Cold Therapy and Frostbite

Patients who use a cold therapy machine can miss the early symptoms of frostbite if they do not examine their skin frequently during treatment. Frostbite can typically be avoided if the skin is allowed to re-warm while deeper tissues stay cold.

Cold Therapy and Frostbite

The most common side effect of cold therapy machines is frostbite. This occurs when patients use the machines for hours at a time, delivering “continuous cold therapy” with freezing-cold water to an injury.

Unfortunately, patients may fail to realize that the benefits of cold therapy end at 15ºC (59ºF) and the risk of frostbite, nerve damage, and skin damage increase below this temperature.

Furthermore, patients may not be aware of the importance of checking their skin frequently for symptoms of frostbite (redness, swelling, or pain). Experts also recommend always using skin protection (such as a towel) and only using the machine for 20-30 minute intervals while awake. As a result of a lack of warnings, dozens of people have been seriously injured by cold therapy and frostbite.

What is Frostbite?

Frostbite is skin damage caused by prolonged exposure to freezing-cold temperatures (0ºC or 32ºF). It occurs when ice crystals form from the water that exists inside and/or outside cells. The ice crystals damage cells and blood vessels, causing circulatory problems, swelling, and inflammation that lead to extensive cell death, skin damage, and nerve damage.

A less-severe type of frostbite is frostnip, which causes skin to become red, tingly, and numb. Frostnip is usually curable by slowly warming the skin in warm water (100 to 105ºF) until sensation returns.

Severe frostbite can cause skin necrosis and permanent nerve damage. Treatment for severe frostbite may involve surgery to remove dead skin (debridement), skin-graft procedures, intravenous (IV) medications including antibiotics and painkillers, and even amputation of frostbitten extremities. Unfortunately, even with treatment, many people with severe frostbite suffer from permanent disfigurement, nerve damage, and cold sensitivity.

Case Report of Frostbite from Cold Therapy

One of the most graphic and vivid case reports involving cold therapy and frostbite was published in Orthopedics in 2007. That study, Severe Frostbite of the Knees After Cryotherapy (GRAPHIC), involved a man who used a cold therapy machine continuously for several weeks and caused extensive frostbite on both of his knees. The surgeons stated that frostbite from a cold therapy machine could have been avoided with proper instructions.

Symptoms of Frostbite from Cold Therapy

Symptoms of frostbite can include:

• Loss of sensation (numbness)
• Skin becomes red and then white, hard, and swollen
• Skin burns, tingles, or feels warm
• When skin is re-warmed, it becomes extremely painful, discolored, and swollen
• Blisters or ulcer formation (may be filled with clear or bloody fluid)
• Skin feels hard, waxy, or dry
• Skin turns dark red, purple, or black
• Patient feels deceptively warm, comfortable, and pain-free
• Loss of fine motor control or coordination (clumsiness)
• And more