CRYOTHERAPY
Prepared By: Floriza P. de Leon, PTRP
Cold Application
Cryotherapy: the therapeutic use of cold Cryokinetics: cryotherapy plus therapeutic exercise Heat abstraction/cooling: the removal of heat from an object
Modes of Energy Transfer
a.
b. c. d.
Conduction Factors affecting magnitude of temperature changes Temperature differences between the cold object and the tissue Time and pressure Thermal conductivity or the area being cooled Type of cooling agent
Modes of Energy Transfer
Convection Evaporation consist of highly volatile liquids that evaporate rapidly in contact with warm objects Heat Fusion the amount of heat given off when a liquid turns into solid for as it cools. Ex. PWB
Classification of various types of superficial cooling
Cold packs Ice packs Ice massage
Conduction Conduction Conduction
Cold bath
Cold water immersion Vapocoolant sprays Whirlpool bath
Conduction
Conduction Evaporation convection
Physiologic Effects of General Cold Application
Decresed Metabolic rate Pulse rate Respiratory rate Venous BP
Increased Blood flow to internal organs Cardiac output Stroke volume Arterial BP
Bio-Physical Effects
A.
a.
b.
Hemodynamics Effects Short exposure to cold: Vasoconstriction of cutaneous blood vessels Prolonged exposure to extreme cold: hunting response of Lewis and shivering direction action of cold on smooth mm of blood vessels Reflex cutaneous of anterior hypothalamus as cooled blood returns, more vasoconstriction in general, shivering and increased metabolism occurs
Bio-Physical Effects
B. Decrease in Blood Flow Causes: 1. Vasoconstriction 2. Increased in blood viscosity 3. Decreased production of metabolites 4. Effects on post traumatic edema and inflammation (cold as a treatment of choice for the 1st 24-48 hrs)
Bio-Physical Effects
B. Decrease in Blood Flow 1. Less fluid filtration in the interstitium 2. Less inflammation and less pain 3. Decrease in metabolic rate Effects on peripheral nerve 1. Decrease in sensory and motor conduction velocities Sensory nerves: type A most sensitive (A delta more sensitive than A alpha) Type C least sensitive Motor nerves: A gamma blocked before A alpha for effects on mm strength (isometric mm strength) 1. short periods before exercise increased 2. Prolonged periods decreased - Neuromuscular effects transient reduction in spasticity
General Indications of Cryotherapy
Musculoskeletal conditions (sprain, strain, tendinitis, tenosynovitis, bursitis, capsulitis) Acute and chronic traumatic and inflammatory conditions Myofascial pain syndrome Following certain orthopedics procedures Spasticity Emergent primary treatment for minor burns Edema Mm spasm
General Contraindications
-
Cryopathies Cryoglobulinemia Paroxysmal cold hemoglobulinuria Cold hypersensitivity Raynauds disease Raynauds Phenomenon Cold intelorance: most common relative constrained Impaired circulation Impaired sensation PVD Prolonged application over superficial nerve Cardiac disease or CV insufficiency Cancer and sickle cell anemia Brief icing over the post, primary rami of trunk Emotional subjects and mental instability Throat, ear and side of neck Unreliable patients Severe blood pressure abnormality
Cryotherapy Agents
Cold Packs Mode of transmission: conduction General Description Hydrocollator packs: a vinyl filled with silica gel or sand slurry mixture Ice packs: used at home Endothermic chemical gels: have separate compartments with compounds such as ammonium nitrate and water Temperature: -5 C for at least 2 hours before use Remains at low temperature for 15-20 mins
Ice massage (ice cubes or ice lollipops) Mode of Transmission: conduction General Description An ice cylinder formed by freezing water in a Styrofoam cup or juice can A lollipop stick or wooden tongue depressor which may or may not be placed in water during freezing process Treatment duration: 5-10 mins Four distinct sensations or physiological responses Intense cold coolness Bulman aching Aching aching Analgesia analgesia
Technique of Application Surface area not longer than 4x6 Method: overlapping longitudinal strokes or circles each stroke covering one half of the previous stroke Advantage of Ice Massage The risk of damaging tissue is minimal (since skin temperature will not drop below 15 C) Precaution Do not massage over bony area or superficial nerve
Ice Towels Mode of Transmission: conduction General description terry cloth soaked in a bucket of crushed ice or slush mixture treatment temperature: 10-14 C treatment duration: 10-15 mins technique of application towel wrapped around a joint or muscled changed every 4-5 mins (others after 45-60 secs) Special Indication Increasing ROM (contract-relax procedure) Isometric strengthening The most impractical method of cold application
Cold Baths Mode of Transmission: conduction General Description: a basic with water and crushed ice Treatment temperature: 13-18 C; 4-10 C(Braddom) Special indication: best for distal extremities Most practical method of cooling the distal extremities
Vapocoolant Sprays (Flourimethane) Mode of Transmission: Evaporation General Description: non toxic, non flammable volatile liquid which procedures rapid cooling when a fine spray is applied to skin Ethyl Chloride: originally used volatile, flammable , can freeze skin Treatment Duration: 10-15 mins Special Indication Trigger points in myofascial referred pain Mm spasm Technique of application (Spray and Stretch) Invert container, nozzle down and hold about 18-24 (45 cm) from the skin Spray at 30 angle and spray over at 4 per sec. do it 2-3x Allow liquid to completely evaporate before applying next sweep (Caution: do not frost skin) The mm should be passively stretched before and during application Cover the entire treatment area, starting at the pain site and moving to the area of referred pain Have patient exercise after above procedures
Controlled Cold Compression Units Mode of transmission: conduction General description: cooled water is circulated through a sleeve which is applied to extremity which is then inflated intermittently Treatment temperature: 10-25 C (7.2 C + pressure up to 6- mm Hg) Primary Indications: acute musculoskeletal injury with soft tissue swelling after some surgical procedure
Advantages
It is an effective method of diminishing pain Diminishes swelling by promoting vasoconstriction Because of the reduction in pain and swelling, the range of motion can be improved without too much discomfort
Disadvantages
Most patients find it disagreeable because of the initial discomfort in the process of cooling and because many believe that cold is contraindicated in joint affections Cold may induce shivering of the pxs particularly when applied to the trunk Application of cold to a large areas of the body can cause a rise of blood pressure particularly in pxs who are borderline hypertensives
Examples of the Prescription
Cold packs to the left thigh, 20 mins, 2x a day
