Cryotherapy Flashcards
What are the mechanisms of heat transfer?
Conduction, Convection, Evaporation, Radiation and Conversion.
What is cryotherapy?
Application of cold for therapeutic purposes
What is cryokinetics?
Combination of cold and exercise
What is CIVD?
CIVD – Cold Induced VasoDilation
– AKA: Hunting response (Hunting-Lewis response)
– Described by Lewis in 1930s
– Increase in tissue temp during cold therapy
– Approx 15 min into tmt and then alternating
– Not above baseline level
What are the goals of cryotherapy?
- Relieve or decrease pain
- Decrease blood flow and metabolism
- Protect injured tissue
- Decrease muscle spasm
What are the contraindications for the use of Cryotherapy?
- Impaired cold sensation
- Cold-induced urticaria (cold allergy)
- Raynaud’s disease (Raynaud’s Phenomenon)
- Cryoglobulinemia
- Paroxysmal cold hemoglobinuria
- Open wounds
- Peripheral vascular disease
- Confused and unreliable patients
What is Cold Urticaria?
Allergic reaction to cold exposure • Anaphylactic reaction – hives – itching • Can result in systemic reaction – Difficulty breathing – Loss of consciousness
What is Raynauds?
Response to cold
– Constriction of arteries and arterioles usually in a distal extremity
– Restricts blood flow and results in color changes
• Classic color change
– White, blue red
– More common in women
What is Cryoglobinemia?
• Abnormal clumping of plasma proteins stimulated by cold application
• Rare
• Leads to skin discoloration and dyspnea
• Associated with multiple myeloma,
Waldenström macroglobulinemia, chronic
liver disease, infections (hepatitis), and
coexistent connective-tissue diseases
(SLE, Sjögren syndrome)
What is Cold induced Hemoglobinuria?
• AKA: Paroxysmal cold hemoglobinuria
• Rare
• Cold temperature activates antibody to RBCs
causing lysis
• Excess hemoglobin is excreted in the urine
• Darkened urine and back pain
• Acute disease affects mostly young children
– Commonly following an acute viral or upper respiratory illness
• Chronic disease is seen in the elderly.
– Secondary causes are usually neoplastic or infectious
What risks do you need to consider before applying cryotherapy?
• Impaired circulation • Thoracic area in pts with coronary artery disease • Hypertensive patients • Cardiovascular and Cardiorespiratory disorders (take BP before, during, and after) • Superficial peripheral nerves • Hemiplegic • Very young and very old • Obesity
What are the stages of sensation?
Cold, Burning, Aching pain, Numbness (CBAN)
What are the different types of cryotherapy techniques?
• Ice Pack (direct application) – Ice bag – Gel pack – Chemical cold pack (only for emergencies) • Cold whirlpool • Ice bath (slush bucket) • Ice massage • Controlled continuous cold unit with compression • Vapocoolant Spray
Which is better: crushed ice or ice cubes?
Crushed Ice! Cubes with water are better than cubes alone.
How do you apply Ice bags?
• Application:
– Position patient comfortably
– Apply ice directly to skin of injured area
– Drape patient with towels to keep clothes dry
– Apply for 10-20 min
A single layer of a ____ towel improves conduction and prevents frostbite.
WET
What is the treatment time for cold whirlpool?
15-20 minutes
What are some advantages to using cold whirlpool?
–Surrounds entire joint
–Can perform active exercises while cooling tissue
What are disadvantages to using cold whirlpool?
- Part cannot be elevated
- Not ideal for acute situation
Will a thermopane be present in a cold whirlpool?
No, Whirlpool constant circulation prevents warmer water layer around part
(thermopane)
What is the application for Ice bath?
• 1/2 ice, 1/2 water in bucket • Tx time: 8-20 minutes • Application – position patient, seated or supine – place treatment area in bucket – monitor patient closely for lightheadedness, nausea, dizziness, syncope
What is the application for Ice massage?
Application:
– Drape with towels to catch melted water
– Rub in small quick circles
– Treat small area
– 5-10 minutes or until numbness (10 min, max)
When would you choose to use ice massage?
- Superficial areas and bony prominence
- Not in acute inflammation where compression is needed
- Pre or post exercise pain relief
- Desensitize trigger points
How does vapocoolant spray create a cooling effect?
Through evaporation
Indication for Vapocoolant sprays
Trigger points, Muscle spasms, Decrease ROM
Precautions for Vapocoolant sprays
– Can cause frostbite
– Ethyl Chloride is extremely flammable
– Ethyl Chloride is a local anesthetic but if inhaled can become general
– It’s use is based on tradition rather than fact
What are some contraindications for the use of Vapocoolant spray?
– Allergy – Open wounds – Post/surgical – Eyes – All other cold contraindications plus any contraindications to passive stretch
Cooling skin
– Rapid skin cooling initially
– Followed by a slower cooling rate
• Levels off a few degrees above ice bag/bath temperature
Re-Warming skin
– Initial rapid rise in temperature, then slower
– Can remain cooler temp. for over 1 hr following 30 min
treatment, when inactive
– Faster re-warming with physical activity
Cooling Deep tissue
– More slowly
• but continues to cool for several minutes after ice
is removed
– SubQ adipose makes big impact on depth
– Cooling in an ice bath will produce greater
reduction in interarticular temperature as
more surface area is exposed to the cold
Re-warming deep tissue
– Can take up to 2.5 hours when at rest
– Should have a re-warming 2X that of the
cooling period
– Re-warming is much more rapid when patient
engages in activity
Indications for cryotherapy
• Pain
– Headache, migraine, sprains, strains, mm
contusions, tendinitis, other ms pain, etc
• Spasm
• Acute injury
– Decreased metabolism, edema, pain, etc
• Chronic and inflammatory arthritis
Describe the physiologic responses to pain regarding Cryotherapy
– Decreased nerve conduction velocity
– Bombard the CNS with cold signals
• counterirritation
Describe the physiologic responses to spasm regarding Cryotherapy
– Affects mm spindle and golgi tendon organs
– Decreased efferent signals noted
– Decreased pain interrupts pain/spasm cycle
Describe the physiologic responses to edema regarding Cryotherapy
– 1st reaction to cold is vasoconstriction of smooth muscle
– Therefore decreased blood flow and decreased edema
Describe the physiologic responses to Metabolic rate regarding Cryotherapy
– Cold decreases metabolism
– Leads to decreased blood demand
– Longer survival of hypoxic tissue
– Less secondary injury
Describe the physiologic responses to performance regarding Cryotherapy
– Vertical jumping is decreased
– Strength of contraction is decreased in some studies and unchanged in others
– Proprioception, balance, and agility –
evidence is mixed
– Good advice: re-warm tissue before returning
to sport participation or proprioception training
What is Cryokinetics?
Active exercise during or immediately
following cryotherapy
Describe how to perform cryokinetics
– Apply cold (slush bucket, whirlpool, ice pack, etc) until numb (15-20 min) – ROM or stretching exercise for 3-5 minutes – Re-numb tissue for 3-5 minutes – Continue exercise – Repeat up to 5 times – Stop if painful – Can perform sport specific activities
