Cold therapy

Use of local or general cooling for therapeutic purposes cryotherapy

COLD THERAPY
To lower the local tissue temperature and provoke the thermoregulatory responses.

Applying ice to the body surface is a very effective way of withdrawing energy (heat) and hence lowering the surface temperature.

 For a constant source of cooling the temperature drop in the tissues will depend on.

The temperature difference between the coolant and the tissues. The thermal conductivity of the tissues. The length of time for which the cold is applied. The size of the area that is being cooled.

Cold therapy
Effects of cooling the skin surface Therapeutic effects of cold Types of application Contra indications and dangers of cryotherapy

Principles
30 min to lower muscle temperature at 4cm depth by 3.5C 2.5cm-20min to drop by 2.5C

Physiological changes due to cooling the skin

The local effects General effects of local cooling

Local effects
Immediate vasoconstriction there is increased blood viscosity, due to cooling, contribute to the slowed blood flow. Followed by vasodilatation Lewis Hunting response

 Cold applied to the skin provides a strong sensory stimulus by stimulating the cold receptors. This may be used therapeutically in the suppression of pain and treatment of hypertonicity.

Local effects
Decrease metabolic rate-oxygen uptake, metabolite production,cellular activity=slowed healing Decrease nerve conduction velocities Decrease strength, fine movements,tremors,spasticity,dexterity

General effects of local cooling

Stimulate cold receptors. Extreme cold is experienced as pain, involving pain receptors. Cutaneous vasoconstriction. Increase metabolism. Heat production, by irregular muscle contractions.

Therapeutic uses of cold

Recent injuries Pain Muscle Spasm Spasticity Muscle Strengthening Chronic Inflammatory Conditions Chronic edema and joint effusions Other therapeutic effects

Recent injuries
Limits bleeding by vasoconstriction Limits pain-decreased pain nerve irritants Reduces metabolic rate and secondary cell necrosis Reduces joint effusion/edema Reduces edema formation

Alleviation of pain
Reduces conduction of nerves Sensory stimulation acts on pain gate Strong cold sensation releases endorphins

Reduction in muscle spasticity

Increased viscosity diminish rapid stretch reflex Affects muscle spindle Stimulation of cutaneous receptors Decreased nerve velocities

Other therapeutic effects

Pressure sores. Conjunction with stretching. Acute lesions

 General contraindications

If frostbite has been in area Pt has Raynauds disease Circulation to part is compromised Pt very old or young Pt extremely sensitive to cold

Technique of application
preparation of patient Preparation of apparatus Preparation of part Instructions for the patient Application Termination

 Before applying cryotherapy

Inspect skin Test small area of skin, to determine if hypersensitive Verify good circulatory status Make certain patient never had frostbite in area to be treated Make certain pt never experienced a lot of spasticity when used Position & drape pt comfortably

Methods of applying cold therapy

Local immersion Cold packs-ice packs\commercial cold packs Ice towels Ice massage Cold-Compression units Evaporating sprays

 Cold or Ice Water Immersion

Equipment

Variety of basins or containers can be used, small whirlpool Temperature should be 50-60 degrees F Circumferential cooling of a body part

Indications

Application

Athlete immerse body part in water and goes through four stages of cold response Treatment may last 10-15 minutes Once numb body part can be removed from immersion and ROM exercise can be performed As pain returns re-immersion should take place Cycle can be repeated 3 times

 Cold or Ice Water Immersion (continued)

Special Considerations
Cold treatment makes collagen brittle -- must be cautious with return to activity following icing Be aware of allergic reactions and overcooling

 Ice Packs (Bags)

Equipment

Wet ice (flaked ice in wet towel) Crushed or chipped ice in self sealing bag
Not as efficient, but less messy Useful for approximately 15-20 minutes Towel should be placed between skin and pack

Chemical Cold packs

Gel pack Liquid pack

Indications

Athlete experiences four stages of cooling and then proceeds with ROM exercises Avoid excessive cold exposure; w/ any indication of allergy or abnormal pain, treatment should be stopped

Special Considerations

Contrasting cold and of treatment

Could you tell me what the difference is between heat and cold?

Dangers Contraindications
Excessive local cold on normal tissues Certain pathological conditions
Cold sensitivity Cardiac disease Arterial blood pressure Sensory deficiency Hypersensitive areas

Emotional and psychological features Precautions with particular cooling methods