Cold Packs or Ice Packs
Content
COLD PACKS OR ICE PACKS
Equipment Required
• Towels or pillow cases for hygiene and/or
insulation
• For cold packs
• Cold packs in a variety of sizes and shapes
appropriate for
different areas of the body
• Freezer or specialized cooling unit
• For ice packs
• Plastic bags
• Ice chips
• Ice chip machine or freezer
Procedure
1. Remove all jewelry and clothing from the area
to be treated
and inspect the area.
2. Wrap the cold pack or ice pack in a towel. Use
a damp towel if
a maximal rate of tissue cooling is desired. It is
recommended
that warm water be used to dampen the towel to
allow the
patient to gradually become accustomed to the
cold sensation.
A thin, dry towel can be used if slower, less
intense cooling is
desired. A damp towel is generally appropriate
for a cold pack,
whereas a dry towel should be used for an ice
pack because ice
provides more intense cooling.
3. Position the patient comfortably, elevating the
area to be
treated if edema is present.
4. Place the wrapped pack on the area to be
treated, and secure
it well. Packs can be secured with elastic
bandages or towels to
ensure good contact with the patient’s skin.
5. Leave the pack in place for 10 to 20 minutes to
control pain,
inflammation, or edema. When cold is applied
over bandages
or a cast, application time should be increased to
allow the
cold to penetrate through these insulating layers
to the skin.78
In this circumstance, the cold pack should be
replaced with a
newly frozen pack if the original pack melts
during the course
of the intervention.
If cryotherapy is being used to control spasticity,
the pack
should be left in place for up to 30 minutes. With
these longer
applications, check every 10 to 15 minutes for
any signs of adverse
effects.
6. Provide the patient with a bell or other means
to call for
assistance.
7. When the intervention is completed, remove
the pack and inspect
the treatment area for any signs of adverse effects
such
as wheals or a rash. It is normal for the skin to be
red or dark
pink after icing.
8. Cold or ice pack application can be repeated
every 1 to
2 hours to control pain and inflammation.79
Advantages
• Easy to use
• Inexpensive materials and equipment
• Brief use of clinician’s time
• Low level of skill required for application
• Covers moderate to large areas
• Can be applied to an elevated limb
Disadvantages
• Pack must be removed for the treatment area to
be visualized
during treatment.
• Patient may not tolerate the weight of the pack.
• Pack may not be able to maintain good contact
on small or
contoured areas.
• Long duration of treatment compared with
massage with an
ice cup.
Ice Pack Versus Cold Pack
• Ice pack provides more intense cooling.
• Ice pack is less expensive.
• Cold pack is quicker to apply.
ICE MASSAGE
Equipment Required
• Small paper or Styrofoam cups
• Freezer
• Tongue depressors or popsicle sticks
(optional)
• Towels to absorb water
Procedure
1. Remove all jewelry and clothing from the
area to be treated
and inspect the area.
2. Place towels around the treatment area to
absorb any dripping
water and to wipe away water on the skin
during treatment.
3. Rub ice over the treatment area using
small, overlapping circles.
Wipe away any water as it melts on the skin.
4. Continue ice massage application for 5 to
10 minutes, or until
the patient experiences analgesia at the site of
application.
5. When the intervention is completed,
inspect the treatment
area for any signs of adverse effects such as
wheals or a rash.
It is normal for the skin to be red or dark pink
after the application
of ice massage. Ice massage may be applied
in this
manner for local control of pain,
inflammation, or edema. Ice
massage can also be used as a stimulus for
facilitating the
production of desired motor patterns in
patients with
impaired motor control. When applied for
this purpose,
the ice may be rubbed with pressure for 3 to
5 seconds or
quickly stroked over the muscle bellies to be
facilitated.
This technique is known as quick icing.
Advantages
• Treatment area can be observed during
application.
• Technique can be used for small and
irregular areas.
