Cryotherapy Flashcards
Coupling medium only for Gel Cold packs:
Wet towel layer between cryoagent and skin
gel cold pack duration, with wet towel
10-20 min
cryotherapy in patients with Cardiovascular and Cardiorespiratory disorders
precaution
cryotherpay in Patients who are confused*
contrainidicated
Healing phases:
Hemostasis* (secs-mins) → Inflammatory* (hours/days/weeks) → Proliferative (wks/months) → Remodeling/maturation (months/year)
( * most impact of cryotheraoy here)
cryotherapy Over skin areas where sensation of cold is severely impaired
contraindication
cryotherapy over superficial peripheral nerves
precaution
cryotherapy over thoracic areas in patients with coronopathy
precaution
Types of cryoagents:
- Gel pack (Temp. 23-32°F)
- Ice cup/ icicle
- Cubed-ice bag (32-50°F)
- Vapocoolant spray (Pressurized canister)
- Crushed-ice bag (32-50°F)
- Controlled continuous cold unit with compression
(no need to know the temperatures)
look at the evidence; cryothearpy ranked moderate for:
Ankle sprains
Spasticity
Joint/ tendon/ muscle conditions
Arthritic/ Rheumatoid conditions
True or false: cryoagents cannot and do not transfer their coldness to the warmer soft tissues.
True. Instead, the soft tissues themselves lose their heat to the cryoagents. In other words, the application of a cryoagent causes extraction of heat from soft tissues, thus cooling them for therapeutic purposes. The greater the amount of heat extracted by the cryoagent, the greater the cooling effect on the exposed soft tissues.
what is contrast immersion?
Alternate between hot (99-100°F) and cold (41-68°F) water.
4:2 ratio
cellular response to cryotherapy
Reduction of tissue temperature Reduction of cell metabolism → Reduction in Tissue Oxygen Requirement → Reduces Secondary Tissue Damage → Decrease Free Proteins= Decrease Edema
True or false: BOTH thermotherapy and cryotherapy decrease gamma motor neuron activity
true
(cryotherapy) The potential for loss of Joint Position Sense Awareness immediately after use of cryotherapy over stressed joints is a:
precaution
metabolic response to cryotherapy
Depolarization of sympathetic adrenergic nerve fibers → Norepinephrine causes smooth muscles to contract in blood vessels → Vasoconstriction
Look at the evidence; cryotherapy ranked strong for:
Post-operative knee arthroplasty (conflicting evidence)
Mixed post-op musculoskeletal conditions
cryotherapy on Patients with hemiplegia
precaution
cryotherapy Over open dermal wounds
contraindicated
Indications for cryotherapy agents
- Treatment of acute and sub-acute phases of soft tissue conditions (early phases of tissue repair)
- Within 24-48 hours to reduce secondary tissue damage
cryotherapy Over areas of impaired circulation
precaution
crytherapy In hypertensive patients (monitor BP)
precaution, monitor BP
Vapocollant duration (application):
3-5 Quick sprays for a second to a fraction of a second depending on area followed by 1-2 minute stretching of targeted tissue
what are the effects of compression with a gel pack on underlying tissue?
precaution, risk of causing frostbite
cryotherapy In very young/ old patients
In Overweight/ Obese patients
precaution
2 steps for preparing your patient for cryotherapy:
1. screening via hot/cold discrimination
2. what to expect:
“I-BANA”
Intense Cold
Burning
Aching
Numbness
Analgesia
Ice cup/ Icicle duration
5-10 minutes
cryotherapy in patients presenting with Raynaud’s disease/ phenomenon
contrainidicated
cryotherapy In patients with cryoglobulinemia
contrainidicated
Other Biophysiological Responses to cryotherapy:
Cold induced vasodilatation: Occurs post prolonged application of cryoagent causing soft tissue temperatures to drop below 50°F (10º C)
However, widely accepted that a small increase in blood flow is observed post prolonged cryoagent use. However, the net difference does not negate the cryotherapy effect on the cooling of the tissue.
Controlled Continous Cold Unit with Compression (Cryocuff) duration
1-8 hours depending on condition
cryotherapy In patients with cold induced urticaria
contraindicated
The therapeutic use of cryoagents relates primarily to the treatment of which phases of tissue repair?
acute and subacute soft-tissue conditions, characterized by the two early phases of tissue repair: the hemostatic and inflammatory phases. It is hypothesized that by decreasing soft-tissue temperature, cryotherapy promotes the regulation of these two important phases, thus aiding in the process of tissue repair and recovery. Moreover, cooling other soft tissues, such as peripheral nerves, provides the rationale for using cryotherapy to manage pain and spasticity.
cryotherapy Over peripheral vascular disease areas
contrainidicated
neurological response to cryotherapy
Cold stimulus competes with pain stimulus → Decrease localized pain substances (Histamine + Prostaglandin) → Decrease nerve conduction velocity of pain nerve fibers → Decrease gamma motor neuron= decrease mm spasm/ tone
