Cryotherapy and Thermotherapy

• Cryotherapy

  Application of cold agents that results in the transfer of heat from the patient's body and between tissues/fluids
• Thermotherapy

  Application of heating agents that transfer heat to the body
• Types of heat transfer

  • Conduction
  • Convection
  • Conversion
  • Radiation
  • Evaporation
• Cryotherapy indications

  • Decrease pain
  • Mitigate inflammation
  • Reduce edema
  • Reduce severity of DOMS
  • Modify spasticity
  • Manage symptoms in multiple sclerosis
  • Facilitation (quick icing)
• Effects of cryotherapy

  • Influence on hemodynamics, neuromuscular and metabolic processes
• Types of cryotherapy

  • Ice packs: Crushed ice in a wet towel
  • Cold packs: Filled with a gel composed of silica or a mixture of saline and gelatin, covered with vinyl
  • Ice massage: Applied using ice cups or frozen water ice pops
  • Cold compression: NICE, Game Ready
  • Cold tub: Submersion
• Ice pack & cold pack

  • Cold pack used to control inflammation, pain, and edema
• Ice massage

  • Used to control inflammation, pain, and edema. Also used to provide temporary analgesia
• Cold compression

  • Unit used to control inflammation, pain, and edema
• Cold tub submersion

  • Used to control inflammation, pain, and edema
• Effects of cryotherapy

  • Lessens DOMS by decreasing inflammation post exercise, decreasing blood flow, and decreasing enzymatic metabolic activity
• Effects of cryotherapy

  • Decreases spasticity by decreasing muscle spindle firing, allowing spastic muscle to stretch and not respond to velocity changes
• Effects of cryotherapy on inflammation

  • Reduces heat and swelling by causing local vasoconstriction and decreased blood flow, increased blood viscosity, decreased capillary permeability - stops the movement of fluid from capillaries to interstitial fluid so there is less bleeding and fluid loss, decreases edema formation
• Effects of cryotherapy on inflammation

  • Prevents microvascular damage in soft tissue injuries by decreasing WBC activity which damage vessel walls and increase capillary permeability, decreases edema formation
• Effects of cryotherapy on inflammation

  • Reduces pain by decreasing activity of the A-delta pain fibers and by gating at the spinal cord level
• Cryotherapy contraindications

  • Cold hypersensitivity
  • Cold intolerance
  • Cryoglobulinemia
  • Paroxysmal cold hemoglobinuria
  • Raynaud's syndrome
• Cryotherapy contraindicated over regenerating nerves
• Cryotherapy contraindicated over an area with circulatory compromise or peripheral vascular disease
• Cryotherapy precautions

  • Over the superficial main branch of a nerve
  • Over an open wound
  • Hypertension
  • Poor sensation
  • Poor mentation
  • Very young and very old patients
• Hemodynamic effects of cryotherapy

  • Initial local vasoconstriction, later cold-induced vasodilation
• Neuromuscular effects of cryotherapy

  • Decreased nerve conduction velocity, reduced pain and increased pain threshold, altered muscle strength, temporary decrease in spasticity, brief facilitation of muscle contraction when applied to flaccid muscles
• Metabolic effects of cryotherapy

  • Decreased metabolic rate of all cell and tissue reactions including those involved in inflammation and healing
• Thermotherapy

  Application of heating agents to transfer heat to the body
• Thermotherapy indications

  • Control pain
  • Increase soft tissue extensibility
  • Increase circulation
  • Accelerate healing
• Specific heat

  Amount of energy required to raise the temperature of the unit mass of a material by 1° C
• Types of superficial thermotherapy

  • Hot packs
  • Contrast baths
• Hot packs

  • Cervical, Standard, Oversized
• Hot packs

  • Stored in a hydrocollator at 160-170° F
  • capable of retaining heat for about 30 minutes
  • heat for two hours before use, and at least 30 minutes after use
• Contrast bath

  • Applied by immersing a body part (usually a distal extremity) first into warm/hot water, and then into cool/cold water
• Other types of superficial thermotherapy

  • Paraffin
  • Fluidotherapy
  • Infrared lamps
• Paraffin

  • Melted wax mixed with mineral oil
• Fluidotherapy

  • Consists of a cabinet filled with finely ground cellulose particles made from corn, dry heating agent
• Infrared lamps

  • Emit electromagnetic radiation within a frequency range that gives rise to heat when absorbed by the body
• Cryotherapy and thermotherapy - depths of penetration

  • Cryotherapy 2-4 cm
  • superficial heat modalities equal or less than 1 cm
  • deep heat modalities 3-5 cm ultrasound
  • 2-3 cm for diathermy
• Hemodynamic effects of thermotherapy

  • Vasodilation and increase in blood flow to tissues, dilation occurs locally where heat is applied but can also occur in more distal and deeper vessels
  • distant vasodilation effects can be used to increase cutaneous blood flow to areas where it is difficult/unsafe to apply heat directly
• Neuromuscular effects of thermotherapy

  • Increased nerve conduction velocity and decreased conduction latency of sensory and motor nerves, increased pain threshold, transient changes in muscle strength
• Metabolic effects of thermotherapy

  • Increases the rate of chemical reactions within cells and tissues, including enzymatic biologic reactions, causes an increase in oxygen uptake and acceleration of wound healing
• Effects of heat on tissue extensibility

  • Increasing the temperature of soft tissue increases its extensibility, tissue temperature must reach an appropriate level for heat to increase soft tissue extensibility
• Adverse effects of thermotherapy

  • Burns
  • Fainting
  • Bleeding
• Thermotherapy contraindications

  • Recent or potential hemorrhage
  • Thrombosis
  • Impaired sensation
  • Impaired mentation
  • Malignancy