• Short duration of treatment
• Inexpensive
• Can be applied to an elevated limb
Disadvantages
• Too time-consuming for large areas
• Requires active participation by the
clinician or the patient
throughout application
CONTROLLED COLD COMPRESSION
Equipment Required
• Controlled cold compression unit
• Sleeves appropriate for area(s) to be treated
• Stockinette for hygiene
Procedure
1. Remove all jewelry and clothing from the area to be treated
and inspect the area.
2. Cover the limb with a stockinette before applying the sleeve.
3. Wrap the sleeve around the area to be treated.
4. Elevate the area to be treated.
5. Set the temperature at 10° C to 15° C (50° F to 59° F).
6. Cooling can be applied continuously or intermittently. For
intermittent treatment, apply cooling for 15 minutes every
2 hours.
7. Cycling intermittent compression may be applied at all times
when the area is elevated.
8. When the intervention is completed, remove the sleeve and
inspect the treatment area.
Advantages
• Allows simultaneous application of cold and compression
• Temperature and compression force are easily and accurately
controlled.
• Can be applied to large joints
Disadvantages
• Treatment site cannot be visualized during treatment.
• Expensive
• Usable only for extremities
• Cannot be used for trunk or digits
VAPOCOOLANT SPRAY AND BRIEF ICING
Procedure
1. Identify trigger points and their related tight muscles.
2. Position the patient comfortably, with all limbs and the back
well supported and the area to be treated exposed and accessible.
Inspect the area to be treated. Cover the patient’s eyes,
nose, and mouth if spraying near the face, to minimize the
patient’s inhalation of the spray.
3. Apply two to five parallel sweeps of the spray or strokes of the
ice 1.5 to 2 cm (0.5 to 1 inch) apart at a speed of approximately
10 cm (4 inches) per second along the direction of the
muscle fibers. When using a spray, hold the can upright about
30 to 46 cm (12 to 18 inches) from the skin and angled so that
the spray hits the skin at an angle of about 30 degrees. Continue
until the entire muscle has been covered, including the
muscle attachment and the trigger point.
4. During cooling, maintain gentle, smooth, steady tension on
the muscle to take up any slack that may develop.
5. Immediately after cooling, have the patient take a deep
breath and then perform a gentle passive stretch while
exhaling. Contraction/relaxation techniques may be used
to enhance the ROM increases obtained with this procedure.
6. Following this procedure, the skin should be rewarmed with
moist heat, and the muscles should be moved through their
full active ROM (AROM).
Advantages
• Brief duration of cooling
• Very localized area of application
Disadvantages
• Limited to use for brief, localized, superficial application of cold
before stretching
• Other means of applying cryotherapy
DOCUMENTATION
The following should be documented:
• Area of the body treated
• Type of cooling agent used
• Treatment duration
• Patient positioning
• Response to the intervention
Documentation is typically written in the SOAP
(Subjective, Objective, Assessment, Plan) note format.
The following examples only summarize the modality
component of the intervention and are not intended to
represent a comprehensive plan of care.
EXAMPLES
When applying an ice pack (IP) to the patient’s (pt) left (L)
knee to control postoperative (postop) swelling, document
the following:
S: Pt reports postop L knee pain and swelling that increases with
walking.
O: Pretreatment: Midpatellar girth 161⁄2 in. Gait “step to” when
ascending stairs.
Intervention: IP L anterior knee for 15 min, L LE elevated.
Posttreatment: Midpatellar girth 15 in. Gait “step through” when
ascending stairs.
A: Decreased midpatellar girth, improved gait.
P: Instruct pt in home program of IP to L anterior knee, 15 min,
with L LE elevated, 33 each day until next treatment session.
When applying ice massage (IM) to the area of the right
(R) lateral (lat) epicondyle to treat epicondylitis, document
the following:
S: Pt reports pain in R lat elbow.
O: Pretreatment: 8/10 R lat elbow pain. R elbow unable to fully extend.
Intervention: IM R lat elbow for 5 min.
Posttreatment: Pain 6/10. Full elbow extension.
A: Pain decreased and elbow ROM improved.
