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  • Writer's pictureRobin R Varghese, PT.

Cryotherapy is not meant to make you Cry!!! You must have heard of ICE therapy, instead.

  • Cryotherapy, also known as ice application, is the simplest and oldest way to treat injuries.

  • Ice helps in controlling pain by instigating local anesthesia.

  • It also decreases oedema, nerve conduction velocities, cellular metabolism and local blood flow.

  • The effect of the cryotherapy depends on the method, the duration, temperature of the ice and the depth of the subcutaneous fat.

Principle Behind Cryotherapy

Lewis Hunting Reaction

  • The Lewis hunting reaction or hunting response is a process of alternating vasoconstriction and vasodilation in extremities exposed to cold.

  • The term Lewis reaction is used as it is named after Thomas Lewis, who first described the effect in 1930.

  • Vasoconstriction occurs first to reduce heat loss, but also results in strong cooling of the extremities.

  • Approximately five to ten minutes after the start of cold exposure, the blood vessels in the extremities will suddenly vasodilate.

  • This is probably caused by a sudden decrease in the release of neurotransmitters from the sympathetic nerves to the muscular coat of the arteriovenous anastomoses due to local cold.

  • This cold-induced vasodilation increases blood flow and subsequently the temperature of the fingers.

  • A new phase of vasoconstriction follows the vasodilation, after which the process repeats itself.

  • Vasodilation can be cold induced after initial period of vasoconstriction when cold is maintained for longer than approximately 15 min or when temperature is reduced below 10C.

Methods of Application

Ice packs

Ice sprays


Ice massage


Acute swelling

Acute soft tissue injuries like ankle sprain, muscular strain, ligament sprain

Myofascial trigger points

Post orthopedic surgery e.g. TKR, ACL reconstruction, arthroscopic shoulder surgery

Acute sports injuries

Contra indications

CRPS or Complex Regional Pain Syndrome



Impaired circulation like Raynaud’s disease


Hypersensitivity to cold

Skin anesthesia.


  • Gives pain relief

  • Reduces swelling

  • Reduces surface temperature

  • Effective on a wide range of soft tissue injuries


  • There is little evidence regarding duration and frequency of application, for the treatment to be effective

  • Compression has been shown to be more effective post operatively

  • In rare cases, symptoms like bradycardia and frostbite have been observed.

  • Certain advanced cryotherapy devices can reduce range of movement following TKR due to immobilization of the joint.

Risks involved with Cryotherapy

1. Inhibition of muscle function

Cooling can temporarily Inhibit muscle function leading to increased risk of injury/re‐injury

Be cautious when patients weight bear or perform complex exercise after icing a lower extremity

2. Ice burns

Those especially elderly with impaired circulation or altered sensation are vulnerable to an ice‐burn. Therefore, less intense techniques and use of an insulating layer may be used.

3. Nerve injury induced by cryotherapy

This is common when ice is applied in combination with compression. Capillary filling may be checked frequently to ensure proper blood circulation

4. Decrease in core temperature

Decrease in core temperature may compromise patient safety especially in elderly and in those with fever.

5. Reduced ROM due to shortening of collagen fibre.

Cryotherapy can reduce the ROM.

Post exercise cooling may be done in the lengthened position of the muscle.

In patients with significantly restricted ROM due to scar tissue, it may be preferable not to use ice.

Cryotherapy has proven to be very effective in the acute stages where there is sever pain, swelling and spasm. The best person to reach out for the right way of application of ice at the right stage of you injury is none other than you physical therapist. Always consult your therapist for the proper use of the techniques or methods of treatment as improper use of these methods, without knowing the indications and contra indications can cause adverse effects.

At Valley Healing Hands, Brownsville, Texas, we provide the best Physical therapy management in all acute cases of injury like sports injuries, sprains, strains, Soft tissue injuries, etc where cryotherapy is an integral part of our therapy. Check out what our patients has to say about us and Reach out to us for an evaluation. Patients love our services, You will too!

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