Cryotherapy PDF

Cryotherap y Cryotherapy or ice therapy is the application of cold to the body tissues after injury. This practice is as old as medicine itself.  Equipments for Cryotherapy Cold Packs Ice packs Ice cups(Cryocup, Styrofoam Cup or Paper cup) or frozen water popsicles Vapocoolant Spray Control...

Cryotherap y Cryotherapy or ice therapy is the application of cold to the body tissues after injury. This practice is as old as medicine itself.  Equipments for Cryotherapy Cold Packs Ice packs Ice cups(Cryocup, Styrofoam Cup or Paper cup) or frozen water popsicles Vapocoolant Spray Controlled cold compression units Cold whirlpool Ice whirlpool  Physiological Effects of Cold Application Circulatory Response The initial skin reaction to cooling is an attempt to preserve heat. It is accomplished by an initial vasoconstriction. This haemostatic response has the effect of cooling of  Continue...... period of time, the duration After a short depends on the area involved, a vasodilatation follows with alternating periods of constriction and dilatation. This reaction of "hunting" for a mean point of circulation is called "Lewis's Hunting Reaction".  Continue....... the vasodilatation, the During arteriovenous anastomosis is closed, thus causing an increase blood flow through the capillaries. This is beneficial in the treatment of swelling and tissue damage.  THERAPEUTIC EFFECT reductions in pain blood flow edema inflammation muscle spasm metabolic demand  INDICATIONS Acute soft tissue injuries (e.g., ankle sprain, muscular strain, ligament sprain) Muscle spasm Tendiniti Acute swelling Bursitis Post orthopaedic surgery Reducing temperature CONTRAINDICATIONS  CRPS  Hypersensitivity to cold  Haemoglobinuria  Skin anesthesia  Cryoglobulinemia  Over a regenerating  Peripheral peripheral nerve  Open wounds vascular disease  Raynaud’s disease  Urticaria  Procedures/Techniques Ice massage Quick Icing Ice Immersion Contrast baths Cryostretch  Guidelines for Cryotherapy Procedures Choices Depends on Accessibility Body part to be treated Size of treatment area  Cold Packs Cold packs are usually filled with a gel composed of silica or a mixture of saline and gelatin and are usually covered with vinyl. The temperature of a cold pack is maintained by storing it in a specialized cooling unit or in a freezer at -5o C (23o F). Cold packs should be cooled for at least 30 minutes between uses and for 2 hours or longer before initial use Patients can use plastic bags of frozen vegetables  TECHNIQUES OF APPLICATION Either a commercial available gel pack kept in a freezer at 8°C can be used, or fill a plastic bag full of ice and a little water Treatment time: 15-20 minutes. Wait at least 60- minutes before reapplying. Mode of heat transfer: Conduction Penetration: 1/2 inch Application Procedure: Step 1: Dampen a towel and wrap cold pack in it (1 layer, allows even and more efficient conduction of cold Step 2: Place on treatment area  Ice Packs Ice packs consist of a crushed ice placed in a plastic bag or folded in a moist towel.  Procedure Wrap cold pack in wet towel. Warn the patient that you are going to put the cold pack on the body part to be treated then do so. Set a timer for the appropriate treatment time (generally about 20 minutes), and give the patient a signaling device. Make sure the patient understands how to use the signaling device. Check the patient’s response verbally after the first 2 minutes, then about every 5 minutes. Perform a visual check of the area if the patient reports any unusual sensation. If wheals or welts appear, if the skin color changes to absolute white within the first 4 minutes of treatment stop the treatment. Ice Massage Directly ice is used for cryotherapy Styrofoam cups, paper cup, cryocup (Commercial) or Ice cups or frozen water popsicles can be used to apply ice massage Frozen ice cups are made by freezing small paper or  Styrofoam A regularcups 6- to 8-ounce styrofoam cup should be filled with water and placed in the freezer. After it is frozen, all the styrofoam on the sides should be removed down to 1 inch from the bottom. A frozen cup of ice with a tongue depressor inserted is preferred because it has a handle with which Ice cups: A cup is filled with water, and a wooden tongue blade is placed in the cup. The cup is then placed in the freezer. After it is frozen the paper cup is torn off. A block of ice on a stick is now ready to be used for massage. Paper cups: Utilize the same technique as the Styrofoam cups, except toweling may be