Cryotherapy

(ice therapy)
 Application of cold to the body tissues after injury.
 Nowadays, local cold application may be applied by the
use of various forms of ice or frozen gel packs, or
evaporation of volatile fluids from the skin. Often skin
temperature is reduced to 10 C.
Physical Principles

Specific amount The solid

of energy form into a This energy
required to liquid, or into knows as
change gas latent heat

 When ice is applied on skin heat is conducted from the

skin to the ice in order to melt it.
 To change its state, ice requires some energy known as
latent heat of fusion.
Factors affecting heat loss
 Temperature changes in tissues will depend on rate and
amount of heat energy removed.
colder application greater the heat loss

Water filled tissue like muscle, have high thermal

conductivity compared to fat or skin. Thus, the cooling of
deeper tissue depend on nature of overlying tissue.
Amount of energy loss dependent on length of time of
cryotherapy.
Larger the area = the more heat energy lost
Physiological Effects
 1……Circulatory Response:
 The initial skin reaction to cooling is an attempt to
preserve heat. Accomplished by initial vasoconstriction.
Haemostatic response has the effect of cooling of the
body part.
 The duration depends on the area involved, a
vasodilatation follows alternating periods of constriction
and dilation. This is called LEWIS’S HUNTING
REACTION.
 During vasodilatation the AV anastomosis is closed. Thus
increase blood flow through capillaries and its beneficial
of swelling and tissue damage.
 Ice therapy is usually followed by some forms of
compression bandage.
 The alternate periods of vasoconstriction and
vasodilatation affect the capillary blood flow and it is
across the capillary membrane that tissue fluid can be
removed from the area and returned in the systemic
circulation. Increased circulation allows more nutrients
and repair substances into the damaged areas.
 Thus ice therapy is very useful in removing swelling and
accelerating tissue repair.
 2……On Metabolic rate:
 The principal effect of cooling living tissue will be to reduce
metabolic rate in accordance to Van’t Hoff Law.
 It states that the rate of any chemical action that can be
affected is increased/decreased by a temp. rise/fall.
 Metabolism being a series of chemical reactions will decrease a
fall of temp.

 3……On motor system:

 Muscle strength seen to diminish on cooling the limb in water
at 10-15 C because of its effect on viscosity and metabolic
rate.
 But there are evidences that the strength increases over the
original value about an hour or so after cooling has ceased.
 4……Neural Response/ PNS:
 Skin contains primary thermal receptors. Cold
receptors > warm receptor. Helpful in treating
 pain and hyper tonicity.
The rate of
conduction of First fibers
Peripheral nerve
nerve fibers in affected by
in reduced by
a mixed gradual cooling
cooling
(sensory
+motor)

Eventually at
Synaptic low temp. B&C A fibers
transmission can fibers (non- (mylinated)
also be delayed mylinated)
Uses of Ice Therapy

 Reduces pain
 Reduces spasticity
 Reduces muscle spasm
 Reduces swelling
 Promote repair of damaged tissues
 Provide excitatory stimulus to inhibited muscles
 Strength training
 1……Reduction of Pain:
 Stimulation of cold receptors, impulses will be send back
and it pass into posterior root of spinal cord. Impulses
arriving through large diameter nerves, and it block pain
impulses to access the spinal cord.
 Reduces pain temporarily. For permanent pain relief,
strengthening, mobilization has to be given during this
period of transient relief.

 2……Reduction of Spasticity:
 Pathological state of increased muscle tone from damage
to UMN.
 3……Spasm:
 This is manifested as an increase in muscle tone in specific
area with the apparent aim of limiting movement and
further damage. However the amount of spasm is often
exceeding and the sustained contraction of muscles will in
turn start to produce pain, often resulting then in more
spasm.
 The mechanisms by which cold reduces spasticity and
spasms probably:
 Reduced velocity of nerve conduction.
 Depressed sensitivity of receptors.
Indications
 Acute/Chronic pain
 Acute swelling
 Myofacial trigger points
 Muscle spasm
 Muscle guarding
 Acute muscle strain
 Acute ligament sprain
 Acute contusion
 Bursitis
 Tenosynovitis
 Tendinitis
 Delayed onset muscle soreness
Contraindications
 Impaired circulation
 Peripheral vascular disease
 Hypersensitivity to cold
 Skin anesthesia
 Open wounds or skin conditions
 Infection
Techniques of Application
 Ice towels
 Ice packs
 Immersion
 Ice cube massage
 Cold compression units
 Ice spray
 Contrast bath
Time of application of various technique
 Depends upon condition but several authors indicate
within 5-20 minutes.
 After 12-15 hunting response is demonstrated with
intense cold (10 C-50 F). Thus, a minimum of 15 min. are
necessary to achieve extreme analgesic effects.

