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Cold Therapy or Cryotherapy

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.

The local tissues are cooled by ice therapy as the water warms up or the ice melts, taking heat away from the body part. Physiologically the main effects of cryotherapy are constriction of the blood supply, reduction in metabolism locally, cold reaction circulatory increase, decrease in tissue bleeding, swelling and oedema reduction, painkilling effect from cold effects on nerve transmission and muscle efficiency reduction. Another effect of pain reduction from cold is to reduce the amount of muscle spasticity or muscle spasm occurring.

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.

In an acute injury cold is to be preferred as compared to heat because the local tissue metabolism will be increased due to the injury, bringing increased circulation, heat and tissue oedema to the area. Application of cold reduces the inflammatory response, reduces pain, limits oedema and reduces the local metabolic rate, controlling the overall response and allowing a quicker resolution of the injury. To be most effective the cold should be applied as soon as possible after the injury along with compression. Compression has been shown in research to be the more important part of acute injury management but cold is still useful.

It is important to understand the risks to skin integrity which potentially come with using cold therapy. Contraindications to cold are understood by physiotherapists and they will examine the skin for normal sensibility and good colour with lack of broken or abnormal areas. To protect the skin integrity oil can be applied to the area before cold application. A common treatment is performed using an ice pack, made by packing crushed ice into a towel bag and applied closely to the part to be treated. Thorough wetting of the towel and eliminating any pockets of air between the pack and the skin ensure a good cooling effect.

Convenient and cheap home cold application is often performed using a pack of frozen peas but these should be used with caution as they come out from the freezer at -18 degrees centigrade and this could result in skin injury. This temperature is too low for direct skin application and a wet cloth should always be interposed between the skin and the pack to avoid the chance of frostbite which is cold-mediated local skin damage. From five to twenty minutes is the typical application time used and the skin should be checked after five or ten minutes to make sure skin reaction is normal. Small white spots appearing on the skin indicate overcooling and treatment should stop.

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.

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