Cryotherapy involves applying cold to the body and can have therapeutic effects. It works by reducing cell metabolism, inflammation, muscle spasm, and pain while increasing pain tolerance. The appropriate temperature range is between 32-65°F. It provides pain relief and reduces swelling by causing vasoconstriction and decreasing metabolic rate in tissues. Precautions must be taken for patients with poor circulation, open wounds, or nerve damage in the area being treated.

1. Cryotherapy

2. Cryotherapy
 The term used to describe the application of
cold modalities that have a temperature range
between 32° and 65° F
 Alter cell metabolism
 Each 1.8°F (1°C) change in tissue temp. results
in a 13%  or  in the tissue’s metabolic rate.

3. 5 Mechanisms of Energy (Heat) Transfer
in the Body: Added or Removed
 Conduction – transfer of heat through the direct
contact between a hotter and a cooler area (2 objects
touching each other)
 Ice Massage, Hydrocollator Pack, Ice Pack
 Convection – transfer of heat by the movement a
medium (air, liquid) between regions of unequal
temperature
 Whirlpool
 Conversion – energy is changed from one form to
another; does not relate to superficial heat or cold
 Electrical energy into heat, Acoustical energy into heat
 Ultrasound, Diathermy

4.  Radiation – emitted from surfaces with
temperatures above absolute 0° (all atomic &
molecular motion ceases)
 Transfer of energy without the use of a medium
 Body, Sun, Infrared lamp, LASER, Ultraviolet light
 Evaporation – change from liquid state to
gaseous state requiring thermal energy be
removed from the body
 Vapocoolant Spray

5. Cryotherapy – Cold Therapy
 Heat is removed from the body & absorbed by the cold
modality
 Cryotherapy exerts its therapeutic effects by influencing
hemodynamic, neuromuscular, and metabolic processes.

7. Cryotherapy
 The normal body temp. is 98.6 °F (37 °C).
 Normal skin temp. range
 for men is 91.4°F to 94 °F (33° to 34.5 °C)
 for women is 90 °F to 95 °F (32.2°C to 35 °C)
 Skin is cooler than adipose which is cooler than
muscular tissue.
 Thermoreceptors in skin are responsive to heat or cold
(more to cold than heat).
 Measurements of decreased temp. have been recorded
at a 4 cm depth.

8. Classification of temperatures: for
treatment purposes, are classified as
follows:
Very Cold 32 to 55 F
Cold 55 to 65 F
Cool 65 to 80 F
Neutral 80 to 92 F
Warm 92 to 98 F
Hot 98 to 104 F
Very Hot 104 
Hot
1 to 13 °C
13 to 18 °C
18 to 27 °C
27 to 33.5 °C
33.3 to 36.5 °C
36.5 to 40 °C
40 to 46 °C

9. Stages of Analgesia induced by
Cryotherapy
 Cold Sensation 0-3 Mints
 Burning or aching 2-7 Mints
 Local numbness or analgesia 5-12 Mints
 Deep tissue vasodilation without increase in metabolism
12-15 Mints

10. Sequence of Sensations with Cold
Application
 Intense Cold
 Burning
 Aching
 Analgesia and numbness (absence of pain)

11.  Change in Temperature depends on:
 Type of Agent
 Temp. difference between agent and tissue
 Amount of insulation
 Thermal Conductivity
 Duration of application

12. Cryotherapy Contraindications
 Cold Hypersensitivity (Cold-induced Urticaria).
 Cold intolerance
 Cryoglobulinemia
 Paroxysmal cold hemoglobinuria
 Raynaud's disease or Raynaud's phenomenon
Contraindications…

13. Cold Hypersensitivity (Cold-induced Urticaria).
 Some individuals have a familial or acquired
hypersensitivity to cold that causes them to develop a
vascular skin reaction in response to cold exposure.
 This reaction is marked by the transient appearance of
smooth, slightly elevated patches, which are redder or
more pale than the surrounding skin and are often
attended by severe itching.
 These symptoms can occur only in the area of
application or all over the body.
Contraindications…

14. Cold-induced Urticaria

15. Cold intolerance
 It is in the form of severe pain, numbness, and
color changes in to cold, can occur in patients
with some types of rheumatic diseases or
following severe accidental or surgical trauma to
the digits
Contraindications…

