Cold compression therapy

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Cold compression therapy
Other namesHilotherapy

Cold compression therapy, also known as hilotherapy, combines two of the principles of rest, ice, compression, elevation to reduce pain and swelling from a sports or activity injury to soft tissues and is recommended by orthopedic surgeons following surgery. The therapy is especially useful for sprains, strains, pulled muscles and pulled ligaments.

Cold compression[edit]

Cold compression is a combination of cryotherapy and static compression, commonly used for the treatment of pain and inflammation after acute injury or surgical procedures.[citation needed] Cryotherapy, the use of ice or cold in a therapeutic setting, has become one of the most common treatments in orthopedic medicine. The primary reason for using cryotherapy in acute injury management is to lower the temperature of the injured tissue, which reduces the tissue's metabolic rate and helps the tissue to survive the period following the injury. It is well documented that metabolic rate decreases by application of cryotherapy.[1]

A study done found that current literature on the use of cryotherapy on acute ankle sprains has insufficient evidence for the efficacy.[2]

Static compression is often used in conjunction with cryotherapy for the care of acute injuries. To date, the primary reason for using compression is to increase external pressure on the tissue to prevent edema formation (swelling). This occurs by hindering fluid loss from the vessels in the injured area, making it more difficult for fluids to accumulate. Ice with compression is significantly colder than ice alone due to improved skin contact and increased tissue density caused by extended static compression.[1] Tissue reaches its lowest temperature faster and the tissue maintains its cool even after treatment ends.

Compression therapy has been used in deep venous thrombosis prevention, wound care, as well as managing edema.[3] Literature suggests that compression therapy use for perioperative ankle fractures will be beneficial for edema reduction and therefore, will probably be beneficial for pain and ankle joint mobility as well.[4] Post operative arthroscopic surgeries also shows significant recovery with cold compression.[5]

It has been studied following facial surgery where it has been found to decrease pain and swelling on day two or three.[6] In athletes, cryotherapy has its greatest effect on recovery by using it within the first 24 hours[7] of exercise or injury. Cryotherapy has also been shown that it can increase joint flexibility.[8] It is unclear if it affects the risk of bruising.[6]


Continuous cold therapy devices (also called ice machines) which circulate ice water through a pad are currently the subject of class action lawsuits for skin and tissue damage caused by excessive cooling or icing time and lack of temperature control. Reported injuries range from frostbite to severe tissue damage resulting in amputation.

Studies have shown that the body activates the hunting reaction after only 10 minutes of cryotherapy, at temperatures less than 49 °F (9.5 °C). The hunting response is a cycle of vasoconstriction (decreased blood flow), then vasodilation (increased blood flow) that increases the delivery of oxygen and nutrient rich blood to the tissue.[9] Studies show a debate whether cold should be used or not for faster recovery.[9] Increased blood flow can slow cell death, limit tissue damage and aid in the removal of cellular debris and waste products. Under normal circumstances the hunting reaction would be essential to tissue health but only serves to increase pain, inflammation and cell death as excess blood is forced into the area.


Cold compression wraps using either re-freezable ice or gel are a much safer product, as such products do not exceed the cooling or icing time recommended by the established medical community.

Many of the ice wraps available use adjustable elastic straps to aid in compression over the injured areas. More advanced single-use wraps have guidelines to indicate how the bandage should be applied in order to achieve optimum compression required for an acute injury.

Most ice wraps that use ice, have a built-in protective layer, so ice is not applied directly to the skin, which can result in a burn to the area, sometimes known as a "cryoburn".

See also[edit]


