1. Principles and Practices of Cryotherapy National Fitness Center Lee Young Mi

2. 국민체력센터 운동처방실 2 What is Cryotherapy? Cryotheapy is applied of cold to remove heat from the body. Cryotheapy is applied of cold to remove heat from the body. Cryotherapy is one of the superficial heat therapies. Usually its physiological effects are more prolonged than superficial heat therapy of same intensity. Cryotherapy is one of the superficial heat therapies. Usually its physiological effects are more prolonged than superficial heat therapy of same intensity. Cryotherapy is used various fields of musculoskeletal injury such as muscle spasm, pain, early arthritis, and burn etc. Cryotherapy is used various fields of musculoskeletal injury such as muscle spasm, pain, early arthritis, and burn etc.

3. 국민체력센터 운동처방실 3 Review of Research Harris E & McCroskery PA(1974) : The influence of temperature and fibril stability on degradation of cartilage collagen by rheumatoid synovial collagenase. N Engl J Med 290:1-6. Harris E & McCroskery PA(1974) : The influence of temperature and fibril stability on degradation of cartilage collagen by rheumatoid synovial collagenase. N Engl J Med 290:1-6. - collagenase activity significantly - collagenase activity significantly decrease below 30-35°C. decrease below 30-35°C.

4. 국민체력센터 운동처방실 4 Review of Research Wrigh V & Johnson RJ (1960): Physical factors concerned with the stiffness of normal and diseased joints. Bull Johns Hopkins Hosp 106:215-231. Wrigh V & Johnson RJ (1960): Physical factors concerned with the stiffness of normal and diseased joints. Bull Johns Hopkins Hosp 106:215-231. -joint stiffness was increased by -joint stiffness was increased by cryotherapy whereas was decreased cryotherapy whereas was decreased by thermotherapy by thermotherapy

5. 국민체력센터 운동처방실 5 Review of Research Konrath, G.A.,Lock, T.,Goittz, H.T.,& Scheidler, J.(1996).The use of cold therapy after ant. Cruciate ligament reconstruction The American Journal of Sports Medicine,24(5),629-633. Konrath, G.A.,Lock, T.,Goittz, H.T.,& Scheidler, J.(1996).The use of cold therapy after ant. Cruciate ligament reconstruction The American Journal of Sports Medicine,24(5),629-633. -non-significant -non-significant Chon, B.T., Draeger, R.I., & Jackson, D.W.(1989). The effects of cold therapy in the postoperative management of pain in patients undergoing ant. Cruciate ligament reconstruction. The American Journal of Sports Medicine, 17,344-349. Chon, B.T., Draeger, R.I., & Jackson, D.W.(1989). The effects of cold therapy in the postoperative management of pain in patients undergoing ant. Cruciate ligament reconstruction. The American Journal of Sports Medicine, 17,344-349. -significant -significant

6. 국민체력센터 운동처방실 6 Physics Related to Cryotherapy Energy Transmission Conduction : removal of heat from warmer object to cooler object through direct molecular interaction of objects in physical contact Conduction : removal of heat from warmer object to cooler object through direct molecular interaction of objects in physical contact - conductive modalities : cold pack, - conductive modalities : cold pack, ice pack, ice massage, cold bath. ice pack, ice massage, cold bath.

7. 국민체력센터 운동처방실 7 Physics Related to Cryotherapy Energy Transmission Evaporation (heat of vaporation) : highly volatile liquids that evaporate rapidly on contact with warm object. Evaporation (heat of vaporation) : highly volatile liquids that evaporate rapidly on contact with warm object. - Vaporation modalities : vapocoolant - Vaporation modalities : vapocoolant sprays, machine. sprays, machine. * Continued use questionable due to * Continued use questionable due to environmental concerns. environmental concerns.

