OVERVIEW.

Cryotherapy involves the application of cold substances for the purposes of reducing blood flow and tissue metabolism and increase pain thresholds. Agents include cold packs, ice massage, and vapo-coolant spray.¹

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Nine sources cited a total of 30 concerns for cryotherapy. Concerns ranged from 4 to 13 per source, with a physical therapist citing the greatest number. The largest proportion of concerns is contained within skin or circulatory categories (each 17% of concerns). The most frequently cited concerns were Raynaud’s phenomenon and circulatory impairment. It is noteworthy that only 55% of sources cited impaired sensation as a concern.

Notes: (1) Although not routinely listed under contraindication guidelines, protocols for cryotherapy generally limit its use to short durations (i.e., 15 to 20 minutes). Proulx² describes a 79-year-old man who self-administered ice packs unremittingly for 3 days to his toe and subsequently sustained frostbite.

(2) Sources used a variety of terms to describe cold sensitivity: urticaria, sensitivity to cold, cold intolerance, cold hemoglobinuria, and cryoglobulins. In 1962, Shelley and Caro³ classified three main types of cold sensitivity: (1) Cold urticaria from cold-induced histamine release, (2) cold hemoglobinuria with the presence of cold agglutinins and hemolysis, and (3) presence of cryoglobulins that precipitate when blood is chilled.