 1……Ice packs:
 Silica gel packs
 Endothermic reaction / chemical cold packs
2……Ice towel:
 Wet towel is used
 Ice towel need to be replaced after 2-3 min. total 20 min
of treatment.

 3……Immersion:
 Simple and whirlpool immersion

 4……Ice cube massage:

 Slow circular motion 5-10 min. during this time pt. will
feel cold, burning and aching sensation before the part
become numb.
 Short stroke should be given.
 5……Cold compression unit:
 Cold water is circulated in sleeve which is put over limb
and part of its inflamed at intervals.

 6……Cold / Ice sprays:

 Fluorimethane is now used widely as its non inflammable.
 Liquid is sprayed on to area to be cooled in series of
stroke about 5sec each with few seconds interval btwn
each.The nozzle is held at the angle at 45 or right angle
from the skin surface.
CRYOTHERAPY IN SPORTS
 ACUTE PHASE:
 Injury either on field or while exe. Direct application is
cold packs or cold spray.
 Icetherapy is given for at least 72 hrs from injury but it
provides best result within 48 hrs of injury in acute
phase.

 REHABILITATIVE PHASE:
 Cryokinetics
 Cryostretch
Cryokinetics
 Combination of cold application and active exe.
 Cold decreases pain, which facilitates active exe.
 Exercise reduces swelling and promotes healing and
return to function
DISADVANTAGES:
 Pain during initial session
 Cold can be messy.
INDICATIONS:
Sprains—dynamic treatment
Ankle, Fingers, Strength training
CONTRAINDICATIONS:
Any exe. or activity that causes pain
Use of ice on pt. who is hypersensitive to cold

PRECAUTIONS:
Use pain as a guideline.
Don’t allow pt. to limp.

PRINCIPLES OF CRYOKINETICS EXERCISE:

All exe. should be active and performed by pt.
Exe. Must be graded….
begin with ROM exe
progress through increasing level of difficulty
full sport activity is final level
Non-weight-bearing ROM
plantar flexion
dorsiflexion
inversion
eversion
circumduction

Weight-bearing-ROM
stand up
shift weight from foot to foot
gradually increased weight in injured limb
Cryostretch for muscle injuries
 Spasm and tightness are common factors.
 Reduce spasm with cryostretch.

 REHABILITATION GOAL:
 Promote healing, if tissue torn.
 Control pain
 Reduce spasm
 Control neural inhibition
 Reset central control through aggressive, progressive
reorientation of full function.
 Develop muscle strength.
 Promote other phases of rehab.
Cryostretch: Application Parameters
Three sets:
numb with ice then activity
activity consists of two 65 sec bouts of exe. With 20 sec rest between bouts

65 sec bout:
stretch muscle to limit and hold 20 sec
three static stretches, interspersed with maximum isometric contraction (hold-relax)

Example exe. bout

20 sec static stretch
5 sec isometric contraction
10 sec static stretch
5 sec isometric contraction
10 sec static stretch
5 sec isometric contraction
10 sec static stretch
 Numb muscle (20 min max)
 65 sec stretch-contraction
 20 sec rest
 Repeat 65 sec stretch—contraction
 Renumb
 Two more stretching bouts (20 sec rest)
 Renumb
 Two more stretching bouts (20 sec rest)
Combined Cryostretch and Cryokinetics
 Begin and end with stretch
 Begin cryokinetics exe. With manually resisted muscle
contractions (6-10) through a full ROM
 Use DAPRE technique for further progression.
 Progress through all phases of rehab using progressive
functional activities.

 DANGERS OF CRYOTHERAPY:
 Frost bite
 Nerve palsy
References
 Clayton’s electrotherapy, 9th edition- Sarah & Bazin- W.B
Sunders.
 John low & reed: Electrotherapy Explained, Butterworth.
 Lehman- therapeutic heat and cold; ch.14 application
procedure.-Willian & Wilkins.
 William E.Prentice: Therapeutic modalities in Sports
Massage- Mosby.