8. 국민체력센터 운동처방실 8 Physics Related to Cryotherapy Energy Transmission Heat of Fusion : the amount of heat given off when a liquid turns into a solid form as it cools. Heat of Fusion : the amount of heat given off when a liquid turns into a solid form as it cools. Modality : paraffin bath Modality : paraffin bath

9. 국민체력센터 운동처방실 9 Physiological Effects of General Cold Application Large body surface area exposed to cold modality ; e.g. Whirlpool and therapeutic pool Large body surface area exposed to cold modality ; e.g. Whirlpool and therapeutic pool DECREASEDINCREASED Metabolic rate Pulse rate Respiratory rate Venous blood pressure Blood flow to internal organ Cardiac output Stroke volume Atrial blood pressure Shivering(occur s when core temperature drops)

10. 국민체력센터 운동처방실 10 Physiological Effects of Local Cold Application Body tissue responses to cold: Body tissue responses to cold: a. Skin temperature falls rapidly and a. Skin temperature falls rapidly and exhibits greatest temperature change. exhibits greatest temperature change. b. Subcutaneous temperature falls less b. Subcutaneous temperature falls less rapidly and displays smaller rapidly and displays smaller temperature change. temperature change. c. Muscle and joint shows least temperature c. Muscle and joint shows least temperature change, requiring longer cold exposure. change, requiring longer cold exposure.

11. 국민체력센터 운동처방실 11 Physiological Effects of Local Cold Application Hunting reaction : cyclic construction Hunting reaction : cyclic construction and dilation of blood vessels following prolonged cold exposure. Occurs mostly in apical areas(hands, face, ears, and dilation of blood vessels following prolonged cold exposure. Occurs mostly in apical areas(hands, face, ears, feet) where arteriovenous anastomoses feet) where arteriovenous anastomoses are found in the skin are found in the skin

12. 국민체력센터 운동처방실 12 Physiological Effects of Local Cold Application Vasocontriction of skin capillaries resulting in blanching of skin in center of contact area and hyperemia due to histamine reaction, around the edge of contact area in normal tissue. Vasocontriction of skin capillaries resulting in blanching of skin in center of contact area and hyperemia due to histamine reaction, around the edge of contact area in normal tissue.

13. 국민체력센터 운동처방실 13 Physiological Effects of Local Cold Application Physiological responses of body systems and structures to local cold application Physiological responses of body systems and structures to local cold application DECREASEDINCREASED Blood flow Capillary permeability Elasticity of nonelastic tissues Metabolism Muscle spasm Muscle strength(long duration: >5-10min)Spasticity Vasoactive agents Joint stiffness Pain threshold Increased blood viscocity Muscle strength(short duration: 1-5min)

14. 국민체력센터 운동처방실 14 Adverse physiological effects of cold due to hypersensitivity Cold urticaria : errythema of the skin with wheal formation associated with severe itching due to histamine reaction Cold urticaria : errythema of the skin with wheal formation associated with severe itching due to histamine reaction Facial flush, puffiness of eyelids, respiratory problems and in severe cases, anaphylaxis(decreased blood pressure, increased heart rate) with syncope are also related to histamine release. Facial flush, puffiness of eyelids, respiratory problems and in severe cases, anaphylaxis(decreased blood pressure, increased heart rate) with syncope are also related to histamine release.

15. 국민체력센터 운동처방실 15 General Indications for Cryotherapy Acute and chronic traumatic and inflammatory conditions Acute and chronic traumatic and inflammatory conditions Edema Edema Muscle spasm Muscle spasm Musculoskeletal pain, and thermal burns Musculoskeletal pain, and thermal burns

16. 국민체력센터 운동처방실 16 General Contraindications for Cryotherapy Impaired circulation Impaired circulation Impaired sensation Impaired sensation Peripheral vascular disease Peripheral vascular disease Prolonged application over superficial nerves could result in neuropraxia Prolonged application over superficial nerves could result in neuropraxia Raynaud’s disease, sensitivity or allergic reaction to cold Raynaud’s disease, sensitivity or allergic reaction to cold

17. 국민체력센터 운동처방실 17 Coo ling Physical Agents Cold packs Description : vinyl casing filled with silica gel or sand-slurry mixture. Method of application : (1)Keep the patient warm throughout treatment. (2)Dampen a towel with warm water, wring out excessive water, fold in half, width-wise and place cold pack on towel. (3)Place pack on patient and cover with dry towel to retard warming (4)Secure pack Treatment temperature and Time : 0°-10°F, 10-20min

