Download CRYOTHERAPY

• Cryotherapy or ice therapy is the
application of cold to the body tissues after
injury. This practice is as old as medicine
itself.
• Nowadays, local cold application may be
applied by the use of various forms of ice
or frozen gel packs, or by evaporation of
volatile fluids from the skin.Often skin
temperature is reduced to 10 C°.
A. Physiological Effects of Cold
Application
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Circulatory Response
The initial skin reaction to cooling is an attempt to
preserve heat. It is accomplished by an initial
vasoconstriction. This haemostatic response has the
effect of cooling of the body part.
After a short period of time, the duration depends on
the area involved, a vasodilatation follows with
alternating periods of constriction and dilatation. This
reaction of “hunting” for a mean point of circulation is
called “Lewis’s Hunting Reaction”.
During the vasodilatation, the arteriovenous
anastomosis is closed, thus causing an increase blood
flow through the capillaries. This is beneficial in the
treatment of swelling and tissue damage.
Physiotherapeutic Uses of the
Circulatory Effect:
• The initial vasoconstriction is often used to limit
the extravasations of blood into the tissues
following injuries (e.g. sports injuries). Ice
therapy is then usually followed by some forms
of compression bandage.
• The alternate periods of vasoconstriction and
vasodilatation affect the capillary blood flow and
it is across the capillary membrane that tissue
fluid can be removed from the area and returned
in the systemic circulation. Increased circulation
allows more nutrients and repair substances into
the damaged areas.
• Thus ice therapy is very useful in removing
swelling and accelerating tissue repair. i.e.
ice cubes massage may be used to
accelerate the rate of repair of pressure
sores.
• The reduced metabolic rate of cooled
tissues allows cooled muscle to contract
many more times before fatigue sets in.
Neural response
• The skin contains primary thermal receptors. Cold
receptors are several times more numerous than warm
receptors. The cold receptors respond to cooling by a
sustained discharge of impulses, the rate of which
increases with further cooling.
• The rate of conduction of nerve fibers in a mixed (motor
and sensory) peripheral nerve is reduced by cooling. The
first fibers affected by gradual cooling are the A fibers
(myelinated) and eventually at very low temperatures the
B and C fibers (non-myelinated) are affected.
• In practice, motor nerve paralysis is never produced by
ice.
Excitatory Cold Mechanism
• When cold is applied in an appropriate way on
the skin, ice can be used to increase the
excitatory bias around the anterior horn cell.
• Combined with other forms of excitation
(brushing, tapping,…) and with the patients’
volitation, this can often produce contraction of
an inhibited muscle (only with intact peripheral
nerve supply).
• This effect can be used when muscle are
inhibited postoperatively or in the later stages of
regeneration of a mixed peripheral nerve
B. Uses of Ice Therapy
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Reduces pain.
Reduces spasticity.
Reduces muscle spasm.
Reduces swelling.
Promote repair of the damaged tissues.
Provide excitatory stimulus to inhibited
muscles.
Reduction of Pain
• Pain reduction is one of the major effects of ice
application which has been used for many years.
• The probable mechanism is that by the stimulation of
cold receptors, impulses will be send back which will
pass into the posterior root of the spinal cord. These
impulses, arriving through large diameter nerves,
effectively block out any other (pain) impulses attempting
to access the spinal cord (pain gate theory).
• This reduces the pain temporarily. For permanent pain
relief, positive physiotherapy (strengthening,
mobilization) has to be given during this period of
transient pain relief.
Reduction of Spasticity
• Spasticity is the pathological state of
increased muscle tone resulting from
damage to the upper motor neurons. The
small anterior horn cell from the higher
control of extrapyramidal system and fires
spontaneously at an increased rate. The
net result of this is ultimately to increase
tone in the extrafusal muscle fibers, when
the hypertonic spastic state appears.
• Spasm is a normal response to injury or
pain and is manifested as an increase in
muscle tone in a specific area with the
apparent aim of limiting movement and
further damage. However the amount of
spasm is often exceeding and the
sustained contraction of muscles will in
turn start to produce pain, often resulting
then in more spasm.
• The mechanisms by which cold reduces
spasticity and spasm are probably:
• the reduced velocity of nerve conduction.
• the depressed sensitivity of receptors such
as the muscle spindle.
• These structures are fairly deep and it would take
several minutes to produce a sufficiently low temperature
to affect them.
• As it was clinically demonstrated that the reduction of
spasm and spasticity occurs within 30 seconds of ice
application, the reaction to cooling can only be at the
superficial tissues at the skin.
• The skin stimulus produced by cold must have an effect
on the general level of excitation and inhibition in the
region of the anterior horn cells.
• Once spasm and spasticity have been reduced, more
long-time treatment is given in order to sustain the
condition. In the case of spasm, active movements are
used to break down the vicious circle of pain-spasmmore pain- more spasm.
• With spasticity, the technique will depend upon the
preference of the physical therapist.
Techniques of Application of Cryotherapy
• The way which ice is applied will vary according
to the required effects.
• It may be applied in the following ways:
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Ice towels
Ice packs
Immersion
Ice cube massage
Excitatory cold ( quick ice)
Ice spray
Cold gel
D. Contraindications to Ice Treatment:
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Cardiac Conditions
Psychological:
Peripheral Nerve Injuries
Vasospastic Disease
Peripheral Vascular Disease
Cold Sensitivity