EEI 10/9c Cryotherapy Flashcards
define cryotherapy
the removal of heat from a body part to decrease cellular metabolism, improve cellular survival, decrease pain and muscular spasm, and promote vsaoconstriction
what are examples of cryotherapy
- ice/cold gel pack
- ice massage
- vapo-coolant spray
- cold water immersion
- cryo-cuff/game ready(cold compression)
what are the indications of cryotherapy
- acute inflammation
- analgesic effects
- decrease muscle spasm/guarding
- delayed onset muscle soreness
- muscle disinhibition
why is cryotherapy important for acute inflammation?
- secondary cellular injury may occur if the swelling continues before the use of cryotherapy
- it helps with decreasing some inflammation
- it helps with decreasing some pain
why is it important to use cryotherapy for acute or chronic analgesic effects?
- the higher the rate of firing of pain receptors, the more pain.
- to decrease pain, ice can be used in addition to pain killers
physiology behind cryotherapy use
- anti-inflammatory benefits (vasoconstriction response)
- analgesic effect (gate theory of pain)
- relaxation of muscle spasm (inhibition of nerves/muscle spindles)
- muscle disinhibition (reverse muscle activation inhibition related to joint swelling)
importance of anti-inflammatory benefits of cryotherapy
vasoconstriction response decreases the ability of fluid to go to the area and decreases permeability to fluid
gate theory of pain
used for analgesic effects of cryotherapy
- if you have another stimulus in the area that your pain signal is coming from, you can slow down the pain signal with a similar stimulus
- pain signal is firing quickly, so you can decrease the nerve conduction velocity with the ice pack
importance of muscle disinhibition benefits with cryotherapy
- reverse muscle activation inhibition related to joint swelling/effusion
- swelling at knee has motor inhibition at certain muscles
decreasing muscle spasms with cryotherapy
muscle spindles that are associated with keeping muscles in a spastic state. You can use cryotherapy to try to decrease the spasms of the muscle fibers
edema vs effusion
effusion is at the joints
edema is within the ISF
how do we measure swelling?
- girth measurements
- volumeters
- sweep test
- pitting edema
what is a girth measurment?
- using a tape measure to measure swelling
- fair to high reliability
- figure 8 ankle measurement is the most common
what is the purpose of a volumeter?
- used a lot with hand therapists
- often used for patients who you want to monitor over time, more specific to distal extremities, don’t use with open wounds
- pros: good accuracy, good reliability
- cons: time consuming, limited to distal extremities
what is the sweep test?
- assessing swelling as you sweep across the area of swelling
- 0 no wave produced on downstroke
- trace is small wave on medial side with downstroke
- 1+ larger bulge no medial side with downstroke
- 2+ effusion returns to medial side after upstroke
- 3+ fluid cannot be moved out of medial knee
pitting edema test?
