10-9c Cryotherapy/Assess Swelling/Compression Flashcards
What is cryotherapy?
he removal of heat from a body part to decrease cellular metabolism,
improve cellular survival,
decrease inflammation, decrease pain and muscular spasm, and promote vasoconstriction
What are different examples of cryotherapy?
Ice/cold gel pack Ice massage Vapo-coolant spray Cold water immersion Cryo-cuff/Game-ready (cold/compression)
What are the indications for cryotherapy?
Acute inflammation Analgesic effects (acute/chronic) Decrease muscle spasm/guarding Spasticity management Delayed onset muscle soreness Muscle disinhibition
What are the indications for cryotherapy?
Acute inflammation (secondary cellular injury if swelling continues beyond original purpose)
Analgesic effects (acute/chronic)
Decrease muscle spasm/guarding
Spasticity management
Delayed onset muscle soreness
Muscle disinhibition (from swelling in joint space)
What is the physiology behind cryotherapy?
Anti-inflammatory benefits (Vasoconstriction response: decrease fluid to area of injury)
Analgesic effect (Gate theory of pain; decreases rate of nerve signaling)
Relaxation of muscle spasm
Inhibition of nerves/muscle spindles
Muscle disinhibition
Reverse muscle activation inhibition related to joint swelling/effusion
How does one assess swelling?
Girth measurements (tape measure), volumeters, and sweep tests
What are the pros to a volumeter?
good accuracy, reliability, specificity, diffused swelling, good for distal extremeties
What are the cons to a volumeter?
time consuming, limited to distal extremeties, cannot use if post surgery
How reliable are girth measurements?
fair to high reliability
How does one assess swelling?
Pitting edema and sweep test
What is the scale for pitting edema?
0 – no clinical edema
1 – slight pitting (2 mm depth), immediate rebound
2 – somewhat deeper pit (3-4 mm), < 15 sec rebound
3 – noticeably deep pit (5-6 mm), up to 30 sec rebound
4 – very deep pit (7-8 mm), > 20 sec rebound
What is the scale for the sweep test? How is it performed?
0 – no wave produced with downstroke
Trace – small wave on medial side with downstroke
1+ - larger bulge no medial side with downstroke
2+ - Effusion returns to medial side after upstroke
3+ - Fluid cannot be moved out of medial knee
sweep up med. side and down on lat. side; if goes down then see if fluid goes down medially
What are different methods for reducing swelling?
ice
compression (decreases inflammatory cytokines, increases capillary flow, and limits capillary leakagel
elevation (gravity assisted fluid return)
What are the different types of compression?
bandages and compression stockings
intermittent pneumatic compression
What are the contraindications to compression?
Uncontrolled heart disease (CHF)
Arterial disease
Skin abnormalities (healing wounds, fragile skin)
Advanced peripheral neuropathy
What are the advantages to compression bandages?
Additional anti-inflammatory benefits
Inexpensive
Re-usable
What are the disadvantages to compression bandages?
Requires proper set-up (education)
Time to apply (ACE wrap)
May need to be re-applied with change in swelling
What are ACE wrap principles?
Pressure greater distally to proximally
No circumferential measurements
Over-lap by ½ width
Secure with tape (no sharp pieces)
POLICE
protection optimal loading ice compression elevation
What does the evidence show cryotherapy does?
decreases pain by decreasing temp of peripheral nerves (decreased neural signal leads to decreased perceived pain)
gate control theory of pain (large diameter neurons activated in spinal cord blocks perceived pain)
What does the literature say about cryotherapy?
better than no cryotherapy in 50% of trials
10 degrees celsius better than 5 degrees
no adverse effects
decrease in pain medication intake
improves weight bearing following an acute ankle sprain
What does cryotherapy do for muscle inhibition?
moderate-quality evidence in support of cryotherapy + exercise
Contraindications for cryotherapy?
Cold urticaria/allergies Raynaud’s disease Cryoglobulinemia Paroxysmal cold hemoglobinuria Impaired circulation (Peripheral vascular disease & Blood clot) Open wounds
What are the precautions for cryotherapy
Sensory deficits
Hypertension
Elderly patients
Rheumatoid conditions
What are ice pack recommendations?
ice packs
Typically 10-20 minutes*, frequency TBD
(Not directly on the skin
Long enough for desired cooling effects)
Benefits – inexpensive, maintain constant temperature
Negative side-effects: frost-bite, blistering
What are the benefits of ice and compression? (cryo-cuffs, game-ready, intermittent compression units)
cold water flow creating therapeutic effects
offers compression,
requires more expensive treatment, more difficult set-up, little carryover to home
What are the benefits of ice massage? Typical uses?
Frozen water (cup) rubbed over localized area in circular motions (Typically, 5-10 minutes) Typical uses - Muscle belly, tendon, bursa, trigger points
Inexpensive, good carryover to home
Superficial use (not deep structures)
What are the benefits of water immersion? Typical uses?
Water immersion
(Used for distal edema and pain relief
10-20 minutes
Longer cooling temperature after removal (Rupp et al., 2012))
What are the benefits of contrast bath? Typical uses?
alternates hot/cold temps (Vasoconstriction/vasodilation alternating effects
Variable ratios reported between cold/hot temperatures)
What are the benefits of vapo-coolant spray Typical uses?
Fluoromethane – cools skin prior to muscle stretching
ROM/trigger point
(Muscle passively stretched
Spray 2-3 times
Trigger point/myofascial pain)
What are the stages of cryotherapy?
Cold
Pain, stinging, burning
Aching, burning discomfort
Numbness
Thought process for ice pack
- Choose a rationale for using cryotherapy (pain, muscle activation, swelling)
- Screen for contraindications / precautions
- Select a method of cryotherapy and describe dosage recommendations (duration, frequency)
- Consider depth of cooling effects (superficial vs deep)
- Make cryotherapy a PART of your treatment plan
