Therapeutic Application of Cryotherapy

Cryotherapy removes heat from the body, heat is transferred from the client to the cold object.

We want to apply forms of cryotherapy to help reduce muscle spasms, decrease pain caused by sprains, strains, and contusions and to help reduce edema formation, bleeding, and inflammation.  It is also used prior ro stretching and ROM exercises. 

These effects are accomplished by decreasing the local tissue temperature, capillary permeability, local tissue metabolism, nerve conduction velocity, and muscle spindle firing.  Edema formation is decreased and there is a vasoconstriction of the arteries and capillaries in the area.  Pain threshold is increased.

The following is a list of several ways to apply cryotherapy to a patient:

  1. Ice Bag
  2. Cold or Gel Pack
  3. Ice Water Immersion
  4. Vapocoolant Spray
  5. Cold Whirlpool
  6. Ice Massage
  7. Compressure
  8. Ice Towel
  9. Ice Slush Bath
  10. Contrast Bath
  11. Biofreeze

Before applying any form of cryotherapy we must check for any contraindications, such as:

  • Rheumatoid Conditions if an increase in pain and joint stiffness is noted.
  • Raynaud's Phenomenon
  • Hypersensitivity - can be anywhere from discomfort to cold to cold allergy causing giant hives and joint stiffness.
  • Sensory Impairment.
  • Circulatory Impairment.
  • Obtunded Patient.

We need to always remember to never leave the a cryotherapy treatment on an area to the point that it will lower the tissue temperature below 13 degree C or 33 degrees F.  If this happens tissue necrosis may occur caused by intracellular ice crystal formation - frostbite.  Treatment times should be no longer than 20 minutes but may be less.

Below are several examples of how to administer different methods of Cryotherapy.  They were taken from the SPTA Course Content website. 

TECHNIQUE FOR ADMINISTERING AN ICE PACK

  1. Position client comfortably.
  2. Fill a plastic bag with ice chips two-thirds full. Evacuate the air from the bag and tie a knot in the end of the bag to seal it.
  3. Explain the procedure to the client. The client may experience the following sequence of sensations: cold, burning, aching and numbness.
  4. The ice pack can be applied directly to the skin or covered with a single layer of moist toweling prior to application.
  5. An elastic wrap can be used to secure the ice pack to the body area.
  6. Duration of treatment will depend on the diagnosis. Average treatment time is 10 to 20 minutes.
  7. At the conclusion of the treatment remove the pack and toweling and inspect the skin.

TECHNIQUE OF ADMINISTERING A COLD GEL PACK

  1. The cold gel pack should be kept in a freezer at about 10 degrees F ( - 12 degrees C).
  2. Explain the procedure to the client. The client may experience the following sequence of sensations: cold, burning, aching and numbness.
  3. Comfortably position the client.
  4. Remove the cold gel pack from the freezer and cover it with a single layer of moist toweling. Moisture facilitates the energy transfer.
  5. Place the towel covered pack on the desired area of the body and contour it to appropriately cover the surface.
  6. Duration of treatment will depend on the diagnosis. The average treatment time for most conditions is 10 to 20 minutes.
  7. At the conclusion of the treatment, remove the pack and toweling and inspect the skin.
  8. Return the cold gel pack to the freezer.

TECHNIQUE FOR ADMINISTERING AN ICE WATER IMMERSION

  1. Select a container or bucket large enough to completely immerse the part to be treated.
  2. Fill the container or bucket with ice chips and water to the desired level. Be careful not to overfill. Allow for displacement upon immersion of extremity.
  3. Check water temperature with thermometer: 55 to 65F (13 to 18 C) is recommended.
  4. Comfortably position the client.
  5. Instruct the client to immerse extremity immediately and completely into the water.
  6. Duration of treatment will depend on the diagnosis. The average treatment for ice water immersion is 10 to 20 minutes.
  7. At conclusion of treatment have the client remove the extremity and dry it thoroughly.

TECHNIQUE FOR ADMINISTERING VAPOCOOLANT SPRAY

  1. Comfortably position the client and appropriately drape. Client should be positioned so not vapor is inhaled during the treatment session.
  2. Fill one container two thirds full with water at 100 to 110 F (38 to 43 C). Fill the other container two thirds full with water at 55 to 65 F (13 to 18 C).
  3. Explain the procedure to the client.
  4. Position the client comfortably and remove appropriate clothing.
  5. Have the client immerse the body part in the hot water container first. Leave body part immersed for 3 to 5 minutes.
  6. At the end of the desired time immediately remove the body part from the hot container and immerse it in the cold container for one minute.
  7. Repeat the cycle of hot immersion followed immediately by cold immersion and continue the sequence for 20 to 30 minutes.
  8. The final immersion can be in either the hot or cold container. Hot immersion produces vasodilation and cold vasoconstriction.
  9. At conclusion of the treatment remove the extremity from the water and dry thoroughly.
  10. Inspect the skin.

TECHNIQUE FOR ADMINISTERING ICE MASSAGE

  1. Comfortably position the client and appropriately drape.
  2. Explain the procedure to the client. The client may experience the following sequence of sensations during the treatment: cold, burning, aching and numbness.
  3. Remove ice from freezer.
  4. Apply ice to the desired area by moving it back and forth over the skin with parallel stroking or small over lapping circular motions. A slow movement is recommended.
  5. Continue treatment for 5 to 10 minutes or until client claims to feel numbnee in the treated area.
  6. At the conclusion of the treatment dry the client and inspect the skin.