Cold applications and treatment:
The simplest and most effective method of applying cold treatment consists of immersing the injured part in ice-cold water. Other methods include ice-packs and compresses. Cold applications must be applied immediately, or as soon as possible, after the injury has taken place. It should be noted, however, that cold can be used to relieve pain and associated muscle spasm in the later phases of recovery. Indeed, in recent years many therapists have advocated cold applications and treatment for this purpose instead of traditional forms of heat.
Effects of cold applications and treatment
The application and treatment of cold to an injured part relieves the pain, through its effect on the nerve endings in the skin: in some cases the relief seems to last for a longer time than when heat is used as a palliative agent. Physiologists investigating the effects of local cooling on the body tissues have not only found that cold reduces the conductivity of nerves, but that the susceptibility of nerves to cooling varies with the type and size of the fibers. Experiments have shown that some smaller diameter fibers are more readily influenced than large diameter fibers. If the intention is to use cold to reduce muscle spasm and initiate active movement a temperature of between 12°C. and 15°C. (53’6° F. and 59°F.) is best.
Limiting swelling
It is possible that cold applications and treatment also help to restrict the traumatic effusion or swelling which accompanies a local inflammation, by causing a constriction of the dilated capillaries of the superficial structures. The practical difficulty associated with this form of treatment is that the initial vasoconstriction is followed later by a marked vasodilatation.
Effect on deeper structures
Cold applications and treatment have little effect on the capillaries of the deeper structures. This is because the network of blood vessels in the skin acts as an insulator; in other words, the blood flowing through the skin vessels absorbs the cold before it can penetrate to the deeper structures. Because of this, the immediate treatment of soft-tissue injuries should consist of pressure bandaging combined with a cold application and treatment.
Cold Treatment techniques:
This cold treatment is suitable only for injuries of the wrist, hand, foot and ankle. It consists of immersing the injured part for about 10 to 20 minutes in a pail or deep bowl of cold water to which ice cubes or crushed ice have been added. It is advisable to check the temperature of the water with a bath thermometer. After cold treatment the wet pressure bandage is removed and a new bandage applied. If immersion is not practicable the pressure bandage may be soaked thoroughly, the water being applied with a sponge
Wet towels
Several pieces of terry toweling, about 30 x 24 in. are soaked in a bucket containing a mixture of cold water and crushed or flaked ice. The towels are wrung out to get rid of excess moisture, and then applied this cold treatment to the injured area. They are changed every minute, and the whole sequence of cooling should last for about 10 to 20 minutes. From a practical point of view half the number of towels required (having been folded lengthwise) should be left soaking in the bucket while the others are used.
Cold packs
Damp terry toweling bags of a suitable size are filled with flaked-or crushed ice. The injured part is wiped with oil to prevent the possibility of an ice burn, and covered with a paper tissue to prevent soiling of the bag. The ice pack is then molded round the part. If the trunk is being treated it is helpful to hold the pack in place by a broad canvas strap passed round the body. As an alternative to toweling plastic or rubber bags may be used.
Ice massage
A paper tissue is wrapped round one end of an ice cube. The cube is then massaged slowly over the painful area for about 5 minutes. This is a useful form of cold treatment for relieving pain over a small area (ligaments, for example); it is possible that ice massage acts as a counter-irritant and helps to reduce the conductivity of the pain fibers in the nerves involved.
Cold compresses
A piece of white lint, cut and folded to the required size (to make a double thickness), is soaked in ice-cold water. The lint is squeezed out gently, so that it is not made too dry, and applied to the affected part. It is then covered with a piece of jaconet or oiled silk, and bandaged lightly in position with a few turns of cotton bandage. The compress of cold treatment must be changed frequently, and used for about 20 minutes. A pressure bandage is then applied. In general, cold compresses have a very limited effect.
