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ByMs.B.Nelson
What is Cryotherapy Effects of Cryotherapy Uses of Cryotherapy Methods of application Contraindications
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 effects
Metabolic effects
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
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
Decreased nerve conduction velocity
Increased pain threshold
Altered muscle strength
Decreased spasticity
Facilitation of muscle contraction
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
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
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
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
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.
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
Cooling lasting for 10 – 30 minutes results in temporary decrease of spasticity and clonus.
These effects generally last for 1 to 1 ½ hours
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
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
Control of inflammation
Control of oedema
Control of pain
Facilitation
Modification of Spasticity Cryokinetics and cryostretch
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.
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
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
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
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
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
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)
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
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
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
Over an area with poor circulation or peripheral vascular disease
Directly over regenerating peripheral nerves
Cold hypersensitivity/cold intolerance
Reynaud’s Disease and Phenomenon
Over superficial main branch of a nerve Over open wound Poor sensation or poor mentation Very young and very old patients Hypertension diabetics
Ice burn
Improper application can result , in tissue damage (ice burn), tissue death, nerve conduction abnormalities
The typical sequence of sensations in response to icing is :intense cold
Burning Aching Analgesia Numbness
Includes cold pack or ice pack, ice massage,
Vapocoolant spray ,cold whirlpool, ice immersion, controlled cold compression unit
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