Cryotherapy: Therapeutic Use of Cold

• Physiotherapy involves using natural or artificial physical agents for therapeutic purposes in many countries.
• Physical agents include water, air, climate, altitude, heat, cold, rest, movement, exercise, massage, electricity, mechanical waves, and electromagnetic waves.
• Physiotherapists use these physical therapy techniques.
• In France and some French-speaking countries, the term "masseur-kinésithérapeute" is used.
• Physiotherapy in French means therapy using physical agents, excluding movement, exercise, massage, and manual techniques.
• French physiotherapy includes all physical agents aside from manual techniques, massage, and exercises.

Cryotherapy

• Cryotherapy is the therapeutic use of cold applied locally or systemically.
• Cold can be applied in liquid (cold water), solid (ice), or vapor (nitrogen) forms.
• There are three types of cold application: conduction (solid or liquid), convection (fluid such as cold blood), and sublimation (gaseous).
• Cryogenic sources vary from local applications to immersing body parts.

Physiology of Body Temperature Regulation

• Humans are homeothermic, maintaining an internal temperature around 37°C.
• Homeothermy is maintained by metabolic adaptation via the autonomic nervous system.
• Heat exchange occurs through four physical processes: radiation (IR), evaporation (sweat), conduction (direct contact), and convection (fluid).
• Adaptation to heat involves sudation and vasodilation to evacuate heat.
• Adaptation to cold involves thermal shivering and vasoconstriction to conserve heat.
• Cold and heat are transmitted through the body from the surface to deeper tissues via thermal tissue conduction or blood convection.
• Thermal tissue conduction passes through muscle, aponeurosis, and bone, but adipose tissue is a poor conductor.

Effects of Cryotherapy: Analgesic

• Sensitivity to pain decreases within 15 seconds.
• It is not the same as analgesia, which is a reduction in pain.
• The speed of nerve conduction slows down.
• The gate control effect transmits thermal messages instead of pain messages.
• The threshold of nociceptors elevates, which slows down chemical processes at free nerve endings.
• Anesthetic effects can last from 30 minutes to 3 hours post-application.

Anti-inflammatory Effects

• Arterial and capillary vasoconstriction stops inflammatory crises and limits edema.
• Secondary reflex vasodilation occurs after 15 minutes, aiding lymphatic drainage.
• Mediators of inflammation, such as prostaglandins and pro-inflammatory cytokines, decrease.
• Anti-inflammatory cytokines increase.
• The vasoconstriction-vasodilation phenomenon is a defense mechanism called the Hunting response which reduces cold's action and avoids skin lesions.

Neuromuscular Effects

• Recovery improves by accelerating lactic acid elimination through vasoconstriction.
• Spasticity diminishes, useful for multiple sclerosis.
• Local muscular strength decreases.
• Muscular endurance improves by increasing contraction duration.
• Endorphins and serotonins release due to autonomic nervous system activity.

Best Practices

• Generate a thermal shock by intensely and rapidly decreasing skin temperature.
• Decrease skin temperature to below 15°C, without falling under 7°C to avoid nerve damage.
• Rapidly reduce skin temperature in seconds.
• Apply ice packs or cold compresses for 20 minutes.
• Use at least three times a day after a trauma.

Techniques for Local Applications

• For an ice pack, add some water with the ice to apply pressure and to have a good surface.
• Allow 10 minutes for skin temperature to reach 15 degrees.
• Best time to apply is 20-25 minutes with the addition of a humid cloth to add better diffusion.
• Apply crushed ice directly on the region for 20 minutes.
• The skin temperature will reach about 10°C and the underlying temperature will reach about 30°C.
• Use a refrigerant pack with unscented crystals that retains moisture.
• Frozen peas are ineffective as they heat up too quickly.
• Apply sweeping movements with an ice cube to treat region.
• This lowers skin temperature to around 15°C.
• Use a spray made with butane and mint essences at -20 degrees.
• Spray at a distance with sweeping motions at 10-15 cm and for 3-6 minutes for short term pain relief
• The skin temperature would be around 28-30 degrees.
• Do not linger over the area or you could burn the area and create skin lesions.
• Nozzle cryotherapy uses gas impulses at -30°C or -60°C.
• Be sure to regulate the distance for the skin temperature to remain consistent.
• Compressive cryotherapy involves a compressive sleeve with air and low temperature waters that gradually provide compression.
• Effective for reducing edema and recovery.
• A compressive cold splint is effective in reducing and recovering from edema.

Cryotherapy for immersion

• Can apply a cold water immersion from 4-16°C for 10 minutes
• Alternate the hot and cold bathwater every rotation for 14 minutes.
• The cold water should be at 10-15°C and the hot bath should be at 38-40°C.
• It allows an alternating vasoconstriction and vasodilation called vaso-pumping.

Cryotherapy for Whole Body

• Cabins used for individual cryotherapy cool to -180 degrees using nitrogen.
• The body is not cooled evenly.
• Freeze whole body during -110 to -140°C for 3 minutes.
• Most effective for treating chronic rheumatic pains.

Indications

• Calming pain and reducing pain during acute and post-operative procedures.
• For treatment during rheumatic flare-ups.
• Helpful for sports to improve recovery.
• Helpful to lower spasticity during neurological conditions.

Contraindications

• Forbidden to use during vascular conditions like arterial hypertension, cardiopathy, recent heart attacks, and artioriopathy.
• The device, such as peacemakers, implantable defibrillaters and insulin pumps, are beneath the skin
• Do not use during venous thromboembolic disease such as phlebitis and pulmonary embolism
• Do not use, if there a chronic respiratory insufficiency
• Do not use, if you have allergies to cold like urticaria
• Do not use, if you have raynaud's syndrome.
• Use with caution if you have problems with cutaneous sensitivity, the risk can burn the skin due to the lack of sensation.

Protocols

• Protocol with or without the RICE obsolete format.
• The modern protocol has not been scientifically proven, but it follows POLICE
• First, protect the area and use an orthesis or splint.
• It encourages the body to return to normal activity
• Vasoconstriction for the use of ice limits recovery
• Compress during the ice phase to promote reflex recovery
• Elevate the area to help lymphatic fluid drainage
• Do not use it on athletes because it is needed as a first step.

Conclusion

• For best results, use at 15°C
• If someone has had post-op minimum of times a day for 20 days for 5 days.
• Better to use ice in a clean towel, instead of one made out of gel.
• Helpful with the recovery
• Whole-Body Cryotherapy works for chronic rheumatic conditions.