Download Cryotherapy

By
Ms.B.Nelson
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What is Cryotherapy
Effects of Cryotherapy
Uses of Cryotherapy
Methods of application
Contraindications
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Describe the physiologic effects of
cryotherapy
List the indications ,contraindications and
precautions in the use of cryotherapy
Describe the rationale for the use of
cryotherapy as an intervention
 Describes
the therapeutic use of
cold /ice application
 When
cold is applied to the skin,
which is a warmer object ,heat is
lost; this is referred to as cooling
 Cooling occurs via conduction and
evaporation
 Hemodynamic
effects
 Neuromuscular
 Metabolic
effects
effects
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Initial decrease in blood flow
Immediate constriction of the cutaneous
blood vessels– vasoconstriction
Decrease in blood flow to the area
Vasoconstriction persists with cold
application of 15 minutes duration or less
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Later increase in blood flow occurs when
cold is applied for longer periods of time
Phenomenon is called cold induced
vasodilatation (CIVD) or Hunting response
CIVD occurs mainly in the extremities
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Decreased nerve conduction velocity
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Increased pain threshold
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Altered muscle strength
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Decreased spasticity
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Facilitation of muscle contraction
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Cold application can alter the conduction
velocity and synaptic activity of peripheral
nerves
Quantity of change depends on the duration
and degree of temperature change
Decrease conduction velocity in both motor &
sensory nerves
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Greatest effect on myelinated and small nerve
fibres
A- delta fibres, small –diameter ,myelinated
pain transmitting fibres – greatest response
to cooling
Reversal within 15 minutes of removal of ice
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Reversible total nerve block can occur with ice
application over superficially located major
nerve branches.
For example, the peroneal nerve on the
lateral aspect of the knee ,medial aspect of
the elbow
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Stimulation of the cutaneous cold receptors
can partially block the transmission of painful
stimuli to the brain
Resulting in an increased pain threshold and
decrease in pain sensation
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Cryotherapy is associated with both increase
and decrease of muscle strength
Isometric muscle strength has been shown to
increase with application of ice- massage for
5 minutes or less.
Isometric muscle strength has been shown to
decrease after cooling for 30 minutes or
longer.
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Cryotherapy can temporary decrease
spasticity
The decrease in spasticity is due at least two
mechanisms:
(1) decrease in gamma- motor neuron activity
through stimulation of the cutaneous nerves
(2) decrease in muscle spindle and Golgi
Tendon activity
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Cooling lasting for 10 – 30 minutes results in
temporary decrease of spasticity and clonus.
These effects generally last for 1 to 1 ½
hours
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Brief application of ice ( between 1 to 5
minutes) is thought to produce a muscle
contraction in a muscle that is flaccid from
upper motor neuron dysfunction.
Sometimes used clinically to stimulate muscle
contraction in patients with upper motor
neuron injuries
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Decrease metabolic rate occurs with cooling:
Decrease rate of activity in the inflamed
tissue
Decrease activity of cartilage degrading
enzymes with decreases in joint temperature
Cryotherapy recommended as intervention
for Osteoarthritis and Rheumatoid arthritis
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Control of inflammation
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Control of oedema
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Control of pain
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Facilitation
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Modification of Spasticity
Cryokinetics and cryostretch
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Ice/cryotherapy is used to control acute
inflammation and accelerate recovery from
injury
Cryotherapy used within the first 2 days of
injury resulted in reduced pain, swelling and
shortened recovery time.
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Decreased temperature slows the rate of
chemical reaction that occurs during acute
inflammation
Cryotherapy also reduces the heat ,redness,
swelling and pain associated with
inflammatory phase of healing
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Heat associated with inflammatory response
is decreased by application of ice to the area
Vasoconstriction and increased blood
viscosity associated with application of
cryotherapy controls bleeding and fluid loss
after acute trauma
Cryotherapy is thought to control pain by
decreasing activity in the A-delta pain fibres
and by gating at the spinal cord level
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Apply cryotherapy immediately after injury
and during the inflammatory phase of healing
to help control bleeding, swelling and pain
and to accelerate recovery.
Acute inflammation usually resolves in 48 –
72 hours
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Cryotherapy reduces blood flow into the are
by vasoconstriction and increased blood
viscosity
Cryotherapy also reduces the release of
vasoactive substances such as histamine and
prostaglandins
Ice ,along with compression and elevation
reduces postinjury swelling
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Cryotherapy modifies the sensation of pain by
gating pain transmission with activity of the
cutaneous receptors
Application of ice for 10- 15 minutes can
control pain for approximately 1 hour or
more
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Ice can be used to temporarily decrease
spasticity in upper motor neuron dysfunction
Brief application of ice for approx 5 mins
results in decreased tendon reflex
Ice application of 10 – 30 mins decreases
resistance of muscles to passive stretch for
approximately 1 hour or longer( therapeutic
activities can be done)
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Quick icing is a technique used in
rehabilitation for patients with flaccidity due
to upper motor neuron dysfunction.
Research on the effective use of this
technique to elicit muscle contraction is not
strong
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Cryokinetics involves applying a cooling
agent to the point of numbness,to reduce
pain sensation
The patient can then exercise to achieve his
goal
Caution: be careful not to avoid further tissue
damage due to numbness
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Application of cooling agent before stretching
Aim of this activity is to reduce muscle
spasm and allow greater range of movement
when stretching the joint
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Over an area with poor circulation or
peripheral vascular disease
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Directly over regenerating peripheral nerves
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Cold hypersensitivity/cold intolerance
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Reynaud’s Disease and Phenomenon
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Over superficial main branch of a nerve
Over open wound
Poor sensation or poor mentation
Very young and very old patients
Hypertension
diabetics
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Ice burn
Improper application can result , in tissue
damage (ice burn), tissue death, nerve
conduction abnormalities
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The typical sequence of sensations in
response to icing is :intense cold
Burning
Aching
Analgesia
Numbness
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Includes cold pack or ice pack, ice massage,
Vapocoolant spray ,cold whirlpool, ice
immersion, controlled cold compression unit
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Physical Agents in Rehabilitation: From
Research to Practice: Michelle H. Cameron
Physical Agents: Theory And Practice:
Barbara J. Behrens, Susan L. Michlovitz
Therapeutic Modalities in Rehabilitation by
William Prentice