Principles and Practices of Principles and Practices of CryotherapyCryotherapy

National Fitness CenterNational Fitness CenterLee Young MiLee Young Mi

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What is Cryotherapy?What is Cryotherapy?

• Cryotheapy is applied of cold to remove heat froCryotheapy is applied of cold to remove heat from the body.m the body.

• Cryotherapy is one of the superficial heat therapiCryotherapy is one of the superficial heat therapies. Usually its physiological effects are more proles. Usually its physiological effects are more prolonged than superficial heat therapy of same inteonged than superficial heat therapy of same intensity.nsity.

• Cryotherapy is used various fields of musculoskelCryotherapy is used various fields of musculoskeletal injury such as muscle spasm, pain, early artetal injury such as muscle spasm, pain, early arthritis, and burn etc.hritis, and burn etc.

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Review of ResearchReview of Research

• Harris E & McCroskery PA(1974) : The influHarris E & McCroskery PA(1974) : The influence of temperature and fibril stability on dence of temperature and fibril stability on degradation of cartilage collagen by rheumategradation of cartilage collagen by rheumatoid synovial collagenase. N Engl J Med 29oid synovial collagenase. N Engl J Med 290:1-6.0:1-6.

- collagenase activity significantly - collagenase activity significantly decrease below 30-35°C.decrease below 30-35°C.

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Review of ResearchReview of Research

• Wrigh V & Johnson RJ (1960): Physical factWrigh V & Johnson RJ (1960): Physical factors concerned with the stiffness of normal ors concerned with the stiffness of normal and diseased joints. Bull Johns Hopkins Hand diseased joints. Bull Johns Hopkins Hosp 106:215-231.osp 106:215-231.

-joint stiffness was increased by -joint stiffness was increased by cryotherapy whereas was decreasedcryotherapy whereas was decreased by thermotherapyby thermotherapy

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Review of ResearchReview of Research• Konrath, G.A.,Lock, T.,Goittz, H.T.,& Scheidler, J.(1996).TKonrath, G.A.,Lock, T.,Goittz, H.T.,& Scheidler, J.(1996).T

he use of cold therapy after ant. Cruciate ligament reconshe use of cold therapy after ant. Cruciate ligament reconstruction The American Journal of Sports Medicine,24(5),truction The American Journal of Sports Medicine,24(5),629-633.629-633.

-non-significant-non-significant Chon, B.T., Draeger, R.I., & Jackson, D.W.(1989). The effChon, B.T., Draeger, R.I., & Jackson, D.W.(1989). The eff

ects of cold therapy in the postoperative management of ects of cold therapy in the postoperative management of pain in patients undergoing ant. Cruciate ligament reconspain in patients undergoing ant. Cruciate ligament reconstruction. The American Journal of Sports Medicine, 17,3truction. The American Journal of Sports Medicine, 17,344-349.44-349.

-significant-significant

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Physics Related to Cryotherapy EnerPhysics Related to Cryotherapy Energy Transmissiongy Transmission

• Conduction : removal of heat from Conduction : removal of heat from warmer object to cooler object warmer object to cooler object through direct molecular interaction through direct molecular interaction of objects in physical contactof objects in physical contact

- conductive modalities : cold - conductive modalities : cold pack, pack,

ice pack, ice massage, cold ice pack, ice massage, cold bath.bath.

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Physics Related to Cryotherapy EnerPhysics Related to Cryotherapy Energy Transmissiongy Transmission

• Evaporation (heat of vaporation) : highly volEvaporation (heat of vaporation) : highly volatile liquids that evaporate rapidly on contaatile liquids that evaporate rapidly on contact with warm object.ct with warm object.

--Vaporation modalities : vapocoolant Vaporation modalities : vapocoolant sprays, machine.sprays, machine. * Continued use questionable due to * Continued use questionable due to environmental concerns. environmental concerns.

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Physics Related to Cryotherapy EnerPhysics Related to Cryotherapy Energy Transmissiongy Transmission

• Heat of Fusion : the amount of heat Heat of Fusion : the amount of heat given off when a liquid turns into a given off when a liquid turns into a solid form as it cools. solid form as it cools.

