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  1. Cryotherapy • Used in first aid treatment of trauma to the musculoskeletal system • When applied intermittently w/ compression, rest and elevation it reduces many adverse conditions related to inflammation and the reactive phase of an acute injury • RICE (rest, ice compression, elevation) may be used for the initial days of and injury and continue up to 2 weeks after injury © 2011 McGraw-Hill Higher Education. All rights reserved

  2. Physiological Effects of Cold • Type of electromagnetic energy (infrared radiation) • Relies on conduction -- degree of cooling depends on the medium, length of exposure and conductivity • At a temperature of 38.3oF, muscle temperature can be reduced as deep as 4cm • Tissue w/ a high water content is an excellent conductor • Most common means of cold therapy are ice packs and ice immersion • Wet ice is a more effective coolant due to the energy required to melt ice © 2011 McGraw-Hill Higher Education. All rights reserved

  3. Vasoconstriction • Reflex action of smooth muscle due to sympathetic nervous system and adrenal medulla • Hunting response • Intermittent period of vasodilation will occur if cooling continues for >20 minutes • Blood viscosity will also increase with extended cooling • Decreases extent of hypoxic injury to cells • Decreases cell metabolic rate and the need for oxygen through circulation, resulting in less tissue damage • Decreased metabolic rate and vasoconstriction decreases swelling associated w/ inflammatory response © 2011 McGraw-Hill Higher Education. All rights reserved

  4. Decreases muscle spasm • Muscle becomes more amenable to stretch as a result of decreased GTO and muscle spindle activity • Decreases free nerve ending and peripheral nerve excitability • Analgesia caused by raising nerve threshold • Cold is more penetrating than heat • Ability to decrease muscle fatigue and increase and maintain muscular contraction • Attributed to the decrease of local metabolic rates and tissue temperature © 2011 McGraw-Hill Higher Education. All rights reserved

  5. Ice Massage • Equipment • Foam cup with frozen water - creating a cylinder of ice (towel will be required to absorb water) • Indications • Used over small muscle areas (tendons, belly of muscle, bursa, trigger points) • Application • Ice is rubbed over skin in overlapping circles (10-15 cm diameters) for 5-10 minutes • Patient should experience sensations of cold, burning, aching, & numbness --when analgesia is reached athlete can engage in rehab activities • Special considerations • Keep in mind comfort of the athlete during treatment © 2011 McGraw-Hill Higher Education. All rights reserved

  6. Figure 15-5 © 2011 McGraw-Hill Higher Education. All rights reserved

  7. 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 • Patient immerses 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 © 2011 McGraw-Hill Higher Education. All rights reserved

  8. 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 © 2011 McGraw-Hill Higher Education. All rights reserved

  9. 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 © 2011 McGraw-Hill Higher Education. All rights reserved

  10. Special Considerations • Avoid excessive cold exposure • With any indication of allergy or abnormal pain, treatment should be stopped • When using gel packs, a single layer of toweling should be used • Crushed or flaked ice can be directly applied to skin Figure 15-6 © 2011 McGraw-Hill Higher Education. All rights reserved

  11. Vapocoolant Sprays • Equipment • Fluori-methane - non-flammable substance that is released in fine spray from pressurized canister • Indications • Reduces muscle spasm, increases ROM, effective on trigger point • Application • For spasm and ROM • Hold can 12-18 inches from skin, treat entire length of muscle - covering an area 4 inches/second • Apply spray 2-3 times, while gradually applying a stretch © 2011 McGraw-Hill Higher Education. All rights reserved

  12. Vapocoolant Spray (continued) • Application • For trigger points • Locate trigger point • Position athlete in relaxed position; place muscle on stretch; apply spray in specific region and over the length of the muscle • Apply passive stretch while spraying • After first session, heat area and then repeat if necessary • When stretch is complete, have athlete move limb throughout ROM; but do not overload © 2011 McGraw-Hill Higher Education. All rights reserved

  13. Figure 15-7 © 2011 McGraw-Hill Higher Education. All rights reserved

  14. Cryokinetics • Technique that combines cryotherapy with exercise • Goal is to numb region to point of analgesia and work towards achieving normal ROM • Equipment • Treat area with ice pack, massage or immersion • Application • When analgesia is experienced, exercises should be performed (window will last 4-5 minutes) • As pain returns, process may be repeated • Sequence can be repeated 5 times • Exercises should be pain free • Changes in intensity should be limited by both healing and patient’s perception of pain © 2011 McGraw-Hill Higher Education. All rights reserved

  15. Special Considerations for Cryotherapy • Cooling for an hour at 15.8o - 30.2o F produces redness and edema that lasts for 24 hours post exposure • Immersion at 41oF increases limb fluid volume by 15% • Exposure for 90 minutes at 57.2o - 60.8o F can delay resolution of swelling up to one week • Some individuals are allergic to cold and react w/ hives and joint pain • Icing through a towel or bandage limits the reduction in temperature -- could limit effectiveness of treatment © 2011 McGraw-Hill Higher Education. All rights reserved

  16. Cryotherapy • Heat Abstraction • Depth of 5cm can be cooled • Change in Temperature depends on: • Type of Agent • Temp. difference between agent and tissue • Amount of insulation • Thermal Conductivity • Limb circumference • Duration of application © 2011 McGraw-Hill Higher Education. All rights reserved

  17. Cryotherapy • Leads to vasoconstriction • Decreases tissue metabolism • Decreases tissue permeability • Decreases capillary permeability • Decreases pain • Decreases spasms • Analgesic relief of pain © 2011 McGraw-Hill Higher Education. All rights reserved

  18. Cryotherapy • Ideal Temperature 32-65°F • 20-30 mins. (10-15 mins.) of treatment • 30+ mins. If a towel is used • 90 mins. Is the bodies rewarming period • Four progressive sensations • Cold Burning Aching Analgesia © 2011 McGraw-Hill Higher Education. All rights reserved

  19. Types of Cryotherapy Applications • Cryokinetics • Ice Massage • Ice Packs • Cryocuffs • Ice Immersion (Whirlpool) • Contrast Bath • Commercial Gel and Chemical Packs © 2011 McGraw-Hill Higher Education. All rights reserved

  20. Types of Cryotherapy Applications cont. • Controlled Cold-Compression Units • Vapocoolant sprays © 2011 McGraw-Hill Higher Education. All rights reserved

  21. Cryotherapy • Indications • Acute or chronic pain, or muscle spasm • Acute inflammation • Post surgical pain or edema • Superficial first-degree burns • Facilitate mobilization • Relieve Pain • Decrease Muscle spasiticity © 2011 McGraw-Hill Higher Education. All rights reserved

  22. Cryotherapy • Contraindications • Hypersensitivity • Cold Allergy • Circulatory or sensory impairment • Reynaud’s disease • Hypertension • Open wounds • Cardiac or respiratory disorders • Nerve palsy • Arthritis © 2011 McGraw-Hill Higher Education. All rights reserved

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