How to use Cold Therapy

There would not be a working day that goes by that I don’t encounter someone that either could have been helped by the correct application of cold therapy or applied cold therapy incorrectly.  Alternative names for cold therapy are Ice Therapy or Cryotherapy and these names are often used interchangeable, but in this article, I will use the term ‘Cold therapy’ for uniformity.

When do we use Cold therapy and when do we use Heat therapy?  This is quite possibly one of the most common questions an Osteopath, or any manual medicine practitioner will be asked in practice.  A good general rule of thumb is Cold therapy is used to assist in the treatment of Acute injuries, and Heat Therapy is used to assist in the treatment of Chronic injuries.   

How do I know if an injury is acute or chronic?  An acute injury is one that has a sudden, often traumatic onset.  Common examples are a sprained ankle, fractured bone, or a strained muscle like a hamstring.  Acute injures can vary in severity and vary in time frames.  They can be very complex and that is why early diagnosis is imperative by a trained medical professional.  Osteopathic practitioners are trained to diagnose acute injuries.

A good example of best practice in the treatment of Acute injuries is set out on the Better Heath Channel on the Victorian Government website.

  • Rest – keep the injured area supported and avoid using for 48-72 hours.
  • Ice – apply ice to the injured area for 20 minutes every two hours for the first 48-72 hours.
  • Compression – apply a firm elastic bandage over the area, extending above and below the painful site.
  • Elevation – raise the injured area above the level of the heart at all times.
  • Referral – as soon as possible, see a doctor.
  • No Heat – heat will increase bleeding.
  • No Alcohol – alcohol increases bleeding and swelling.
  • No Running – running or exercise increases blood flow, delaying healing.
  • No Massage – massage increases swelling and bleeding, also delaying healing.

Cold therapy works by reducing blood flow to the injured tissue, which can significantly reduce inflammation and swelling and it can also temporarily reduce nerve activity (nociceptors), which can also relieve pain.  The pain-relieving effect of cold is much slower than heat, which is what leads some practitioners recommending Heat therapy in some cases of acute pain for short term pain relief.  This is a mistake in most cases as applying heat to an acute condition will lead to vasodilation in the area and therefore significantly more swelling in the area, which will in turn, lead to more swelling and pain in the area.   When applying Cold Therapy do not apply directly to the skin as this may cause damage to the nerve, tissue or skin.  Apply for approximately 15 minutes at a time, but no more than 20 minutes so that damage does no occur.  Give the tissue time to recover from the Cold Therapy.  This is approximately 30 minutes, or when the temperature of the tissue has returned back to the temperature of the surrounding tissue.


Cold Therapy in a Nutshell:

  • Apply to acute injuries.
  • Apply directly to the inured area.
  • Never apply directly – apply cold pack wrapped in a cloth, or apply in ice bath.
  • Apply for 15-20 minutes at a time.
  • Allow approximately 30 minutes for the tissue to recover before reapplying the Cold Therapy.
  • Apply on and off as regularly as reasonably possible.
  • Always consult a medical professional.