CRYOTHERAPY ´ ͞cryos͟ - cold ´ Common Considerations: « Tissue temperature could be reduced by: 1.
Application of low-temperature solid (ice), liquid, or slush directly to the skin (conduction) 2. Immersion of a body part in cold or ice water (conduction and convection) 3. Blowing a volatile liquid on the part being treated (evaporation) 4. Blowing cold air on the part being treated (convection) ´ Effects of temperature reductions on body tissues: 1. Less than 10C - hunting response 2. At -5C - cellular damage, frostbite, ice burns 3. At 20C-29C - improved endurance ´ COLD DOES NOT TRANSFER TO THE BODY. ´ COLD: 1. Reduces pain and spasm. 2. Decreases the inflammatory process, bleeding and hemorrhage, and possibly traumatic edema. 3. Diminishes the effects of central and peripheral nerve disorders ´ Things the therapist should do before applying any form of cryotherapy: 1. Inspect patient͛s skin. 2. Test the skin for hypersensitivity to cold. 3. Verify the circulatory status of the body part. 4. Clear the patient for previous frostbite. 5. Clear the patient for exacerbation of spasticity to cold. 6. Position the patient comfortably and drape well to avoid chilliness. ICE MASSAGE ´ Equipment: 1. Frozen ice in insulated cup. 2. Ice lollipop. 3. Ice cube wrapped in washcloth/paper towel. ´ Technique: « applied in circular, smooth, rhythmical strokes over treatment area, reducing the size of the circles as the massage proceeds « wipe melted ice « avoid bumping into bony prominences ´ Duration: « 3 to 10min to anesthesize area ´ Advantages: 1. Colder than chemical cold packs 2. Could anesthesize skin easily 3. Could be used to treat areas near bony prominences 4. Readily available ´ Disadvantages: 1. Drips of cold water 2. Could induce frostbite CHEMICAL COLD PACKS
Breaking inner seal to induce chemical reaction in pack ´ Technique: « apply damp cloth between skin and pack (moisture increases thermal conductivity) « dry towel could also be used « check skin after 5min ´ Duration: « 10-15min ´ Advantages: 1.stored in refrigeration tank (-12. Bag filled with ice shavings and sealed well 2. depending on amount of fat in treated area and depth of cold penetration desired « 20-40min in some cases of plasticity
.2 to 9. Procedure repeated every few minutes to achieve greatest cooling possible ´ Duration: « 10-15min ´ Advantages: 1.´ Equipment: 1.should remain in tank for 24 hours (first use) and 30min (between subsequent uses) 2. Constant changing of towels 2. Available almost anywhere 2. May have less intense cooling than ice 2. Smaller cold pack than #1 3. Long storage time before use ICE TOWELS ´ Equipment: « towels with ice shavings ´ Technique: 1. Terry cloth towel thoroughly soaked in water and ice-shaving mixture 2. Found in almost all PT clinics 2. Messy ICE PACKS ´ Equipment: « bags filled with ice cubes or crushed ice ´ Technique: 1. No special ref unit required ´ Disadvantages: 1. Plastic cover with silica gel . damp towel placed between plastic bag and skin ´ Duration: « 5 to 15min. Warm. Reusable 4.4C) . Could be used immediately after injuries ´ Disadvantages: 1. Comes in different shapes and sizes 3. Towel wrung out and applied to treated part 3.
tongue. thermal burns (esp. Allows subcutaneous areas to cool more ´ Disadvantages: 1. Begin at origin of pain and continuing out over area of referred pain over a position of stretch 3. Offers a quick reaction for immediate reduction of pain A. joint sprains B. suck ice lolly
To initiate micturition by relaxing the internal sphincter of urethra and contracting bladder wall and transversus abdominis
Over the skin of gluteus maximus front and side of lower trunk . Plastic bag can leak 2. Muscle stretched passively before and after spraying ´ Duration: « should not exceed 6 seconds ´ Advantages: 1. first degree) C. moving at a rate of 4͟/sec 2. can cause general anesthesia) « Fluori-Methane ´ Technique: 1. Messy 3. Coolant sprayed via inverted bottle @ 30deg. Could cause frostbite VAPOCOOLANT SPRAY ´ Equipment: « ethyl chloride (flammable.´ Advantages: 1. explosive. inside cheek (teeth must be avoided).(L1 and 2 region of iliohypogastric nerve supply)
To facilitate manual skilled movements As a preventive measure for the occcurence of decubitus ulcers
Ice finger tips Icing over the affected area
. Can be molded around the part easily 2. painful areas in acute MI ´ Disadvantages:
FACILITATION AREA To facilitate extensor muscles to obtain knee stability if extensor lag is present ICED AREA Skin over vastus medialis and lateralis
Swallowing and speech
Area over suprasternal notch Lips. 18͟ away from skin.
To facilitate diaphragmatic breathing
T7 to T12 in the anterior part of the trunk. cold water=1min « Cycle repeated 3x « Treatment should begin and end with HOT water ´ Duration: « Not more than 15min ´ Physiological Effect: « Immediate marked vasodilation « Increased skin temperature « Increase in deeper circulation « Marked sedative effect ´ Indications: « Post-traumatic swelling « Pain due to swelling « Chronic inflammation ´ Contraindications: « Advanced PVD
. A motor response may be seen once patient is past flaccid stage ´ Disadvantage: « Response may not be seen immediately Brief icing for stimulation COMBINATION TREATMENT: RICE ´ Rest : immobilization. right side first
1. weight relief ´ Ice: cold modality ´ Compression: bandage/ air splint ´ Elevation: raising limb above heart for first 24-48 hours COMBINATION TREATMENT: contrast bath ´ Technique: « Two baths are filled with water: ² HOT = 40-45C ² COLD = 15C « Hot water=3min. Frosting of the skin 3. Ethyl chloride bottle could explode when dropped QUICK ICING ´ Equipment: « Ice cube and towels ´ Technique: « 3-5 quick swipes over muscle belly for facilitatory effect (might occur immediately minutes after application) ´ Advantages: 1. Not dangerous/uncomfortable 2. avoid rectus. Careful draping to protect the face 2.
tendons. PVD. Reduction of spasticity GENERAL INDICATIONS 5. cerebrovascular insufficiency 4. or side of neck 11. Loss of sensation 7. and ligaments may decrease patient͛s ability to perform quick movements. high-volt galvanic/electrotherapy D.
. Brief icing over the posterior primary rami of the trunk 9. ear. Cold could reduce speed of contraction due to slowed NCV. Reduction of acute pain 2. Emotional subjects and mental instability 10. Application of cold before exercise remains a controversial issue. Increased viscosity of joints. cardiac disease. Frostbite 2. Compromised circulation. In conjunction with: A. strenuous workouts/competitive events E. Sensitivity/allergy to cold 6. Extremes in age 5. Raynaud͛s disease 3. elevation GENERAL CONTRAINDICATIONS 1. Facilitation of motor responses 6. Cancer and sickle-cell anemia 8. 3.« Arterial insufficiency « Diabetes GENERAL INDICATIONS 1. Acute burns 7. Reduction of local bleeding and swelling 3. Severe blood pressure abnorrmalities SPECIAL CONSIDERATIONS 1. compression. PJM B. deep friction massage C. rest. 2. Reduction of spasm 4. Throat.