P: Continue IM at end of treatment sessions until pt has
pain-free elbow function.
Equipment Required
• Towels or pillow cases for hygiene and/or
insulation
• For cold packs
• Cold packs in a variety of sizes and shapes
appropriate for
different areas of the body
• Freezer or specialized cooling unit
• For ice packs
• Plastic bags
• Ice chips
• Ice chip machine or freezer
Procedure
1. Remove all jewelry and clothing from the area
to be treated
and inspect the area.
2. Wrap the cold pack or ice pack in a towel. Use
a damp towel if
a maximal rate of tissue cooling is desired. It is
recommended
that warm water be used to dampen the towel to
allow the
patient to gradually become accustomed to the
cold sensation.
A thin, dry towel can be used if slower, less
intense cooling is
desired. A damp towel is generally appropriate
for a cold pack,
whereas a dry towel should be used for an ice
pack because ice
provides more intense cooling.
3. Position the patient comfortably, elevating the
area to be
treated if edema is present.
4. Place the wrapped pack on the area to be
treated, and secure
it well. Packs can be secured with elastic
bandages or towels to
ensure good contact with the patient’s skin.
5. Leave the pack in place for 10 to 20 minutes to
control pain,
inflammation, or edema. When cold is applied
over bandages
or a cast, application time should be increased to
allow the
cold to penetrate through these insulating layers
to the skin.78
In this circumstance, the cold pack should be
replaced with a
newly frozen pack if the original pack melts
during the course
of the intervention.
If cryotherapy is being used to control spasticity,
the pack
should be left in place for up to 30 minutes. With
these longer
applications, check every 10 to 15 minutes for
any signs of adverse
effects.
6. Provide the patient with a bell or other means
to call for
assistance.
7. When the intervention is completed, remove
the pack and inspect
the treatment area for any signs of adverse effects
such
as wheals or a rash. It is normal for the skin to be
red or dark
pink after icing.
8. Cold or ice pack application can be repeated
every 1 to
2 hours to control pain and inflammation.79
Advantages
• Easy to use
• Inexpensive materials and equipment
• Brief use of clinician’s time
• Low level of skill required for application
• Covers moderate to large areas
• Can be applied to an elevated limb
Disadvantages
• Pack must be removed for the treatment area to
be visualized
during treatment.
• Patient may not tolerate the weight of the pack.
• Pack may not be able to maintain good contact
on small or
contoured areas.
• Long duration of treatment compared with
massage with an
ice cup.
Ice Pack Versus Cold Pack
• Ice pack provides more intense cooling.
• Ice pack is less expensive.
• Cold pack is quicker to apply.
ICE MASSAGE
Equipment Required
• Small paper or Styrofoam cups
• Freezer
• Tongue depressors or popsicle sticks
(optional)
• Towels to absorb water
Procedure
1. Remove all jewelry and clothing from the
area to be treated
and inspect the area.
2. Place towels around the treatment area to
absorb any dripping
water and to wipe away water on the skin
during treatment.
3. Rub ice over the treatment area using
small, overlapping circles.
Wipe away any water as it melts on the skin.
4. Continue ice massage application for 5 to
10 minutes, or until
the patient experiences analgesia at the site of
application.
5. When the intervention is completed,
inspect the treatment
area for any signs of adverse effects such as
wheals or a rash.
It is normal for the skin to be red or dark pink
after the application
of ice massage. Ice massage may be applied
in this
manner for local control of pain,
inflammation, or edema. Ice
massage can also be used as a stimulus for
facilitating the
production of desired motor patterns in
patients with
impaired motor control. When applied for
this purpose,
the ice may be rubbed with pressure for 3 to
5 seconds or
quickly stroked over the muscle bellies to be
facilitated.
This technique is known as quick icing.
Advantages
• Treatment area can be observed during
application.
• Technique can be used for small and
irregular areas.
