Localized cooling is commonly used after orthopedic surgery and in sports medicine to reduce bleeding, inflammation, metabolism, muscle spasm, pain, and swelling following musculoskeletal trauma and injury. The therapeutic application of cold therapy has a long history dating from the time of Hippocrates and has been widely documented in the literature1–3. Nonetheless, there remains to the present time considerable controversy over the appropriate protocol for application of cryotherapy. One extreme camp advocates continuous use of cryotherapy to a treatment site with no break in cooling for days or even weeks4–5, whereas other practitioners recommend a maximum application duration of 20 to 30 minutes followed by a cessation period of about 2 hours6–7. Although continuous cooling appears to be tolerated by many patients, there has been a large number of reported incidences in which continuous application of cryotherapy device led directly to extensive tissue necrosis and/or nerve injury in the treatment area, sometimes with dire medical consequences6,8.

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