cryotherapy (when to ice an injury)

[Doc.Sust]

Cryotherapy refers to the local application of cold for therapeutic purposes. It is one of the most inexpensive and widespread therapeutic modalities. Most of the population at one time or another have used ice therapy in one form or another. Its most common use is in the management of acute musculoskeletal injuries; however, it is also useful in the rehabilitation of injuries in the subacute or even chronic stages.

Cryotherapy falls within the infrared range of the electromagnetic radiation spectrum. Although therapies falling within this range are considered heat producing, when applied to an object, which has a higher temperature, it will have a hypothermic action. In other words, ice removes heat from the body. A hyperthermic action denotes that heat is added to the body. The primary reason why cold is used after an acute injury lies within its effect upon the circulatory system and pain perception.

As body heat decreases in the area of application, the following occurs: -Vasoconstriction of blood vessels in an attempt to preserve body heat-resulting in control of hemorrhage and edema.
-Decreased metabolism results in decreased metabolite production, which helps to protect the tissues from the resultant hypoxia following injury.
-Decreased excitability of the nerve endings and peripheral nerve fibers, as well as reduced conduction rate of nerve fibers results in decreased pain. When this effect is combined with the increased threshold for muscle spindle fibers, it results in decreased muscle spasm.
-Increased firing of cold receptors resulting in decreased pain perception through the Melzack/Wall Spinal gate theory of pain control.

Melzack, Wall and Castel first proposed the concept of analgesia following cutaneous receptor stimulation in the late 1960' s. The theory states that sensory stimulation is carried to the substansia gelatinosa through large diameter A-beta fibers, while pain is carried by large and small A-delta and C fibers. Impulses are carried faster along large diameter fibers. Stimulation of the A-beta afferents sends impulses to the substantia gelatinosa, which inhibit synaptic transmission in the A-delta and C afferent fibers. The pain message sent along the smaller diameter fibers is not transmitted to the second order neurons and thus never reaches the senso centers. The balance between the small and large diameter fibers determines the amount of that is blocked or gated.

Additionally, cold application tends to stiffen soft tissues leading to increased joint stiffness.

Based upon these physiological responses to local cold application, in which conditions would cold application be beneficial?
-Any acute conditions- such as sprain/strain, contusions, burns, myospasm, hemorrhage
Edema
-Inflammatory conditions such as tendonitis, bursitis, tenosynovitis, myositis, neuritis, IVD,
insect/snake bites,and myofascial trigger points.
Acute or chronic pain
Specific uses of cryotherapy are seen in dermatology where warts are frozen off using liquid nitrogen, and when a patient has a high fever, tepid baths are used to lower overall body temperatures.

When cold application results in overall body cooling (hypothermia), the following physiological effects are seen: increased pulse rate, increased blood pressure, increased respiration, and involuntary shivering as the Hypothalamus (the temperature regulating center in the brain) seeks to regulate body temperature back to nonnal.


Local application of cold first results in vasoconstriction of the underlying capillaries. Alternating vasoconstriction and dilation for the initial 20 minutes follows vasoconstriction. The phenomenon is known as the "hunting response" (or "Lewis's hunting reaction") and represents the bodies attempt to "hunt for" a mean temperature. If cold is continued, constant vasoconstriction occurs until 30 minutes total elapsed time. Then there is resultant constant vasodilation (over 30 minutes). This constant vasodilation is in response to what is called
supercooling and is necessary to prevent local tissue injury due to prolonged cold.

Due to the above stated physiological effects, what conditions might cryotherapy be contraindicated in?
-Impaired circulation such as peripheral vascular disease, Raynauds disease, cardiac conditions (6 months following Myocardial infarction due to risk of marked drop in blood pressure following prolonged exposure to cold).
-Patients who do not exhibit reactive hyperemia .Conditions with poor sensory perception- Peripheral nerve injuries, Diabetes, the very old. -Hypersensitivity to cold (Cryesthesia), or in previously frostbitten areas.
-Rheumatoid or gouty arthritis
-Chilblain (pernio) congestion/swelling of skin due to cold application.
-Coma
-Paroxysmal cold hemoglobinuria (rare acquired hemolytic syndrome occurring with certain diseases such as syphilis, measles, mumps, chicken pox. Mono or influenza).

Application of Cryotherapy

Based upon the above physiological effects, how long should cryotherapy be applied?
No more than 30 minutes; however each individual is different and in general 10-20 minutes is sufficient. To assure that the supercooling effect is not induced, the National Boards recommends no more than 20 minutes. We also need to keep in mind that adipose tissue acts as great insulation: therefore our leaner patients (ectomorph or mesomorph) will require much shorter treatment times than patients with higher body fat levels (endomorph and obese). Cryotherapy can be applied every two waking hours during the acute stage. you don't want to use ice during the night, in case you fall asleep on it, and induce the supercooling effect (vasodilation and subsequent edema formation).

[Doc.Sust]

also would like to thank Dr. M Mcmullen for the information and her wisdom

[63190]

Ok, I read this. I thought I was an endo or mesomorph, but I put the ice on over my shirt and it begins to feel uncomfortably stingy after just a few seconds. Should I be using a towel between the ice and my shirt?

[guest589745]

Good post doc.

[Dr. Musclehead]

I could not have said it any better myself.

[Doc.Sust]

Ok, I read this. I thought I was an endo or mesomorph, but I put the ice on over my shirt and it begins to feel uncomfortably stingy after just a few seconds. Should I be using a towel between the ice and my shirt?

yes you can use a towel, i dont but that is just me, if it feels to cold, use a light towel

[xpijeonx]

Awesome!

I was just comin on here to see if there was something like this, if not my newb ass was gonna make a new thread...

[Doc.Sust]

glad it helped you out

[Hiphopharry]

I've also heard that after a week or so, localized heat can be used to heal an area, (I also read that there was a hot/cold 15 min on/ off strategy used by the trainer of the Vikings last year....)?

[Doc.Sust]

^^^yes that therapy can be used after 2 wks,

[Flieloadoceri]

I got into ICE games starting with HARP and then branching out into Rolemaster.

[Kinglondon]

Great info!