• Short duration of treatment
• Inexpensive
• Can be applied to an elevated limb
Disadvantages
• Too time-consuming for large areas
• Requires active participation by the
clinician or the patient
throughout application
CONTROLLED COLD COMPRESSION
Equipment Required
• Controlled cold compression unit
• Sleeves appropriate for area(s) to be treated
• Stockinette for hygiene
Procedure
1. Remove all jewelry and clothing from the area to be treated
and inspect the area.
2. Cover the limb with a stockinette before applying the sleeve.
3. Wrap the sleeve around the area to be treated.
4. Elevate the area to be treated.
5. Set the temperature at 10° C to 15° C (50° F to 59° F).
6. Cooling can be applied continuously or intermittently. For
intermittent treatment, apply cooling for 15 minutes every
2 hours.
7. Cycling intermittent compression may be applied at all times
when the area is elevated.
8. When the intervention is completed, remove the sleeve and
inspect the treatment area.
Advantages
• Allows simultaneous application of cold and compression
• Temperature and compression force are easily and accurately
controlled.
• Can be applied to large joints
Disadvantages
• Treatment site cannot be visualized during treatment.
• Expensive
• Usable only for extremities
• Cannot be used for trunk or digits
VAPOCOOLANT SPRAY AND BRIEF ICING
Procedure
1. Identify trigger points and their related tight muscles.
2. Position the patient comfortably, with all limbs and the back
well supported and the area to be treated exposed and accessible.
Inspect the area to be treated. Cover the patient’s eyes,
nose, and mouth if spraying near the face, to minimize the
patient’s inhalation of the spray.
3. Apply two to five parallel sweeps of the spray or strokes of the
ice 1.5 to 2 cm (0.5 to 1 inch) apart at a speed of approximately
10 cm (4 inches) per second along the direction of the
muscle fibers. When using a spray, hold the can upright about
30 to 46 cm (12 to 18 inches) from the skin and angled so that
the spray hits the skin at an angle of about 30 degrees. Continue
until the entire muscle has been covered, including the
muscle attachment and the trigger point.
4. During cooling, maintain gentle, smooth, steady tension on
the muscle to take up any slack that may develop.
5. Immediately after cooling, have the patient take a deep
breath and then perform a gentle passive stretch while
exhaling. Contraction/relaxation techniques may be used
to enhance the ROM increases obtained with this procedure.
6. Following this procedure, the skin should be rewarmed with
moist heat, and the muscles should be moved through their
full active ROM (AROM).
Advantages
• Brief duration of cooling
• Very localized area of application
Disadvantages
• Limited to use for brief, localized, superficial application of cold
before stretching
• Other means of applying cryotherapy
DOCUMENTATION
The following should be documented:
• Area of the body treated
• Type of cooling agent used
• Treatment duration
• Patient positioning
• Response to the intervention
Documentation is typically written in the SOAP
(Subjective, Objective, Assessment, Plan) note format.
The following examples only summarize the modality
component of the intervention and are not intended to
represent a comprehensive plan of care.
EXAMPLES
When applying an ice pack (IP) to the patient’s (pt) left (L)
knee to control postoperative (postop) swelling, document
the following:
S: Pt reports postop L knee pain and swelling that increases with
walking.
O: Pretreatment: Midpatellar girth 161⁄2 in. Gait “step to” when
ascending stairs.
Intervention: IP L anterior knee for 15 min, L LE elevated.
Posttreatment: Midpatellar girth 15 in. Gait “step through” when
ascending stairs.
A: Decreased midpatellar girth, improved gait.
P: Instruct pt in home program of IP to L anterior knee, 15 min,
with L LE elevated, 33 each day until next treatment session.
When applying ice massage (IM) to the area of the right
(R) lateral (lat) epicondyle to treat epicondylitis, document
the following:
S: Pt reports pain in R lat elbow.
O: Pretreatment: 8/10 R lat elbow pain. R elbow unable to fully extend.
Intervention: IM R lat elbow for 5 min.
Posttreatment: Pain 6/10. Full elbow extension.
A: Pain decreased and elbow ROM improved.
P: Continue IM at end of treatment sessions until pt has
pain-free elbow function.
