Cold Therapy

How Cold Helps Pain

Cold therapy (cryotherapy) uses cold temperatures to reduce inflammation, numb pain, and decrease blood flow to an area. While often associated with acute injuries, cold can also be helpful for certain chronic pain situations, particularly after activity or during inflammatory flares.¹

How It Works²

• Constricts blood vessels (reduces swelling)
• Numbs the area (reduces pain signals)
• Decreases inflammation
• Reduces muscle spasm
• Slows metabolic activity

When to Use Cold

• Acute injuries (first 48-72 hours)
• After exercise that causes pain
• Inflammatory flares (RA, gout)
• Swelling
• Migraines (some people)
• After overactivity

Cold for Chronic Pain

• After activity that increases pain
• During inflammatory flares
• Some prefer cold to heat
• May be combined with heat
• Personal response varies

Types of Cold Application³

• Ice packs
• Gel packs (reusable)
• Frozen vegetables (peas work well)
• Ice massage
• Cold water immersion
• Cooling sprays

How to Apply

• Always use barrier (cloth) between ice and skin
• Apply for 15-20 minutes
• Allow skin to return to normal before reapplying
• Don't apply to areas with poor circulation

Safety

• Never apply ice directly to skin
• Don't use on areas with numbness
• Watch for signs of frostbite
• Avoid with Raynaud's disease
• Limit application time

When NOT to Use Cold

• Cold sensitivity or cold urticaria
• Poor circulation
• Over areas with no sensation
• Raynaud's phenomenon
• Some heart conditions

Heat vs. Cold Decision

• Swelling present → try cold
• Muscle stiffness → try heat
• After activity → often cold
• Morning stiffness → often heat
• Experiment to see what works for you

References

1. Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury. Am J Sports Med. 2004;32(1):251-261.
2. Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of cryotherapy and thermotherapy. Pain Physician. 2004;7(3):395-399.
3. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.