16. Cryoglobulinemia
 It is an uncommon disorder characterized by the aggregation of
serum proteins in the distal circulation when the distal
extremities are cooled.
 These aggregating proteins from a precipitate or gel that can
impair circulation, causing local ischemia and then gangrene.
 This disorder may be idiopathic or may be associated with
multiple myeloma, systemic lupus erythematosus rheumatoid
Arthritis , or other hyperglobulinemic states.
 Therefore therapist should check with the referring physician
before applying cryotherapy to the distal extremities of any
patient with these predisposing disorders.
Contraindications…

17. Paroxysmal Cold hemoglobinuria
 It is the release of hemoglobin into the urine from
lysed red blood cells in response to local or general
exposure to cold
Rash on lower extremities typical of cutaneous small-vessel vasculitis due to
cryoglobulinemia secondary to hepatitis C infection
Contraindications…

18. Raynaud’s Disease or Raynaud's
phenomenon
 Raynaud’s Disease It is the primary or idiopathic form of
paroxysmal digital cyanosis
 Raynaud's phenomenon, which is more common, is paroxysmal
digital cyanosis due to some other regional or systemic disorder.
 Both conditions are characterized by sudden pallor and cyanosis
followed by redness of the skin of the digits precipitated by cold
or emotional upset and relieved by warmth
 These disorders occur primarily in young women
 In Raynaud's disease the symptoms are bilateral and symmetric
even when cold is applied to only one area
 In Raynaud's phenomenon, the symptoms generally occur only
in the cooled extremity
 Raynaud's phenomenon may be associated with thoracic outlet
syndrome, carpal tunnel syndrome, or trauma.
Contraindications…

19. Raynaud’s Disease or Raynaud's
phenomenon

20. ASK THE PATIENT:
 Do you have any unsual responses to cold?
 If yes to this question, ask for further details. Include the
following questions:
 Do you develop a rash when cold?
 a sign of cold hypersesnsitivity
 Do you have severe pain, numbness and color changes in
your fingers when expose to cold?
 Signs of Raynaud’s disease/phenomenon
 Do you get blood in your urine after being cold?
 A sign of paroxysmal cold hemoglobinuria
 If the responses are positive then cold should not be
applied
Contraindications…

21. over regenerating peripheral nerves
 Cryotherapy should not be applied directly over
a regenerating peripheral nerve because local
vasoconstriction or altered nerve conduction
may delay nerve regeneration.
Contraindications…

22. ASK THE PATIENT:
 Do you havea ny nerved amagein this area?
 Do you have any numbness or tingling in this limb?
 If so, where?
 ASSESS:
 Test sensation
 In the presence of sensory impairment or other signs of
nerve dysfunction, cryotherapy should not be applied directly
over the affected nerve.
Contraindications…

23. over an area with circulatory compromise or
peripheral vascular disease
 Cryotherapy should not be applied over an area with impaired
circulation because it may aggravate the condition by causing
vasoconstriction and increasing blood viscosity.
 Circulatory impairment may be the result of peripheral vascular
disease, trauma to the vessels, or early healing, and is often
associated with edema.
 W hen edema is present, it is important that its cause be
determined, since edema due to inflammation can benefit from
cryotherapy, while edema due to impaired circulation may be
increased
 These causes of edema can be distinguished by observation of
local skin coloration and temperature.
 Edema due to inflammation is characterized by warmth and
redness whereas edema due to poor circulation is characterized
by coolness and pallor.
Contraindications…

24. Ask the patient
 Do you have poor circulation in this limb?
 Assess
 Skin temperature and color
 If the patient has signs of impaired circulation, such as
pallor and coolness of the skin in the area being
considered for treatment, cyrotherapy should not be
applied.
Contraindications…

25. Cryotherapy Indications
 Acute injury or inflammation
 Pain
 Muscle spasm, acute or chronic
 Restoration of ROM
 Small, superficial, 1st degree burns
 Post-surgical pain & edema
 Neuralgia
 Post-exercise
 Decrease Muscle spasiticity
 Reduce Secondary Tissue Injury

