March, 1963 P H Y S I O T H E R A P Y Page 9

Notes on the Application of Wet Ice
By Dena Gardner, M .C .S .P.

The application o f cold has proved an effective means of 
physical therapy. T he physiological effect o f cold applied 
for a short duration is rem arkably similar to  th at o f heat; 
it appears m oreover th a t th e effect o f the form er lasts longer 
and is a m ore suitable preparation for activity because the 
patient feels refreshed, as for example, after a cold b ath  or 
shower, in contrast to the feeling o f ennervation which results 
from the application o f heat. N orm al functional activity is 
the ultim ate aim  o f most physiotherapeutic procedures and 
cold applications help to accelerate the p atien t’s physical 
rehabilitation.

Equipment

The requirem ents are simple and inexpensive, i.e. some 
medium-sized turkish towels and an ordinary household 
bucket three-quarters full of ice. Flaked o r shaved ice is 
preferable because it is no t lumpy and adheres m ore readily 
to the surface o f the towels, however finely crushed ice is 
quite satisfactory and easier to obtain. Tw o wet and folded 
towels are placed between layers o f ice in the bucket and 
water is added to  a depth o f ab o u t tw o or three inches in 
the bottom  o f the bucket. It is essential th at the tem perature 
of the ice and water mixture is as low as possible so th a t the 
flakes or fragments o f ice adhere to  the surface o f the towels; 
ice cubes are unsuitable as they fail to  reduce the tem perature 
sufficiently and also make the application uneven and 
uncom fortable for the patient. Plinths upholstered in plastic

(Continued fr o m  page 8)

The obvious developm ent is th at once such a pilot scheme 
operates successfully, it creates a dem and for an aug­
mented service which cannot reasonably be expected from 
voluntary workers. I t will, o f course, be realised, th at not 
every establishm ent will require a daily, full-time, physio­
therapy service. Part-tim e physiotherapists could be em­
ployed, o r several institutions could pool their efforts and 
organise physiotherapy on alternating days.

Two Johannesburg institutions which started physio­
therapy through pilot schemes, have indeed already in tro ­
duced regular day sessions, fully integrated w ith the medical 

I services, so as to fulfil the increased demand for physio­
therapy.

Summary

I t is felt th a t at this early stage o f the organisation of 
comprehensive geriatric services in our country, physio­
therapy cannot afford to  sit back and w ait for invitations. 
In view o f the great contribution th a t physiotherapy can 
make in the care o f the aged, we should not be reluctant to  
come forw ard and offer o u r services. O ur branches, and 
individual members, could be o f great value to local establish­
ments for the welfare o f the aged, and should express their 
willingness to co-operate, advise, and assist as members 
of the team .

They would thus enhance the efficiency and scope of 
existing services and ensure for physiotherapy the place it 
deserves in the care for the aged.

W here locally physiotherapy services already exist, and 
branches and members are participating in the care for the 
aged, the S.A.S.P. should receive detailed inform ation. The 
C.E.C. will then be able no t only to express appreciation 
o f the contributions m ade by our members, b u t also to 
correlate the experience o f all our workers, provide an 
exchange o f views and increase the value o f our effort.

m aterials make the use o f w aterproof o r plastic sheeting 
unnecessary, a spare towel is all th a t is required to  dry the 
patient and to m op up after the application.

Technique

W hen the patient is adequately undressed and ready for 
treatm ent the therapist takes one folded towel from the ice 
bucket, rings it quickly and thoroughly, unfolds it to  the 
required size and places it firmly on the p atien t’s skin. As 
the towel is unfolded flakes o f ice are seen to  adhere to  the 
towel, any delay o r shaking o f th e towel m ust be avoided 
as this would raise the tem perature and consequently reduces 
the effect o f the application. Once the towel is in contact 
with the patient’s skin its tem perature rises rapidly, it must 
therefore be removed after two o r three minutes and re­
placed by another which has been soaking in the bucket. 
Three o r four towels are usually sufficient.

Effects and Uses

1. The Relief o f Pain

Cold decreases the speed o f nerve conduction therefore the 
feeling o f pain is reduced. Ice towels are applied to  the painful 
area as frequently as possible. Pain is a factor which limits 
movement and inhibits m uscular contraction, it is therefore 
often possible to  obtain an increased range o f movem ent or 
a m ore satisfactory contraction o f muscles while the ice 
towel is in situ.

2. The R elief o f Spasm

Cold decreases the speed o f nerve conduction and the 
stretch stimulus is inhibited. F o r the reduction of spasm 
the ice towel m ust cover the whole length of the affected 
muscles. Reduction o f spasm in a whole limb is usually m ost 
satisfactory when cold is applied to  the distal parts first. 
Subsequent treatm ents produce reduction in spasm in a 
shorter time and the effect is more prolonged.

3. Active Hyperaemia

Cold applications o f short duration reduce the superficial 
blood supply initially but this is followed by an active 
hyperaem ia which is apparent when the towels are removed. 
This local increase in the circulation is useful for the reduc­
tion o f swelling and prior to  joint mobilisation. Ice towels 
are applied over the required area, or a hand o r foot may be 
put directly into the bucket, immersion of hands or feet 
must be o f short duration initially however, as sensation 
is acute in these areas.

Contra-indications

There appears to  be very few contra-indications to  treat­
m ent w ith ice, most parients like it and find it m ore effective 
than heat. Patients w ith circulatory disorders such as 
R eyauds and Buergers disease are however unsuitable for 
this type o f treatm ent.

Advantages

The use o f wet ice as described has many advantages: 
(a) it is effective in a wide variety o f conditions, (6) it is 
time-saving for b o th  p atient and therapist as m any active 
and passive exercise techniques can be continued while the 
ice towels are in situ, (c) applications o f  cold can safely be 
carried out at frequent intervals by the patient in his own 
hom e provided a refrigerator is available.

As in the case o f any o th er technique of physical tre a t­
ment, care and accuracy in the application is essential to ­
gether w ith acute observation o f the results obtained.

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