2019

Cryotherapy

CHAPTER 1 CAPSULE
POSITIVE STUDENTS
Cryotherapy: is a therapeutic use of local or general cold application for testing
the physiological lesion.
The basis for cryotherapy: is the physiological response that occur when the
tissue temperature is lowered.

Types of cryotherapy:
Conductive cooling: direct contact between the coolants to TRANSFER heat from
tissue of body. Temperature of body reach 100C
Like: frozen gel packs (cold packs), Ice Packs.

Convective cooling: heat transfer by circulatory movement of the cold application

(water/air)
Like: whirlpool (water) – air flow (air)

Evaporation cooling: by using volatile fluids for evaporation from the skin.
Temperature of skin reach to -4o c
Like: ethyl chloride, Fluromethane.
 30 min. needed to decrease muscle temp. (at depth 4 cm by 3.5o c)
 The higher the fat content the slower rate of transfer of energy as the
adipose tissue act as insulator {what effect of?} (Longer time to cool
muscle to return to normal temp.)
Temperature changes in tissue will depend on:

A. Temperature deference between coolant and tissue:

High=rapid/deep
Low=slow/superficial

B. Surface area:
Local: ↓ metabolic rate/blood flow/inflammation
General: hypothalamus cause Systemic effects:
1- ↓ respiratory rate
2- ↓ heart rate
3- ↓ muscle tone
4- Shivering
 C. Time
High time=more decrease in skin temp.

D. Tissue fat composition

High fat: ↓ energy transmIssion
Low fat: ↑ energy transmission

Therapeutic effect of cryotherapy:

1- Control of acute injury or inflammation
2- Reduce edema and joint effusion
3- Relief pain
4- Relief of muscle spasm
5- Modification of spasticity
6- Facilitation of motor control
7- Cryokinetics and cryostrech

1- ↓ Circulation (metabolism)  ↓histamine and bradykinin  the chemical

reaction that occur during inflammation.
2- ↑ Smooth muscle tone  vasoconstriction (V.C)  ↓ Bleeding
3- Stimulate D.R.G  V.C  ↓ Bleeding
4- ↑ Blood viscosity  ↓ Bleeding
5- ↑ Pain threshold  ↓ pain after injury
 Cryotherapy can effect on the chronic rheumatoid arthritis and
osteoarthritis by relieving the pain.
 {When to use?}: should be applied immediately following the injury.
 {For how much?}: with time limit 15 min or less.

1- ↓ Circulation & ↓ intravascular fluid pressure by ↓ blood flow by V.C and

↑ viscosity
 2- ↑ capillary permeability by reducing the vasoactive substance as
histamine.
N.B: edema is movement of fluid from inside vessels into interstitium space due
to ↑ intravascular pressure and ↑ vascular permeability.
N.B: compression and elevation reduce edema by driving extravascular fluid out
the swollen area into venous and lymphatic drainage system.

Direct:
1- Pain gate theory
2- Metabolism & circulation and ↓ the enkephalins and endorphins (cause of
pain)
3- Block or slow the peripheral nerve conduction.
4- ↑ Pain threshold.
Indirect: by removing cause of pain (edema or inflammation etc….)

 by muscle spasm cycle and by de-sensation

(block receptor on skin) ↓ activity of α motor neuron.

Prolonged cooling (10  30 min) to ensure cooling of spindles and effect

lasts to one hour or longer.

The rapid application of ice as stimulus known as quick icing and is used in
rehabilitation of patients with flaccidity result from U.M.N dysfunction.

 Use of cold in conjunction with movement and is used to improve

motion by reducing the elements of pain.
 Technique: up to 20 min  reduce pain, then the patient perform the
motion to 3:5 min until the pain return.
  Ice cooling is repeated to 5 times.
 Commonly used in rehabitation of athletes.
 application of a cooling agent before stretching to ↓ muscle
spasm and ↑ ROM.
Modalities used in Cryotherapy:
- Ice packs
- Ice cups  ice message
- Ice bath (Whirlpool)
- Vapocolant sprays
- Cold gel packs.

Indication Contraindication Precautions

A. Acute trauma A. Cold hypersensitivity A. Over a superficial nerve
B. Acute Inflammation B. Cardiac disease ex. lateral peroneal, ulnar
C. Edema & joint effusion C. Raynaud’s disease and radial nerve
D. Muscular pain D. Over a regenerating B. Hypertensive patient
E. Muscle guarding peripheral nerve C. Patients with poor
F. Acute tendonitis E. Over an open wound sensation
/bursitis D. Very young and very old
G. Headaches patients
Note: Raynaud’s disease: idiopathic form of paroxysmal digital cyanosis
:‫شرح مبسط للمرض‬
It is a rare disorder of the blood vessels, usually in the
fingers and toes. It causes the blood vessels to narrow
when you are cold or feeling stressed. When this
happens, blood can't get to the surface of the skin and
the affected areas turn white and blue
 Thermotherapy
Indication Contraindication
A. Painful condition A. Acute inflammation
B. Muscle spasm B. Acute infection
C. Subacute and chronic C. Open wounds
inflammation D. Impaired sensation
D. Acceleration of healing E. Impaired circulation
E. Prior of stretching & mobilization
exercise

Heat
Advantages Disadvantages
↓ Pain Cause swelling
↓ Stiffness
↑ tissue extensibility
Cold
Advantage Disadvantage
↓ Pain ↑ stiffness
Prevent further swelling ↓ tissue extensibility