Ben, Trina, Jake, Levi

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OBJECTIVESHistoryCharacteristicsMethods of CryotherapyEvidence Based ResearchReview QuestionsReferences

HISTORYThe Egyptians used cold to treat injuries and inflammation as

early as 2500 BC. Ancient Greeks and Romans used cold applications of snow

and natural ice to treat a variety of medical problems. Many books and articles were written about

cryotherapy in the early 19th century. By 1835 the application of cold compresses to inflammed wounds was a common treatment option. The first commercially viable ice machine was patent- -ed in 1850 by a Florida physicianBetween 1845 and 1851, Dr. James Arnott of Brighton, England described the benefits of local cold application in

the treatment of numerous conditions, including headaches and neuralgia.

HISTORYBy 1881, cold compresses were a recognized addition to

treatment after surgery. But in the 1930s, the common treatment for acute injuries

was hot compresses combined with soap suds or epsom salts. Medicine books began advocating cold treatments again for

acute injuries by the 1940s. In the early 1960s, athletic trainers were arguing the benefits

of heat vs. cold applications for initial treatments of athletic injuries.

Cold was almost used universally by sports medicine practitioners for immediate care by the 1970s.

Beginning in the 1980s through the 21st century, great efforts have been made to expand the theoretical basis for the use of cold applications in acute injury management.

CHARACTERISTICS Physiological Affects1. Decreases local tissue

temperature2. Decreases metabolic activity3. Decreases nerve conduction

velocity4. Causes vasodialation5. Decreases leukocytes6. Decreases cell permeability7. Decreases lymphatic and

venous drainage8. Decreases muscle spindle

depolarization9. Decreased muscular force

production

Therapeutic Effects1. Decreases perception of pain

(analgesic)2. Slows the acute

inflammation process and limits edema formation.

3. Decreases muscle spasms.

Types of CryotherapyWhirlpoolIce massageCold Compression Therapy UnitIce packs

WhirlpoolMethods of applicationIndicationsContraindicationsPrecautionsRecommendations for useProper use of agent

Methods of Application• Whirlpools are effective for treating large irregular shaped areas.• Patient submerges whole body or body part in the whirlpool after having turned on the turbine. • Once treatment is over, patients will then remove self from the whirlpool, dry off, then turn off the turbine.

• The whirlpool must be plugged into a GFI to prevent electrical surges.• Water temperature will be set at 50-60 degrees or 65-80 degrees for full body emersion.

INDICATIONSLarge irregular areasMuscle atrophyMuscle soreness

CONTRAINDICATIONSOpen woundsCirculatory insufficiencyCold allergyCardiac or respiratory problems

PRECAUTIONS

RECOMMENDATIONS FOR USE

PROPER USE OF AGENT

ICE MASSAGEMethods of applicationIndicationsContraindicationsPrecautionsRecommendations for useProper use of agent

METHODS OF APPLICATIONUsed to deliver cold treatments to small,

evenly shaped areas.Used in cases involving muscle spasm,

contusions, and other minor injuries limited to a well-localized area.

The patient may be able to administer self-treatment either at a clinical setting or as part of a home treatment program.

INDICATIONSSubacute injury or inflammationMuscle strainsContusionsAcute or chronic pain

CONTRAINDICATIONSCases in which pressure on the injury is

contraindicated.Suspected fracturesUncovered open woundsCirculatory insufficiencyCold allergy and/or hypersensitivityAnesthetized skin

PRECAUTIONSIn some injuries, the pressure of the massage

may be contraindicated.

RECOMMENDATIONS FOR USEMost effective for injuries involving muscle

spasm, contusions, and other minor injuries limited to a small localized area.

This method of cold application is convenient, practical, and time efficient, providing cold treatments in situations in which there is no ready access to an ice machine.

PROPER USE OF AGENTPlace patient in position of comfort, elevate if

necessaryTear the cup from the bottom or topRub hand over the top of the blockInform patient you are applying the agentApply using circular or longitudinal strokes,

moving 5-7 cm/s.Treatment time of 15-20 minutes or until

patient experiences an analgesic effect or other desired therapeutic effect.

Cold Compression TherapyMethods of applicationIndicationsContraindicationsPrecautionsRecommendations for useProper use of agent

METHODS OF APPLICATIONApplied 24 to 72 hours after acute injury of

surgery.Cuffs come for specific areas of the body, i.e.

shoulder, ankle, and kneeProvides a cooling effect with compression

and elevation for post surgery patients.

INDICATIONSAcute Injury or InflammationPostsurgical pain and edema

CONTRAINDICATIONSCardiac or Respiratory ProblemsUncovered Open WoundsCirculatory InsufficiencyCold Allergy or HypersensitivityAnesthetized Skin

PRECAUTIONSAvoid applying too much pressureAvoid applying over large superficial nerves,

could cause cold induced neuropathy

RECOMMENDATIONS FOR USERecommended for postsurgical patients for

home use.Can be used for 24 to 72 hours post surgery.

PROPER USE OF AGENT

ICE PacksMethods of applicationIndicationsContraindicationsPrecautionsRecommendations for useProper use of agent

METHODS OF APPLICATION• Apply to affected area

• 15 to 20 minutes at a time several times a day

• Prolonged ice application beyond 1 to 2 days has been shown to impair healing.

INDICATIONSUse of an ice pack is in the acute phase of a

soft tissue injury.Cooling will help prevent swelling.Ice packs are also useful to minimize or

prevent increased inflammation or pain.The depth of anesthesia with an ice pack is

generally considerably less than with an ice massage.

CONTRAINDICATIONSSevere reactions to cold are rare and are related

to hypersensitivity reactions.Cold is contraindicated for patients who have

developed hypertension during cold treatment or have a cold allergy (hives, joint pain) or cryoglobulinemia.

Cold should not be applied to areas of reduced skin sensitivity, or in patients who have Raynaud’s syndrome or sickle cell anemia.

Cold can further impair local blood flow in people who have peripheral vascular disease.

PRECAUTIONS• Prolonged exposure will lead to freezing of tissue.

• A number of cases of peripheral nerve injury from cryotherapy have been reported.

• Injury sites have included the peroneal, lateral femoral cutaneous, and supraclavicular nerves

RECOMMENDATIONS FOR USEDecreases or reduces swellingDecreases inflamationDecreases muscle spasmDecreases painDecreases vasoconstrictionDecreases secondary tissue damage

PROPER USE OF AGENTWhen applying an ice pack, never do so

directly onto the skin unless you are using crushed ice.

15-20min intervals several times a dayDuring the first 24 to 72 hours after an injury

be sure to avoid any form of heat at the injury site, avoid movement and do not massage the injured area as these will increase the bleeding, swelling, and pain.

EXAMINATION OF EVIDENCE BASED RESEARCH

REVIEW QUESTIONS1. Name 3 contraindications of Cryotherapy?2. Who do you think put the picture of the

crack on their slide?

REFERENCES