By Ms.B.Nelson. What is Cryotherapy Effects of Cryotherapy Uses of Cryotherapy Methods of application Contraindications.

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