26. Precautions
 Over the superficial main branch of a nerve
 Over an open wound
 Hypertension
 In patients with poor sensation or poor
mentation
 Very young and very old patients

27. over a superficial main branch ofa
nerve
 Applying cold direcdy over the superficial main
 branch of a nerve, such as the peroneai newe at the
 lateral knee or the radial nerve at the posterolateral
 elbow, may causea nervec onduction 61ock.14,'1572 ,53
 Therefore when applying cryotherapy to such an
 area,o ne shouldm onitor for signso f changesin nerve
 conduction, such as distal numbness or tingling, and
 discontinuec ryotherapyi f theseo ccur.
Precautions…

28. over an open wound
 Cryotherapy should not be applied directly over any deep open
wound because it can delay wound healing by reducing
circulation and metabolic rate. as Cryotherapy may be applied in
areas of superficial skin damage.
 however, it is important to realize that this can reduce the
efficacy and safety of the treatment because when there is
superficial skin damage, the cutaneous thermal receptors may
also be damaged or absent.
 These receptors play a part in activating the vasoconstriction,
pain control, and spasticity reduction produced by cryotherapy;
therefore, these responses are likely to be less pronounced when
cryotherapy is applied to areas with superficial skin damage,
caution should also be used if cryotherapy is applied to such
areas because the absence of skin reduces the insulating
protection of the subcutaneous layers and increases the risk of
excessivce cooling to these tissues.
Precautions…

29. ASSESS:
 Inspect the skin closely for deep wounds, cuts,
or abrasions.
 Do not apply cryotherapy in the area of a deep
wound, and use less intense cooling if cuts or
abrasions are present
Precautions…

30. when treating patients with
hypertension
 Since cold can cause transient increases in
systolic or diastolic blood pressure, patients with
should be carefully monitored during the
application of cryotherapy
 Treatment should be discontinued if blood
pressure increases beyond safe levels
 Treatment. Guidelines for safe blood pressures
individual patients should be obtained from
physician.
Precautions…

31. when treating patients with poor
sensation or mentation
 Although adverse effects with cryotherapy are
rare, if the the patient cannot sense or report
discomfort of other abnormal responses
 The clinician should monitor the patient's
response directly.
 Check for adverse response to cold such as
abnormal changes in color or strength, both in
the area of cold application and generally.
Precautions…

32. when treating very young and very
old
 Caution should be used when applying
cryotherapy to the very young or the very old
because these individuals frequently have
impaired thermal and a limited ability to
communicate
Precautions…

33. Immediate response to Thermal
Modality
 Mild heat or coolness may produce an analgesic effect
in the area of application, it may reduce local pain or
muscle spasm and promote general relaxation.
 If the temperature change is too much then other
reactions occur, examples
 Moderate temperature change may serve as a general
stimulant that produces an arousing, invigorating effect.
 If temp. change is too hot or too cold then the experience
will be of pain or fear, which will stimulate the fight or
flight responses of eye dilation and changes in facial and
skin color, blood pressure and pulse

34. Therapeutic effects of cold
 Immediate local vasoconstriction
 Local metabolism decrease
 Decreased acute inflammatory response
 Slows nerve conduction velocity—decreased motor and sensory
nerve conduction.
 Decreased muscle spindle activity—decreased firing rates of Ia
and II afferent fibers
 Decreased pain/muscle spasm—increases nerve pain threshold
 Decreased spasticity
 Increased tissue viscosity with decreased tissue elasticity
 Transient increase in systolic and diastolic blood pressure
 Release of vasoactive agents (histamine)

35. Local Effects of Cryotherapy
  cell metabolism rate – PRIMARY BENEFIT
  need for oxygen
 Lowers tissue temperature
 Vasoconstriction
  production of cellular wastes
 Prevents or limits swelling
  in pain by  pain threshold
  in acute & chronic muscle spasm
 Limits area of original injury

36.  Deeper tissues cool more slowly & to a lesser
extent than skin
 Muscle tissue requires longer to cool than bony areas
 Deeper tissue temps. have been proven to drop for
several minutes following the removal of an ice pack
 Research has shown that deeper tissues remaining at
rest will be cooled for 2 hr or more after a 20- to 30-
min. ice pack application

