Cryotherapy

Question 1

Coupling medium only for Gel Cold packs:

Answer 1

Wet towel layer between cryoagent and skin

Question 2

gel cold pack duration, with wet towel

Answer 2

10-20 min

Question 3

cryotherapy in patients with Cardiovascular and Cardiorespiratory disorders

Answer 3

precaution

Question 4

cryotherpay in Patients who are confused*

Answer 4

contrainidicated

Question 5

Healing phases:

Answer 5

Hemostasis* (secs-mins) → Inflammatory* (hours/days/weeks) → Proliferative (wks/months) → Remodeling/maturation (months/year)

( * most impact of cryotheraoy here)

Question 6

cryotherapy Over skin areas where sensation of cold is severely impaired

Answer 6

contraindication

Question 7

cryotherapy over superficial peripheral nerves

Answer 7

precaution

Question 8

cryotherapy over thoracic areas in patients with coronopathy

Answer 8

precaution

Question 9

Types of cryoagents:

Answer 9

1. Gel pack (Temp. 23-32°F)
2. Ice cup/ icicle
3. Cubed-ice bag (32-50°F)
4. Vapocoolant spray (Pressurized canister)
5. Crushed-ice bag (32-50°F)
6. Controlled continuous cold unit with compression

(no need to know the temperatures)

Question 10

look at the evidence; cryothearpy ranked moderate for:

Answer 10

Ankle sprains
Spasticity
Joint/ tendon/ muscle conditions

Arthritic/ Rheumatoid conditions

Question 11

True or false: cryoagents cannot and do not transfer their coldness to the warmer soft tissues.

Answer 11

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.

Question 12

what is contrast immersion?

Answer 12

Alternate between hot (99-100°F) and cold (41-68°F) water.

4:2 ratio

Question 13

cellular response to cryotherapy

Answer 13

Reduction of tissue temperature Reduction of cell metabolism → Reduction in Tissue Oxygen Requirement → Reduces Secondary Tissue Damage → Decrease Free Proteins= Decrease Edema

Question 14

True or false: BOTH thermotherapy and cryotherapy decrease gamma motor neuron activity

Answer 14

true

Question 15

(cryotherapy) The potential for loss of Joint Position Sense Awareness immediately after use of cryotherapy over stressed joints is a:

Answer 15

precaution

Question 16

metabolic response to cryotherapy

Answer 16

Depolarization of sympathetic adrenergic nerve fibers → Norepinephrine causes smooth muscles to contract in blood vessels → Vasoconstriction

Question 17

Look at the evidence; cryotherapy ranked strong for:

Answer 17

Post-operative knee arthroplasty (conflicting evidence)
Mixed post-op musculoskeletal conditions

Question 18

cryotherapy on Patients with hemiplegia

Answer 18

precaution

Question 19

cryotherapy Over open dermal wounds

Answer 19

contraindicated

Question 20

Indications for cryotherapy agents

Answer 20

• 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

Question 21

cryotherapy Over areas of impaired circulation

Answer 21

precaution

Question 22

crytherapy In hypertensive patients (monitor BP)

Answer 22

precaution, monitor BP

Question 23

Vapocollant duration (application):

Answer 23

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

Question 24

what are the effects of compression with a gel pack on underlying tissue?

Answer 24

precaution, risk of causing frostbite

Question 25

cryotherapy In very young/ old patients
In Overweight/ Obese patients

Answer 25

precaution

Question 26

2 steps for preparing your patient for cryotherapy:

Answer 26

1. screening via hot/cold discrimination

2. what to expect:

“I-BANA”
Intense Cold
Burning
Aching
Numbness
Analgesia

Question 27

Ice cup/ Icicle duration

Answer 27

5-10 minutes

Question 28

cryotherapy in patients presenting with Raynaud’s disease/ phenomenon

Answer 28

contrainidicated

Question 29

cryotherapy In patients with cryoglobulinemia

Answer 29

contrainidicated

Question 30

Other Biophysiological Responses to cryotherapy:

Answer 30

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.

Question 31

Controlled Continous Cold Unit with Compression (Cryocuff) duration

Answer 31

1-8 hours depending on condition

Question 32

cryotherapy In patients with cold induced urticaria

Answer 32

contraindicated

Question 33

The therapeutic use of cryoagents relates primarily to the treatment of which phases of tissue repair?

Answer 33

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.

Question 34

cryotherapy Over peripheral vascular disease areas

Answer 34

contrainidicated

Question 35

neurological response to cryotherapy

Answer 35

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