How is Cryotherapy Used in Physical Therapy?

When it comes to injuries, some of the common bodily responses are pain and muscle spasms. Your bones and muscles are connected to each other and to other bodily tissues with ligaments and tendons.

The basic building material of those ligaments, muscles, and tendons is a protein that is referred to as collagen. Typically, this collagen causes your ligaments, muscles, and tendons to snap back like a rubber band. That is, when tension is applied, it stretches out and then when the tension is released, it returns to its normal length.

However, there are some situations in which the ligaments, muscles, and tendons are stretched too far, which causes the collagen to tear. When the collagen is torn, it causes your blood vessels to also tear and blood cells/fluids start to escape into the areas of the muscle fibers. You will typically see a bruised, swollen area that indicates this has happened.

What does cryotherapy (cold) do?

When you apply cold to the injured area, it causes the flow of blood cells and fluid being released to be decreased. In addition, the chemicals that result in pain and inflammation are slowed down. Cold reduces your nerve endings’ ability to conduct impulses. Finally, pain may be reduced because you are “countering” your injury. For example, when you have a toothache, you may try to counter the pain by pinching yourself on the leg really hard.

In addition, cold causes cell activity to be decreased, which reduces internal bleeding and swelling at the injury site. By cooling your deep tissues, you also cause a reduction in muscle spasms by reducing your muscles’ ability to stay contracted.

Since cold causes a reduction in swelling and bleeding, that are common with injured tissues, it’s best if you use this type of therapy within the first 48 hours (2 days) of an injury. Typically, after surgery, you will use cold longer. However, you must understand that cryotherapy is not appropriate for everyone. This type of treatment should not be used on individuals who:

  • Have circulatory problems.
  • Are unconscious
  • Cannot respond (after a stroke)
  • Cannot feel cold (have neuropathy or are paralyzed)
  • Have an allergy to cold (yes, it happens)

Cryotherapy & Physical Therapy

Common types of methods used

Looking back in history, back to the ice age, we see that humans have used cryotherapy to their advantage. There are many forms of cryotherapy, from the very simple ice pack (wrapping a few ice cubes in a towel and applying it to the injury), to a much more advanced personal cooling unit that is controlled by a microchip. Of course, each type of cryotherapy has some benefits as well as some limitations.

Below, you will find a bit of background on each cryotherapy technique so that you can make the best decision on which one is best to relieve your own pain, and restore your normal functioning when you are going through physical therapy.

Ice bags

With this technique, you will use simple bags such as a hot water bottle, plastic bags, chemical cold packs, or even frozen veggies.

Make sure the area is clean and dry. Then, apply a towel over the area so that you can keep the ice from directly contacting the skin. Then, apply your choice of ice bag to the area for a maximum of 20 minutes. There are four stages of sensations that your skin will go through in about ten to 15 minutes. These are:

  • Cold
  • Burning
  • Aching
  • Numbness

You can stop the cold therapy once your skin begins to go numb. Then, leave it off for a bit until your skin returns to normal, and start over again.

Ice massage

With this technique, you apply ice directly to the skin in circular motions; do not leave it on for more than three minutes at a time.

Start by placing tap water in a foam cup and then place in freezer until frozen. Then, you will peel back a small amount of the cup and then massage onto the affected area in circular motions. However, you do not want to leave it in one area for more than three minutes because this can result in frostbite. You should only use ice massage until the affected area feels numb. Then, you will want to take a break until the skin returns to normal, and then start again.

Advantages of at-home cryotherapy techniques

As we have mentioned, there are advantages and disadvantages to using at-home cryotherapy techniques. The following are some of the advantages:

  • They are easily available/found in most homes
  • They are typically fairly inexpensive
  • They allow for little prep and quick application
  • They are perfect for minor injuries that only require cold therapy to be used for 24 to 48 hours

However, some of the disadvantages are as follows:

  • The ice is difficult to keep in place and can easily fall off or shift positions
  • The ice can be quite messy, especially if lying in bed or on a couch
  • The ice can only be applied to limited surfaces
  • There is no compression with the ice packs/massages
  • The ice can only be applied for a short amount of time, approximately 10 to 20 minutes
  • Ice can be quite frustrating to use for major injuries or following a surgery


Cryotherapy is appropriate for use in the physical therapy setting. You can do cryotherapy at home, with ice packs/ice massage, or you can visit a medical supply store and obtain a machine that will apply cold and compression for your injury. It all depends upon how serious your injury is.