Which of the following is commonly used with cold therapy to manage pain?

• A. TENS
• B. Ultrasound
• C. Massage
• D. Ice massage

Answer: (B)

Combining modalities that work through different mechanisms gives broader pain relief and tissue healing. Cold therapy quickly reduces pain and swelling by vasoconstriction and lowering metabolic demand, which helps limit secondary injury. Ultrasound adds a deeper, longer-lasting effect by delivering mechanical energy to tissues—whether it’s heating deep tissues to improve blood flow and tissue extensibility or producing non-thermal effects like microstreaming that enhance cellular activity and fluid movement. Using cold therapy first or alongside ultrasound lets you control inflammation and pain while also promoting the healing processes in deeper structures, which is why ultrasound is commonly paired with cold therapy.

Ice massage is itself a form of cold therapy, so it isn’t about pairing with cold therapy. TENS and massage can be used with cold therapy for pain relief, but the combination that most directly targets deeper tissue healing in conjunction with acute pain control is ultrasound.