Transcript Cryotherapy
By Ms.B.Nelson What is Cryotherapy Effects of Cryotherapy Uses of Cryotherapy Methods of application Contraindications 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 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 Hemodynamic effects Neuromuscular Metabolic effects effects 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 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 Decreased nerve conduction velocity Increased pain threshold Altered muscle strength Decreased spasticity Facilitation of muscle contraction 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 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 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 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 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. 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 Cooling lasting for 10 – 30 minutes results in temporary decrease of spasticity and clonus. These effects generally last for 1 to 1 ½ hours 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 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 Control of inflammation Control of oedema Control of pain Facilitation Modification of Spasticity Cryokinetics and cryostretch 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. 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 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 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 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 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 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) 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 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 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 Over an area with poor circulation or peripheral vascular disease Directly over regenerating peripheral nerves Cold hypersensitivity/cold intolerance Reynaud’s Disease and Phenomenon Over superficial main branch of a nerve Over open wound Poor sensation or poor mentation Very young and very old patients Hypertension diabetics Ice burn Improper application can result , in tissue damage (ice burn), tissue death, nerve conduction abnormalities The typical sequence of sensations in response to icing is :intense cold Burning Aching Analgesia Numbness Includes cold pack or ice pack, ice massage, Vapocoolant spray ,cold whirlpool, ice immersion, controlled cold compression unit 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