Sunday, May 20, 2012

Ice and Cold Therapy

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Cold therapy or cryotherapy is a coarse and beneficial therapeutic modality often used by physiotherapists in treating a wide range of conditions. It is easy to apply and if care is taken over cautions and contraindications it is very safe and patients can be instructed to self treat to conduct their conditions independently. Cryotherapy is most generally used in sports and acute injury rehabilitation and is cheap and uncomplicated to use. Cold can be applied in several separate ways together with cold packs, crushed ice, cubed ice or cold water devices.

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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.

Many conditions benefit from the use of cold therapies and the effects are used to reduce oedema and swelling after an injury, a reduction in muscle spasticity once the muscle has cooled after a inescapable time, a lowering in pain, acute inflammatory inhibition such as required after acute injury, facilitation of a local increase in circulation and a lessening of muscle spasm. To facilitate contraction of muscles for functional muscle re-education physiotherapists will use ice and to increase ranges of movement after injury by stimulating muscle contraction.

Tissue damage from an injury to an area increases the blood provide locally, is hotter and suffers from oedema, all secondary to heightened tissue metabolism as the area reacts to damage. At this early stage these responses need to be damped down so cold is preferred over heat which would increase them. Cold reduces inflammation, eases pain, prevents swelling and slows the metabolic rate of the injured tissues, encouraging injury healing. It is important to get the cold onto the injured part as close to the precipitating event as you can, with compression if possible. Compression has been shown to be efficient and may be more important than the cold.

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 scrutinize the skin for normal sensibility and good colour with lack of broken or abnormal areas. To safe the skin integrity oil can be applied to the area before cold application. A coarse rehabilitation is performed using an ice pack, made by packing crushed ice into a towel bag and applied intimately to the part to be treated. Proper wetting of the towel and eliminating any pockets of air between the pack and the skin ensure a good cooling effect.

Frozen peas in the pack are generally 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 effect from direct application of such a cold pack. A wet tea towel or similar cloth should always be located between these packs and the skin to avoid the chances of local skin damage known as frostbite. Length of rehabilitation varies from 5 to 20 minutes and a check after 5 or 10 minutes is good convention 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 rehabilitation should be terminated.

Acute strains and sprains and pains after operation can be treated by cold within the first twenty four to forty eight hours to reduce pain and inflammation. The skin sensation under the treated areas should be normal so the patient can monitor their treatment. Contraindications to cold rehabilitation are poor blood provide in the legs, allergy to cold, impairment of blood provide and Reynauds disease. Typical techniques are spray and stretch, cold packs, divergence baths, cold water immersion and ice massage. Spray and stretch is used in myofascial pain syndrome to treat trigger points.

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