  1. ^ a b Kullenberg, Björn; Ylipää, Staffan; Söderlund, Kerstin; Resch, Sylvia (2006-12-01). "Postoperative Cryotherapy After Total Knee Arthroplasty: A Prospective Study of 86 Patients". The Journal of Arthroplasty. 21 (8): 1175–1179. doi:10.1016/j.arth.2006.02.159. ISSN 0883-5403. PMID 17162178.
  2. ^ Miranda, Júlio Pascoal; Silva, Whesley Tanor; Silva, Hytalo Jesus; Mascarenhas, Rodrigo Oliveira; Oliveira, Vinícius Cunha (2021-05-01). "Effectiveness of cryotherapy on pain intensity, swelling, range of motion, function and recurrence in acute ankle sprain: A systematic review of randomized controlled trials". Physical Therapy in Sport. 49: 243–249. doi:10.1016/j.ptsp.2021.03.011. ISSN 1466-853X. PMID 33813154. S2CID 233026666.
  3. ^ Winge, R.; Bayer, L.; Gottlieb, H.; Ryge, C. (2017-08-01). "Compression therapy after ankle fracture surgery: a systematic review". European Journal of Trauma and Emergency Surgery. 43 (4): 451–459. doi:10.1007/s00068-017-0801-y. ISSN 1863-9941. PMID 28624992. S2CID 873231.
  4. ^ Winge, R.; Bayer, L.; Gottlieb, H.; Ryge, C. (2017-08-01). "Compression therapy after ankle fracture surgery: a systematic review". European Journal of Trauma and Emergency Surgery. 43 (4): 451–459. doi:10.1007/s00068-017-0801-y. ISSN 1863-9941. PMID 28624992. S2CID 873231.
  5. ^ Gatewood, Corey T.; Tran, Andrew A.; Dragoo, Jason L. (2016-10-01). "The efficacy of post-operative devices following knee arthroscopic surgery: a systematic review". Knee Surgery, Sports Traumatology, Arthroscopy. 25 (2): 501–516. doi:10.1007/s00167-016-4326-4. ISSN 0942-2056. PMID 27695905. S2CID 5680815.
  6. ^ a b Glass, GE; Waterhouse, N; Shakib, K (October 2016). "Hilotherapy for the management of perioperative pain and swelling in facial surgery: a systematic review and meta-analysis". The British Journal of Oral & Maxillofacial Surgery. 54 (8): 851–856. doi:10.1016/j.bjoms.2016.07.003. PMID 27516162.
  7. ^ Jinnah, Alexander H; Luo, Tianyi David; Mendias, Christopher; Freehill, Michael (May 17, 2019). "Cryotherapy duration is critical in short-term recovery of athletes: a systematic review". Journal of ISAKOS. 4 (3): 131–136. doi:10.1136/jisakos-2018-000259. ISSN 2059-7754. S2CID 198304421.
  8. ^ Kalli, Kallis; Fousekis, Konstantinos (April 17, 2020). "The effects of cryotherapy on athletes' muscle strength, flexibility, and neuromuscular control: A systematic review of the literature". Journal of Bodywork and Movement Therapies. 24 (2): 175–188. doi:10.1016/j.jbmt.2019.11.001. ISSN 1360-8592. PMID 32507142. S2CID 209274206 – via Science Direct.
  9. ^ a b Wang, Zi-Ru; Ni, Guo-Xin (2021-06-16). "Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?". World Journal of Clinical Cases. 9 (17): 4116–4122. doi:10.12998/wjcc.v9.i17.4116. ISSN 2307-8960. PMC 8173427. PMID 34141774.

Works cited

  • Kullenberg B, Ylipää S, Söderlund K, Resch S (2006). "Postoperative cryotherapy after total knee arthroplasty: a prospective study of 86 patients". J Arthroplasty. 21 (8): 1175–9. doi:10.1016/j.arth.2006.02.159. PMID 17162178.
  • Webb JM, Williams D, Ivory JP, Day S, Williamson DM (1998). "The use of cold compression dressings after total knee replacement: a randomized controlled trial". Orthopedics. 21 (1): 59–61. doi:10.3928/0147-7447-19980101-14. PMID 9474633.
  • Levy AS, Marmar E (1993). "The role of cold compression dressings in the postoperative treatment of total knee arthroplasty". Clin. Orthop. Relat. Res. 297 (297): 174–8. doi:10.1097/00003086-199312000-00029. PMID 7902225.
  • Knobloch K, Grasemann R, Jagodzinski M, Richter M, Zeichen J, Krettek C (2006). "Changes of Achilles midportion tendon microcirculation after repetitive simultaneous cryotherapy and compression using a Cryo/Cuff". Am J Sports Med. 34 (12): 1953–9. doi:10.1177/0363546506293701. PMID 16998082. S2CID 26044792.
  • Ohkoshi Y, Ohkoshi M, Nagasaki S, Ono A, Hashimoto T, Yamane S (1999). "The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction". Am J Sports Med. 27 (3): 357–62. doi:10.1177/03635465990270031601. PMID 10352774. S2CID 2131347.
  • Martin SS, Spindler KP, Tarter JW, Detwiler K, Petersen HA (2001). "Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy". Am J Sports Med. 29 (3): 288–91. doi:10.1177/03635465010290030501. PMID 11394596. S2CID 39740857.