy is one of the modalities used to alleviate pain and swelling caused by musculoskeletal injuries. The process involves the use of a cold substance over the injured area to reduce the tissue temperature.
RICE (rest, ice, compression, elevation) is a simple, self-care, at-home strategy used during acute injuries and rehabilitation post-definitive treatment. The letter 'I' in the RICE method refers to cold therapy (ice). Cold therapy can also be called ice fomentation.
What Are the Types of Cold Therapy?
Sources for cold therapy are available in various forms like:
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Crushed ice bags.
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Over-the-counter ice packs.
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Cold compression units.
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Whirlpools.
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Ice massage.
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Coolant sprays.
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Ice baths.
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Topical gels or creams.
A newer and more popular option where freezing chambers are used for the whole body for a shorter period of time is called whole-body cryotherapy. People will remain in closed chambers where the temperature is reduced and frozen using liquid nitrogen.
Some other types of cold therapy include:
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Cryo Stretching: In this, stretching of the muscles is combined with cold therapy to reduce muscle spasms.
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Cryokinetics: Physical activity combined with cold therapy is used in case of ligament tears.
What Are the Benefits of Cold Therapy?
The benefits of cold therapy are:
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Minimizes inflammation, sore muscles, and swelling.
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Athletes use ice baths and other types of cold therapy to hasten recovery after physical exercise.
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Improves immunity, and quality of sleep, and enhances one’s focus.
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Scientists have found that exposure to cold hastens metabolism.
How Do Heat and Cold Therapies Work?
Heat therapy works in the following ways:
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It enhances the blood flow and relaxes the muscles. It is indicated in long-term (chronic) pain.
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The application of heat is beneficial in relieving strains and sprains, osteoarthritis (deterioration of the cartilage that cushions the ends of bones in the joints), stiffness, and chronic irritation in the tendons, relieves pain or spasms related to back or neck injury and helps warm up stiff tissues or muscles before activity.
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Using heat and cold therapies alternatively can help minimize exercise-induced muscle pain.
Cold therapy has various physiological reactions in the injured tissues such as:
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By reducing the temperature of the skin and muscle tissue, there is a restriction in the flow of blood to the injured site because of the blood vessel constriction reflex. This minimizes inflammation and edema.
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Cold temperature reduces the demand for oxygen, hence, saving the tissues from hypoxic (insufficient oxygen) damage.
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Reduced tissue temperature decreases nerve conduction (nerve activity) in both the sensory (responsible for generating various senses in the body) and motor nerves (sends signals to muscles for movement).
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By minimizing inflammation and nerve activity and creating a numb sensation, one might experience significant relief from pain in the injured area.
What Are the Applications of Cold Therapy?
Cold therapy has been widely used during sports activities to prevent muscle cramps and relieve sports-related trauma. The following are the conditions where cold therapy can give symptomatic relief:
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Overuse injury of the knee cap as in runner’s knee (patellofemoral pain syndrome).
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Ligament and tendon injury (tendonitis).
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Inflammatory and degenerative joint pain.
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Ligament tear (sprain).
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Sciatica (pain along the course of the sciatic nerve extending from the lower back to the legs).
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To alleviate pain and swelling after surgeries.
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Closed wounds during a fall.
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Other occupational or health-related pain that one encounters in daily life, like pain in the back, legs, neck, and shoulders.
What Is the Best Way to Apply Cold Therapy?
The following are the general suggestions that need to be kept in mind while applying cold therapy:
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It is better to wrap the ice cubes or other cold objects in a thin cloth and then apply it to the skin. The cold items should not be placed directly on the injured site, as it can harm the external skin.
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The ice pack should be placed in an intermittent way to ease the pain and, at the same time, one must check if sensations could be felt.
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Cold therapy should be applied for about 20 minutes many times a day (typically eight to ten times in 24 hours).
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The cold therapy should be applied over a broad six-inch area around the site of pain. For example, cold therapy hats are available online that can help in treating headaches.
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Cold therapy is very effective when used immediately after the injury or at least between 24 to 72 hours post-injury.
Cold therapy is an adjuvant treatment and must be combined with other therapeutic remedies like rest (avoiding physical activities), compression (applying pressure to the injured area), elevation (keeping the injured site in a raised position), medications (taking painkillers and muscle relaxants), physical therapy (hands-on care and patient education), and exercises (stretching and strengthening).
What Is the Wim Hof Method?
In the Wim Hof method, cold is applied in the form of ice baths or cold showers. By following this method, Wim Hof (founder of the Wim Hof method) is capable of standing in a container that is filled with ice cubes and can run a half marathon in the snow with bare feet. Several experiments have been conducted in recent years to understand the Wim Hof method. The results are as follows:
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A study was conducted by Radboud University wherein both the followers of the Wim Hof method and non-followers were exposed to a pathogen and closely observed.
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The followers of the Wim Hof method displayed fewer symptoms and increased immune response.
Further studies are being carried out to apply the effects of the Wim Hof method in areas like metabolism, stress, and inflammation.
What Are the Complications of Cold Therapy?
The complications of cold therapy are as follows:
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Applying cold therapy for a long time can cause nerve damage resulting in loss of sensation.
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Frozen items, kept in contact with the skin directly, can cause cold burns in the skin and the underlying tissue.
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Cold therapy may infrequently give a stinging sensation to the skin.
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The nitrogen vapors used in the freezing chambers may cause hypoxia conditions (oxygen deprivation), leading to unconsciousness. It is one of the significant hazards in relation to whole-body cryotherapy.
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The extremely altered temperature may also cause eye injury.
When Is Cold Therapy Contraindicated?
There are no absolute contraindications for cold therapy. Some of the relative contraindications are:
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Patients with cardiovascular (heart problems) and neurological disorders can avoid cold therapy until prescribed by the physician.
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Diabetic patients have to be more careful regarding the application of cold therapy because of their changed perception of sense.
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It is not advisable to use cold therapy on open wounds.
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Cold therapy is not an appropriate treatment for patients with rheumatoid arthritis (a long-term inflammatory disorder that affects many joints like those in the hands and feet), Raynaud’s syndrome (a condition in which certain areas of the body feel cold and numb in certain situations), and paralysis (partial or complete loss of muscle function).
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Cold therapy is contraindicated in deep vein thrombosis (blood clots in the veins).
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Patients with circulatory disorders (especially poor circulation) should not use cold therapy.
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There is no evidence to support the role of whole-body cryotherapy in relieving pain associated with migraines, fibromyalgia (widespread pain and tenderness in the muscles), multiple sclerosis (a condition in which the immune system destroys the protective covering of the nerves), and stress or anxiety-related problems.
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Cold therapy should not be used on stiff or rigid muscles and joints.
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Cold therapy should be avoided in cases of sensory processing disorder or nerve damage.
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Cold therapy should be stopped if it has not provided any symptomatic relief.
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It is better to visit a physician in case one experiences any sensory changes or persistent pain after applying cold therapy.
Conclusion:
Cold therapy is a cost-effective remedy to relieve pain and swelling. They are readily available items at the patient's convenience during an injury. A simple frozen item from a home refrigerator wrapped in a towel will serve the purpose. Even if a specified cold therapy product is unavailable, any simple means of ice fomentation will give a mild degree of relief and benefit the patient until definitive treatment is planned.
