Cryo Therapy

CRYOTHERAPY
1
INTRODUCTION
The application of cold for various therapeutic
purposes is called cryotherapy.
Cryotherapy is commonly used in the treatment
of acute trauma and subacute injury.
The temperature of the body tissue is reduced and
the heat is transferred from the body tissue to
the cold medium.
12/18/2023 CRYOTHERAPY 2
INTRODUCTION
The magnitude of cooling depends
upon…
The area of the body tissue exposed,
Temperature of the cooling agent and
The duration of exposure.
The depth of penetration is also related
to…
Intensity and duration of cold application and
The circulatory response to the body segment
12/18/2023
exposed. CRYOTHERAPY 3
INTRODUCTION
The temperature drop in the tissues will
depend upon:
1. The temperature difference between the
coolant and the tissues: the colder the application,
the greater the heat loss from the tissues.
INTRODUCTION
depend upon:
2. The thermal conductivity of the tissues: This
differs from one area to another. In general, water-
filled tissues, such as muscles, have a high thermal
conductivity as compared to fat or skin.
The normal layer of subcutaneous fat serves as a
thermal insulation for the inner tissues so that the
heat loss through the tissues and the cold
penetration is largely dependent upon the blood
flow.
INTRODUCTION
depend upon:
3. The length of time for which the cold is
applied: The amount of energy loss is fully
dependent upon the length of exposure.
INTRODUCTION
depend upon:
4. The size of area that is being cooled: The
smaller the area, more will be cooling
TECHNIQUES FOR ADMINISTERING
COLD
i. Ice massage
ii. Ice towels
iii. Immersion in cold or cold whirlpool
iv. Ice packs or cold packs
v. Evaporative cooling or vapocoolant sprays
vi. Excitatory cold.
COLD
COLD
COLD
Excitatory cold
● The marked sensory
stimulus of ice on skin
facilitate contraction of
inhibited muscle.
● Find the spinal root level
supply of the inhibited
muscle and then find area
of skin which has same
root supply.
COLD
Excitatory cold
● Stroke the ice 3 times quickly
over the dermatome.
● Sensory stimulus passes via
the peripheral nerve and
enters the posterior horn.
Anterior horn cells have
many connections with these
sensory fibers and thus level
of excitation around anterior
horn is raised.
BASIC PRINCIPLE
When cold therapy is applied to the tissues, the
heat is absorbed from the tissues by the cooling
agent. Ice changes its state from solid to liquid by
absorbing heat.
A specific amount of energy is required to change
the solid form of ice into water which is called
latent heat of fusion.
PHYSIOLOGICAL EFFECTS &
THERAPEUTIC USES
Effects on circulatory system:
The initial response of the body tissue to cold is
that to preserve the heat. This is accomplished by
an initial phase of local vasoconstriction.
When homeostasis is reached and the body part
has become cooled, there follows phase of
vasodilatation.
Then there follows alternate periods of
vasoconstriction and vasodilatation.
THERAPEUTIC USES
Hemodynamic Effects
 Cold applied to the skin causes immediate
constriction of the cutaneous vessels and reduces
blood flow
 This vasoconstriction persists as long as the
duration of the cold application is limited to less
than 15 to 20 minutes
THERAPEUTIC USES
Hemodynamic Effects
 the body reduces blood flow in response to
decreased tissue temperature to protect other
areas from excessive cooling and to stabilize core
body temperature
 When cold is applied for longer periods of time or
when the tissue temperature reaches less than
10°C (50°F), vasodilation may occur.
THERAPEUTIC USES
Hemodynamic Effects
 This phenomenon is known as cold-induced
vasodilation (CIVD) and was first reported by
Lewis in 1930.
 After some minutes, the vasoconstriction may
give way to marked vasodilation which itself lasts
for some minutes after being replaced by another
episode of vasoconstriction. This alteration of
vasoconstriction and vasodilation is called lewis
“hunting reaction”
THERAPEUTIC USES
Effects on circulatory system:
Lewis Hunting Reaction
THERAPEUTIC USES
Neuromuscular Effects
 Cold has a variety of effects on neuromuscular
function including decreasing nerve
conduction velocity, pain relief, and
decreasing spasticity.
THERAPEUTIC USES
 Cold application decreases the rate that nerve
impulses are transmitted and increases the
depolarization threshold required to initiate the
impulse.
 Nerve conduction velocity is decreased by
reducing the rate of synaptic transmission and
increasing the time required for the nerve to
depolarize and repolarize.
THERAPEUTIC USES
PAIN RELIEF:
 If the hand is immersed in cold water there is
immediate perception of coldness that gradually
reduces and numbness sets in. This is usually
accompanied by deep aching pain sensation.
 The primary sensation is produced by the
