CRYOTHERAPY 2.pdf

CRYOTHERAPY PART 2 General Intervention Methods Academic Year 2023-2024 Degree in Physical Therapy USP-CEU SCHEME INDICATIONS, PRECAUTIONS, CONTRAINDICATIONS, ADVERSE EFFECTS APPLICATIONS 2 OPTIMAL DOSE ????? TIMING: Less time in small areas with minimal fat and muscle: 3-5 min vs larger and deeper...

CRYOTHERAPY PART 2 General Intervention Methods Academic Year 2023-2024 Degree in Physical Therapy USP-CEU SCHEME INDICATIONS, PRECAUTIONS, CONTRAINDICATIONS, ADVERSE EFFECTS APPLICATIONS 2 OPTIMAL DOSE ????? TIMING: Less time in small areas with minimal fat and muscle: 3-5 min vs larger and deeper tissues: 20 min APPLICATION: Intermitent icing (10 min on: 10 min off) more effective for managemet of acute inflammation than icing 20 consecutive min. AIM: Cooling to reduce pain less intense (ice pack) and shorter (5 min). Cooling to reduce metabolism more intense cooling (ice bath or ice cubes on a towel) for longer durations (10-15 min) Most to least intense cooling: ice water immersion, crushed ice, frozen peas and cold gel packs. INSULATION 3 INDICATIONS Acute/subacute traumatic and postsurgical injuries. Pain Muscle Spasms Spasticity disorders Burns 4 PRECAUTIONS Over the superficial main branch of a nerve Over an open wound Hypertension Patients with poor sensation/mentation Very young/old patients Complex regional syndrome 5 NEUROPATHY CAUSED BY COLD EXPOSITION 6 CONTRAINDICATIONS COLD URTICARIA: Vascular skin reaction appearance of smooth, slightly elevated patches, which are redder or paler than the surrounding skin and are often attended by severe itching. 7 CONTRAINDICATIONS COLD INTOLERANCE: Severe pain, numbness and colour changes in response to cold (in some types of rheumatic diseases or following severe accidental or surgical trauma to the digits). PAROXYSMAL COLD HEMOGLOBINURIA: Release of hemoglobin in the urine from lysed red blood cells in response to local or general exposure to cold. 8 CONTRAINDICATIONS RAYNAUD’S DISEASE RAYNAUD’S PHENOMENON Primary or idiopathic form of paroxysmal digital cyanosis. Paroxysmal digital cyanosis Only in the cooled extremity Bilateral and symmetric Young women Sudden pallor and cyanosis followed by redness of the skin of the digits due to cold or emotional upset and relieved by warmth. 9 ADVERSE EFFECTS Tissue death Frostbite Nerve damage Unwanted vasodilation 10 APPLICATION TECHNIQUES ICE BAGS/PACKS GEL COLD PACKS CHEMICAL COLD PACKS CRYOMASSAGE CRYOKINETICS CRYOSTRETCH SPRAY AND STRETCH 11 ICE PACKS / BAGS More cooling that cold packs More insulation needed For 20’ they reduce intramuscular temperature 3-5ºC. Acute injuries: cold with limb in a raised position with an elastic bandage. 12 GEL COLD PACKS Filled with a gel of silica or a mixture of saline and gelatin covered with vinyl. Various sizes and shapes. Flat surfaces, using a towel Never attach a cold pack directly. Intermitent application 10’ + 10’ rest better than 20’ in pain reduction (MacAuley et al.2006) 13 INSTANT CHEMICAL COLD PACKS Filled with 2 bags, one with water inside other with ammonium nitrate, calcium ammonium nitrate or urea. A portable source of cold. Used once. If the liquid leaks, it can burn the skin! 14 ICE MASSAGE-CRYOMASSAGE A plastic bag filled with ice and air. Soap applied generously over the treatment area. The bag will be pierced several times and will be applied vigorously by sliding the bag over the area being treated in a longitudinal direction, with circular movements for 3-4 minutes. Total time: 10 minutes. 15 CRYOKINETICS METHOD Combination of 5 cold applications followed by a session of graded and progressive, active exercises of 3’ duration. Durations of cold application: 20 minutes for the initial numbing 5 minutes for each of the next four renumbings, with each bout of active exercises 16 CRYOSTRETCH METHOD Combination of 3 cold applications to the level of numbness followed by a bout of mixed passivestretch and isometric contractions Durations of application: 20 minutes for the initial numbing 5 minutes for each of the next two renumbing periods. 17 SPRAY AND STRETCH Technique used as a stand alone modality or with other hands-on techniques. Vapocoolant acts as counterirritant to myofascial pain a It is a ‘no pain’ treatment. Mechanism based on the Gate Control Theory 18 GATE CONTROL THEORY Afferent pain-receptive nerves are comprised of: a fast, relatively thick, myelinated “Aδ” fiber that carries messages quickly with intense pain a small, unmyelinated, slow "C" fiber that carries the longer-term throbbing and chronic pain. Activation nonnociceptive fibers can interfere with signals from pain fibers, inhibiting pain. The large-diameter A β fibers are nonnociceptive (do not transmit pain stimuli) and inhibit the effects of firing by A delta and C fibers. 19 SPRAY AND STRETCH Patient placed in a position to stretch the muscle and apply parallel sweeps of spray over the muscle and its referred pain using new muscular slacks. 20 SPRAY AND STRETCH Spray applied at an angle of 30º and a distance of 45 cm Use one hand to spray and the other to stretch. Contraindications: Acute tendinopathy, muscle traumatisms, hypermobility and articular instability. 21 OTHER METHODS Frozen wet towels Cold water: cold baths and showers Cold whirlpool Cryopressure units. 22 CRYOCHAMBERS 23 CRYOCHAMBERS 3-5’ Shorten recovery time -140º-180 ºC Enhance sport perfomance Protection of certain body parts. Air still and dry. Pain relief Strengthens collagen No metals. 24 EFFECTS OF CRYOTHERAPY/THERMOTHERAPY EFFECT CRYOTHERAPY THERMOTHERAPY Pain - - Muscle spasm - - Blood flow - + Edema formation - + Nerve Velocity - + Metabolic rate - + Collagen extensibility - + Joint Stiffness + - Spasticity - 0 Conduction -: decreases; +: increases; 0: no effect 25 BIBLIOGRAPHY Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. British Journal Sports Medicine 2020, 54:72-73. Hawkins HW, Hawkins JR. Clinical applications of cryotherapy among sports physical therapists. IJSPT 2016; 11(1): 141 Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. American Journal of Sports Medicine 2004; 32(1): 251-261 Hoens A, Paul M. Cryotherapy evidence informed practice, 2013. Freire B et al. Effects of cryotherapy methods on circulatory, metabolic, inflammatory and neural properties: a systematic review. Fisioter. Mov., Curitiba, 2016; 29(2):389-398. Cameron MH. Physical Agents in Rehabilitation: From Research to Practice. Elsevier, 2012. Bélanger AY. Evidence-Based Guide to Therapetic Physical Agents. Elsevier Churchill Livingstone 2.002. 26