Cryotherapy is used to control inflammation, pain, edema, reduce spasticity, control symptoms of demyelinating diseases, and facilitate movement through increased muscle contraction 

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​Effects of cold:

Initial decrease in blood flow (due to vasoconstriction), followed by increase in blood flow- vasodilation occurs to protect tissues after approximately 15 minutes and below 10 deg C (Hunter's Law)



Decreased nerve conduction velocity- slows conduction within 5 minutes (resolves in 15 minutes), mainly on myelinated and small fibers (Affects pain A-delta fibers)



Increased pain threshold- decreases pain sensation through gating mechanism (blocks pain transmission to the cortex)



Altered muscle strength- increases strength performance (after 5 minutes of ice massage) and decreases strength (after 30 minutes)



​Decreased spasticity- cold decreases gamma motor neuron activity, muscle spindle, and GTO activity with prolonged application (10-30 minutes)



Facilitation of muscle contraction- brief application can produce contraction in flaccid muscles



Decreased metabolic rate- slows all metabolic processes (inflammation, chemical reactions, edema, heat, pain in response to these, etc). To get this effect, make sure you apply cold right after the initial injury and continue to apply throughout the acute inflammatory phase.  Only apply for 15 minutes at a time (after that the vessels will vasodilate, which is the opposite of what you want). 



Contraindications:

Cold hypersensitivity, cold intolerance, cryoglobulinemia, paroxysmal cold hemoglobinuria, Raynaud's, over-regenerating peripheral nerves, or over an area with circulatory compromise or PVD (vasoconstriction and decreased blood flow won't be good for an area that doesn't get enough blood as it is). 



Precautions

Over a superficial nerve, over an open wound, hypertension, decreased sensation or ability to differentiate hot and cold, and with very young or very old patients. 



Beware adverse effects! Tissue death due to prolonged vasoconstriction and ischemia (occurs when tissue temperature is below 15 deg C (avoid this by limiting treatment time to less than 45 minutes)



 

Cryokinetics- apply cold until the point of numbness in order to reduce the pain senation. Patient can then perform strengthening and stretching for approximately 3-5 minutes before sensation returns



Cryostretch- cooling agent before stretching to decrease muscle spasm



If you have a patient that hasn't experienced a cold modality before, make sure you explain what it will feel like: intense cold, then burning, aching, then analgesia, then numbness



​Parameters for various cold modalities

Cold packs- 10-20 minutes for pain, inflammation, and edema. 30 minutes for spasticity reduction. Always check on the patient & check the skin about halfway through a treatment session to make sure there are no adverse effects



Ice massage- 5-10 minutes, directly on skin



Controlled cold compression (e.g. cryocuff)- water between 10-25 degrees C, 15 minutes



Vasocoolant sprays- "spray and stretch", used in conjunction with soft tissue manipulation for trigger points or for stretching tight musculature 

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