Cold Therapy or Cryotherapy
Posted: Monday, May 11, 2009
by Jonathan Blood Smyth
Ice and cold therapy is a widely used treatment technique employed routinely by physiotherapists in the management of acute and chronic conditions of various types. It is a relatively safe treatment and simple to apply, with patient instruction usually successful in self managing their injuries or pains with this method. Physiotherapists will know the contraindications and indications for using this therapy and use this method commonly in acute injuries and sporting injuries as it is effective, easy and cheap to use. Different techniques can be used such as cold water immersion, cubed ice, crushed ice or cold packs.
Cryotherapy is used for a large variety of conditions which include decreasing the swelling and oedema following trauma, to inhibit spasticity although it takes some time to cool the muscle effectively, a reduction in muscle spasm, pain reduction, reduction of an acute inflammatory reaction such as after injury and to produce a local circulatory increase. Physiotherapists also use ice to facilitate muscle contraction to re-education muscle use and to cause muscular contraction to allow increases in joint range in damaged limbs.
An injury to an area with tissue damage increases the metabolism of the area and thereby brings more circulation in, causing a rise in temperature and oedema to the local tissues. For this kind of condition cold is much preferable as heat will increase all the unwanted tissue responses. Cold application causes a reduction in the inflammatory reaction, lowers the metabolic rate of the tissues, allows pain reduction and inhibits oedema, limiting the inflammatory response and allowing speedier recovery. Compression and cold should be applied to the damaged area as soon as possible after the event and while cold is an important treatment compression may be more critical.
The application of cold is not without risks and should be considered carefully before use. Initially the physiotherapist will make sure there are no contraindications to cold and then examine the area for intact skin and normal skin colour and texture. Oil can be applied to the skin to reduce the effect of the cooling if necessary to ensure skin integrity. A typical application of cold is an ice pack, a towelling bag full of crushed ice, and it is important that the towelling should be thoroughly wetted for optimal cooling and that the cold pack should model itself as closely as possible to the skin of the area. Any pockets of air will act as insulators and reduce the effectiveness of the cooling.
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.
For treatment of acute injuries such as strains and sprains and post-operative pain cold can effectively be used in the first 24 to 48 hours to limit inflammation and pain. Cold should not be applied on an area of altered skin sensation and other contraindications include Reynauds Disease, lower limb ischaemia, cold allergy and vascular impairment. Ice massage, immersion in cold water, contrast baths, cold packs and spray and stretch can be used. The latter is a treatment technique used for trigger point problems in a myofascial pain syndrome.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Sheffield. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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