Cryotherapy: Difference between revisions
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* [[Delayed onset muscle soreness (DOMS)|DOMS]]<ref name=":1" /> | * [[Delayed onset muscle soreness (DOMS)|DOMS]]<ref name=":1" /> | ||
== | ==Pros== | ||
* Pain relief<ref name=":0">Hubbard TJ, Denegar CR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/ Does cryotherapy improve outcomes with soft tissue injury?]. Journal of athletic training. 2004 Jul;39(3):278.</ref> | * Pain relief<ref name=":0">Hubbard TJ, Denegar CR. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC522152/ Does cryotherapy improve outcomes with soft tissue injury?]. Journal of athletic training. 2004 Jul;39(3):278.</ref> | ||
* Swelling reduction<ref name=":0" /> | * Swelling reduction<ref name=":0" /> | ||
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* Effective on a wide range of soft tissue injuries | * Effective on a wide range of soft tissue injuries | ||
== | == Cons == | ||
* Little evidence regarding duration and frequency of treatment to be effective<ref name=":0" /> | * Little evidence regarding duration and frequency of treatment to be effective<ref name=":0" /> | ||
* Compression has been shown to be more effective post operatively<ref name=":0" /> | * Compression has been shown to be more effective post operatively<ref name=":0" /> | ||
* In rare cases bradycardia and frostbite symptoms have been observed. <ref name=":1" /> | * In rare cases bradycardia and frostbite symptoms have been observed. <ref name=":1" /> | ||
* Some more advanced cryotherapy devices can reduce range of movement following TKR due to immobilisation of the joint. <ref>Thienpont E. [https://link.springer.com/article/10.1007/s11999-014-3810-8 Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty?]. Clinical Orthopaedics and Related Research®. 2014 Nov 1;472(11):3417-23.</ref> | * Some more advanced cryotherapy devices can reduce range of movement following TKR due to immobilisation of the joint. <ref>Thienpont E. [https://link.springer.com/article/10.1007/s11999-014-3810-8 Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty?]. Clinical Orthopaedics and Related Research®. 2014 Nov 1;472(11):3417-23.</ref> | ||
==Possible Risks/Undesirable Effects== | |||
=== Inhibit Muscle Function === | |||
*Cooling can temporarily Inhibit muscle function with potential for increased risk of injury/re‐injury | |||
*Be cautious when having patients weight bear/undertake complex exercise after icing a lower extremity | |||
=== Ice Burn === | |||
Elderly patients with impaired sensation and/or circulation will be more vulnerable to an ice‐burn, therefore consider using less intense icing techniques (e.g., moderately cold ice pack wrapped in an insulating layer(s) of toweling) | |||
*Younger patients with intact sensation and circulation may benefit most from direct immersion of the limb in cold water then progressively adding ice cubes | |||
*Cold gel packs stored in a freezer have a surface temperature below 0°C (32°F) and thus an insulating layer should be used between the cold pack and the patient’s skin | |||
=== Cryotherapy‐Induced Nerve Injuries === | |||
*Most common when cold is applied in combination with compression | |||
*Check capillary refill during application of ice combined with compression therapy to ensure adequate blood flow | |||
=== Generalized Cooling and Decrease in Core Temperature === | |||
*Shivering and piloerection are signs of decrease in core temperature which may compromise patient safety (especially in the elderly and those with fever) | |||
*The application of therapeutic cryotherapy should produce only local effects | |||
=== Reduced ROM === | |||
Ice may contribute to shortening of collagen fibers in connective tissue | |||
*After gaining ROM by warming, stretching and then strengthening in the newest part of the ROM, it is likely counterproductive to cool the tissue in a shortened position | |||
*If one wishes to cool the tissue post stretch and exercise, it is best to do so with the tissue in a lengthened position | |||
*In patients with significantly restricted ROM due to scar tissue, it may be preferable not to use ice | |||
=== Contraindications === | |||
Be aware of conditions in which icing is contraindicated | |||
E.g. CRPS, hemoglobinuria, cryoglobinemia, Raynaud’s disease and cold uticaria | |||
== Resources == | == Resources == | ||
Revision as of 20:47, 19 January 2020
Original Editor - Francky Petit Top Contributors - Neha Duhan, Garima Gedamkar, Francky Petit, Abbey Wright, Kim Jackson, Venus Pagare, Reece Black, Kale Schneider, WikiSysop, Peyton Cooper, Admin, Uchechukwu Chukwuemeka and Claire Knott
Definition/Description[edit | edit source]
Cryotherapy, also known as ice application, is the simplest and oldest way to treat injuries. Its worldwide use spread because of its effectiveness, convenience, low cost and ease of transportation. Ice is believed to control pain by instigating local anaesthesia. It also decreases oedema, nerve conduction velocities, cellular metabolism and local blood flow. The effect of the cryotherapy depends on the method, the duration, temperature of the ice and the depth of the subcutaneous fat. [1][2]
