Cold therapy

Use of local or general cooling for

therapeutic purposes
“cryotherapy”
 COLD THERAPY

 To lower the local tissue temperature and

provoke the thermoregulatory responses.

 Applying ice to the body surface is a very

effective way of withdrawing energy (heat)
and hence lowering the surface temperature.
 For a constant source of cooling the
temperature drop in the tissues will depend
on.
 The temperature difference between the coolant
and the tissues.
 The thermal conductivity of the tissues.
 The length of time for which the cold is applied.
 The size of the area that is being cooled.
 Cold therapy

 Effects of cooling the skin surface

 Therapeutic effects of cold
 Types of application
 Contra indications and dangers of
cryotherapy
 Principles

 30 min to lower muscle

temperature at 4cm depth by 3.5C
 2.5cm-20min to drop by 2.5C
Physiological changes
due to cooling the
skin

The local effects

General effects of local cooling
 Local effects

 Immediate vasoconstriction
 there is increased blood viscosity, due to
cooling,
 contribute to the slowed blood flow.
 Followed by vasodilatation
 Lewis Hunting response
 Cold applied to the skin provides a strong
sensory stimulus by stimulating the cold
receptors.
 This may be used therapeutically in the
suppression of pain and treatment of
hypertonicity.
 Local effects

 Decrease metabolic rate-oxygen

uptake, metabolite
production,cellular activity=slowed
healing
 Decrease nerve conduction
velocities
 Decrease strength, fine
movements,tremors,spasticity,dext
erity
 General effects of local cooling

 Stimulate cold receptors.

 Extreme cold is experienced as pain, involving pain
receptors.
 Cutaneous vasoconstriction.
 Increase metabolism.
 Heat production, by irregular muscle
contractions.
Therapeutic uses of cold

Recent injuries
Pain
Muscle Spasm
Spasticity
Muscle Strengthening
Chronic Inflammatory Conditions
Chronic edema and joint effusions
Other therapeutic effects
 Recent injuries

 Limits bleeding by vasoconstriction

 Limits pain-decreased pain nerve
irritants
 Reduces metabolic rate and
secondary cell necrosis
 Reduces joint effusion/edema
 Reduces edema formation
 Alleviation of pain

 Reduces conduction of nerves

 Sensory stimulation acts on pain
gate
 Strong cold sensation releases
endorphins
 Reduction in
muscle spasticity
 Increased viscosity diminish rapid
stretch reflex
 Affects muscle spindle
 Stimulation of cutaneous receptors
 Decreased nerve velocities
 Other therapeutic effects

 Pressure sores.
 Conjunction with stretching.
 Acute lesions
 General contraindications
 If frostbite has been in area
 Pt has Raynaud’s disease
 Circulation to part is compromised
 Pt very old or young
 Pt extremely sensitive to cold
 Technique of
application
 preparation of patient
 Preparation of apparatus
 Preparation of part
 Instructions for the patient
 Application
 Termination
 Before applying cryotherapy
 Inspect skin
 Test small area of skin, to determine if hypersensitive
 Verify good circulatory status
 Make certain patient never had frostbite in area to be
treated
 Make certain pt never experienced a lot of spasticity
when used
 Position & drape pt comfortably
 Methods of applying
cold therapy
Local immersion
Cold packs-ice packs\commercial cold
packs
Ice towels
Ice massage
Cold-Compression units
Evaporating sprays
 Cold or Ice Water Immersion
 Equipment
 Variety of basins or containers can be used, small whirlpool
 Temperature should be 50-60 degrees F
 Indications
 Circumferential cooling of a body part
 Application
 Athlete immerse body part in water and goes through four stages of cold response
 Treatment may last 10-15 minutes
 Once numb body part can be removed from immersion and ROM exercise can be
performed
 As pain returns re-immersion should take place
 Cycle can be repeated 3 times
 Cold or Ice Water Immersion (continued)
 Special Considerations
 Cold treatment makes collagen brittle -- must be
cautious with return to activity following icing
 Be aware of allergic reactions and overcooling
 Ice Packs (Bags)
 Equipment
 Wet ice (flaked ice in wet towel)
 Crushed or chipped ice in self sealing bag
 Not as efficient, but less messy
 Useful for approximately 15-20 minutes
 Towel should be placed between skin and pack
 Chemical Cold packs
 Gel pack
 Liquid pack
 Indications
 Athlete experiences four stages of cooling and then proceeds with ROM exercises
 Special Considerations
 Avoid excessive cold exposure; w/ any indication of allergy or abnormal pain,
treatment should be stopped
Contrasting cold and
of treatment
Could you tell me
what the difference
is between heat and
cold?
 Dangers
Contraindications
Excessive local cold on normal tissues
Certain pathological conditions
Cold sensitivity
Cardiac disease
Arterial blood pressure
Sensory deficiency
Hypersensitive areas
Emotional and psychological features
Precautions with particular cooling
methods