Ice therapy is a really common method of acute injury management. In the initial stage of a soft tissue injury, we have to stop bleeding, reduce swelling and pain immediately. As a very safe and easy to use method, cryotherapy is utilized by physical therapists, players, and normal people in sports as well as day to day lives. So, here I mainly focus on how the ice reduces swelling.
There are various types of methods to apply cold therapy to the tissues.
- Crushed ice
- Ice/gel packs
- Cold compressive devices
- ice immersion
- Ice bags
Among these variations, Crushed ice application is the most effective way and safest way.
What is swelling and how does ice reduce it?
When you apply ice in the acute phase of the injury, it cools the affected tissues, decreases the tissue temperature, and decreases the metabolic demand of surrounding cells. So, this increases the blood viscosity (thickness of Blood plasma) and decreases the need for oxygen to the tissues (decreased secondary injury). these processes decrease blood flow to the damaged tissue area. and also, it narrows the blood vessels (vasoconstriction). Finally, swelling is reduced as a result of these actions
Cold application varies according to the area. you know that some areas of the human body have a very deep subcutaneous fat layer. So, ice should be applied 15min- 20min to achieve the expected goal. The duration of icing for a small area with minimal fat and muscle, such as a finger, would be significantly less (~3-5 minutes).
It is true that Applying ice can reduce pain, it also suggested in the 2007 study. According to the research paper, the cold application reduces nerve conduction velocity and it affects to decrease pain. Though the above process is a very logical and possible way, reducing swelling by ice is debatable now since less evidence to prove it scientifically. In acute injury management, there are three common principles called the PRICE method, RICE method, and PEACE method. PRICE and RICE methods are used for the past decades but now the PEACE method is the widely used injury management protocol. So, Both PRICE and RICE methods recommend using Ice therapy. But PEACE Method clearly refuses it by mentioning that using ice damages the active healing process. It is true that Cold therapy decrease inflammation. Moreover, cryotherapy application restricts and delays the white blood cells infiltration from capillaries to the injury site.
However, these methods can be changed according to future research studies. So, it is significant to know how to apply ice correctly. you can’t apply patients who are suffering from peripheral vascular diseases, sensory loss, cold hypersensitivity, advanced diabetes, severe blood pressure abnormalities.
On the other hand, as precautions, you should not apply ice over the carotid sinus of the patient. As well as, do not apply cold over areas of infection and near the eyes.
It is better if you follow these steps, it will bring more outcome than you expect.
- Preparation of patient- the reasons for applying and nature of treatment are explained to the patient.
- Preparation of apparatus- the means of applying cold is checked, including the correct temperature of the water bath.
- Preparation of part- a suitable position and support for the part is arranged, depending on whether it is to be immersed or have a pack applied.
- Instructions for the patient- what to do and warned to indicate any increased pain or discomfort.
- Application- during treatment it is appropriate to check the application every few minutes and inspect the skin at the same time.
- Termination- the cold apparatus is removed and the skin is dried and inspected once more.
You should keep in mind that when you apply ice directly without towel or bandages, it can cause ice burns to the skin. The clinical presentation of ice burns are similar to a thermal burn.