Application Methods[edit | edit source]
The most common method of cryotherapy is the use of ice packs. There are different types of ice used in ice packs. The most common types are ice packs made with cubed, crushed and wetted ice.[2] It was discovered that wetted ice is better to lower surface temperature during treatment and maintaining the lower temperature during recovery. It is also more effective in lowering the intramuscular temperature during treatment.[2]
A cooling effect can also be produced by icing spray for a similar effect.[3]
More recently whole body cryotherapy has become popular for athletes, to help aid recover, as well as in persistent pain patients such as rheumatological conditions. More research is needed to understand the effect on the body and its relation to pain.[4]
Conditions treated[edit | edit source]
- Acute soft tissue injuries e.g. ankle sprain, muscular strain
- Post orthopaedic surgery e.g. TKR, ACL reconstruction, arthroscopic shoulder surgery.[5]
- Acute sports injuries
- DOMS[3]
Pros[edit | edit source]
- Pain relief[6]
- Swelling reduction[6]
- Decreased surface temperature
- Effective on a wide range of soft tissue injuries
Cons[edit | edit source]
- Little evidence regarding duration and frequency of treatment to be effective[6]
- Compression has been shown to be more effective post operatively[6]
- In rare cases bradycardia and frostbite symptoms have been observed. [3]
- Some more advanced cryotherapy devices can reduce range of movement following TKR due to immobilisation of the joint. [7]
Possible Risks/Undesirable Effects[edit | edit source]
Inhibit Muscle Function[edit | edit source]
- Cooling can temporarily Inhibit muscle function with potential for increased risk of injury/re‐injury
- Be cautious when having patients weight bear/undertake complex exercise after icing a lower extremity
Ice Burn[edit | edit source]
Elderly patients with impaired sensation and/or circulation will be more vulnerable to an ice‐burn, therefore consider using less intense icing techniques (e.g., moderately cold ice pack wrapped in an insulating layer(s) of toweling)
- Younger patients with intact sensation and circulation may benefit most from direct immersion of the limb in cold water then progressively adding ice cubes
- Cold gel packs stored in a freezer have a surface temperature below 0°C (32°F) and thus an insulating layer should be used between the cold pack and the patient’s skin
Cryotherapy‐Induced Nerve Injuries[edit | edit source]
- Most common when cold is applied in combination with compression
- Check capillary refill during application of ice combined with compression therapy to ensure adequate blood flow
Generalized Cooling and Decrease in Core Temperature[edit | edit source]
- Shivering and piloerection are signs of decrease in core temperature which may compromise patient safety (especially in the elderly and those with fever)
- The application of therapeutic cryotherapy should produce only local effects
Reduced ROM[edit | edit source]
Ice may contribute to shortening of collagen fibers in connective tissue
- After gaining ROM by warming, stretching and then strengthening in the newest part of the ROM, it is likely counterproductive to cool the tissue in a shortened position
- If one wishes to cool the tissue post stretch and exercise, it is best to do so with the tissue in a lengthened position
- In patients with significantly restricted ROM due to scar tissue, it may be preferable not to use ice
Contraindications[edit | edit source]
Be aware of conditions in which icing is contraindicated
E.g. CRPS, hemoglobinuria, cryoglobinemia, Raynaud’s disease and cold uticaria
Resources[edit | edit source]
- ↑ Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. The American journal of sports medicine. 2004 Jan;32(1):251-61.
- ↑ 2.0 2.1 2.2 Dykstra JH, Hill HM, Miller MG, Cheatham CC, Michael TJ, Baker RJ. Comparisons of cubed ice, crushed ice, and wetted ice on intramuscular and surface temperature changes. Journal of athletic training. 2009 Mar;44(2):136-41.
- ↑ 3.0 3.1 3.2 Galiuto L. The use of cryotherapy in acute sports injuries. Annals of Sports Medicine and Research. 2016;3(2):1060.
- ↑ Banfi G, Lombardi G, Colombini A, Melegati G. Whole-body cryotherapy in athletes. Sports medicine. 2010 Jun 1;40(6):509-17.
- ↑ Ni SH, Jiang WT, Guo L, Jin YH, Jiang TL, Zhao Y, Zhao J. Cryotherapy on postoperative rehabilitation of joint arthroplasty. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov 1;23(11):3354-61.
- ↑ 6.0 6.1 6.2 6.3 Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury?. Journal of athletic training. 2004 Jul;39(3):278.
- ↑ Thienpont E. Does advanced cryotherapy reduce pain and narcotic consumption after knee arthroplasty?. Clinical Orthopaedics and Related Research®. 2014 Nov 1;472(11):3417-23.