37. Muscle Spasm
 Cold therapy affects pain threshold
  nerve conduction velocity by slowing
communication at the synapse
  pain by reducing the threshold of afferent nerve
endings.
  sensitivity of muscle spindles
 May inhibit the stretch reflex mechanism reducing muscle
spasm & breaking pain-spasm cycle

38. Inflammation
 Changes in cellular function & blood dynamics
serve to control effects of acute inflammation.
 Cold suppresses the inflammatory response by:
  the release of inflammatory mediators (histamine,
prostaglandin)
  prostaglandin synthesis
  capillary permeability
  leukocyte/endothelial interaction
  creatine-kinase activity

39. Pain Control
 Cold therapy acts as a counterirritant
 Cold application affects pain perception &
transmission by:
 Interrupting pain transmission (stimulates large-
diameter A-beta nerve fibers)
 Decreasing nerve conduction velocity
 Reducing muscle spasm
 Reducing or limiting edema
A-beta nerve fibers transmit information
pertaining to touch and muscle movement

40. Systemic Effects of Cold Exposure
 If circulating blood temp.  0.2°F, then the
hypothalamus (body’s thermoregulatory center) kicks in
 General vasoconstriction in response to cooling
of the posterior hypothalamus
 Decreased respiratory & heart rates
 Heart rate  (wants to localize the cold area)
 Shivering & increased muscle tone
 If heart rate  too much where the core temp.
reaches hypothermia shivering starts.

41. Cellular Response
  cellular metabolic rate
 During a 20-min. treatment, cell metabolism  19%
 With  b. flow, there is less metabolic activity & O2
demand on the cells
  need for O2
 Reduces number of cells killed by lack of O2
 Reduces secondary hypoxic injury damage
 Reduces amount of chemical mediators released in area
 Slows nerve conduction

42. Vascular Responses
 Vasoconstriction occurs due to stimulation of
nerve receptors
 Viscosity of blood & tissue fluids 
 Resistance to blood flow 
 Soft tissue  of 26% & skeletal blood flow  of
19% with 20-min. ice pack in injured ankles

43. How cryotherapy decreases blood
flow

44. COLD-INDUCED VASODILATION
Later increase in blood flow
 when cold is applied for longer periods of time or
when the tissue temperature reaches less than 10 'C (50
'F), vasodilation may occur. This phenomenon is
known as cold-induced vasodilation( CIVD) and was
first reported by Lewis in 1930.
 His findings were replicated in a number of later
studies; however, vasodilation has not been found to be
a consistent response to prolonged cold application

45. Hunting response, cold-induced vasodilation of finger imrnersed
in ice water, measured by skin temperature change

46.  Lewis reported that when an individual's fingers
are immersed in an ice bath, their temperature
initially decreased however, after 15 minutes,
their temperature cyclically increased and
decreased.
 Lewis correlated this temperature cycling with
alternating vasoconstriction and vasodilation and
called it the “Huntingr response”

47.  It is proposed that the hunting Response is
mediated by an axon reflex in response to the
pain of prolonged cold or very low
temperatures, or that it is caused by inhibition of
contraction in the smooth muscles of the blood
vessel walls by extreme cold.
 Maintained vasodilation, without cycling has also
been observed with cooling human forearms at
1" C (35" F for 15 minutes)

48. Neuromuscular Effects
 Cold has a variety of effects on neuromuscular
function, including
 decreasing nerve conduction velocity
 elevating the pain threshold
 altering muscle force generation
 Decreasing spasticity
 Facilitating muscle contraction.

49. Decreased nerve conduction velocity
 When nerve temperature is decreased nerve
conduction velociry decreases in proportion to
the degree and duration of the temperature
change.
 Decreased nerve conduction velocity has been
documented in response to the application of a
superficial cooling agent to the skin for 5
minutes or longer.