18. 국민체력센터 운동처방실 18 Coo ling Physical Agents Ice packs Description : crushed ice folded in moist towel or placed in plastic bag covered by moist towel Method of application : (1)Apply the ice pack to body part (2)Cover pack with dry towel Treatment time : 10-20min

19. 국민체력센터 운동처방실 19 Coo ling Physical Agents Ice towel Description : towels soaked in ice slush. Water is added to shaved ice to produce an ice slush. Method of application : (1)Immerse two towels in slush, wring one out and apply to body part. (2)Secure towel manually (3)Exchange towels when applied towel warms up, usually in 45-60 seconds. (4)Repeat procedure to reach or maintain effect. Treatment time : 10-15min

20. 국민체력센터 운동처방실 20 Coo ling Physical Agents Ice massage Description : ice cylinder formed by freezing water in a paper cup, styrofoam cup or juice can. Method of application : (1)Remove ice from container. (2)Apply the ice massage to an area no larger then 4”x 6” slow (2”/sec) overlapping longitudinal strokes, each sstroke covering one-half of previous circle or stroke. If treating a large area, divide into smaller areas. (3)DO not massage over boney area or superficial nerves e.g.peroneal. (4)Use a towel to dab excess water from treatment area. Ice will melt rapidly initially, but rate of melting will slow as skin cools. (5)Continue treatment until anesthesia is achieved. Treatment time : 5-10min

21. 국민체력센터 운동처방실 21 Cooling Physical Agents Vaporcoolant spray Description : a non-toxic, non-flammanble volatile liquid which produces rapid cooling when a fine spray is applied to the skin. Vaporcoolant sprays are primarily used to reduce muscle spasm, desensitizing trigger points. Method of application : spray and stretch method (1) Invert container, nozzle down, hold about 18”-24” from treatment area. (2) Spray at 30° angle and sweep spray over treatment at 4”/sec. (3) Allow liquid to completely evaporate before applying next sweep. Caution! Do not frost skin. (4) The muscle should be passively stretched before and during application (5) Cover the entire treatment area, starting at the pain site and moving to the area of referred pain. (6) Having patient perform active exercise after spraying Treatment time : 10-15min

22. 국민체력센터 운동처방실 22 Coo ling Physical Agents Contrast bath Description : the alternating immersion of a body in warm and cold water to produce a vascular exercise through active vasodilation and vasoconstraction of the blood vessels. Method of application : (1) The treatment usually begins in warm water. (2) Place part in the warm water for 6-10min, then transfer to cold water for 1min. (3) Immerse part in warm water for 4min. (4) Continue sequence of 4:1. End in warm water. Other warm/cold ratios may be used depending on patient tolerance. (5) The condition treated may determine the ending temperature. Ending in cold water may be more beneficial if treating edema.

23. 국민체력센터 운동처방실 23 Contrast bath Treatment temperature and Time : (1) Hot water:100°F-100°F (2) Cold water:55F°-65°F (3) During initial treatment you may wish to begin with the upper end of the cold range and lower end of the warm range. (4) Time:20-30min. Indications: any condition requiring stimulation of peripheral circulation in limbs, peripheral vascular disease, sprains, strains, and trauma (after first few hours). Contraindications: advanced arteriosclerosis, arterial insufficiency, loss of sensation to heat and cold.

24. 국민체력센터 운동처방실 24 Crykinetics Combination of : cold application & active exercise Combination of : cold application & active exercise Method Method Apply ice until tissue is numb(20min) Apply ice until tissue is numb(20min) Exercise within limits of pain(3 t0 5min) Exercise within limits of pain(3 t0 5min) Renumb with ice(5min) Renumb with ice(5min) Exercise within limits of pain(3 to 5min) Exercise within limits of pain(3 to 5min) Renumb with ice Renumb with ice Pain is limiting factor for exercise Pain is limiting factor for exercise Exercise should be deliberate and controlled Exercise should be deliberate and controlled

25. 국민체력센터 운동처방실 25 Thank you for your attention!!