8 Cryotherapy

CRYOTHERAPY
• OUTLINE
• Definition
• History
• Principals
• Physiological and therapeutic
effects
• Methods/techniques of cryotherapy
It is defined as the use of cold modalities for therapeutic
purposes, is used as a first-aid measure after trauma and as an
adjunctive tool in the rehabilitation of musculoskeletal and
neuromuscular dysfunctions.
• The use of cold as a therapeutic agent has a long
history, beginning in Egypt around 2500 BC.
• However, the use of cold for injury management and
rehabilitation did not become prevalent until the
1950s and 1960s.
• 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
soli form of ice into water which is called latent heat of
fusion.
– 1gm of ice at 0ºC = 336 J whereas
– 1 gm of water at 0ºC =155 J
• Thus, for cooling the body tissues it is better to use ice for
1. Effect on circulatory system
2. Effect on nervous system and neural system
3. Effect on pain management
4. Reduction of spasticity
5. Excitatory cold
• LEWIS-HUNTIN REACTION
• The rate of conduction of the nerve fibers is reduced by
cold.
A fibers > B fiber > C fibers.
• Effects on the muscle tone.
– The short, brisk application of cold is thought to enhance the
muscle tone (i.e. excitatory cold)
– The prolonged use of cold (as in immersion of cold) reduces
the muscle tone to a greater extent.
MECHANISM FOR PAIN
REDUCTION
ii. The cold stimulus is itself, is a noxious one and can
stimulate the midbrain which may release beta
endorphin or enkephalin into the posterior horn and
thus reduces pain.
iii. Increased circulation by the cold could carry away
chemical substances which are stimulating nociceptors
and thus the pain is reduced.
• Spasticity is a pathological state of increased muscle tone
resulting from damage of UMN lesion which cause
increase tone of extrafusal muscles.
• It is a normal response to injury or pain which aim to limit
movement and further damage.
• MECHANISM:
– It reduced velocity of nerve conduction or depressed sensitivity
of receptor and reduced spasticity within 30sec.
Helpful with active movement, contract antagonist or by
achieving postural reaction.
• It can be used to increase excitatory bias around
AHC.
• It can produced contraction in inhibited muscles and
used post-operatively and mixed peripheral nerve.
1. Ice packs or cold packs
2. Ice massage
3. Ice towels
4. Immersion in cold or cold whirlpool
5. Excitatory cold (quick ice)
6. Cool baths
7. Cold compression devices
8. Hyper cooled air or vapocoolant sprays.
Composition
Preparation of the
patient
Technique
Advantage
Duration
Uses
• There are some cold packs that are chemically activated by
squeezing or hitting them against a hard surface. These
packs are usually marketed for first aid and designed for one-
time use only.
• The chemical reaction inside some of the packs is at an
alkaline pH and can cause skin burns if the package splits
open and the contents spill out. Therefore, these packs are
not recommended for general use.
Ice massage:
Composition
Technique
Duration
Use
• Four common sensations are felt:
– intense cold
– Burning
– Aching
– Analgesia.
• However, the stages of burning and aching should
each pass rapidly within about 1 to 2 minutes.
• A prolonged aching or burning due to area covered
is too large or hypersensitive skin.
• Skin temperature will usually not drop below 59°F
(15°C) when the ice is continually moved over the skin;
therefore frostbite is minimal.
Composition
Preparation
Technique
Duration
Use
Composition • Flaked ice or crushed ice(50%) with water (50%) to form
slush
Technique • .
Duration • 10 minutes for a single session or for a series of shorter

immersions.
Use • Extremities of the body like feet, hands and elbow
Composition • Fluoromethane or ethyl chloride.
Technique
Duration • Repeated treatment is done during same session.

Use
TECHNIQUE FOR TRIGGER POINT:
– The patient is positioned comfortably and the muscle

containing the trigger point is placed on passive stretch.
– Spraying is done in unidirectional sweeps along the muscle
over the trigger point areas and over the areas of referred
pain while maintaining and gently increasing the passive
stretch.
– To increase muscle length without identified trigger
points, the muscle is sprayed along its length from the
proximal to the distal attachments.
– Repeated treatments during the same session are done only
after the skin has been rewarmed to avoid frosting the skin.
Composition • A basin of water or a small whirlpool filled with water
and crushed ice can be used.
Technique
Duration • Every 1-2 hours

Use • Distal extremities
Composition • Ethanol and menthol
Duration • Four times daily for 2 weeks
Use • Apply to the skin overlying the area of injury and pain
Advantage • Ease of application
• Ease of portability
1. Cardiac conditions: In patient with a recent myocardial infarction, the
application of cold may cause further drop in blood pressure and further
reduces the blood supply of the heart.
 The left shoulder and the heart have the same sympathetic nerve supply
and overflow of excitatory impulses to the heart so it should be avoided.
2. Peripheral nerve injuries: In the patients with peripheral nerve injuries
the
application of cold should be avoided.
3. Peripheral vascular disease: It should be avoided because the cold may
further reduce an already inadequate blood supply. In cases of vasospastic
disease like the Raynaud’s disease, It should be avoided.
4. Psychological or cold sensitive: The patients having fear of the cold may
react adversely. Following the application of cold, they start producing
histamine like substance causing urticaria with skin rash and itching. So it

8 Cryotherapy

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8 Cryotherapy

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CRYOTHERAPY

Duration • 10 minutes for a single session or for a series of shorter

Duration • Repeated treatment is done during same session.

– The patient is positioned comfortably and the muscle

Duration • Every 1-2 hours

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