50. Decreased nerve conduction velocity
 The decrease in nerve conduction velocity that
occurs with 5 minutes of cooling fully reverses
within 15 minutes in individuals with normal
circulation
 after 20 minutes of cooling, nerve conduction
velocity may take 30 minutes or longer to
recover due to the greater reduction in
temperature caused by the longer duration of
cooling

51. Decreased nerve conduction velocity
 Cold can decrease the conduction velocity of
both sensory and motor nerves
 It has the greatest effect on conduction by
myelinated and small fibers and the least effect
on conduction bv unmvelinated and large fiber

52. Decreased nerve conduction velocity
 A-delta fibers, which are small-diameter
myelinated, pain-transmitting fibers,
demonstrate the greatest decrease in conduction
velocity in response to cooling
 Reversible total nerve conduction block can also
occur with the application of ice over
superficiallly located major nerve branches such
as the peroneal nerve at the lateral aspect of the
Knee

53. Pain Control
 Cryotherapy directly and rapidly modifies the sensation of pain
by gating pain transmission with activity of the cutaneous
thermal receptor
 Applying cryotherapy for 10 to 15 minutes or longer can control
pain tor 1 or more hours
 This prolonged effect is thought to be the result of blocking
conduction by deep pain-transmitting A -delta fibers, and by
gating of pain transmission by the cutaneous thermal receptor
 Rewarming of the area is slow because cold-induced
vasoconstriction limits the flow of warm blood into the area
and subcutaneous fat insulates the deeper tissues from
rewarming by conduction from the ambient air

54. Increased Pain threshold
 The application of cryotherapy can increase the
pain threshold and decrease the sensation of
pain.
 The proposed mechanisms for these effects
include counter-iritation via the gate control
mechanism and the reduction of muscle spasm,
sensory nerve conduction velocity

55. Increased Pain threshold
 Stimulation of the cutaneous cold receptors by
cold may provide sufficient sensory input to
block the transmission of painful stimuli fully or
partially along the spinal cord to the cerebral
cortex, increasing pain threshold or decreasing
pain sensation.
 Such gating of the sensation of pain can also
reduce muscle spasms by interrupting the pain-
spasm-pain cycle

56. Increased Pain threshold
 Cryotherapy may also reduce the pain
associated with an acute injury by reducing
the rate of blood flow in an area and
decreasing the rate of reactions related to
acute inflammation, thus controlling post-
injury edema formation.
 Reducing edema can aileviate pain that results
from compression of nerves or other pressure-
sensitive structures.

57. Altered muscle strength
 Depending on the duration of treatment and the
timing of measurement cryotherapy has been
associated with both increases and decrease in
muscle strength
 after cooling for 30 minutes or longer, isometric
muscle strength has been found to decrease
initially and then to increase an hour later, to
reach greater than precooling strength for the
following 3 hours or longer

58. Altered muscle strength
 The proposed mechanisms for the reduced
strength after prolonged cooling include
reduction of blood flow to the muscles, slowed
motor nerve conduction, increased muscle
viscosity, and increased joint or soft tissue
stiffness

59. Altered muscle strength
 Isometric muscle strength has been found to
incraese directly after the application of ice
massage for 5 min or less; however the duration
of this effect has not been documented.
 The proposed mechanism for this response to
brief cooling include facilitation of motor nerve
excitability and an increased psychological
motivation to perform.

60. Effects of cold on
strength of muscle contraction

61. Modification of Spasticity
 Cryotherapy can be used to temporarily reduce
spasticity in patients with upper motor neuron
dysfunction
 brief applications of cold, lasting for about 5 minutes,
cause an almost immediate decrease in deep tendon
reflexes
 reflexes. Longer applications, for 10 to 30 minutes, also
decrease or eliminate clonus and decrease the resistance
of muscles to passive stretch

62.  Because longer applications of cryotherapy control
more of the signs of spasticity cryotherapy should be
applied for up to 30 minutes
 The decrease in spasticity produced by prolonged
cooling generally lasts for 1 hour or longer after the
treatment, which is sufficient to allow for a variety of
therapeutic interventions, including active exercises,
stretching, functional activities.

