Cryotherapy or cold therapy is a widespread treatment modality used by physiotherapists to treated chronic and acute conditions of differing kinds. It is safe if regard is taken of the indications and contraindications and it is simple to use and to teach patients to self manage their pain problems. Sports physiotherapists and other physiotherapists managing acute injuries use cryotherapy due to its ease of use and lack of expensive equipment needed. The contraindications and indications to ice or cold treatment should be familiar to the physiotherapist before use. Cold water, cold packs, crushed or cubed ice may be used.
The local tissues are cooled by ice therapy as the water warms up or the ice melts, taking heat away from the body part. Physiologically the main effects of cryotherapy are constriction of the blood supply, reduction in metabolism locally, cold reaction circulatory increase, decrease in tissue bleeding, swelling and oedema reduction, painkilling effect from cold effects on nerve transmission and muscle efficiency reduction. Another effect of pain reduction from cold is to reduce the amount of muscle spasticity or muscle spasm occurring.
Many conditions benefit from the use of cold therapies and the effects are used to reduce oedema and swelling after an injury, a reduction in muscle spasticity once the muscle has cooled after a certain time, a lowering in pain, acute inflammatory inhibition such as required after acute injury, facilitation of a local increase in circulation and a lessening of muscle spasm. To facilitate contraction of muscles for functional muscle re-education physiotherapists will use ice and to increase ranges of movement after injury by stimulating muscle contraction.
Tissue damage from an injury to an area increases the blood supply locally, is hotter and suffers from oedema, all secondary to heightened tissue metabolism as the area reacts to damage. At this early stage these responses need to be damped down so cold is preferred over heat which would increase them. Cold reduces inflammation, eases pain, prevents swelling and slows the metabolic rate of the injured tissues, encouraging injury healing. It is important to get the cold onto the injured part as close to the precipitating event as you can, with compression if possible. Compression has been shown to be effective and may be more important than the cold.
As with all therapies there are risks involved in applying cold to the skin and these should be understood before using this therapy. Physiotherapists know the contraindications to cold therapy and assess the area for normal sensation, unbroken skin and normal skin texture and colour. Oil applied to the skin can protect against the amount of cooling and reduce the skin risks. An ice pack is typically used, crushed ice being placed in a towelling bag which is then placed snugly around the body part. The towelling should be wet or cooling will be limited and any air gaps between the ice pack and the skin will again reduce the cooling effect.
Frozen peas in the pack are commonly used and re-used by patients as they are cheap and convenient but come with a caution. Freezer temperatures are 18 degrees centigrade below zero and skin damage can result from direct application of such a cold pack. A wet tea towel or similar cloth should always be placed between these packs and the skin to avoid the chances of local skin damage known as frostbite. Length of treatment varies from 5 to 20 minutes and a check after 5 or 10 minutes is good practice to ensure the skin is reacting normally. Overcooling of the skin can be indicated by the appearance of discrete white spots and if they appear then the treatment should be terminated.
Pain after operative intervention or acute injuries are good subjects for cold therapy in the first two days after onset to control inflammation and pain. Areas of altered skin sensibility should be avoided as they may react abnormally and other contraindications are arterial insufficiency, cold allergy, Reynauds syndrome and lower limb ischaemia. Physiotherapists use various techniques including cold packs, water immersion, contrast baths, spray and stretch and massage with ice. Myofascial pain syndrome trigger points are treated with spray and stretch. - 14130
The local tissues are cooled by ice therapy as the water warms up or the ice melts, taking heat away from the body part. Physiologically the main effects of cryotherapy are constriction of the blood supply, reduction in metabolism locally, cold reaction circulatory increase, decrease in tissue bleeding, swelling and oedema reduction, painkilling effect from cold effects on nerve transmission and muscle efficiency reduction. Another effect of pain reduction from cold is to reduce the amount of muscle spasticity or muscle spasm occurring.
Many conditions benefit from the use of cold therapies and the effects are used to reduce oedema and swelling after an injury, a reduction in muscle spasticity once the muscle has cooled after a certain time, a lowering in pain, acute inflammatory inhibition such as required after acute injury, facilitation of a local increase in circulation and a lessening of muscle spasm. To facilitate contraction of muscles for functional muscle re-education physiotherapists will use ice and to increase ranges of movement after injury by stimulating muscle contraction.
Tissue damage from an injury to an area increases the blood supply locally, is hotter and suffers from oedema, all secondary to heightened tissue metabolism as the area reacts to damage. At this early stage these responses need to be damped down so cold is preferred over heat which would increase them. Cold reduces inflammation, eases pain, prevents swelling and slows the metabolic rate of the injured tissues, encouraging injury healing. It is important to get the cold onto the injured part as close to the precipitating event as you can, with compression if possible. Compression has been shown to be effective and may be more important than the cold.
As with all therapies there are risks involved in applying cold to the skin and these should be understood before using this therapy. Physiotherapists know the contraindications to cold therapy and assess the area for normal sensation, unbroken skin and normal skin texture and colour. Oil applied to the skin can protect against the amount of cooling and reduce the skin risks. An ice pack is typically used, crushed ice being placed in a towelling bag which is then placed snugly around the body part. The towelling should be wet or cooling will be limited and any air gaps between the ice pack and the skin will again reduce the cooling effect.
Frozen peas in the pack are commonly used and re-used by patients as they are cheap and convenient but come with a caution. Freezer temperatures are 18 degrees centigrade below zero and skin damage can result from direct application of such a cold pack. A wet tea towel or similar cloth should always be placed between these packs and the skin to avoid the chances of local skin damage known as frostbite. Length of treatment varies from 5 to 20 minutes and a check after 5 or 10 minutes is good practice to ensure the skin is reacting normally. Overcooling of the skin can be indicated by the appearance of discrete white spots and if they appear then the treatment should be terminated.
Pain after operative intervention or acute injuries are good subjects for cold therapy in the first two days after onset to control inflammation and pain. Areas of altered skin sensibility should be avoided as they may react abnormally and other contraindications are arterial insufficiency, cold allergy, Reynauds syndrome and lower limb ischaemia. Physiotherapists use various techniques including cold packs, water immersion, contrast baths, spray and stretch and massage with ice. Myofascial pain syndrome trigger points are treated with spray and stretch. - 14130
About the Author:
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Bolton visit his website.
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