Cryotherapy – Ice Therapy

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Ice therapy (Cryotherapy) is a treatment involving the application of ice. This is one of the commonest and very old method of treatments.

Ice isn’t just to make drinks cold any longer; in this advantage age ice has relocated its position as a therapeutic modality. Ice therapy is a treatment involving the application of ice. This is one of the commonest and very old method of treatments wherein the temperature of the skin over the ailment is reduced to 10° Centigrade during the treatment.

What does ice do?

1. Reduces Pain and Muscle Spasm:

Pain and muscle spasms are common responses to injury. The basic building material of muscles, tendons and ligaments is a protein called collagen. Under normal conditions, collagen acts like a rubber band: It stretches when tension is applied (just like we pull a rubber band) and returns to its normal length when the tension is released. However, when the collagen is stretched too far, it tears. In this tearing process, blood vessels are torn and blood cells and fluid escape into the spaces among the muscle fibers. This is sometimes visible on the surface of the skin as a swollen, bruised area producing muscle spasm and pain.

Cold applied to such areas reduces pain as :-

  • It decreases the flow of the fluid into the tissues and slows the release of chemicals that cause pain and inflammation
  • It decreases the feeling in an area by reducing the ability of the nerve endings to conduct impulses. It may also reduce by “countering” the injury. For example, you might counter the pain of a sore tooth by pinching yourself hard in the leg
  • Cooling the deep tissue also reduces spasm by reducing the muscle’s ability to maintain a contraction (contractility).

2. Reduces Swelling

Cold also decreases the activity of cells to reduce swelling and internal bleeding at the site of injury.

Because cold reduces bleeding and swelling within injured tissue, it is best used in the first 48 hours after an injury and usually longer after a surgery.

3.Facilitates Rehabilitation Procedure:

Ice can also be applied in later stages for rehabilitation of injuries or chronic (long-term) problems as it helps m:-

a. Reducing spasticity, in order to facilitate muscle activity.
b. Healing of pressure sores.

4. Can be used in conjunction with exercise:

Ice can be used to enhance the restricted movement e.g. post-fracture stiffness. Once the fourth stage of icing has been achieved, numbness, gentle range of motion and isometric exercises can begin. These movements should be painless, stressing circular, spiral and diagonal movements. Once the numbness has worn off, re-ice and exercise again. This can be done two or three times a day. Ice can cause changes in the collagen fibers of the muscle. Strenuous exercise is a bad idea during an ice treatment, as this can result in further damage to the injury.

How Does The Ice Therapy Work?

Ice initially constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, which can limit hemorrhage and cell death in an acute traumatic injury. After approximately 20 minutes of ice application, blood vessels in the injured area then dilate (open) slowly; increasing the tissue temperature, an effect which is termed “reactive vasodilatation” found that despite the reactive vasodilatation, there was a significant sustained reduction in local blood volume after ice was applied.

There occur four official stages on ice application. The first stage is “extreme cold” sensation; the second one is that of “burning/ pricking”, and the third stage “aching” sensation which can sometimes be worse than pain itself. The fourth and most important stage is numbness. As soon as this stage is achieved, remove the ice. Time duration depends upon body weight. Twenty to thirty minutes should be the maximum time per area. If it is necessary to reapply ice, let the skin go to normal temperature or go back to the third stage of aching.

Various Modes of Ice Application:

  • Cold Pack
  • Ice towels
  • Cold bath/immersion technique
  • Vaporizing spray
  • Ice massage

Cold Pack : These are of two types: ( See also : Benefits of cold ice packs and cold compresses )

1. One category consists of a bag which contains a mixture of water and anti-freeze substance. These are usually cooled in a freezer and then molded to the part.

2. Other category consists of the packs which rely on chemical reactions of their cooling properties,’ such packs may only be used once.

Both types of packs are effective in cooling the tissue temperatures, but it has been demonstrated that chemical packs are most effective in lowering subcutaneous temperature.

Ice Towels : This is one of the superficial modes of cooling. In this, the terry towels are placed in the mush of flaked ice and water, wrung out and applied to the part. In this case the benefit is that large areas can be covered but towel need to be replaced frequently as it warms up rapidly. In order to attain the desired results, the towel should be in contact with the part for at least 20 minutes.

Cold Bath : This is one of the simplest method of cooling the tissue i.e. to place the part in the cold water or the mixture of ice and water. In this method the body temperature can be controlled by varying the ratio of ice to water. The temperature of 16 to 18 ° Centigrade may be tolerated for 15 to 20 minutes; even the lower temp can be used but will require intermittent immersion of the part.

Vaporizing Sprays : A volatile liquid is sprayed directly onto the area, which needs to be treated. It is used for athletes for instant relief. It is important that spray used should be both non-inflammable and non-toxic for safety reasons. It should be applied to the area in short burst. This technique uses role of evaporation to produce cooling of the skin thus reducing the temperature of the tissues, but is short lived.

