Cryotherapy Flashcards by Sean Ellingworth

What are the mechanisms of heat transfer?

Conduction, Convection, Evaporation, Radiation and Conversion.

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What is cryotherapy?

Application of cold for therapeutic purposes

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What is cryokinetics?

Combination of cold and exercise

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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

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What are the goals of cryotherapy?

Relieve or decrease pain
Decrease blood flow and metabolism
Protect injured tissue
Decrease muscle spasm

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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

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What is Cold Urticaria?

Allergic reaction to cold exposure
• Anaphylactic reaction
– hives
– itching
• Can result in systemic reaction
– Difficulty breathing
– Loss of consciousness

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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

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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)

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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

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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

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What are the stages of sensation?

Cold, Burning, Aching pain, Numbness (CBAN)

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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

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Which is better: crushed ice or ice cubes?

Crushed Ice! Cubes with water are better than cubes alone.

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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

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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 ```