Cryotherapy

By
Faisal Mehboob

Introduction
The application of cold to the tissues after injury is a practice as
old as medicine itself.
Nowadays the local temperature of the tissues may be reduced
by the application of various forms of ice or frozen gel packs, or
by the evaporation of volatile fluids from the skin.
Often the skin temp is reduced to 10C.

Uses
Reduce pain
Reduce spasticity
Reduce muscle spasm
Reduce swelling
Promote repair
Provide excitatory stimulus, when muscle are
inhibited.

Physical principle
When ice is applied to skin
Heat is conducted from skin to the ice in order to
melt it.
To change its state, the ice requires considerable
energy (latent heat of fusion). {to raise the temp of
1g of ice at 0degree to 1g of water at 37 degree
requires 491j, whereas to raise 1g of water at 0C to
37C requires only 155j}
When trying to cool tissues it is important to use
ice during treatment and not just cold water.

Physiological effects and uses

Circulatory response (initial vasoconstriction then vasodilation and then
alternate periods of constriction and dilation.) this is called as Lewiss Hunting
reaction.
Physiotherapeutic uses of circulatory effect
Initial vasoconstriction often used to limit the extravasation of blood into the
tissues following injury. E.g. sports injuries.
Alternate periods of vasoconstriction and dilation affect the capillary blood flow,
and it is across the capillary membrane that tissue fluid and metabolic exchange
take place.
Hoffs law ! (Reduced metabolic rate of cooled tissues), it allows cooled muscle to
contract many more times before fatigue sets in.
It is possible that the increased circulation could carry away chemical substances
which are stimulating nociceptors and producing pain.

Neural response
Reduction in pain
Reduction of spasticity
Excitatory cold

Techniques of application
Ice towels
Ice packs
Immersion
Ice cube massage
Excitatory cold

Ice towels (most popular method )

Preparation
Prepare bed by removing blankets
and sheets and cover it with
waterproof material.
Adequately expose the part to be
treated
Prepare the ice solution by filling a
bucket or large bowl with two parts of
flaked or crushed ice to one part
water. This mix should give a mulch
in which two terry towels are
immersed.

Application
The surplus water is wrung from one
towel, leaving as much ice clinging to
it as possible.
The towels are changed when they
have been in position for at least 30sec
but not longer than 2 min.
Up to ten towels can be applied
consecutively more if the
physiotherapist considers they will be
beneficial. The total treatment time is
of the order of 15 to 20 min.

Modification of technique
In the presence of SWELLING it
is permissible to elevate the limb
and completely surround the
joint with ice towels.
The patient can exercise with the
towel in position. It is also
possible for the physiotherapist
to apply manual resistance tech
with the towel in position.

Ice packs (crushed ice may be placed inside a

specially made terry-towel bag)
Preparation of the bed

Preparation of the patient

A gutter made of polythene sheet

is folded and placed on the bed.

The part to be treated is exposed

and put into a comfortable
position over the prepared gutter.
Vegetable or nut oil spread over
the skin on which ice pack is to
be used. this prevent an ICE
burn.

Application
The wet ice pack is placed on top of the part
to be treated.
packs should never surround a limb as this
as this would inevitably put pressure on one
aspect of the limb and could reduce the
circulation locally.
A reduced circulation would prevent a
normal circulatory response to cooling and
might precipitate an ice burn.
The pack may left in position for 10 to 20
min.

Immersion (a tech in which the part to be

treated is immersed in an ice solution)
Preparation
Solution is made up of 50%ice
and 50%water, placed in a
suitable container.

Application
The patient immerses the part in the
solution and keeps it in either for a
single 10min session or for a series of
shorter immersions until a cumulative
total of 10 min has been reached.
Often the patient experiences intense
pain in the immersed area, sometimes
severe enough to cause him to faint.
He should therefore be suitably
supported, and watched throughout the
treatment.

Ice-cube massage (useful method, it does not

require an ice machine )
Preparation

Application

A large block of ice E.g. water

frozen in a yoghurt pot, has one
end wrapped in a towel, the outer
end being left free.
The patient is adequately
exposed and supported.

The exposed end of the ice block

is massaged in a circular manner
over the treatment area, applying
only minimal pressure to the
part.
The max time of application is
ten min.
The desired effect may be
achieved before this.

Excitatory cold
Marked sensory stimulus of ice on skin may be used to facilitate contraction of
inhibited muscles.
It is necessary first to ascertain the spinal root level supply (myotome) of the
inhibited muscle and then to find the area of skin which has the same root
supply (dermatome ).
Once this has been done, the ice is stroked quickly three times over the
dermatome and the skin is then dried.
This sensory stimulus passes back via the peripheral nerve and enters the cord
through the posterior horn.
The anterior horn cells have many connections with these sensory fibers and the
net result, it is thought , is a raising of the level of excitation around the ant horn
cells.

Contraindication
Psychological
Cardiac condition
Peripheral nerve injuries
Vasospastic disease
Peripheral vascular disease
Cold sensitivity

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