Cryotherapy

Question 1

Hemodynamic effects

Answer 1

Initial decrease in blood flow

• Vasoconstriction
• Smooth muscles of vessel wall contract
• decrease in production of histamine and prostaglandins which decreases vasodilation

Later increase in blood flow

• Vasodilation
• Cold-induced vasodilation occurs in an attempt to increase temperature

Known as hunting reflex

Question 2

Why increase in skin redness?

Answer 2

Increase in oxyhemoglobin concentration in the blood due to decrease in oxygen-hemoglobin dissociation

Question 3

Decreased NCV

Answer 3

Nerve Conduction Velocity

• Cold temperatures decreases velocity
• Cold has greatest effect on myelinated and small fibers
• Least effect on unmyelinated and large fibers
• A-delta fibers is the the greatest decrease (pain)

Question 4

Increased Pain Threshold

Answer 4

• Gating the pain transmission with activity of the cutaneous thermal receptors
• Blocking conduction by A-delta fibers

Question 5

Altered Muscle Strength

Answer 5

• Brief cooling - increased nerve excitability, initial increase in muscle strength
• Longer coolling - Initially decrease strength, but increase after one hour

Question 6

Decreased Spasticity

Answer 6

• Decrease in gamma motor neuron activity
• laer, decrease in afferent spindle and golgi tendon organ activity

Question 7

Facilitation of Muscle Contraction

Answer 7

Brief application of cryotherapy facilitates alpha motor neuron activity to produce a contraction in a flaccid muscle

Question 8

Metabolic effects

Answer 8

Cold decreases the rate of all metabolic reations

Question 9

Edema Control

Answer 9

• Reduces blood flow
• increases capillary permeability by reducing vasoconstrictive substances such as histamine
• usually applied with compression and elevation

Question 10

Symptom Management in MS

Answer 10

Patients respond to generalized cooling in clinical symptoms and function

Question 11

Cryokinetics and Cryostretch

Answer 11

• Cool to the point of numbness
• Exercise to avoid pain, sensitivity

Question 12

Counterindications

Answer 12

• Cold hypersensitivity
• Cold intolerance
• Cryoglobulinemia (clotting)
• Paroxysmal cold cryoglobinuria (blood in urine)
• Raynaud’s disease (ischemia)
• Over regenerating nerve
• Over area with compromised circulation