Cryo Therapy Lecture

7/27/2019 Cryo Therapy Lecture

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Thermal Agents: Cryotherapy


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Basics of Heat

Heat: a term used to describe the energy

that matter can store in the form of

electronic, atomic, or molecular motion.The great the molecular motion, the greater the

heat production


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Basics of Cold

Cold: in a physical sense is a negative

condition, depending on the decrease in the

amount of molecular vibration thatconstitutes heat. The less the molecular

motion, the less heat production. Thus, a

sensation of cold results.


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Temperature:

Temperature is a measure of the average

amount kinetic energy possessed by an

individual molecule of a body (kinetictheory of heat).

Temperature is a measure of sensible heat of

cold in a body.Temperature is expressed as Fahrenheit or

Centigrade.


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Classification of temperatures:

for treatment purposes, are

classified as follows:

Very Cold 32 to 55 F

Cold 55 to 65 F

Cool 65 to 80 F

Neutral 80 to 92 F

Warm 92

to 98

FHot 98 to 104 F

Very Hot 104Hot


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Transfer of energy: heat, or the

loss of hear, occurs in any of the

following ways: Conduction: Contact

Convection: movement

Evaporation: through liquid-gas transfer

Radiation: electromagnetic waves

Conversion: transfer from one energy typeto another


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Factors in heat transfer Cont

Conductivity: the power of transmitting

heat, electricity or sound. A tissues

conductivity is usually dependent on thewater content; the higher the water content

the better the conductivity

Muscle - 72-75% water and conducts well Bone and skin are 5-16% water and poor

conductors


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Factors in heat transfer Cont

Resistance: the tissues opposition to the

passage of energy

Expressed in Ohms.

Bone and fat have high resistance

Muscle and Skin low


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Cryotherapy

Used to describe the application of cold

modalities that have a temperature range

between 32 and 65 F


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Cryotherapeutic Benefits

To obtain therapeutic benefits

skin temp. must be reduced to 57 F for optimal

decrease in local blood flow

skin temp must be reduce to 58F for analgesia

Skin tempertaure must be reduced to 36F to

produce intra-articular temp. changes in theknee

The temp of the skin over a joint decreased the temp

in a joint proportionally 10 F skin 6.5 F joint

Also remember that temperature is relative!


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Effects of Cold on

Application Site Vasoconstriction

Decreased Rate of Cell metabolism

resulting in a decreased need for oxygen

Decreased production of cellular wastes

Reduction of inflammation

Decreased Pain

Decreased Muscle Spasm

S i Eff f C ld


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Systemic Effects of Cold

Exposure

General vasoconstriction in response tocooling of the posterior hypothalamus (this

happens with a .2F of circulating blood

Heart rate is decreased Respiration Decreases

Shivering and increased muscle tone

If core temperature continues to drop this is the

bodys response to increase heat

IN GENERSAL THIS DOES NOT OCCUR

WITH ICE APPLICATION!

Th Eff f I I j


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The Effects of Ice on Injury

Response

Indications

Acute injury or Inflam

Acute or chronic pain

Small 1st degree burns

Postsurgical pain and

edema

In conjunction with rehab

ex.Neuralgia

Acute or chronic muscle

spasm

Spastically accompanyingCNS disorders

Contraindications

Cardiac or Resp.

involvement

Uncovered open

wounds

Circ. Insufficiency

Cold Allergy

Anesthetic Skin Advanced Diabetes

Raynauds

Phenomenon


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Raynauds Phenomenon

A vascular reaction to cold application or

stress that results in a white, red, or blue

discoloration of the extremities. The fingersand toes are the first to be affected. This is

a sympathetic nervous system reflex


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Physiological Effects of Cold:

MetabolicDecreased secondary cell deaths by hypoxia

(swelling prevents oxygen from reaching cells).

The decrease in metabolism allows them to livewithout as much oxygen.

Normal body temperature is 37 C.

Increase above 45 C (113 F) proteins

denature


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MetabolicReduction of edema through decreased

capillary hydrostatic pressure and decreased

permeability and osmotic pressureIncrease blood viscosity (make it thicker so it

wont flood the area as quickly)

Decrease in chemical mediator effectiveness

(they cause vasodilatation)


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MetabolicDecreases below 15 C (58 F) a hunting

response (Lewis 1932) incurs

Histamine like release yields an increasevasodilatation as a self defense response

Arterio-venal anastomoses (artery directly to

veins) allow pooling of blood in feet, hands,

ears, and lips. May be place of huntingresponse

Dont go below 58 F and keep time shorter

than 30 minutes to be on the safe side


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Pain Local decrease in free nerve ending

sensitivity

Increases the threshold for nerve firing

Slows synaptic activity

Allows disruption of pain-spasm-pain cycle

via analgesia


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Physiological effects of cold:

Hemodynamic

Vasoconstriction from smooth muscle in

arterioles

reflex vasoconstriction from A-delta (spinal

reflex to preserve body heat)

Cold blood hits hypothalamus and may start

shivering response if cold enough

A small amount of vasoconstriction gives a 4fold decrease in blood flow


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Muscle Activity

Decreased muscle spasm by decreasingmuscle spindle activity.

