cryotherapy

Question 1

what is cryotherapy?

Answer 1

application of any substance to the body which results in a withdrawal of heat from the body, effectively lowering the temperature of the tissue . Conduction (cold on skin causes a transfer of energy through conduction) or evaporation (sprays: occurs when the liquid of the spray is changed to a gas causing cooling of the underlying tissue)

Question 2

what does cryotherapy do?

Answer 2

• used to treat acute injuries (24 – 48 hours after an injury or re-injury such as post exercise)
• decrease spacticity or spasm : cooling causes slowing of muscle contraction and relaxation of the muscle fiber. Decreased muscle spasm and increased ROM when combined with static or positional stretch or contract – relax techniques. (works well for clients with acute bursitis or tendonitis or those with spasm secondary to pain)
• reduce edema (works best when combined with elevation and/or compression): Vasoconstriction as a response to decreased tissue temperature by sympathetic reflex response to the smooth muscle of the blood vessels (arterioles and venues)
• Lowers tissue temperature: 1-2 cm effect on the tissue: superficial thus lowering metabolic activity
• Produces analgesia (decreased perception of pain): Small, myelinated pain fibers are the first affected by cold, reducing nerve velocity of these fibers (slowing the pain perception)

Question 3

what is cryotherapy’s response to cold?

Answer 3

1. Intense cold with reddening,
2. Burning sensation,
3. Deep achy feeling,
4. Analgesia,
5. Rewarming (takes about 15 – 20 minutes).

Question 4

Techniques/Indications

Answer 4

ice massage
cold packs
cold compression unit
vapocoolant sprays

Question 5

ice massage

Answer 5

used when targeting small area, to anesthetize or to target a trigger point, can use frozen Styrofoam cup.

Question 6

cold packs

Answer 6

used when needing to cool larger area. Commercially prepared or bag of frozen corn or mixture of water and alcohol in Ziploc bag.

Question 7

cold compression unit

Answer 7

Cryocuff: used when you would like to add compression to the modality or as a more moldable way of applying cold to an area such as a shoulder or ankle that is difficult to hold a cold pack onto.

Question 8

vapocoolant sprays

Answer 8

an aerosol that is directed at a trigger point or for spray and stretch techniques. Used more often in higher level sports activities by athletic trainers and less often in the clinic due to environmental implications as ice massage will achieve similar effects.

Question 9

contraindications

Answer 9

Contraindications
•	Cold hypersensitivity
•	Raynauds
•	Cryoglobulinemia
•	Over a regenerating peripheral nerve
•	Compromised circulation

Question 10

precautions

Answer 10

Precautions
• Never place a cold gel pack directly on the skin
• Never longer than 20 mins
• Avoid use with patients with cold urticaria, PVD, hypertension, frostbite opr monitor closely
• Avoid over superficial nerves
• Avoid over an open wound
• Avoid over areas of poor sensation
• Obese patients may need more time to achieve effects (muscle has higher water content, conducts heat more efficiently than adipose or fat tissue.
• Kids and elderly may need more layering due to decrease adipose.

Question 11

application of ice massage:

Answer 11

Use a ice wand with gel or an ice cube/block in Styrofoam cup without gel slowly rub the ice in rhythmical circles. Using the largest side of the cold tool, maintaining direct contact with the skin.
Inform the patient of the stages of cold; cold, burning, achy, analgesic or numbing. Usually 2-5 minutes unless very large muscular area (ie. Deltoid on a well developed athlete). Stop when lost feeling of touch or cold.

Question 12

application of cold packs

Answer 12

Apply directly to the area using a moist thin towel (will increase rate of cooling) or dry pillow case. Be aware of bony prominences, providing adequate insulation from cold. Can wrap with ace wrap to provide compression: will intensify cold. Leave on 10 – 15 minutes.

Question 13

application of cold compression unit

Answer 13

Cryocuff: Cover limb with shirt or stockinette or pillow case. Fill cooler with ice and water as diagrammed inside of vessel. Close cooler including lid and valve. Apply cryocuff sleeve around area to be treated. Elevate cooler above shoulder level; open valve and allow sleeve to fill to patient comfort. Close valve. Leave on 10 – 15 minutes.

Question 14

application of vapocoolant sprays

Answer 14

Spray directly at site shielding clients face. Spray for 2-5 seconds depending on area to be covered.