Physiological Effects of Cold
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Hemodynamic |
Decreased circulation, then increased circulation |
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Neuromuscular |
Decreased nerve conduction velocity Increased pain threshold Decreased muscle spasticity |
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Metabolic |
Decreased metabolic rate |
Goals for Using Cold as an Intervention
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Impairments and Goals |
Treatment considerations |
Functional Outcome |
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Decrease pain
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Position patient for comfort |
Improve functional activity or improved functional ROM |
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Control spasticity |
Close monitoring of skin and elapsed time, especially when there is associated sensory loss |
Improved mobility and functional use |
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Decrease edema |
Position to facilitate fluid return to circulatory system (e.g. elevate affected area) |
Improve functional use |
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Decrease circulation Promote tissue healing
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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
- Ice massage
- Cold packs
- Ice baths
- Cryostretching
- Vapocoolant
- Cryostretching
Be sure to spend time with the "Cold Application" linked slide show in preparation for the unit and for lab
Contraindications and Precautions
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Contraindications |
WHY? Apply knowledge of physiological responses Explain why the contraindications "make sense" |
Precautions |
WHY? Apply knowledge of physiological responses Explain why the precautions "make sense"
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Cold hypersensitivity |
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Poor sensation |
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Cold intolerance |
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Over an open wound |
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Hypertension (HTN) |
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Paroxysmal cold cryoglobulinema |
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Altered mental status |
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Pediatric and geriatric patients |
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Directly over a regenerating peripheral nerve |
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Directly over the superficial or main branch of a nerve |
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Directly over and area with circulatory compromise or peripheral vascular disease |
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Parameters for Cold Application
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Cold packs |
15-20 minutes; or 15-20 on: 10 minutes off x 2 |
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Ice massage |
5-10 minutes or until pain is reduced/region is numb "CBAN" |
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Vapocoolant sprays |
2-5 parallel sweeps at 10cm/sec with bottle 45cm from skin and at a 30 degree angle |