swelling where there is indentation that requires a rebound
- 0 no clinical edema
- 1 slight pitting (2mm depth), immediate rebound
- 2 somewhat deeper pit (3-4mm) <15s rebound
- 3 noticeably deep pit (5-6mm), up to 30 sec rebound
- 4 very deep pit (7-8mm), >20 sec rebound
methods of reducing swelling
- ice
- compression
- elevation
importance of compression
- decrease inflammatory cytokines
- decrease capillary leakage
- increase capillary flow
importance of elevation
gravity assisted fluid return
types of compression
- bandages and compression stockings
2. intermittent pneumatic compression
intermittent pneumatic compression
medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who suffer edema or the risk of deep vein thrombosis or pulmonary embolism
contraindications with using compression
- uncontrolled heart disease (CHF)
- arterial disease
- skin abnormalities (healing wounds, fragile skin)
- advanced peripheral neuropathy
compression bandages
Pros: additional anti-inflammatory benefits; inexpensive, re-usable
Cons: requires proper set up(education); time to apply (ACE wrap); may need to be re-applied with change in swelling
ACE wrapping principles
- pressure greater distally to proximally, to push swelling upward instead of downward
- no circumferential measurements (doesn’t guide the fluid in a specific movement)
- over-lap by 1/2 width
- secure with tape (no sharp pieces)
other measures of reducing swelling
- ICE: Ice, Compression, Elevation
- RICE: Rest, Ice, Compression, Elevation
- PRICE: Protection, Rest, Ice, Compression, Elevation
- POLICE: Protection, Optimal Loading, Ice, Compression, Elevation
cryotherapy and pain
- cryotherapy decreases pain because decreasing the temperature of the nerves associated with pain signalling can decrease the neural signalling and decrease the amount of perceived pain
- Gate control theory, neural signal coming from ice pack and from pain receptors, so there is only so much they can get past the CNS
Methods for pain control management
- intra-articular injections
- Regional nerve blocks
- IM/IV injections
- Oral medications
- Cryotherapy/compression
- Mobilization/weight-bearing
Cryotherapy and RCT
cryotherapy reduced pain post op for ACL reconstruction. 6/10 decreased pain with cryotherapy
- when cryotherapy used with compression, cryotherapy only was better
- no adverse effects in the study**
- low risk
- decrease in pain medication intake!
cryotherapy used to decrease muscle inhibition
- effusion in knee joint can decrease the effects of the quad muscle activation
- used as a tactic to stimulate the muscle and allow for further healing
when would you not want to use cryotherapy?
Contraindications:
- Cold urticaria (allergies)
- raynauld’s disease
- cryoglobulinemia
- paroxysmal cold hemoglobinuria
- impaired circulation (peripheral vascular disease and blood clot)
- open wounds
Precautions:
- sensory deficits
- hypertension
- elderly patients
- rheumatoid conditions
raynauld’s disease
cold fingers/toes
color changes in skin in response to cold or stress
Numb, prickly feeling or stinging pain upon warming or stress relief.
whitening in response to temperature change
cryoglobulinemia
blood disorder that results in thickening of the blood from abnormal proteins associated with blood anemia or myeloma
paroxysmal cold hemoglobinuria
blood disorder that results in antibodies attacking RBCs a result of going from cold to warm temps
methods for energy transfer
- radiation: infrared waves, no physical contact (microwave/short diathermy)
- conduction: two objects in contact (distinct temp difference)
- convection: more rapid; medium moves across the body leading to temperature variations (water or air/whirlpool)
- conversion: change of another energy form into heat (ultrasound using sound wave to warm up tissue)
- evaporation: heat loss with transfer of liquid to gaseous state (vapor cooling spray)
types of cryotherapy
- Ice Packs
- ice massage
- ice and compression
- water immersion
- contrast bath
- vapo-coolant spray
ice packs as a means of cryotherapy
- typically 10-20 minutes, frequency is TBD
- not directly on skin
- long enough for desired cooling effects
- pros: inexpensive
- cons: frost bite, blistering
Ice and compression
- cryo-cuffs/game ready, intermittent compression units
- cold water flow creating therapeutic effects
- offers compression; less risk of frostbite
- requires more expensive equipment, more difficult set up, little carryover to home
ice massage
- frozen water cup rubbed over localized area in circular motions
- 5-10 minutes
- used on muscle bellies, tendons, bursa, and trigger points
- inexpensive, good carry over to home
- superficial use (not for deep structures)
water immersion
- used for distal edema and pain relief
- 10-20 minutes
- longer cooling temperature after removal
contrast bath
- alternates cold/hot temps
- vasoconstriction/vasodilation alternating effects
- variable ratios reported between cold/hot temperatures
vapo-coolant spray
- fluoromethane cools skin prior to muscle stretching
- ROM trigger point: muscle passively stretched (spray 2-3 times; trigger point, myofascial pain)
stages of cryotherapy
- cold
- pain, stinging, burning
- aching, burning discomfort 4. numbness
