Sports Medicine 15

UNIT II: CARE, PREVENTION AND

REHABILITATION OF ATHLETIC INJURIES –

CRYOTHERPAPYBy Andrew Morgan BPE/BEd

Cryotherapy

CRYO = ICE

THERAPY = TO TREAT

Cryotherapy Applying cold to an

injury is widely used in the field of Sports Medicine.

Ice is the simplest, and safest immediate measure for relieving pain, decreasing internal bleeding, bruising and inflammation (swelling).

CryotherapyVasoconstriction This is the narrowing

of blood vessels. Ice causes the blood

vessels in the area to vaso-constrict.

This reduces the amount of blood that flows to the injured area.

CryotherapyPhysical principles When a cold object is

applied to a warm object, heat is abstracted.

In terms of Cryotherapy, the most common method for cold transfer is through conduction.

In most cases the longer the cold exposure, the deeper the cooling.

At 3.5 degrees Celsius muscle temp. can be reduced as deep as 4cm.

Cryotherapy Cooling is

dependent on type of tissue.

Tissue with high water content such as muscle, is an excellent cold conductor.

Fat is a poor conductor.

CryotherapyPhysiological Effects of Cold

Vasoconstriction occurs after 15 minutes or less at a temp. of 10 degrees celsius or less.

Reflex action of the smooth muscles.

If cold is continuously applied for 15-30 minutes, vasodilation occurs for a 4-6 minute period.

Hunting Response occurs, this is a slight temp. increase, a reaction against tissue damage.

Cryotherapy – skin response to cold

Stage Response Estimated time after initiation

1 Cold sensation

0-3 minutes

2 Mild burning, aching

2-7 minutes

3 Relative, cutaneous (skin) anesthesia

5-12 minutes

Table courtesy of Arnheim

Table courtesy of Arnheim

Cryotherapy – Physiological Variables of Cryotherapy

Table courtesy of Arnheim

Table courtesy of Arnheim

Variable Response to cryotherapy

Muscle Spasm Decreases

Pain Perception Decreases

Blood Flow Decreases up to 10 minutes

Metabolic Rate Decreases

Collagen Elasticity Decreases

Joint Stiffness Increases

Capillary Permeability

Increases

Edema* *swelling as a result of collection of fluid in connective tissue

Controversial

Cryotherapy The first 48-72 hours after injury are

crucial for controlling inflammation and secondary injury.

This does not mean an injury should stop receiving ice treatment after 3 days.

In the knee joint, for example, blood can enter the capsule and can cause more damage to the structures inside the capsule.

Cryotherapy Application of Ice 10-20 minutes will give

desired vasoconstriction. Beyond 15 minutes may

experience “hunting response”.

Apply ice intermittently with 40 minutes off to allow for tissue to return to normal body temperature.

CryotherapyApplication of icecontd. Crushed ice is

best. Although

sometimes you are forced to improvise – ice cubes, snow…

Frozen vegetables work very well.

CryotherapyApplication of icecontd. Wrapped in a towel or

put in a plastic bag is the best way to ice the skin.

Avoid direct contact if at all possible.

Complete immersion in cold water or ice water also works very well.

CryotherapyCryotherapeuticMethods Ice massage: Freeze water in a foam or paper

cup, remove foam an inch from top of cup, use a tongue depressor as a handle, have a towel handy to absorb water.

Use over small muscle area – tendons.

Rub on athlete’s skin in overlapping circles (10-15cm area) for 10 minutes, once analgesia is reached, athlete can start to engage in exercise or stretching.

CryotherapyCold or Ice Water Immersion: Depending on the body part, a

wide variety of containers can be used. Ice temperature should be around 10 degrees C.

When a large area of the body needs cooling, i.e ankle “rollover”, ice immersion is usually the best method.

10-15 minutes in the ice bath, 45 minutes off, repeat three times.

The comfort of the athlete must be considered at all times.

Skin temp. rarely gets below 15 degrees C.

CryotherapyVapocoolant Sprays: Most popular is fluori-methane, a non-

flammable, non toxic substance, under pressure in a bottle it gives off a fine spray when emitted.

Reduces muscular spasm and increase ROM (range of motion).

Also a treatment for trigger points – wait till sports massage unit for more info.

Care must be taken however to avoid frostbite.

Application: 1.Hold at 30 degree angle, 12 to 18 inches from skin. 2. Spray entire length of muscle from proximal to distal attachment. 3. Cover the skin at a rate of 4 inches per second, apply the spray 2 or 3 times as a gradual stretch is applied.

Cryotherapy

Precautions… Be careful with

chemical cold packs and sprays, as they can cause frostbite and tissue damage.

Ice can be placed on any part of the body except the eye.

CryotherapyOther

Considerations: Watch out for cold

allergies, some people break out in hives.

Nerve palsy – ice was on for too long and affects nerves close to the surface of the skin.

Cryotheryapy