CRYOTHERAPY cryos - cold Common Considerations: Tissue temperature could be reduced by: 1.

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 patients 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

 Equipment: 1. Plastic cover with silica gel - stored in refrigeration tank (-12.2 to 9.4C) - should remain in tank for 24 hours (first use) and 30min (between subsequent uses) 2. Smaller cold pack than #1 3. 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. Found in almost all PT clinics 2. Comes in different shapes and sizes 3. Reusable 4. Could be used immediately after injuries Disadvantages: 1. May have less intense cooling than ice 2. 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. Towel wrung out and applied to treated part 3. Procedure repeated every few minutes to achieve greatest cooling possible Duration: 10-15min Advantages: 1. Available almost anywhere 2. No special ref unit required Disadvantages: 1. Constant changing of towels 2. Messy ICE PACKS Equipment: bags filled with ice cubes or crushed ice Technique: 1. Bag filled with ice shavings and sealed well 2. Warm, damp towel placed between plastic bag and skin Duration: 5 to 15min, depending on amount of fat in treated area and depth of cold penetration desired 20-40min in some cases of plasticity

 Advantages: 1. Can be molded around the part easily 2. Allows subcutaneous areas to cool more Disadvantages: 1. Plastic bag can leak 2. Messy 3. Could cause frostbite VAPOCOOLANT SPRAY Equipment: ethyl chloride (flammable, explosive, can cause general anesthesia) Fluori-Methane Technique: 1. Coolant sprayed via inverted bottle @ 30deg, 18 away from skin, moving at a rate of 4/sec 2. Begin at origin of pain and continuing out over area of referred pain over a position of stretch 3. Muscle stretched passively before and after spraying Duration: should not exceed 6 seconds Advantages: 1. Offers a quick reaction for immediate reduction of pain A. joint sprains B. thermal burns (esp. first degree) C. 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, tongue, inside cheek (teeth must be avoided); 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 - (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

To facilitate diaphragmatic breathing

T7 to T12 in the anterior part of the trunk; avoid rectus; right side first

1. Careful draping to protect the face 2. 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. 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, 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: HOT = 40-45C COLD = 15C Hot water=3min, 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

or 27-42

 Arterial insufficiency Diabetes GENERAL INDICATIONS 1. Reduction of acute pain 2. Reduction of local bleeding and swelling 3. Reduction of spasm 4. Reduction of spasticity GENERAL INDICATIONS 5. Facilitation of motor responses 6. Acute burns 7. In conjunction with: A. PJM B. deep friction massage C. high-volt galvanic/electrotherapy D. strenuous workouts/competitive events E. rest, compression, elevation GENERAL CONTRAINDICATIONS 1. Frostbite 2. Raynauds disease 3. Compromised circulation, PVD, cardiac disease, cerebrovascular insufficiency 4. Extremes in age 5. Sensitivity/allergy to cold 6. Loss of sensation 7. Cancer and sickle-cell anemia 8. Brief icing over the posterior primary rami of the trunk 9. Emotional subjects and mental instability 10. Throat, ear, or side of neck 11. Severe blood pressure abnorrmalities SPECIAL CONSIDERATIONS 1. Cold could reduce speed of contraction due to slowed NCV. 2. Increased viscosity of joints, tendons, and ligaments may decrease patients ability to perform quick movements. 3. Application of cold before exercise remains a controversial issue.