Description of Intervention
The use of cryotherapy, or cold therapy, dates back to ancient Greece, when Hippocrates documented the application of snow and ice to relax muscles and reduce edema and pain.1,2 Today, cold therapy is one of the easiest and most frequently used therapeutic modalities, representing as a central tenet in the management of nearly any type of trauma to the musculoskeletal system.2
Cold therapy is commonly recommended by Hand Therapists, both Occupational Therapists and Physical Therapists, athletic trainers, and many other clinicians in the aftermath of an injury to reduce nerve activity, pain, and swelling. In most cases, cold therapy is prescribed with other post-injury interventions and represents the "I" in the RICE (rest, ice, compression, and elevation) protocol, in which it is often combined with compression.3 It can be administered in numerous ways, including ice or gel packs, coolant sprays, ice massage, and ice baths, and can be easily performed at home, which is one of the main reasons for its frequent use.3,4
While its exact mechanism of action has not yet been elucidated, it is believed that by decreasing tissue temperature, cold therapy diminishes pain, metabolism, and muscle spasm, minimizing the inflammatory process and thereby aiding recovery after trauma.3 The physiologic pathways involved in these changes may include vasoconstriction, elevation of the pain threshold, and decreased muscular tones.5
Indications for Intervention
Cold therapy is indicated for any patient presenting with pain, swelling, and/or inflammation from a traumatic injury to the hand, wrist, or elbow. Patients recovering from injections or surgery are also prime candidates for cold therapy. For patients with edema, which is more chronic, Contrast Bath may be introduced to the patient, which consists of a alternating delivery of hot and cold water baths (approximately 60* and 100*).
Diagnosis
- Ask the patient to describe their medical history, including any recent injuries to the hand/fingers, wrist, or elbow, and any recent surgeries performed, or injections administered in those regions.
- Ask if the patient has any comorbidities, including smoking, diabetes, or osteopenia.
- Perform a physical examination of the area of interest. If range of motion (ROM) is impaired, measure the active and passive ROM of any involved joint(s) and compare these measurements to the contralateral side.
- Ask the patient to rate their pain on the visual analogue scale (VAS) or a similar outcome measure.
- Consider using the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire score to evaluate the patient’s subjective impairment of the upper extremity.
- If edema is present, assess and document its severity. The water displacement method with a volumeter, which accurately measures the composite volume of the hand and lower arm, is the gold standard for evaluating edema.6
- If the patient presents with pain, swelling, and/or inflammation following an injury, surgery, or injection, prescribe cold therapy.
Intervention Options1-4,7
In most cases, cold therapy should be integrated into a comprehensive, individualized treatment program designed by a physical therapist or hand therapist. Depending on the patient’s diagnosis, the program may also include strengthening exercises, stretching exercises, manual therapy, functional training, and/or other therapeutic modalities to alleviate symptoms and increase physical function. Additional tips for how to administer cold therapy are below:
- It’s best to apply cold therapy as soon as possible after an injury, surgery, or injection
- To prepare the ice, cold, or gel pack, wrap it in a thin towel or pillowcase to protect the skin from the direct cold
- Have the patient sit in a comfortable position with the injured area exposed and elevated above the heart
- Apply the cold pack directly to the injured area and ensure that it is stable
- Consider wrapping the pack with an ace bandage or similar device to provide additional compression
- Check in with the patient periodically and ask if the treatment is too cold or if they have lost any feeling in their skin; if so, remove the pack and wrap it in another towel or pillowcase
- Remove the cold pack after 10—20 minutes, depending on the injury type and severity
Instruct the patient to continue using cold therapy for a set duration, which is usually 2–3 times per day until the swelling has subsided. Patients should allow the injured area to warm for at least 30 minutes in between cold therapy sessions. Patients with certain medical conditions may be contraindicated from cold therapy, including those with diabetes, who may not be able to properly sense tissue damage.