Modality : paraffin bath Modality : paraffin bath

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Physiological Effects of Physiological Effects of General Cold ApplicationGeneral Cold Application

• Large body surface Large body surface area exposed to area exposed to cold modality ; e.g. cold modality ; e.g. Whirlpool and Whirlpool and therapeutic pooltherapeutic pool

DECREASED DECREASED INCREASEDINCREASED

Metabolic rateMetabolic rate

Pulse ratePulse rate

Respiratory Respiratory raterate

Venous blood Venous blood

pressurepressure

Blood flow to inBlood flow to internal organternal organCardiac outputCardiac outputStroke volumeStroke volumeAtrial blood preAtrial blood pressure ssure Shivering(occurShivering(occurs when core tes when core temperature dropmperature drops)s)

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Physiological Effects of Physiological Effects of Local Cold ApplicationLocal Cold Application• Body tissue responses to cold:Body tissue responses to cold: a. Skin temperature falls rapidly anda. Skin temperature falls rapidly and exhibits greatest temperature change.exhibits greatest temperature change. b. Subcutaneous temperature falls less b. Subcutaneous temperature falls less rapidly and displays smaller rapidly and displays smaller temperature change.temperature change. c. Muscle and joint shows least c. Muscle and joint shows least

temperature temperature change, requiring longer cold exposure.change, requiring longer cold exposure.

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Physiological Effects of Physiological Effects of Local Cold ApplicationLocal Cold Application

• Hunting reaction : cyclic construction Hunting reaction : cyclic construction and dilation of blood vessels following proland dilation of blood vessels following prol

onged cold exposure. Occurs mostly in apionged cold exposure. Occurs mostly in apical areas(hands, face, ears, cal areas(hands, face, ears,

feet) where arteriovenous anastomoses feet) where arteriovenous anastomoses are found in the skinare found in the skin

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Physiological Effects of Physiological Effects of Local Cold ApplicationLocal Cold Application

• Vasocontriction of skin capillaries resulting Vasocontriction of skin capillaries resulting in blanching of skin in center of contact arein blanching of skin in center of contact area and hyperemia due to histamine reactioa and hyperemia due to histamine reaction, around the edge of contact area in normn, around the edge of contact area in normal tissue.al tissue.

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Physiological Effects of Physiological Effects of Local Cold ApplicationLocal Cold Application• Physiological responses of body systems Physiological responses of body systems

and structures to local cold applicationand structures to local cold application

DECREASEDDECREASED INCREASEDINCREASEDBlood flowBlood flowCapillary permeabilityCapillary permeabilityElasticity of nonelastic tissuesElasticity of nonelastic tissuesMetabolismMetabolismMuscle spasmMuscle spasmMuscle strength(long duration:Muscle strength(long duration:>5-10min)>5-10min)SpasticitySpasticityVasoactive agentsVasoactive agents

Joint stiffnessJoint stiffnessPain thresholdPain thresholdIncreased blood viscocityIncreased blood viscocityMuscle strength(short duration:Muscle strength(short duration:1-5min)1-5min)

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Adverse physiological effects Adverse physiological effects of cold due to hypersensitivityof cold due to hypersensitivity

• Cold urticaria : errythema of the skin with Cold urticaria : errythema of the skin with wheal formation associated with severe itcwheal formation associated with severe itching due to histamine reactionhing due to histamine reaction

• Facial flush, puffiness of eyelids, respiratorFacial flush, puffiness of eyelids, respiratory problems and in severe cases, anaphylaxy problems and in severe cases, anaphylaxis(decreased blood pressure, increased heis(decreased blood pressure, increased heart rate) with syncope are also related to hiart rate) with syncope are also related to histamine release.stamine release.

