LEACTURE 7 CRYOTHERAPY Cryotherapy is the treatment of certain pathological conditions or lesions by the use of low temperature. Methods Of Cooling Tissues:- *Convection cooling:- An electric fan is used to blow air over the skin for reduction of hyperthermia. * Evaporative cooling:- The use of volatile fluids such as ethylchoride for evaporation from the skin. The thermal energy is removed and the skin temperature may be reduced about 4 C. * Conductive cooling:- Therapeutic application of cold will cause a reduction of heat from the tissues of the body. Temperatures are about 10 C in most cases.e.g. Crushed ice packs –Frozen gel packs- Ice baths, wet iced towels- and Ice cubes.

Indication Of Cold Application:- 1- Pain and muscle spasm: *The iced towel must remain on the muscle for at least 10 minutes to obtain a 10 C reduced of temp. *In arthritis---- pain in joints is decreased. *In rheumatoid arthritis-----there is an increase in joint temperature( normal= 8 C) which causes destruction of the cartilage. This will be reduced by cold therapy, which cause vasoconstriction+ reduction of nerve conduction velocity of pain fibers. *In acute ligaments , tendon lesions and tenosynovities----decrease pain and compete the inflammation.

2- Acute Inflammation Following Trauma: *Following trauma----- the injured tissue secretes (H) histamine like substances-----causing vasodilatation of the arterioles and capillares. These are bleeding from the lacerated tissue and increase tissue fluid causing edema. These process take place in the first 24 to 72 hours. *Uncontrolled edema vasodilatation-----contractures and chronic swelling+ impaired function of muscles and joints. *Ice application to the injured place-----vasoconstriction will limit bleeding and formation of haematoma----absorption of edema.

3- Chronic inflammation ( alternative hot and cold packs for 20 min). 4- Prevention of injury ( after vigorous sports in order to prevent after – effects of minor injuries). 5- Spasticity immersion for 5 min. in icing followed by therapeutic ttt. 6- Facilitation of movement-----stimulation by brief icing in cases of Bell,s palsy or paresis of any form. 7- Increase of isometric strength----- by using ice pack or ice towel on a muscle then start the isometric ex.------immediately after icing.

Contraindication:- 1-Peripheral vascular disease. 2-Cardiac disease or cerebrovascular insufficiency. 3-Loss of sensation. 4- Cancer---- not for a large area---- affect general circulation. 5- Emotional subjects and mental instability. 6- Hypersensitivity to cold. 7- Throat and side of neck----cerebral reaction. 8- Unreliable patients----too old, too young incomprehensive people

Dangers And Precautions With Ice Techniques:- 1- Venous thrombosis -----in old patints. 2- Skin or sof tissue injury. 3- Ice cube massage shouldnot lower the temp. below 14 C. so no danger of ice burn.