Sreeraj S R

Sreeraj S R

� Hemodynamic effects

o Initial decrease in blood flow

o Later increase in blood flow

� Neuromuscular effects

o Decreased nerve conduction velocity

o Increased pain threshold

o Altered muscle strength

o Decreased spasticity

o Facilitation of muscle contraction

� Metabolic effects

o Decreased metabolic rate

Sreeraj S R

Sreeraj S R

� Cold induced vasodilation

� Lewis’ hunting reaction

� Skin redness result of an increase in oxygen hemoglobin dissociation of blood

Sreeraj S R

� Decrease conduction velocity of both sensory and motor nerves

� Greater effect on myelinated and small fibers like A- delta fibers

Sreeraj S R

� Cryotherapy can increase pain threshold and decrease the sensation of pain

� Due to

o counter irritation

o gate control

o Reduction in muscle spasm

o Sensory nerve conduction velocity

Sreeraj S R

� Short duration cold exposure increases muscle strength due to

o Facilitation of motor nerve excitability

o Increased psychological motivation

� Long duration cold exposure decreases muscle strength due to

o Reduced blood flow

o Slow motor nerve conduction

o Increased muscle viscosity

o Increased tissue stiffness

Sreeraj S R

� Due to

o Decrease in gamma motor neuron activity

o Decrease in the discharge of afferent spindle and Golgi tendon organ activity

Sreeraj S R

� Facilitate alpha motor neuron activity to produce a contraction in a muscle that is flaccid due to UMN lesion

� Brief icing

Sreeraj S R

� So Cryotherapy is helpful in inflammation and healing

� The release of cartilage degrading enzymes including collaginase, elastase, hyalurodinase and protease are inhibited

Sreeraj S R

� Inflammation control

� Edema control

� Pain control

� Modification of spasticity

� Facilitation/Rood’s technique

� Cryokinetics and cryostretch

Sreeraj S R

� Cold hypersensitivity/cold induced urticaria

� Cold intolerance

� Cryoglobulinemia- aggregation of serum protein

� Paroxysmal cold cryoglobinuria

� Raynaud’s disease/digital cyanosis

� Regenerating peripheral nerve

� Local impaired circulation/peripheral vascular disease

Sreeraj S R

Sreeraj S R

� Superficial main branch of a nerve

� Open wound

� Hypertension

� Poor sensation

� Very young and very old patients

Sreeraj S R

� Cold pack

� Ice cups

� Ice towels

� Immersion

� Controlled compression units

� Vapocoolant sprays

Sreeraj S R

� Commercial� Storage

� Do not apply directly to skin

� Ice Packs� Moist towels

facilitate cold transmission

� Can place directly on skin

Sreeraj S R

� Indications

� Spasm, contusions localized injuries

� Small treatment areas

Sreeraj S R

� Circumferential cooling

� Can be used in combo with other modalities

Sreeraj S R

� Combines the benefits of cold with the advantages of pneumatic compression

� Uses sleeves with circulating cold water, attached to an intermittent pump unit. Edematous extremities are placed inside the sleeves

� Used primarily to treat acute musculoskeletal injury with soft tissue swelling. Also used after some surgical procedures

� Temperatures used are 7.2° C and pressures up to 60 mmHg

Sreeraj S R

� Volatile liquids such as Fluori-methane spray are commonly used

� Used for spray-and-stretch techniques to treat myofascial pain ; also used for local anesthesia

� Produce an abrupt temperature change over a small surface area

� Precautions: risk for skin site irritation and local cutaneous freezing