pain, and redness by minimizing blood flow to the area. Cold ther- apy normally decreases the muscle performance, but increases the pain threshold, plastic deformation, and viscosity of the tis - sue [9] . Ice application, used intermittently for 10 minutes, is the touted as the most effective method of cryotherapy. In his review, Kellett (1986) found that cold therapy for 10 to 20 minutes (depending on the site of injury), 2 to 4 times per day for the initial 2 to 3 days, is effective for full recovery [10] . The therapeutic effect of cold therapy seems to be maximized when the optimal tissue tempera- ture is reduced by 100C to 150C. When the tissue temperature is 13.60C, the analgesic effect is achieved. Though cold therapy is the most effective, widely used, least expensive therapeutic mo- dality after an acute soft tissue injury, it also has some unpleasant side effects. According to many case studies, skin burns (i.e., ice burns), frostbite, and nerve damage are reported with 20 to 30 minutes of cooling. Therefore, care should be taken not to apply ice directly on the skin. Temperature changes of the joint, intra- muscular tissues, subcutaneous tissues, and skin usually depend on initial temperature, application method of cryotherapy, and time of application. These are a few guidelines for ice application [8] , including: ● Ice should be applied immediately after an injury. ● Do not directly apply ice on the skin. Direct application of ice may cause ice burns or frostbite. ● If there is no cooling modality available, a bag of crushed ice covered in a damp towel can be used. ● Usually, the most effective method of application is repeated application of ice for 10 minutes; however, this depends on the location of the injury and the thickness of the subcutaneous fat layer. ● Contraindications for cryotherapy are people with diabetes, the elderly, and people with Raynaud’s syndrome, peripheral vascular disease, and sickle cell anemia. Studies have shown that ice application combined with compres- sion and elevation is most effective for acute soft tissue injury management rather than applying ice alone [11] . Compression It is effective to give external pressure to the injured area through an elastic bandage. This will reduce bleeding; enhance the mus- cle pump, and the venous return. Nevertheless, compression in- creases the hydrostatic pressure of the interstitial fluid. So, the fluid is pushed back into the capillaries and lymphatic system. There are several ways to apply compression, including adhe- sive or non-adhesive elastic bandages/tapes, tubigrips, inflatable splints, and adjustable supports. Guidelines for applying compression: ● The compression should be applied evenly. ● The direction of application should be from distal to proximal. ● It should be applied as early as possible and should continue for 3 days (72 hours). ● Do not fully stretch the bandage. ● Always apply in spiral fashion (never apply circumferential method) and overlap half of the previous tape to enhance the strength of the bandage. ● If necessary, apply protective padding, such as gauze, to cover the injury. ● Distal areas should be checked after applying the compression for any signs of increased pain, numbness, swelling, pallor, and coldness. These signs denote diminished circulation to the area. Elevation Elevating the affected body part above the heart level will reduce swelling. Due to gravity, the blood tends to pool in the lower areas of the body. The action of the muscles pushes the blood up to the heart level. During a soft tissue injury, this muscle pump may get impaired; thereby the blood may accumulate in the affected body parts, especially in the lower extremities. Therefore elevating the affected body part is very important.
limb only, he or she can still participate in sports such as walking, jogging, or hiking. Taping and bracing are the most commonly used mechanisms of ensuring rest. These techniques restrict unintended, possibly inju- rious movements and allow only desired movements, which also enhances proprioception (one’s own perception of the position of the joint or the body part). Prevention and rehabilitation are the key indications for taping and bracing. Taping an injury Limiting a movement and supporting the joint is the main pur- pose of taping. There are various types of tapes such as rigid tapes, elastoplast, co-bands, and kinesio tapes. ● Rigid tape is a non-stretch, adhesive tape that restricts the joint motion when applied over the joint. ● Elastoplast is a stretchable adhesive tape that sticks to itself and not to the skin, which is good for small areas like fingers. It can also be used as an anchor to position the tapes during the taping procedure. ● Co-bands are reusable adhesive tapes that stick to themselves but not to the skin. They are used to reduce the swelling via compression and can also be used as anchors. ● Kinesio tapes are thin, stretchable adhesive cotton tapes that can be applied to give certain amount of pressure to selective areas. Guidelines for taping: ● A tape should provide support, but not restrict essential movement. ● The injured ligament should be held in a shortened position while non-affected ligaments remain in neutral position. ● Shave body hair before applying the tape (preferably more than 8 hours before application). ● Clean the skin before taping. ● Care should be taken to avoid sweat. ● Use underwrap (a hypoallergenic tape that protects the skin from irritation) if there is a possibility of skin allergy. ● When applying the tape, anchor proximally and distally to the injury. ● Apply even pressure throughout. ● Overlap previous tape by one half to one third of the length used to ensure strength. ● When removing the tape, use a tape cutter or scissors. Complications: ● If the tape is too tight, it will reduce the blood circulation. ● It requires practice to apply the tape with perfect technique. ● The effect of the tape is reduced with time and daily activities. Using a brace There are many braces used for various purposes. Any joint of the body can be stabilized using a brace. Knee braces are especially used in the rehabilitation phase following ligament and menis- cus injuries of the knee as well as knee surgeries. Cervical collars, thoracolumbar, and lumbosacral braces are some of the types of braces used for the pathologies of spine. Advantages: ● Easier to apply than a tape. ● Good quality products will provide long-term support. Disadvantages: ● The patient may experience slipping of the brace during use. ● May require custom-made braces that will be more expensive. ● Patient may rely too much on bracing for support. Ice Ice therapy (i.e., cryotherapy, ice treatment, cold treatment, and cold therapy) is a well known strategy of managing acute soft tis- sue injuries. Cold therapy can be performed using ice packs, gel packs, ice massage, ice towels, inflatable splints, and vapocool- ants (e.g., butane, propane, pentane, ethyl chloride, and fluoro- hydrocarbon). Application of cryotherapy will reduce the swelling, ● Skin irritation. Disadvantages:
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