Intramuscular fibers (muscle spindle) runs

parallel to fibers of the muscle. Ia and II runto dorsal horn of spinal cord and respond to

stretch. As the muscle contracts the spindle

contracts so it remains sensitive. Colddirectly decreases the activity in the Ia and

II fibers. The lower the temperature, the

lower the activity.


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Effects of Immediate Treatment

RICE - Rest, Ice, Compression, Elevation

Serves to counteract the bodys initial response

to injury

Rest limits scope of original injury by

preventing further trauma

Ice - function is to decrease cells metabolism,

decrease the need or oxygen and reduce the

amount of secondary hypoxic injury by

enabling tissues to live on limited oxygen and

secondarily reduce pain

Crushed ice is the ideal form of cold application

during initial injury because it produces the mostrapid temp. decrease.


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Effects of Ice on Immediate Tx

Compression -

decreases the pressure gradient between blood

vessels and tissue and discourages furtherleakage from capillaries.

Also Encourages Lymphatic drainage

Compression Types Circumferential - provides even pressure

Collateral - Pressure on 2 sides (aircast)

Focal Compression - U-shaped horseshoe pads


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Effects of Ice on Immediate Tx

Elevation

Decreases the hydrostatic pressure within the

capillary beds to encourage absorption ofedema by lymphatic system

This has the greatest effect at 90 perpendicular

to the ground

at 45 the effect of gravity is 71% comparatively


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Cryokinetics

The use of cold in conjunction with

movement

Used to decrease pain and allow for free motion

through the normal ROM

Results in more pronounced macrophagereaction, quicker hematoma resolution,

increased vascular growth, faster regeneration

of muscle and scar tissue

Initiated when the underlying soft tissue and

bone are intact and the pain is limiting the

amount of function


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Penetration depends on many

factors: Cold has a longer wavelength than heat

Local temperature gradient

Treatment surface area covered

thickness and characteristics of tissue

treated (fat is an insulator, tissues with high

water content have better heat transfer)


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Clinical Application

Cold Pack

Ice Massage

Ice Immersion

Cryostretch

Whirlpools

Slides in Packet for specific review of each

Clinical Application


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Cold Packs

Ice Bags,

Reusable Cold Pack

Instant Cold Back

Tx time for all are 15-30 minutes

Because of lasting effects application should be

no less than 2 hours apart

For controlled Cold Therapy Units - may be

applied continuously for 24 to 48 hours post

acute injury or surgery


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Cold Packs

Indications Acute injury (may use

with wet wrap)

Acute or Chronic Pain

Postsurgical Pain andEdema

Shape of Body part

Precautions

AC joint and other areas

may not be suitable for wet

wrap

Tension of elastic wrap

should be enough to

provide adequate

compression without

unwarranted pressure

Ensure Circulation w/wrap

Frostbite - if had before

chance for reoccurrence

over large or superficial

nerves


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Ice Massage

Appropriate for

delivering cold tx to

small evenly shapedareas.

Most effective for

muscle spasm,

contusion and otherminor well-localized

areas

Duration of tx

5-15 minutes or until

ice runs out

if the purpose is

analgesic, then stop

when numb


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Ice Massage Indications

Subacute inflam or inj

Muscle strain

Contusion Acute or chronic pain

Contraindications

All other ice contraind.

When pressure is not

warranted

Suspected Fx

Precautions

Injuries where pressure

massage may be

contraindicated


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Ice Immersion

Temp. 50 - 60 F

Time 10-20 min.

Indications Acute Injury or Inflam.

Acute or Chronic Pain

Post surgical pain

Contraindications

Same as general

Contraindications

Acute injury where

gravity is

contraindicated


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Cryostretch

Spray and Stretch vapocoolant

Traditionally preformed with ethyl chloride

due to its ability to quickly evaporate andcool superficial tissue

This technique is limited to a counterirritant

simply masks the symptoms to allow for astretch


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Cryostretch

Precautions

Can cause frostbite

Ethyl Chloride is

extremely flammable

Ethyl Chloride is a

local anesthetic but if

inhaled can become

general

Its use is based on

tradition rather than

fact

Contraindications Allergy

Open wounds

Post/surgical

Eyes

All other cold

contraind & contraind

to passive stretch

Indications

Trigger points

Muscle spasms

Decreased ROM


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Cold Whirlpools

Duration of Tx

15-20 minutes

Temp 50 - 60 F Indications

Decreased ROM

Cryokinetics

Subacute to chronic

inflammation

Peripheral nerve

injuries (avoid

extremes)

Contraindications

Acute conditions

where water turbulence

would further irritate

area

Gravity

Postsutural

Skin Conditions

All other

contraindications

Documents

Cryo Therapy Lecture