1. By Ms.B.Nelson

2.  What is Cryotherapy  Effects of Cryotherapy  Uses of Cryotherapy  Methods of application  Contraindications

3.  Describe the physiologic effects of cryotherapy  List the indications,contraindications and precautions in the use of cryotherapy  Describe the rationale for the use of cryotherapy as an intervention

4.  Describes the therapeutic use of cold /ice application  When cold is applied to the skin, which is a warmer object,heat is lost; this is referred to as cooling  Cooling occurs via conduction and evaporation

5.  Hemodynamic effects  Neuromuscular effects  Metabolic effects

6.  Initial decrease in blood flow  Immediate constriction of the cutaneous blood vessels– vasoconstriction Decrease in blood flow to the area  Vasoconstriction persists with cold application of 15 minutes duration or less

8.  Later increase in blood flow occurs when cold is applied for longer periods of time  Phenomenon is called cold induced vasodilatation (CIVD) or Hunting response  CIVD occurs mainly in the extremities

9.  Decreased nerve conduction velocity  Increased pain threshold  Altered muscle strength  Decreased spasticity  Facilitation of muscle contraction

10.  Cold application can alter the conduction velocity and synaptic activity of peripheral nerves  Quantity of change depends on the duration and degree of temperature change  Decrease conduction velocity in both motor & sensory nerves

11.  Greatest effect on myelinated and small nerve fibres  A- delta fibres, small –diameter,myelinated pain transmitting fibres – greatest response to cooling  Reversal within 15 minutes of removal of ice 

12.  Reversible total nerve block can occur with ice application over superficially located major nerve branches.  For example, the peroneal nerve on the lateral aspect of the knee,medial aspect of the elbow

13.  Stimulation of the cutaneous cold receptors can partially block the transmission of painful stimuli to the brain  Resulting in an increased pain threshold and decrease in pain sensation

14.  Cryotherapy is associated with both increase and decrease of muscle strength  Isometric muscle strength has been shown to increase with application of ice- massage for 5 minutes or less. Isometric muscle strength has been shown to decrease after cooling for 30 minutes or longer.

15.  Cryotherapy can temporary decrease spasticity  The decrease in spasticity is due at least two mechanisms:  (1) decrease in gamma- motor neuron activity through stimulation of the cutaneous nerves  (2) decrease in muscle spindle and Golgi Tendon activity

16.  Cooling lasting for 10 – 30 minutes results in temporary decrease of spasticity and clonus.  These effects generally last for 1 to 1 ½ hours

17.  Brief application of ice ( between 1 to 5 minutes) is thought to produce a muscle contraction in a muscle that is flaccid from upper motor neuron dysfunction.  Sometimes used clinically to stimulate muscle contraction in patients with upper motor neuron injuries

18.  Decrease metabolic rate occurs with cooling:  Decrease rate of activity in the inflamed tissue  Decrease activity of cartilage degrading enzymes with decreases in joint temperature Cryotherapy recommended as intervention for Osteoarthritis and Rheumatoid arthritis

19.  Control of inflammation  Control of oedema  Control of pain  Facilitation  Modification of Spasticity  Cryokinetics and cryostretch

20.  Ice/cryotherapy is used to control acute inflammation and accelerate recovery from injury  Cryotherapy used within the first 2 days of injury resulted in reduced pain, swelling and shortened recovery time.

21.  Decreased temperature slows the rate of chemical reaction that occurs during acute inflammation  Cryotherapy also reduces the heat,redness, swelling and pain associated with inflammatory phase of healing

22.  Heat associated with inflammatory response is decreased by application of ice to the area  Vasoconstriction and increased blood viscosity associated with application of cryotherapy controls bleeding and fluid loss after acute trauma  Cryotherapy is thought to control pain by decreasing activity in the A-delta pain fibres and by gating at the spinal cord level

23.  Apply cryotherapy immediately after injury and during the inflammatory phase of healing to help control bleeding, swelling and pain and to accelerate recovery.  Acute inflammation usually resolves in 48 – 72 hours

24.  Cryotherapy reduces blood flow into the are by vasoconstriction and increased blood viscosity  Cryotherapy also reduces the release of vasoactive substances such as histamine and prostaglandins  Ice,along with compression and elevation reduces postinjury swelling

25.  Cryotherapy modifies the sensation of pain by gating pain transmission with activity of the cutaneous receptors  Application of ice for 10- 15 minutes can control pain for approximately 1 hour or more

26.  Ice can be used to temporarily decrease spasticity in upper motor neuron dysfunction  Brief application of ice for approx 5 mins results in decreased tendon reflex Ice application of 10 – 30 mins decreases resistance of muscles to passive stretch for approximately 1 hour or longer( therapeutic activities can be done)

27.  Quick icing is a technique used in rehabilitation for patients with flaccidity due to upper motor neuron dysfunction.  Research on the effective use of this technique to elicit muscle contraction is not strong

28.  Cryokinetics involves applying a cooling agent to the point of numbness,to reduce pain sensation  The patient can then exercise to achieve his goal  Caution: be careful not to avoid further tissue damage due to numbness

29.  Application of cooling agent before stretching  Aim of this activity is to reduce muscle spasm and allow greater range of movement when stretching the joint

30.  Over an area with poor circulation or peripheral vascular disease  Directly over regenerating peripheral nerves  Cold hypersensitivity/cold intolerance  Reynaud’s Disease and Phenomenon

31.  Over superficial main branch of a nerve  Over open wound  Poor sensation or poor mentation  Very young and very old patients  Hypertension  diabetics

32.  Ice burn  Improper application can result, in tissue damage (ice burn), tissue death, nerve conduction abnormalities

33.  The typical sequence of sensations in response to icing is :intense cold  Burning  Aching  Analgesia  Numbness

34.  Includes cold pack or ice pack, ice massage,  Vapocoolant spray,cold whirlpool, ice immersion, controlled cold compression unit

35.  Physical Agents in Rehabilitation: From Research to Practice: Michelle H. Cameron  Physical Agents: Theory And Practice: Barbara J. Behrens, Susan L. Michlovitz  Therapeutic Modalities in Rehabilitation by William Prentice