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General Indications for CryotherapyGeneral Indications for Cryotherapy

• Acute and chronic traumatic and Acute and chronic traumatic and inflammatory conditionsinflammatory conditions

• EdemaEdema

• Muscle spasmMuscle spasm

• Musculoskeletal pain, and thermal Musculoskeletal pain, and thermal burnsburns

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General Contraindications for CryothGeneral Contraindications for Cryotherapyerapy

• Impaired circulationImpaired circulation• Impaired sensationImpaired sensation• Peripheral vascular diseasePeripheral vascular disease• Prolonged application over superficial nervProlonged application over superficial nerv

es could result in neuropraxiaes could result in neuropraxia• Raynaud’s disease, sensitivity or allergic reRaynaud’s disease, sensitivity or allergic re

action to coldaction to cold

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CooCooling ling Physical AgentsPhysical Agents

Cold packsCold packs

DescriptionDescription : : vinyl casing filled with silica gel or sand-slurry vinyl casing filled with silica gel or sand-slurry mixture.mixture.

Method of application :Method of application :(1)Keep the patient warm throughout treatment.(1)Keep the patient warm throughout treatment.

(2)Dampen a towel with warm water, wring out excessive (2)Dampen a towel with warm water, wring out excessive water, fold in half, width-wise and place cold pack on towel.water, fold in half, width-wise and place cold pack on towel.

(3)Place pack on patient and cover with dry towel to retard (3)Place pack on patient and cover with dry towel to retard warmingwarming

(4)Secure pack(4)Secure pack

Treatment temperature and Time :Treatment temperature and Time :0°-10°F, 10-20min0°-10°F, 10-20min

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CooCooling ling Physical AgentsPhysical Agents

Ice packsIce packs

DescriptionDescription : : crushed ice folded in moist towel or placed crushed ice folded in moist towel or placed in plastic bag covered by moist towel in plastic bag covered by moist towel

Method of application :Method of application :(1)Apply the ice pack to body part(1)Apply the ice pack to body part

(2)Cover pack with dry towel (2)Cover pack with dry towel

Treatment time : Treatment time : 10-20min10-20min

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CooCooling ling Physical AgentsPhysical AgentsIce towelIce towel

DescriptionDescription : : towels soaked in ice slush. Water is added towels soaked in ice slush. Water is added to shaved ice to produce an ice slush.to shaved ice to produce an ice slush.

Method of application :Method of application :(1)Immerse two towels in slush, wring one out and apply to (1)Immerse two towels in slush, wring one out and apply to body part.body part.

(2)Secure towel manually(2)Secure towel manually

(3)Exchange towels when applied towel warms up, usually in (3)Exchange towels when applied towel warms up, usually in 45-60 seconds.45-60 seconds.

(4)Repeat procedure to reach or maintain effect.(4)Repeat procedure to reach or maintain effect.

Treatment time : Treatment time : 10-15min10-15min

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CooCooling ling Physical AgentsPhysical AgentsIce massageIce massage

DescriptionDescription : : ice cylinder formed by freezing water in a paper cup, styrofoaice cylinder formed by freezing water in a paper cup, styrofoam cup or juice can. m cup or juice can.

Method of application :Method of application :(1)Remove ice from container.(1)Remove ice from container.(2)Apply the ice massage to an area no larger then (2)Apply the ice massage to an area no larger then 4”4”x 6” slow (2”/sec) overlx 6” slow (2”/sec) overlapping longitudinal strokes, each sstroke covering one-half of previous circlapping longitudinal strokes, each sstroke covering one-half of previous circle or stroke. If treating a large area, divide into smaller areas. e or stroke. If treating a large area, divide into smaller areas.

(3)DO not massage over boney area or superficial nerves e.g.peroneal.(3)DO not massage over boney area or superficial nerves e.g.peroneal.

(4)Use a towel to dab excess water from treatment area. Ice will melt rapidly (4)Use a towel to dab excess water from treatment area. Ice will melt rapidly initially, but rate of melting will slow as skin cools.initially, but rate of melting will slow as skin cools.

(5)Continue treatment until anesthesia is achieved.(5)Continue treatment until anesthesia is achieved.

