Physiological Effects of Cold


Decreased circulation, then increased circulation


Decreased nerve conduction velocity

Increased pain threshold

Decreased muscle spasticity


Decreased metabolic rate


Goals for Using Cold as an Intervention

Impairments and Goals

Treatment considerations

Functional Outcome

Decrease pain


Position patient for comfort

Improve functional activity or improved functional ROM

Control spasticity

Close monitoring of skin and elapsed time, especially when there is associated sensory loss

Improved mobility and functional use

Decrease edema

Position to facilitate fluid return to circulatory system (e.g. elevate affected area)

Improve functional use

Decrease circulation

Promote tissue healing



Improve function


Clinical Indicators for Cold Application

Acute soft tissue injury and post-surgical conditions show ability to benefit from cold, primarily through pain and edema reduction. Neuromuscular conditions that include increase spasticity (e.g. neurologically-mediated resistance to stretch) can be treated with cold to decrease nerve firing and improve available ROM. Pain from chronic spine and joint conditions can also be reduced with cold.

Depth of penetration is up to 5 cm and and application effects can last 1-2 hours

Methods of Cold Application

Be sure to spend time with the "Cold Application" linked slide show in preparation for the unit and for lab


  alternative accessible content

Cold Application

More presentations from Angie Moser

Contraindications and Precautions



Apply knowledge of physiological responses

Explain why the contraindications "make sense"



Apply knowledge of physiological responses

Explain why the precautions "make sense"


Cold hypersensitivity


Poor sensation


Cold intolerance


Over an open wound




Hypertension (HTN)

Paroxysmal cold cryoglobulinema


Altered mental status


Raynaud's disease and phenomenon


Pediatric and geriatric patients


Directly over a regenerating peripheral nerve


Directly over the superficial or main branch of a nerve


Directly over and area with circulatory compromise or peripheral vascular disease





Parameters for Cold Application

Cold packs

15-20 minutes; or

15-20 on: 10 minutes off x 2

Ice massage

5-10 minutes or until pain is reduced/region is numb


Vapocoolant sprays

2-5 parallel sweeps at 10cm/sec with bottle 45cm from skin and at a 30 degree angle