The thought of ice terrifies many patients, particularly the elderly. In fact many claim that their condition is made worse by the cold. If the therapist cannot persuade or demonstrate to the patient that ice will be beneficial then it might be better not to use it.
Cardiac conditions
For 6 months after a myocardial infarct ice treatment should be avoided. The initial shock of the ice application may cause marked drop in blood pressure, thus causing an increase in heart rate: a weak heart may not be able to meet this demand.
The left shoulder and the heart have the same sympathetic nerve Supply and it has been shown that ice applied to the left shoulder can cause an overflow of excitatory impulses to the heart via the Sympathetic nerves. ice to the left shoulder should therefore be avoided in patients with any sort of cardiac disease.
Peripheral nerve injuries
Blood vessels in the area supplied by a severed peripheral nerve lose their normal response to cooling. lf such an area were cooled with ice, the net result would be that the part would get very cold and take many hours to regain normal temperature.
Vasospastic disease
The vasospasm in diseases such as Raynaud's is made worse by the application of ice.
Peripheral vascular disease
As cold application may reduce an already inadequate blood supply, ice is avoided. However, since the metabolic rate of the tissue is also lowered it is doubtful whether gangrene would ensue from cold treatment.
Cold sensitivity
Even if all precautions are taken there will still be a small number of patients who react adversely to ice. Following the application of ice, these patients produce a local histamine-like urticaria which looks like a nettle rash and itches. These patients are unsuitable for treatment with ice.
