Conventional wisdom dictates that ice bags should be applied for 10 to 20 minutes per hour, several times per day. Often cold therapy seems like an effective approach, especially for acute injuries which involve inflammation. The wisdom of this prescription perhaps pivot 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. It should be noted that inflammation in itself is not bad, but rather it is necessary for healing and for life. It is excess inflammation, sometimes inadvertently provoked by nutritional factors, which we are addressing here. Also there are pain conditions which really should not have cold applied to them and some which do better with heat. So this is something to first discuss with your physician
However sometimes patients are advised to use the cold pack for longer periods of time, perhaps as much as 30 or 45 minutes per hour so that greater and deeper tissue cooling can occur. It stands to reason that it takes a longer period of time for larger and deeper body parts to cool, than it does for a smaller superficial body part, such as a little finger.
Spinal discs and nerves may be 2-3 inches below the surface of our skin, so therefore over the course of a day it may require several hours of therapeutic cold application to sufficiently cool these potential pain sources.
Usually I recommend that one uses plain ice cubes with some water in double zip lock bags or purchase an ice bag as shown in the picture. Chemical gel packs run the risk of being much colder than ordinary ice, depending upon freezer temperature settings. So chemical gel packs run the risk of excessively cooling a body part and eve causing frost bite. Most people place a towel under a gel pack for this reason, but I still prefer to use plain ice. Also with gel packs, the gel does not circulate well within the pack, so as the gel adjacent to the surface of the pack warms cooling potential can be reduced. On the other hand, with plain ice bags the temperatures of water and melting ice will not fall below 32 degrees Fahrenheit, but will likely range between 34 and 40 degrees Fahrenheit, well above freezing temperature.
If our goal is to reduce the internal temperature and swelling of the inflamed pain generators such as joints, ligaments, & nerves, then it may take an accumulated several hours (with breaks) for cold to penetrate and sufficiently cool targeted deep pain generating body tissues. The amount of pain relief (the anti-inflammatory response) we experience may be proportional to the duration of cold therapy application. Having consulted with hundreds of chronic pain patients I have often heard the praises of cold therapy–especially for those with the most chronic and stubborn pain conditions. This strategy gives some patients tremendous advantage and self-control over their health.
INSTRUCTIONS for PROLONGED COLD THERAPY
- Use a LARGE 11 inch size ice 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 pack 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 appplying 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)