Posted in PHYSIOTHERAPY on Sunday, 01 September 2013.

Best practice and misconceptions

What is cryotherapy?

What is Cryotherapy?

Is the therapeutic use of local or general body cooling. Cooling effect on the body has the effect of heat transfer away from the body tissues. Cooling in an area results in the lowering of local tissue temperature and provokes thermoregulatory responses.

Methods of cooling:
•    Ice packs
•    Gel packs
•    Ice baths
•    Cryocuff or game ready cooling device

Dangers using ice therapy:
Excessive local cold can lead to damage in normal tissues, leading to a frost burn.
Pathologies that contraindicate cryotherapy are:
•    Acute febrile illness
•    Cold sensitivity
•    Vasospasm (Raynaud disease, arthrosclerosis)
•    Cryoglobinaemia (Local blood clots due to low temperature)

Therapeutic uses of cold:
1)    Acute soft tissue injuries
•    Limits bleeding by vasoconstriction and increases local blood viscosity (tmp.14-42®).
•    Limiting pain by decreasing oedema formation
•    Limits pain by reducing production of painful nerve irritants
•    Reduces the metabolic rate and hence decreases secondary cell death.
2)    Alleviation of pain
3)    Reduces muscle spasm and spasticity

•    Effect of ice on swelling:
Most people are taught that the proper first aid after an acute injury (ankle sprain) is to apply ice directly to the injured area to minimize swelling. According to the latest research this is far from being proven. If ice is applied without the aid of compression then the initial vasoconstriction effect is followed by an excessive vasodilation effect, therefore instead of decreasing swelling we tend to increase it more (to read more look for “the hunting effect”). This is more extensive at temperatures below 15°.
Therefore the best applicable practice is to follow the PRICE or RICE principles which follow the acronym REST-ICE-COMPRESSION-ELEVATION.

There are NO!!! specific protocols or a “Gold” standard rule of how to use ice therapy due to different forms of ice treatment (crushed ice, ice gel pack, cold water immersion), therefore according to a recent study (Bleakley et al., 2006) recommends 10 minutes of ice therapy followed by 10 minutes of rest and then repetition of ice therapy for further 10 minutes every two hours. This may optimize both the swelling and analgesic effect.
In this study they also added that for acute injuries the best possible treatment is to apply ice for a maximum of 5 minutes to avoid any potential increased effusion and swelling.

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