Cryotherapy Modalities

Electrophysics Low Frequency Current

Bayu Prastowo, MSi(Biofis)

Department of Physiotherapy | Faculty of Health Sciences
Definition
 Cryotherapy, also known a ice application, is the simplest and oldest way
to treat injuries
 Ice is control pain by instigating local anaesthesia
 Ice can decreases oedema, nerve conduction velocities, cellular
metabolism and local blood flow
 The effect of the cryotherapy depends on the method, the duration,
temperature of the ice and the depth of the subcutaneous fat
Lewis Hunting Reaction
 The Lewis hunting reaction or hunting response is a process of
alternating vasoconstriction and vasodilation in extremities exposed to
cold
 The term Lewis reaction is used too, named after Thomas Lewis, (1930)
 Vasoconstriction occurs first to reduce heat loss, but also results in strong
cooling of the extremities
 Approximately 5-15 minutes after the start of cold exposure, the blood
vessels in the extremities will suddenly vasodilate
Lewis Hunting Reaction
 This is probably caused by a sudden decrease in the release
of neurotransmitters from the sympathetic nerves to the muscular coat
of the arteriovenous anastomoses due to local cold
 This cold-induced vasodilation increases blood flow and subsequently
the temperature of the fingers
 Vasodilation can be cold induced after initial period of vasoconstriction
when cold is maintained for longer than approximately 15 min or
temperature in 10°C
Indications of Treated
 Acute soft tissue injuries e.g. muscular sprain, ligament sprain
 Myofascial trigger points
 Acute swelling
 Tendinitis or bursitis
 Post orthopaedic surgery e.g. arthroscopic
 Acute sports injuries
 DOMS (Delayed Onset Muscle Syndrome)
Contraindications of Treated
 Haemoglobinuria, cryoglobulinemia
 Peripheral vascular disease
 Impaired circulation blood flow
 Sensory disorder
 Hypersensitivity to cold
 Skin anaesthesia
Dosage of Cryotherapy
 The duration of icing for a small area with minimal fat and muscle, would be
significantly less (~3‐5 minutes) than that for a larger area and deeper
tissue (~20 minutes)
 Intermittent icing (e.g., 10 minutes on: 10 minutes off) more effective for
management of acute inflammation than icing for 20 minutes
Application Methods
 Ice Packs
– There are different types of ice
used in ice packs
– The most common types are ice
packs made with cubed,
crushed and wetted ice
– It is also more effective in
lowering the intramuscular
temperature during treatment
 Guideline Ice Pack
– Treatment 5-20 mins
Application Methods
 Ice Spray
– A cooling effect can also be produced
by icing spray for a similar effect
 Guideline Ice Spray
– Position of the sprayer is upright
– Sprayer distance 25 cm
– Spray dose 2-5 time a spray with speed
10 s
– For portabilities and emergency
situational
Application Methods
 Ice Massage
– Treatment for 10-20 mins
– Therapeutic technique with
linear, repetitive, circular
– Using a bunt ice cube surface
Application Methods
 Immersion
– Put the ice in the barrel/ chamber
– Wait 5 minutes for homogenity
between ice and water
– Soak the body for 10-15 mins
– Set the water temperatur 15-25°C
Application Methods
 Cryotherapy machine
Application Methods
 Cryotherapy machine
– Evaporation : Air fan production
– Hose : to eject or blow air from the
fan
– Display
Possible Risk/ Undesirable Effects
 Inhibit Muscle Function
‒ Cooling can temporarily inhibit muscle function with potential for
increased risk of injury/re‐injury
‒ Be cautious when having patients weight bear/undertake complex
exercise after icing a lower extremity
 Ice Burn
‒ Elderly patients with impaired sensation and/or circulation will be more
vulnerable to an ice‐burn, therefore consider using less intense icing
techniques
‒ Cold gel packs stored in a freezer have a surface temperature below 0°C
(32°F) and thus an insulating layer should be used between the cold
pack and the patient’s skin
Possible Risk/ Undesirable Effects
 Induced Nerve Injuries
– Most common when cold is applied in combination with compression
– Check capillary refill during application of ice combined with compression
therapy to ensure adequate blood flow
 Reduced ROM
‒ After gaining ROM by warming, stretching and then strengthening in the
newest part of the ROM, it is likely counterproductive to cool the tissue
in a shortened position
‒ In patients with significantly restricted ROM due to scar tissue, it may
be preferable not to use ice
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