Cryotherapy Flashcards
Uses of cryotherapy
To decrease
- Inflammation or swelling
- Pain
- Muscle spasm
- Neurological spasticity
Management of swelling and inflammation
- Vasoconstriction: decrease in blood flow to superficial tissues
- Reduces the amount of chemical irritants to injured tissue
- “Reflex” vasodilation. Increase in blood flow with prolonged application
* cyclic vasoconstriction and vasodilation occurs with prolonged exposure (typically greater than 15 minutes); this is known as the hunting reaction and occurs most frequently in the hands, feet, and face
Management of the acute inflammatory response
- best if applied within and for the 1st 72 hours post injury (or as long as CSI present)
- often used in conjunction with PRICE
PRICE
Protection - rest - ice - compression - elevation
*inflammation phase peaks 24-72 hrs post injury
Pain reduction
- lessens pain perception by stimulating thermal (temperature) receptors (gate control theory)
- increases the pain threshold and decreases nerve conduction velocity
- decreases the inflammatory process and associated swelling
- produces analgesia (inability to feel pain)
Reduction of muscle spasm
- blocks “pain” which interrupts the pain-spasm cycle
- decreases associated muscle tightness and/or spasm by inducing analgesia which allows stretch to the muscle
- decreased inflammation associated with muscle spasm
- how long does cryotherapy analgesia last?
Reason for cryotherapy
- Modulate pain
- Control the inflammatory process and limit swelling
- Control muscle spasm
Reduction of spasticity
Spasticity: increase resistance to passive stretch, associated with abnormal tone
- decrease amplitude of deep tendon reflexes
- long lasting effects up to several hours to increase outcomes and participation with treatment
- **regulate body temperature to avoid shivering
Management of spasticity
Low grade cold application applied x 30 min
- last 1+ hr
Gel pack parameters
Depth of cold: 1-2 cm after 10-15 minutes
- temp of machine 0-10 degrees F
- Rx time: 10-15 min (20 ok)
- DO NOT place gel pack directly onto skin, use a pillow case or towel
- NEVER apply >45 minutes
- more insulation is needed for ice packs vs gel packs
Ice massage parameters
- Rx time 5-10 min, determined by amount of time needed to reach analgesia (when numbness achieved)
- generally used for a smaller, more localized area
- Tx area: no larger that 2x the size of the ice (generally 4-6 in)
- slow, overlapping circles (2in/sec)
Cold compression
- alternately pumps cold water and air into sleeve wrapped around patient’s limb
- water temp 50-77 deg F (10-25 deg C)
- most commonly used to control post-op inflammation and edema
- pts have home units a few days to a few weeks post surgery
Cold / ice baths
- immersion in water that contains partially melted ice cubes
- typically used for extremities or larger body parts
- water allows complete conformity around the incloved area and provides some compression
- temp 50-65 deg F
4 stages of cold
Intense cold - burning - aching - numbness
Contras to cold application
Vasospastic conditions
- Cryoglobulinemia
- Paroxysmal cold hemoglobulinemia
- Raynaud’s disease
- Cold hypersensitivity or intolerance (smooth, elevated red patches on skin with itching (wheals) or sever pain, numbness or color changes)
- Infection
- Over regenerating nerves or with absent sensation
- Peripheral vascular disease with poor circulation
Cryoglobulinemia
Result of abnormal blood proteins which forms a “gel” when exposed to cold
- impaired circulation, local ischemia, gangrene
- often seen in pts with multiple myeloma, chronic liver disease, and multiple rheumatic conditions
Paroxysmal cold hemoglobulinemia
With exposure to the cold, hemoglobin gets broken down and excreted bu kidneys and out in urine
- characterized by “blood in the urine”
Raynaud’s disease
- sudden pallor, cyanosis (B), even when cold is only applied to one side
- can be associated with dx such as carpal tunnel syndrome (CTS) and thoracic outlet syndrome (TOS)
- N&T, burning may also occur
Questions to ask
Do you have any unusual responses to cold?
- develop a rash with cold?
- experience any sever pain, numbness, or color changes to your skin with cold?
- blood in urine after cold?
- nerve damage / impaired sensation?
- any N&T?
- any issues with circulation?
- any recent infections?
Relative precautions to cold
- over superficial nerve branches
- over open wounds (esp deep)
- high blood pressure (controlled with meds?)
- impaired sensation
- impaired cognition
- very old or very young
Responses to cold (normal vs abnormal)
Normal
- redness or dark pink (blanchable) - decrease in tissue temp
Abnormal
- c/o severe pain - erythema with wheal formation with itching
Possible adverse effects
- frost bite
- tissue death / ischemia / gangrene
- nerve damage
Documenting cold application
- area treated with cold
- type of cryotherapy application used
- treatment time
- pt position
- response to treatment
- skin integrity before and following removal