needed to insulate the therapist’s hand holding the paper cup. A Cryocup is a commercially available reusable plastic cup that is ideal for ice massage. To use these, the therapist holds on to the bottom of the cup and gradually peels back the edge to expose the surface of the ice and puts it in direct contact with the patient's skin. Ice massage to the lateral epicondyle with an “ice pop” wrapped in a paper Quick Icing Ice massage can also be used as a stimulus for facilitating the production of desired motor patterns in patients with impaired motor control. When applied for this purpose the ice is either rubbed with pressure for 3 to 5 seconds or quickly stroked over the muscle  Quick Icing For local control of pain, inflammation,or edema Rub the ice over the treatment area using small, overlapping circles Wipe away any water as it melts on the skin Continue ice massage application for 5 to 10 minutes or until the patient experiences analgesia at the site of application  Controlled Cold Compression Unit units Controlled cold compression ultimately pump cold water and air into a sleeve that is wrapped around patient’s limb The temperature of the water can be set at between 10' and 25 'C (50' to 77 F) to provide cooling. Compression is applied by intermittent inflation of the sleeve Controlled cold compression units are most commonly used directly after surgery for the control of postoperative inflammation and edema. The application of cold with compression in this manner has been shown to be more effective than ice or compression alone in controlling swelling, pain, and blood loss after surgery and in assisting the patient in regaining  Wrap the sleeve around the area to be treated Elevate the area to be treated. Set the temperature at 10' to 15 'C (50' to 59 F). Cooling can be applied continuously or intermittently. For intermittent treatment apply cooling for 15 minutes every 2 hours. Cycling intermittent compression may be applied at all times when the area is  Ice Temp. 50° - Immersion 60 ° F Time 10-20 min. Indications Acute Injury or Inflam. Acute or Chronic Pain Post surgical pain  Vapocoolant spray Method of cooling the skin by the evaporation of a substance sprayed on the skin They do not provide adequate deep penetration Commonly used to reduce muscle spasm The primary action is reduction of pain spasm sequence secondary to direct Fluori-Methane or Ethyl Chloride Liquid begins to evaporate & continues to evaporate when contacts skin, thus cooling skin briefly Technique Expose area to be Rx’s Eyes should be protected Hold bottle in an inverted position at a 30 angle, 18 inches away at a rate of 4 inches(10 cm) per sec. Duration Spraying should not exceed 6 sec  Contrast Alternating cryotherapy and Therapy agents thermotherapy Results in vasoconstriction & vasodilation of blood vessels in the area Thought to be a “Pumping” action – stimulates venous & lymphatic return Effective transition from cold to hot therapy Use during subacute or chronic  Contrast Therapy Most effective treatment time hasn’t been determined Commonly used 3:1 or 4:1 ratio to equal 20 4:1 mins. 3:2 2:3 C:H C:H C:H Treatment may end in either hot or cold – Usually Ends in warm  Ice Towels Towels containing ice shavings Technique: Towels thoroughly soaked in water & ice mixture Towel squeeze out & applied to part; Procedure repeated every few min Duration: 10-15 min Advantages: Equipment required is available almost anywhere Disadvantages: Therapist must keep changing towels  COLD WHIRLPOOL The cold whirlpool is indicated in acute and subacute conditions in which the exercise of the injured 0o to 26o C (32o to 79o F) part during a cold treatment is desired. A whirlpool is composed of a tank that can hold water and a turbine that provides agitation and aeration in order to produce movement of the water in the tank. The tank is usually made of stainless steel, although fiber A cold whirlpool, at 0o to 26o C (32o to 79o F) should be used for the treatment of acute inflammatory conditions of the distal extremities. Low temperatures can be achieved by adding ice to the whirlpool water very low temperatures should not be used on large areas due to the increased risk of tissue damage  Cold Whirlpools Duration of Tx 15-20 minutes Contraindications Temp 50° - 60 ° F Acute conditions Indications where water Decreased ROM turbulence would Cryokinetics further irritate Subacute to chronic area inflammation Skin Conditions Peripheral nerve All other injuries (avoid contraindications extremes)