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Cold therapy or cryotherapy is a common and useful therapeutic modality often used by physiotherapists in treating a wide range of conditions. It is easy to apply and if care is taken over cautions and contraindications it is very safe and patients can be instructed to self treat to manage their conditions independently. Cryotherapy is most commonly used in sports and acute injury treatment and is cheap and simple to use. Cold can be applied in several different ways including cold packs, crushed ice, cubed ice or cold water devices.

As warming of the cold water or melting of the ice occurs heat is carried away from the body as the cold therapy proceeds. The main biological effects on the body are local metabolic reduction, reduction of tissue bleeding, lowering of muscle efficiency, a reduction in pain due to the sedatory effect of cold on transmission of nerves, an increase in local circulation once the blood vessel constriction phase has passed and a reduction in the amount of swelling and tissue oedema which occurs. Cold therapy also reduces spasticity and spasm in muscles as a secondary effect of reduction of pain by the cold.

There are many tissue based effects which are promoted by the application of cold therapy and these include post-injury reduction of swelling and oedema, a time-related reduction in spasticity once the cold has been applied for some time, an increase in the local circulation, lowering of the acute inflammation which follows tissue damage, muscle spasm reduction, and pain inhibition. Muscle contraction can be facilitated by a physiotherapist using cold therapy and this can be used to improve muscle contraction to increase joint ranges of motion after injury.

Tissue damage from an injury to an area increases the blood supply locally, is hotter and suffers from oedema, all secondary to heightened tissue metabolism as the area reacts to damage. At this early stage these responses need to be damped down so cold is preferred over heat which would increase them. Cold reduces inflammation, eases pain, prevents swelling and slows the metabolic rate of the injured tissues, encouraging injury healing. It is important to get the cold onto the injured part as close to the precipitating event as you can, with compression if possible. Compression has been shown to be effective and may be more important than the cold.

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