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1 Cryotherapy: Chapter 4 - Physiological Therapeutics
1 Cryotherapy: Chapter 4 - Physiological Therapeutics
1
Cryotherapy
Date revised 6/27/03
CRYOTHERAPY
Ice is the modality of choice in acute trauma and sub-acute injury because of its physiologic
effects on injured tissue. Decreased circulation, decreased metabolism, and decreased
inflammatory effects reduce the secondary trauma that can occur following injury. For
example, secondary hypoxic injury (cell death due to poor oxygen supply) caused by disrupted
circulation is minimized by decreasing cellular metabolism, thereby decreasing oxygen
demands.
Inflammation is also reduced because of the effects on blood flow of ice, including
vasoconstriction (slowing the hemorrhaging in the area) and decreased histamine release.
Ice application is absolutely contraindicated in patients allergic to cold (may produce hives and
joint pain), Raynauds phenomenon (causes arterial spasm leading to possible ischemic
necrosis), impaired circulation, peripheral vascular disease, open wounds, and local infection.
Ice should be used with caution over some rheumatoid conditions (increases pain and joint
stiffness), paroxysmal cold hemoglobinuria with renal dysfunction and secondary hypertension,
very young/very old patients, history of frostbite in the area, and coma.
General considerations
Treatment time- Ice applied in one area for extended periods of time (over half an hour for most
patients, less in patients with poor circulation) can result in frostbite. Therefore, length of
treatment time is the most important treatment parameter to consider (see Techniques of
Application for suggested treatment times). In patients with acute conditions, ice is
recommended several times a day during the first three to four days following injury. However,
if the body is not given sufficient time to warm up between applications, each subsequent ice
application will cool the tissue lower and lower, possibly causing tissue damage. To prevent
Educational and Patient Care Protocols 1
Chapter 4 - 1
Date revised 6/27/03
this, time between ice treatments should be at least one hour to allow the tissue to warm back
up.
Modes of application- Ice therapy should provide deep penetration to be fully beneficial.
Therefore, freezing sprays are not as effective as ice because they are very superficial. Ice
packs, ice massage, ice water whirlpool, and iced wet towels are all more effective. Commercial
ice packs are also effective, but the freezer in which they are stored must be at freezing
temperature. Also, commercial packs warm up more rapidly during application, whereas ice
remains at a cooler temperature throughout the treatment.
PATIENT PREPARATION
It is essential to educate the patient regarding the sensations they will feel during the treatment.
When patients are warned in advance what to expect, reported discomfort during ice application
is considerably decreased, therefore, an understanding of the stages of cold is important in
preparing the patient.
TECHNIQUES OF APPLICATION
Application Procedure:
Step 1: Dampen a towel and wrap cold pack in it (1 layer, allows even and more efficient
conduction of cold
Step 2: Place on treatment area
Step 3: Cover with dry towel for insulation
Ice Massage
Treatment time: Until numbness (never more than 15 minutes; always stop when patients say
they feel numbness in the area of treatment)
Mode of heat transfer: Conduction
Penetration: 1/2 inch
Application Procedure:
Step l: Test the patient for reaction to cold.
Step 2: Put a towel around the area of treatment to absorb water (6" square is the
maximum treatment area)
Step 3: Tear away the upper part of the paper cup but leave the lower half of the
paper on the cup to hold on to
Step 4: Rub the ice directly on the treatment area, continuously moving the ice to
prevent frostbite. Apply ice massage in a circular pattern, with each succeeding stroke
covering half the previous stroke, or in a longitudinal motion, with each stroke
overlapping the previous stroke.
Slush bucket
Fill a bucket with half water and half-crushed ice. If treating the foot, a cap to cover the toes
makes the treatment considerably more bearable. This treatment is very intense; occasionally
patients may feel nauseated or lightheaded during the treatment. Except in extreme cases, be
sure the patient remains in the ice constantly throughout the treatment and is fairly still or they
will never get numb. Patients will quickly build up tolerance to this treatment when done on a
regular basis.
Application Procedure:
Step 1: Test the patient for reaction to cold
Step 2: Place the injured area in the bucket of ice
Step 3: Monitor patient throughout the treatment for lightheadedness and nausea
POST-TREATMENT PROCEDURES
Documentation following treatment should include how the patient's condition was immediately
affected following application, the treatment protocols that were used, any changes that need to
be made for the next treatment, frequency of application, and any home instructions that are
given to the patient.
Reference Consulted
Prentice, William E., Therapeutic Modalities for Allied Health Professionals, McGraw-Hill.
1998.
(Cryotherapy)
The first time you apply ice, it can be very uncomfortable, but each treatment will get easier and
easier as you get used to the ice application.
Another method of ice application at home is ice massage, which can be done with an ice cube
or a paper cup filled with water then frozen. Application of ice massage should last until the
area is numb or no longer than 15 minutes and should be applied directly over the site of injury
in a circular motion from the center of the injury out in an area no bigger than your hand. If you
have problems with circulation or decreased sensation in the injured area, talk to your
chiropractor before beginning treatment.