Cold Therapy

Cold therapy

Use of local or general cooling for therapeutic purposes “cryotherapy”

COLD THERAPY  To lower the local tissue temperature and provoke the thermoregulatory responses.  Applying ice to the body surface is a very effective way of withdrawing energy (heat) and hence lowering the surface temperature.

 For a constant source of cooling the temperature drop in the tissues will depend on. 

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The temperature difference between the coolant and the tissues. The thermal conductivity of the tissues. The length of time for which the cold is applied. The size of the area that is being cooled.

Cold therapy  Effects of cooling the skin surface  Therapeutic effects of cold  Types of application  Contra indications and dangers of cryotherapy

Principles  30 min to lower muscle temperature at 4cm depth by 3.5C  2.5cm-20min to drop by 2.5C

Physiological changes due to cooling the skin The local effects General effects of local cooling

Local effects  Immediate vasoconstriction  there is increased blood viscosity, due to cooling,  contribute to the slowed blood flow.  Followed by vasodilatation  Lewis Hunting response

 Cold applied to the skin provides a strong sensory stimulus by stimulating the cold receptors.  This may be used therapeutically in the suppression of pain and treatment of hypertonicity.

Local effects  Decrease metabolic rate-oxygen uptake, metabolite production,cellular activity=slowed healing  Decrease nerve conduction velocities  Decrease strength, fine movements,tremors,spasticity,dext erity

General effects of local cooling  Stimulate cold receptors.  Extreme cold is experienced as pain, involving pain receptors.  Cutaneous vasoconstriction.  Increase metabolism.  Heat production, by irregular muscle contractions.

Therapeutic uses of cold Recent injuries Pain Muscle Spasm Spasticity Muscle Strengthening Chronic Inflammatory Conditions Chronic edema and joint effusions Other therapeutic effects

Recent injuries  Limits bleeding by vasoconstriction  Limits pain-decreased pain nerve irritants  Reduces metabolic rate and secondary cell necrosis  Reduces joint effusion/edema  Reduces edema formation

Alleviation of pain  Reduces conduction of nerves  Sensory stimulation acts on pain gate  Strong cold sensation releases endorphins

Reduction in muscle spasticity  Increased viscosity diminish rapid stretch reflex  Affects muscle spindle  Stimulation of cutaneous receptors  Decreased nerve velocities

Other therapeutic effects

 Pressure sores.  Conjunction with stretching.  Acute lesions

 General contraindications     

If frostbite has been in area Pt has Raynaud’s disease Circulation to part is compromised Pt very old or young Pt extremely sensitive to cold

Technique of application  preparation of patient  Preparation of apparatus  Preparation of part  Instructions for the patient  Application  Termination

 Before applying cryotherapy    

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Inspect skin Test small area of skin, to determine if hypersensitive Verify good circulatory status Make certain patient never had frostbite in area to be treated Make certain pt never experienced a lot of spasticity when used Position & drape pt comfortably

Methods of applying cold therapy Local immersion Cold packs-ice packs\commercial cold packs Ice towels Ice massage Cold-Compression units Evaporating sprays

 Cold or Ice Water Immersion 

Equipment  

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Indications 

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Variety of basins or containers can be used, small whirlpool Temperature should be 50-60 degrees F Circumferential cooling of a body part

Application     

Athlete immerse 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

 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

 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

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Chemical Cold packs  Gel pack  Liquid pack

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Indications 

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Athlete experiences four stages of cooling and then proceeds with ROM exercises

Special Considerations 

Avoid excessive cold exposure; w/ any indication of allergy or abnormal pain, treatment should be stopped

Contrasting cold and of treatment Could you tell me what the difference is between heat and cold?

Dangers Contraindications Excessive local cold on normal tissues Certain pathological conditions Cold sensitivity Cardiac disease Arterial blood pressure Sensory deficiency Hypersensitive areas

Emotional and psychological features Precautions with particular cooling methods