Using Cold Therapy Effectively

When I asked my surgeon about the optimum frequency, duration and strategic use of cold in reducing inflammation, he shrugged his shoulders. “Studies are inconclusive. Fifteen minutes max.”  No big surprise there. With cold, as with nearly every aspect of your recovery, the way forward is to start with an experiment and listen to your body.

But at least make sure you have the right tools.

First of all, don’t for a minute think you can get away with using bags of frozen peas or whatever tiny and rock hard cold packs that might lurk in the bottom of your freezer. This is one place where the best cold therapy tools are NOT expensive:

Top Pick: the Donjoy Iceman Clear3.  The Donjoy is basically a bucket you fill with water (3-4″) and ice that pumps cold water through a flexible pad.  Works best placed roughly level with you (not on the floor). You can find them used on Ebay for $30-50, and Kaiser is now distributing them gratis after surgery. If you’re going bilateral, as I did, you’ll want two. Pro: they deliver 4-6 hours of predictably mild coolth. Con: they’re noisy (50 db when 4 feet from you) and you’ll need 4-5 lbs of ice for each. That means your supply chain has to include ice. What about those days when you don’t have a friend bringing groceries and ice?

Your Coolth Backup Plan: FlexiKold Gel Cold Pack 10.5″x14.5″. At that size, you can wrap it around your thigh (or shoulder) or lay it lengthwise and cover more of your leg.

You can use them in the early part of the day and save the Donjoy for the afternoon/ evening.  At $15/each, I’d recommend buying two for each affected area. Why so many? That way, you can survive a day even if the Iceman Cometh Not.  You should be able to get two cooling sessions from a pack (with a 10-15 minute break in between), but it may be a while before you get them back to the freezer. So you’ll have that second set ready. It takes some hours for them to re-chill.

Nighttime Tip: If you find yourself waking up in the wee hours with discomfort, you can put a pack in a tiny igloo cooler bedside. Of course, if you do that, they won’t be of much use for much of the next day. This is why it’s good to have extra.

Duration & Frequency: If you’re experiencing an abundance of unwanted sensation, you can ice for 15, remove for 15, and then ice again. But don’t just lay around all day icing and listening to Spotify. Do your exercises in between(an explanation is lower down), and after two weeks or so, if you are physically able, you should be getting up at least once an hour, if only to fetch a snack. Don’t cheat and say “just a few more minutes” of cold therapy, as you may lose track of time. If you’re still uncomfortable, try one of your other pain management techniques.  If the ice in your Iceman has melted, you can chill the Iceman with old random icepacks you had in your freezer, or get a few like this, which will actually fit.

Combine with Compression: The Iceman pads are floppy and don’t hug your leg.  So take a pair of pajamas or lounge pants with some stretch in them (you DO have some pants like this, right?) and wrap them around the cooling pads. The Iceman does come with a flexible strap, but I find this works better. Try it- the compression feels great.

Before and After (golden doodle not included, sorry!)

If you have little bolsters, you can make the whole package snug, like so:

Alternate Cold with Activity: Before your surgery, as you struggled with pain and/or stiffness, you may have discovered the benefits of alternating heat with cold. For instance, alternating a heating pad with a cold pack, or standing in the shower and alternating hot with full-on cold (for a few seconds, it doesn’t feel cold at all). Not only is it invigorating, snapping us out of our ruminations, but it works on the muscles like a pump, alternating the expansive, increased circulation of heat with the contracting quality of cold. In addition to relieving pain more powerfully than using heat or cold separately, it wrings out the muscle, pushing out the lactic acid and whatever other sludge and stagnation has accumulated there. But what about post-op?  Thus far, I have only tried using a heat pad on my legs once (during week 6 post-op) and it neither helped nor felt like I should repeat it. So as an alternative I recommend doing your exercises, walking a little, or using a cold laser, which stimulates circulation without actual heat, and thus functions as a good stand-in for heat therapy.