As the team physician for all sports at a university for over twenty years, I had the opportunity to see athletic trainers perform. They were very good at diagnosing injuries and knowing which ones could be managed with therapy and which ones needed additional studies and sometimes surgical treatment. When injuries could be managed with therapy and modalities alone, they were able to accelerate recovery to bring athletes back to high levels of function at a rate that seemed magical.
Among the most frequent modalities was cold therapy and they used it in multiple ways. Naturally ice packs were a must on the sidelines and they always had them handy. When someone was injured icing was begun immediately to reduce blood flow with bleeding into the tissues to try to keep the swelling to a minimum.
They also used cold therapy in accelerate recovery. One of the favorite treatments was immersion of a limb in a bucket of ice-filled water. They would then remove it and apply gentle heat, always being careful to not use cold too long or heat too high. The hyperemic response to removal from cold also occurred without the application of heat.
Hyperemia is an increased blood flow that causes the skin to redden and ultimately warm. You can see it in people’s faces when they come inside from the cold. You can definitely see it when one removes ice packs from the skin. So, not only do you get the benefit of cooling to reduce swelling but you also get the benefit of increased blood flow after removing the cooling device.
Our trainers made a convincing case for another benefit of this so-called “contrast” therapy. They hypothesized that the change in reduced blood flow from cold followed by increased blood flow from warming caused the tissues to shrink and expand with a resulting pumping effect to help drive out swelling (edema).
A third benefit of cold therapy is pain relief. Cold applied to an injured or painful area can reduce the pain. That not only makes the person more comfortable but allows better rehabilitation by making it less painful to move an ankle or tighten a muscle.
In summary, the benefits of cold therapy are
- Temporary reduction of blood flow to
- Reduce bleeding to an area of acute injury
- Possibly to transiently shrink tissues to help pump out edema
- Hyperemia (representing increased blood flow) upon warming to help accelerate the healing process
- Pain reduction
The biggest problem with cold therapy is inconvenience and risk of cold injury.
- It’s not practical to carry around a bucket of ice slush so this sort of immersion therapy generally needs to be provided in a training room.
- Ice packs alone are hard to keep in place and plastic bags of ice tend to leak and “sweat” wetting one’s clothing, etc.
- Cold injury can occur if you treat with too much cold for too long.
- Compression (another therapeutic modality for managing edema) is difficult to apply over ice packs.
- Electrical cooling devices require (believe it or not) electricity, limiting mobility.
A convenient and useful way to provide both cold therapy and compression is provided with the ICE20 Compression Therapy Wraps. You may click on ICE20 to see our list of their nice cold therapy devices.
James D. Hundley, MD; Orthopaedic Surgeon, Retired; Former Athletic Team Physician
