Cryotherapy

Question 1

What is cryotherapy?

Answer 1

Cryotherapy is the local or systemic application of cold for clinical and diagnostic uses

Question 2

What depth can cold penetrate to?

Answer 2

The depth of cold penetration can reach 5cm.

Question 3

The magnitude of temperature change depends
on: 6

Answer 3

1. Type of cooling agent (e.g. ice vs water)
2. Temperature difference between cold object and tissue
3. Amount of subcutaneous insulation (fat)
4. Thermal conductivity of the area cooled
5. Limb circumference
6. Duration of the application.

Question 4

Describe convective cooling.

Answer 4

Convective cooling: is the transfer of cold from one place to another by the movement of fluids and gasses for the reduction of hyperthermia. E.g. using an electric fan to blow air over the face.

Question 5

Describe evaporative cooling.

Answer 5

Evaporative cooling: the use of the volatile fluids (A liquid with the tendency to become vapour at specified conditions of temperature and pressure) for evaporation from skin. Liquids used are ethyl chloride, and non flammable chlorofluoromethane, and fluoromethane

Question 6

Describe conductive cooling.

Answer 6

Conductive cooling: therapeutic application of cold, using methods that will cause a direct conduction of heat from the tissue of the body, includes crushed ice packs, frozen gel packs, ice baths , wet ice towels and ice cubes. Temperatures are reduced to 10 degrees in most cases.

Question 7

List the indications for cryotherapy 8

Answer 7

Inflammation

1. Pain and muscle spasm
2. Increased cellular metabolic rate
3. Acute burn
4. Fever
5. Bursitis and tendonitis
6. Acute spinal cord injury - local hypothermia
7. Spasticity
8. Poor muscle contractions

Question 8

A Large number of Physiological responses to cold have been investigated and found to have therapeutic significance. These include: 7

Answer 8

1. Decrease in circulation
2. Decrease in hemorrhage following trauma
3. Decrease in formation of exudates
4. Decrease in muscle spasm and spasticity
5. Decrease in pain, a reflex stimulation of muscle
6. Delayed vasodilatation in tissues
7. Reduction of muscle fatigue

Question 9

What is the process of normal temperature regulation?

Answer 9

When the body is exposed to a change in temperature it adjust its temperature so that it maintain its core temperature This is called normal temperature regulation.

Question 10

True or false. Skin receptors have a long latency

Answer 10

False.

Temperature is controlled by the skin receptors regulating skin reflexes which are short latency reactions by axon reflex, reflex vasoconstriction
and counter irritation

Question 11

What is involve in longer latency reactions?

Answer 11

Longer latency reaction involve the posterior
hypothalamus, vasomotor center of medulla, the
gamma system and the ‘ response of Lewis

Question 12

True or False. Hot receptors are more sensitive than cold receptors.

Answer 12

False. Cold receptors are 7 to 8 times as many as hot
receptors

Question 13

When you experience cold, describe the short latency response.

Answer 13

When you experience cold, there is short latency response of vasoconstriction of superficial skin vessels by the axon reflex and through the spinal segmental reflexes causing vasoconstriction of adjacent areas such as muscles and joints in the region

Question 14

When you experience cold describe long latency response.

Answer 14

Long latency thermoregulation takes place by reflex action through central nervous system involving the posterior hypothalamus, and vasomotor center of the medulla

Question 15

Describe the Hunting Response 7

Answer 15

1. Is a process of alternating vasoconstriction and vasodilation in extremities exposed to cold.
2. The application of intense cold to the body causes vasoconstriction with the liberation of histamine like (‘H’) substances produced by the intense cold and noxious stimuli
3. Initial vasoconstriction last about 9 to 16 min
4. When there were sufficient ‘ substances vasodilatation occurs for a brief period of time (4 to 6 min) and this vasodilatation removes all the ‘ substances.
5. Vasoconstriction again happens followed by vasodilatation occurring at further intervals of 15 to 16 min
6. After removing prolonged cold there is vasodilatation
   which increases greatly for 20 min and then subsided
   slowly.
7. The sudden vasodilation due to intense cold application is termed the Hunting response

Question 16

Describe cooling At temperatures of 20 ˚C to 29 ˚C

Answer 16

1. Muscles can sustain their activity for longer periods of time without fatigues
2. Isometric endurance can be improved when ice towels are applied for 15 to 20 min bringing temperature of muscles to 20 ˚C to 29 ˚C

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Question 17

What is spasticity?

Answer 17

• Spasticity referrs to an unusual “tightness stiffness, and/or “ of muscles
• It’s a state of hypertonicity of muscle, with hyperactivity of the phasic and tonic stretch reflexes and loss of inhibitory mechanisms from the suppressor areas of the brain through the medial reticular system

Question 18

What is a spasm?

Answer 18

Spasm is an involuntary sustained contraction utilizing large amounts of nutrient substances, while simultaneously creating ischaemia because of compression of intramusclular blood vessels

Question 19

How does cold reduce cell damage?

Answer 19

Decrease metabolism & consumption of oxygen thus reducing cell
damage.

Question 20

How does cryotherapy reduce pain? 2

Answer 20

Reduces pain in two ways:

1. Decreases nerve conduction velocity
2. Decrease free nerve ending excitability.

Question 21

What are the precautions to cryotherapy? 6

Answer 21

1. Should not be applied for longer than 20 30 minutes as a result it will cause vasodilatation to prevent cold induce tissue damage
2. Nerve palsy esp when applied to superficial motor nerves e g ulna nn at the elbow or fibula nn at the fibula head
3. Frostbite from incorrect application
4. Confused or unreliable pts
5. Monitoring of blood flow during application nail bed test
6. Ice burn

Question 22

What are the contraindications to cryotherapy? 6

Answer 22

1. Cold hypersensitivity or urticaria histamine release ( erythema, itching, sweating, respiratory embarrassment, puffiness of eyelids, vomiting abdominal pain)
2. Decrease thermal sensation nerve injury
3. Peripheral vascular disease Raynaud’s disease, diabetics etc
4. Cryoglobulinemia aggregation of serum proteins in small
   distal blood vessels after cold applications that can impair
   blood circulation, possible causing ischemia gangrene
5. Deep open wounds
6. Paroxysmal cold hamoglobinuria undesirable release of haemoglobin in the urine, which results from breaking
   down or lysing of many blood cells after cold applications
   Pts may report blood in the urine after cryotherapy