Cold therapy

Injury type: Acute

Category: Lifestyle options

Rating: Not effective

What is it?

Cold therapy involves the application of a cold pack or ice to the body. It can also take the form of an ice bath. Cold therapy is usually best applied for 10 minutes, several times a day, especially in the initial 48-72 hours after a whiplash injury.

How does it work?

Cold therapy is thought to reduce blood flow to the area via constricting the blood vessels in response to the cold sensation. This may help to reduce the amount of fluid being released from the blood into the surrounding tissues following an injury, thereby reducing the amount of tissue swelling. By reducing swelling, cold therapy may also assist in pain reduction. The cold sensation within the tissues may also distract the brain from pain sensations that might be coming from the same region (the so-called pain gate theory), thereby providing further pain relief.

Is it effective?

There is conflicting evidence on the use of cold therapy for the management of whiplash. A systematic review¹ which updated the evidence on passive physical modalities suggested that cold therapy is ‘likely not helpful/ not worth considering’ as a management option for recent grades I-II whiplash. However, a rapid review² synthesising evidence from highest level primary studies, systematic reviews, and well-conducted clinical practice guidelines reported that ice (and heat) may assist in reducing pain in the initial treatment of neck pain including whiplash. Multiple clinical practice guidelines³ for the management of whiplash also included conflicting recommendations relevant to the use of cold (or heat) therapy, ranging from ‘recommended’ to ‘insufficient evidence’.

When cold (or heat) therapy is included as part of multimodal care (along with manual therapy, exercise and psychological strategies), one randomised controlled trial from a systematic review⁴ reported a statistically but non-clinically significant improvement in self-rated disability for recent whiplash, compared with education.

Are there any disadvantages?

Some people may find cold therapy uncomfortable and are not able to apply it for the recommended time. Care needs to be taken to ensure that the ice pack is wrapped in a cloth to avoid direct contact with the skin.

Where do you get it?

Ice packs range from several blocks of ice wrapped in a cloth to a frozen bag of peas, to commercially produced gel packs. Ice/gel packs are generally available at pharmacies/chemists and medical suppliers.

Recommendations

The use of cold therapy cannot be recommended following whiplash based on the lack of robust and consistent research evidence. More research is required.