Treatment time : Treatment time : 5-10min5-10min

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Cooling Physical AgentsCooling Physical Agents

Vaporcoolant sprayVaporcoolant sprayDescriptionDescription : : a non-toxic, non-flammanble volatile liquid which produces rapia non-toxic, non-flammanble volatile liquid which produces rapi

d cooling when a fine spray is applied to the skin.d cooling when a fine spray is applied to the skin.Vaporcoolant sprays are primarily used to reduce muscle spasm, desensitizing Vaporcoolant sprays are primarily used to reduce muscle spasm, desensitizing

trigger points.trigger points.

Method of application : Method of application : spray and stretch methodspray and stretch method(1)(1) Invert container, nozzle down, hold about 18”-24” from treatment area.Invert container, nozzle down, hold about 18”-24” from treatment area.(2)(2) Spray at 30° angle and sweep spray over treatment at 4”/sec.Spray at 30° angle and sweep spray over treatment at 4”/sec.(3)(3) Allow liquid to completely evaporate before applying next sweep. Caution! Allow liquid to completely evaporate before applying next sweep. Caution!

Do not frost skin.Do not frost skin.(4)(4) The muscle should be passively stretched before and during applicationThe muscle should be passively stretched before and during application(5)(5) Cover the entire treatment area, starting at the pain site and moving to the Cover the entire treatment area, starting at the pain site and moving to the

area of referred pain.area of referred pain.(6)(6) Having patient perform active exercise after sprayingHaving patient perform active exercise after spraying

Treatment time : Treatment time : 10-15min10-15min

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CooCooling ling Physical AgentsPhysical AgentsContrast bathContrast bath

DescriptionDescription : : the alternating immersion of a body in warm and cold wthe alternating immersion of a body in warm and cold water to produce a vascular exercise through active vasodilation and ater to produce a vascular exercise through active vasodilation and vasoconstraction of the blood vessels.vasoconstraction of the blood vessels.

Method of application :Method of application :(1)(1) The treatment usually begins in warm water. The treatment usually begins in warm water. (2)(2) Place part in the warm water for 6-10min, then transfer to cold watPlace part in the warm water for 6-10min, then transfer to cold wat

er for 1min.er for 1min.(3)(3) Immerse part in warm water for 4min.Immerse part in warm water for 4min.(4)(4) Continue sequence of 4:1. End in warm water. Other warm/cold ratContinue sequence of 4:1. End in warm water. Other warm/cold rat

ios may be used depending on patient tolerance.ios may be used depending on patient tolerance.(5)(5) The condition treated may determine the ending temperature. EndiThe condition treated may determine the ending temperature. Endi

ng in cold water may be more beneficial if treating edema.ng in cold water may be more beneficial if treating edema.

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Contrast bathContrast bathTreatment temperature and Time :Treatment temperature and Time :(1)(1) Hot water:100°F-100°FHot water:100°F-100°F

(2)(2) Cold water:55F°-65°FCold water:55F°-65°F

(3)(3) During initial treatment you may wish to begin with the During initial treatment you may wish to begin with the upper end of the cold range and lower end of the warm upper end of the cold range and lower end of the warm range.range.

(4)(4) Time:20-30min.Time:20-30min.

Indications:Indications: any condition requiring stimulation of any condition requiring stimulation of peripheral circulation in limbs, peripheral vascular peripheral circulation in limbs, peripheral vascular disease, sprains, strains, and trauma (after first few disease, sprains, strains, and trauma (after first few hours).hours).

Contraindications: Contraindications: advanced arteriosclerosis, arterial advanced arteriosclerosis, arterial insufficiency, loss of sensation to heat and cold.insufficiency, loss of sensation to heat and cold.

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Crykinetics Crykinetics

• Combination of : cold application & active exercisCombination of : cold application & active exercisee

• MethodMethod Apply ice until tissue is numb(20min)Apply ice until tissue is numb(20min) Exercise within limits of pain(3 t0 5min)Exercise within limits of pain(3 t0 5min) Renumb with ice(5min)Renumb with ice(5min) Exercise within limits of pain(3 to 5min)Exercise within limits of pain(3 to 5min) Renumb with iceRenumb with ice Pain is limiting factor for exercisePain is limiting factor for exercise Exercise should be deliberate and controlledExercise should be deliberate and controlled

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