Ice Massage : Ice lollipops or blocks may be used to produce analgesia (loss of sensation). It is normally performed over the small area such as muscle belly or trigger points. By this treatment, the area of not more than 10* 1 5 cm should be treated for over 20 minutes. Here is a circular motion over a small area is used. Temperature does not drop to the level below 15° Centigrade with this method. Ice massage is also used to facilitate muscle activity, where ice is applied briskly and briefly over the skin dermatome of the same nerve root as the muscle in question.

Use of Ice
When applying ice, never do so directly onto the skin as this may result in ice burns to the skin. Wrap the ice in a damp cloth (a dry cloth will not transmit cold effectively). There is on going debate over how long, to apply ice, and current research suggests that during the acute phase (i.e. first 24-48 hours after injury), 10 minutes is the maximum time needed and may be adjusted downwards according to the depth of tissues it is being applied to. Application for the appropriate time must be repeated every 2 hours during the acute phase.

If the ice pack is left on for more than 10 minutes, a reflex reaction occurs (Hunting effect) where the blood vessels dilate and blood is again pumped into the injured area, causing further bleeding and swelling. During the first 24 to 72 hours after an injury be sure to avoid any form of heat at the injury site (e.g. heat lamps, heat creams, spa’s, Jacuzzi’s and Sauna’s), avoid movement and do not massage the injured area as these will increase the bleeding, swelling and pain.

After the initial healing period of up to 72 hours (depending on the severity of the injury) ice massage may be incorporated into treatments. By applying stroking movements with an ice pack, the blood vessels will dilate and constrict alternately bringing an increased supply of blood and nutrients to the area, and so increasing the rate of healing. This may be done for more than 10 minutes to increase circulation.

What Kind of Ice Therapy Should Be Employed?

Every mode has its own merits and demerits. Like:

Ice packs are very practical and easy to use, but ice massage produces a rapid and profound cooling, because of their potentially extreme temperatures (as low as minus 20° Centigrade.)

Refrigerant gels should be used with extreme caution: always place a towel between the gel and your skin.

Cooling’ sprays most commonly used by athletes and other sports person as it makes them free of muscle cramps and aches instantaneously. But produce only a temporary chilling of the skin and do not lower the temperature of the deeper tissues i.e. provides only temporary relief not a permanent one.

Contraindications :

  • Do not use ice on injuries in the chest region as in some instances this may cause a reaction in the muscles, bringing about anginal pain, possibly from the constriction of coronary arteries.
  • Always check skin sensitivity before applying ice – if a person cannot feel touch before applying ice; this may indicate other problems such as nerve impingement. In such instances ice would only serve to mask this and complicate the problem.
  • Do not apply cold to someone with high blood pressure as vasoconstriction will increase the pressure within the vessels.
  • Check person’s general sensitivity to ice- some people find the application of cold immediately painful.

Various Advantages

  • Easily available.
  • Application is easy.
  • Give good results.
  • Fastest means to prevent bleeding.
  • It fastens the healing process (in case of bed sores or ulcers).

Cold may be applied in number of ways including wet and dry packs, evaporation sprays etc.

Cold vs Hot Therapy

Both heat and cold modalities can be used effectively in various clinical conditions. Many situations lend themselves to use these diverse modalities to take advantage of known biologic effects for managing certain ailments.

The similarities of these 2 modalities include the following :

  • Decreased muscle spasm secondary to musculoskeletal pathology or nerve root irritation.
  • Cold effectively decreases spasticity of upper motor neuron etiology; heat reduces spasticity, but the effects are short-lived and ineffective for muscle re-education.
  • Both heat and cold modalities cause analgesia.

The following examples illustrate the significant differences in the physiological effects between therapeutic heat and cold treatments, which makes the use of cold therapy in acute phase of treatment an important feature:

  • A longer time is necessary for cooled muscle to return to normal temperature, because application of heat increases blood flow, a heated muscle returns to normal temperature after a few minutes.
  • Increased tissue metabolism occurs with temperature elevation; reduced metabolism with cold modalities.
  • Heated muscle tissue can sustain a contraction for a shorter period of time; cooling to approximately 27° Centigrade increases the ability of muscle to sustain contraction.
  • Blood flow increases with heat and decreases with cold.
  • The tendency to bleed increases with heat and decreases with cold.
  • Formation of edema is facilitated by heat and decreased by cooling.
  • Immediate cooling of burns is beneficial; however, frostbite is treated by quick warming.
  • Due to blood pooling, orthostatic hypotension is produced by application of heat to large parts or all of the body. With cold treatment, hypotension is decreased secondary to vasoconstriction.

Injuries can be helped by the use of cold and neat therapy. Each has its place in the rehabilitation phase of an injury as they help healing by reducing swelling, reduce pain, and promote circulation. The rule of thumb is to start with cold and switch to heat or a cold/ heat combination later.

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