Chronic spinal pain patients (after surgery has failed) and athletes recovering from joint therapy alike often praise the effectiveness of simple, inexpensive, home cold therapy. This strategy gives some patients tremendous advantage and self-control over their health.
Cold therapy can be an effective approach, especially for acute injuries, dental work, or surgeries which involve inflammation. The wisdom of this prescription pivots around the 4 cardinal signs of inflammation: Heat, redness, swelling, and pain. Or in Latin, calor, rubor, tumor, and dolar, for heat, redness, swelling, and pain, respectively.
Inflammation in itself is not bad, but rather it is necessary for healing. Excess inflammation however is thought to at times impede healing. Certain conditions should not have cold applied to them, others do better with heat, so it is best to ask your specific treating provider about your specific condition.
Conventional wisdom dictates that cold therapy should be applied for 10 to 20 minutes per hour, several times per day. However, sometimes longer times are indicated. For certain situations longer periods of time, perhaps as much as 30 to 45 minutes per hour are indicated. Longer times allow for greater and deeper cooling. Sometimes this is indicated for large body parts (the back) or after a particularly traumatic event (knee surgery). Pain generating spinal tissues may several inches deep below the surface and quick cold therapy applications may be insufficient to sufficiently penetrate.
Plain ice cubes with some water in a bag as pictured above or a double zip lock plastic bag is perfect. Chemical gel packs run the risk of being too cold (depending on freezer settings) so it is better to stick to plain ice. In fact, chemical gel packs run the risk of causing frost bite which is why people are advised to place a towel underneath, but it is still better to use plain ice. Another problem with gel packs is that the gel within doesn’t circulate so as it warms up cooling potential is reduced. Plain ice in slushy water however stays uniformly cold, and rather than falling below 32 will likely stay in the range of 34 to 40 degrees Fahrenheit (well above frost bite ranges).
If the goal is to reduce and maintain the internal temperature of deep swollen, inflamed, and painful tissues, then it may take an accumulated several hours (with breaks) for penetration to occur. The amount of pain relief (the anti-inflammatory response) may be proportional to the duration of cold therapy application.
- Use a LARGE 11 inch size ice or zip lock bag: DO NOT USE A SMALLER BAG. DO NOT USE GEL OR CHEMICAL PACKS.
- To test for leakage, fill with water, tighten lid and squeeze bag, then turn upside down and squeeze again. This will prove that your ice bag is leak free.
- Fill ice bag ¾ full of ice, then twist top of bag to squeeze EXCESS air out while tightening lid.
- Then apply ice bag. You may place a T-shirt or an open handkerchief between your skin and the ice bag. ANY MATERIAL THICKER THAN A T-SHIRT SHOULD NOT BE USED.
- AFTER 1 HOUR OF APPLICATION, SQUEEZE OUT EXCESS AIR AND REPEAT STEP 3 ABOVE. REAPPLY IMMEDIATELY. Ice should last 3 – 4 hours. For longer periods, ice pack should be refilled.
- Keep warm with EXTRA clothing or blankets. Wear socks with slippers or shoes, long sweatpants, and a long sleeved shirt at all times when applying ice. DO NOT WEAR ONLY SHORTS. Keeping your body warm.
- There are three stage that you might feel. 1) Coldness 2) Slight burning or stinging 3) Slight numbness. After these stages, you should only feel the pressure and weight of the bag. Remember this is frostbite proof.
- DO NOT SLOUCH ON THE COUCH OR PROP YOURSELF UP IN BED. YOU SHOULD SIT UP STRAIGHT IN A HIGH BACK CHAIR WITH YOUR FEET ON THE FLOOR. DO NOT SIT OR LIE ON THE FLOOR OR COUCH. CHANGE YOUR POSITION OFTEN – EITHER SIT, LIE ON A BED OR MILL AROUND.
Several studies have looked at the effectiveness of cold therapy for specific conditions:
- For 100 knee replacement (total knee arthroplasty) procedures, the use of cold compressive dressings resulted in reduced loss of blood, control of swelling, diminished pain, and faster return of motion. (The Role of Cold Compression Dressings in the Postoperative Treatment of Total Knee Arthroplasty Levy AS, Marmar E. Clin Orthop Relat Res (297):174-8, 1993)
- For various conditions, a review of 43 different studies concluded that cold therapy enhanced rehabilitation and healing of rotator cuff injuries with an earlier return of motion and faster return to normal function. (Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach, Millett PJ, et al., J Am Acad Orthop Surg 2006; 14:599-609)
- For knee replacement surgery, cold therapy resulted in reduced blood loss, enhanced pain control, reduced need for pain medication, and improved healing. (Continuous-Flow Cold Therapy After Total Knee Arthroplasty, Morsi E, J Arthroplasty 17(6):718-22, 2002)
- For shoulder surgery, this randomized study of 50 patients observed enhanced pain and swelling control, improved patient comfort, and better healing with use of cold therapy. (The Efficacy of Cryotherapy in the Postoperative Shoulder, Speer KP, et al., J Shoulder Elbow Surg 5(1):62-8, 1996)
- For achilles tendon ruptures, acceleration of tissue healing was noted with cold therapy. (Intermittent Pneumatic Compression Enhances Neurovascular Ingrowth and Tissue Proliferation during Connective Tissue Healing: A Study in the Rat Dahl J, et al., J Orthop Res 25:1185-1192, 2007)
- For surgeries such as anterior cruciate ligament resconstruction (ACLR) the use of cold therapy combined with compression therapy has been shown to result in better pain control and less medication (narcotic) use. (The Efficacy of Combined Cryotherapy and Compression Compared to Cryotherapy Alone Following Anterior Cruciate Ligament Reconstruction Brian R. Waterman, CPT, MC et al., J Knee Surg 1538-8506, 2012)
- For arthoscopic anterior cruciate ligament (ACL) reconstruction the use of continuous flow cold therapy resulted in reduced need for medication and better improvement in both passive motion and knee flexion. (A Comparison of Crushed Ice and Continuous Flow Cold Therapy Barber FA, Am J Knee Surg 13(2):97-101, 2000)
- For anterior cruciate ligament (ACL) reconstruction continuous-flow cold therapy reduced pain and medication use as well as return of normal motion. (Continuous-Flow Cold Therapy for Outpatient Anterior Cruciate Ligament Reconstruction Barber FA, et al., Arthroscopy 14(2):130-5, 1998)
- For knee surgery, this German study observed improved pain relief, reduced swelling and need for medication, and improved function with the use of combined cold and compression therapy compared to cold therapy alone. (Combination of Cold and Compression After Knee Surgery: A Prospective Randomized Study, Schroder D, Passler HH. Knee Surg Sports Traumatol Arthrosc 2(3):158-65, 1994)