Cryotherapy, physiotherapy

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Hemodynamic effects
o Initial decrease in blood flow
o Later increase in blood flow
Neuromuscular effects
o Decreased nerve conduction velocity
o Increased pain threshold
o Altered muscle strength
o Decreased spasticity
o Facilitation of muscle contraction
Metabolic effects
o Decreased metabolic rate

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Cold induced vasodilation
Lewis’ hunting reaction
Skin redness result of an increase in oxygen
hemoglobin dissociation of blood

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Decrease conduction velocity of both sensory
and motor nerves
Greater effect on myelinated and small fibers
like A- delta fibers

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Cryotherapy can increase pain threshold and
decrease the sensation of pain
Due to
o counter irritation
o gate control
o Reduction in muscle spasm
o Sensory nerve conduction velocity

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Short duration cold exposure increases muscle
strength due to
o Facilitation of motor nerve excitability
o Increased psychological motivation
Long duration cold exposure decreases muscle
strength due to
o Reduced blood flow
o Slow motor nerve conduction
o Increased muscle viscosity
o Increased tissue stiffness

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Due to
o Decrease in gamma motor neuron activity
o Decrease in the discharge of afferent spindle
and Golgi tendon organ activity

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Facilitate alpha motor neuron activity to
produce a contraction in a muscle that is flaccid
due to UMN lesion
Brief icing

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So Cryotherapy is helpful in inflammation and
healing
The release of cartilage degrading enzymes
including collaginase, elastase, hyalurodinase
and protease are inhibited

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Inflammation control
Edema control
Pain control
Modification of spasticity
Facilitation/Rood’s technique
Cryokinetics and cryostretch

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Cold hypersensitivity/cold induced urticaria
Cold intolerance
Cryoglobulinemia- aggregation of serum
protein
Paroxysmal cold cryoglobinuria
Raynaud’s disease/digital cyanosis
Regenerating peripheral nerve
Local impaired circulation/peripheral vascular
disease

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Superficial main branch of a nerve
Open wound
Hypertension
Poor sensation
Very young and very old patients

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Cold pack
Ice cups
Ice towels
Immersion
Controlled compression units
Vapocoolant sprays

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Commercial
Storage
Do not apply
directly to skin
Ice Packs
Moist towels
facilitate cold
transmission
Can place directly
on skin

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Indications
Spasm, contusions
localized injuries
Small treatment
areas

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Circumferential
cooling
Can be used in
combo with other
modalities

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Combines the benefits of cold
with the advantages of
pneumatic compression
Uses sleeves with circulating
cold water, attached to an
intermittent pump unit.
Edematous extremities are
placed inside the sleeves
Used primarily to treat acute
musculoskeletal injury with soft
tissue swelling. Also used after
some surgical procedures
Temperatures used are 7.2° C
and pressures up to 60 mmHg

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Volatile liquids such as
Fluori-methane spray
are commonly used
Used for spray-and-
stretch techniques to
treat myofascial pain ;
also used for local
anesthesia
Produce an abrupt
temperature change
over a small surface area
Precautions: risk for skin
site irritation and local
cutaneous freezing