activation of cold receptor that decrease activity
in small diameter, myelinated A-𝜹 fibers.
THERAPEUTIC USES
 The initial perception of cold is because of
decrease in large diameter, myelinated sensory
fibers.
 The delayed-onset deep aching is activation of C-
fibers because of generation of chemical debris,
toxins released by dead and damaged cells.
THERAPEUTIC USES
 If nerve fibers are cooled sufficiently, conduction block
occurs.
 C-fibers are unmyelinated and remain unaffected.
 Comparing the myelinated fibers, the smaller the
diameter, the greater the effect.
 A-δ are most susceptible. A-γ and A-β are less affected
and A-α are affected to a lesser extent.
 This helps to understand that ice is of value in acute
injury because sharp pain (A-𝜹 activity) is reduced.
Effects of cooling the skin
THERAPEUTIC USES
 When applied appropriately, cryotherapy can temporarily
decrease spasticity
 Prolonged cooling for 10 to 30 minutes can reduce
spasticity for the following 60 to 90 minutes, providing a
window for other therapeutic or functional activities.
 These changes are caused by decreased discharge from
afferent spindles and Golgi tendon organs (GTOs) as a
result of decreased muscle temperature.
THERAPEUTIC USES
Metabolic Effects
 Cold decreases the rate of all
metabolic reactions,
including reactions involved
in inflammation and
healing.
 The activity of enzymes
such as collagenase,
elastase, hyaluronidase, and
protease and the level of
histamine are reduced by
decreases in localised
temperature.
THERAPEUTIC USES
Metabolic Effects
 The activity of these
enzymes ceases activity at
joints when temperatures
reach 30°C (86°F) or
lower.
 Thus cryotherapy is
recommended as an
intervention to prevent or
reduce inflammation
CONTRAINDICATION & DANGERS
Cardiac conditions
Peripheral nerve injuries
Peripheral vascular disease or vasospastic disease
Psychological
Malignancy
Cold hypersensitivity or intolerance
Uncooperative patients
THERAPEUTIC USES
 Acute Inflammation control
 Edema control
 Pain control
 Modifications of spasticity
 Facilitation
 Cryokinetics and cryostretch
ANKLE SPRAIN
Most common of all the
sprains.
Particularly in basketball
and football.
Lateral ligament sprain
accounts for 85% of all
ankle sprains.
ANKLE SPRAIN
Mechanism of injury:
Sudden forceful
inversion, plantar flexion
and adduction causes
lateral ligament sprain.
Lateral ligaments
comprises of…
ANKLE SPRAIN
Grades of Sprain
Grade 1 : Minimal pain and disability: weight bearing
not impaired
Grade 2 : Moderate pain and disability: weight bearing
difficult
Grade 3 : Severe swelling, no pain, discoloration, no
weight bearing possible, significant functional loss.
ANKLE SPRAIN
Investigation: X-ray: AP, Lateral (to see any associated
fracture)
Treatment:
PRICES
P : Prevention from the injury
R : Rest (relative rest) to the part
I : Icing (to prevent swelling and pain)
C : Compression (by crepe bandage) of the part
E : Elevation of the part
S : Support.
ANKLE SPRAIN
Cryotherapy is used to prevent swelling and to
minimize pain.
Used for at least 20 minutes.
Swelling is minimized and further injury of the
ligament fibers by swelling is also reduced.
Compression is followed by crepe bandage.
Ice bag can be used along with compression also.
Initially ice can be used for a period of 24 hours, but
can be extended up to 72 hours (depending upon the
severity) following injury.
ANKLE SPRAIN
Gradual exercises are started after 72 hours of the
injury.
Once swelling and pain subsides, partial weight
bearing can be started.
When partial weight bearing is pain-free, full
weightbearing is allowed and early return to activities
is suggested.
MUSCLE CONTUSION/ HAEMETOMA
Very common in contact sports, cause of injury is
direct blow or hit by a blunt object or by a ball.
Quadriceps contusion is common in football and is
also called ‘Charley horse’.
Hematoma occurs when a large sized vessel is
damaged and blood starts accumulating in the area.
Clinical Features:
Contusion: Pain, swelling, decreased ROM and
ecchymosis.
Hematoma: Mass of firm, jelly-like consistency,
ecchymosis, decreased ROM and pain.
Investigations:
X-rays are usually normal, but beneficial to exclude any
fracture.
Treatment:
Initial application of ice is very beneficial.
Cold pack is used for subsidizing swelling and to
reduce pain.
Ice is applied for a period of at least 20 minutes, and
response is seen.
Treatment:
If there is reduction in swelling and hematoma, it can
be continued for another 20 minutes after a interval of
10 minutes.
Aspiration of hematoma under strict sterile conditions
is indicated in recurrent and non-subsidizing
hematomas.
REFERENCES
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CRYOTHERAPY

Lewis Hunting Reaction

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