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 effectsGeneral 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 injuriesPainMuscle SpasmSpasticityMuscle StrengtheningChronic Inflammatory ConditionsChronic edema and joint effusionsOther 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 Raynaud’s 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 immersionCold packs-ice packs\commercial cold

packsIce towels

Ice massageCold-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

Indications Circumferential cooling of a body part

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

Special Considerations Avoid excessive cold exposure; w/ any indication of allergy or abnormal pain,

treatment should be stopped

Contrasting cold and of treatment

Could you tell me what the difference is between heat and

cold?

Dangers Contraindications

Excessive local cold on normal tissuesCertain pathological conditions Cold sensitivity Cardiac disease Arterial blood pressure Sensory deficiency Hypersensitive areas

Emotional and psychological featuresPrecautions with particular cooling

methods