63. Facilitation
 The rapid application of ice as a stimulus to
elicit desired motor patterns, known a quick
icing
 this technique may be used effectively in the
rehabilitation of patients with flaccidity resulting
from upper motor neuron dysfunction, it tends
to have unreliable results and is therefore not
commonly used

64. Facilitation
 T he results of quick icing are unreliable because the
initial phasic withdrawal pattern stimulated in the
agonist muscles may lower the resting potential of the
antagonists, so that a second stimulus elicits activity in
the antagonist muscles rather than in the agonists.
 This produces motion first in the desired direction.
followed by a rebound movement in the opposite
direction.
 It has also been proposed that icing may adversely
impact motor control caused by dysynchronization of
the cortex as a result of increased sympathetic tone

65. Does Inflammation increased or
decreased by cold?
 Decreases in posttraumatic edema, in which
inflammation is induced by mediators such as
histamine and serotonin during the acute stage.
BUT
 Increases in other forms of inflammation,
particularly those mediated by prostaglandins.

66.  Cryotherapy is not effective in controlling the
formation of edema caused by immobility and
poor circulation
 In such cases, increased rather than decreased
venous or lymphatic circulation is required to
move fluid out of the affected area
 This is best accomplished with compression,
elevation, heat, exercise, and massage

67. Cooling to deeper tissues
 Superficial cold modality has deeper effect than
superficial heating modality.
 Bc of the difference in temperature gradient
between these two modalities.
 Example
 With application of ice, muscle at a maximum
depth of 2 cm will cool approx. 3.4 F(2 C) in 10
minutes if the subject’s fat layer is less than 1 cm
thick.

68. Why does skin appear blue
 Because of the lack of blood
 Increase in amount of CO2

69. Therapeutic temp.
 15 to 25 C to achieve optimal physiologic effects

70. Summary

71. Effects of cryotherapy & heating therapy
Heating

72. DECREASED PHYSIOLOGICAL RESPONSES OF BODY
SYSTEMS AND STRUCTURES TO LOCAL COLD APPLICATION
SYSTEM/STRUCTURE MECHANISM
Blood flow Sympathetic adrenergic activity produces vasoconstriction of arteries, arterioles
and venules
Capillary Permeability Decreased fluids into interstitial tissue
ELASTICITY OF
NONELASTIC TISSUES
Decregsed extensibility of collagen tissue.
METABOLISM Decreased rate of cellular oxidation
MUSCLE SPASM Decreased firing of /I afferents of muscle spindle, increased firing of Ib GTO
fibers reduces alpha motor neuron activity and thus decreases tonic extrafusal
activity
MUSCLE STRENGTH Decreased blood flow, increase in viscous properties of muscle (long duration: >5-
10 min.)
SPASTICITY Decrease in muscle spindle discharge (afferents: primary, secondary), decreased
gamma motor neuron activity
VASOACTIVE AGENTS Decreased blood flow

73. INCREASED PHYSIOLOGICAL RESPONSES OF BODY
SYSTEMS AND STRUCTURES TO LOCAL COLD
APPLICATION
SYSTEM/
STRUCTURE
MECHANISM
Joint stiffness Decreased extensibility of collagen tissue and increased
tissue viscosity
Pain threshold Inhibition of A delta and C fibers via activiaton of A beta
fibers (Gate Theory), interruption of pain-spasm cycle,
decreased sensory and motor conduction, synaptic
transmission slowed or blocked.
Muscle strength Decreased blood flow in small vessels facilitates red blood
cells adhering to one another and vessel wall-impeding
blood flow.
Increased blood
viscosity
Facilitation of alpha motor neuron (short duration: 1-5
min)

74. Which One Should be Used?
 You must know the healing phases
 Answer the following questions
 Does the body area feel warm to the touch?
 Is the injured area still sensitive to light to moderate touch?
 Does the amount of swelling continue to  over time?
 Does swelling  during activity (joint motion)?
 Does pain limit the joint’s ROM?
 Would you consider the acute inflammation process to still be
active?
 Does the patient continue to display improvement with the
use of cold modalities?
 If all of the answers are “no”, then heat can be safely
used. If “yes” is the answer to several of the questions
then cold should be used.

78. Cryotherapy
Techniques

79. Cold Packs
 Cold packs are usually filled with a gel
composed of silica or a mixture of
saline and gelatin and are usually
covered with vinyl
 The gel is formulated to be semisolid
at between0 ' and5 'C (32 to 104 “F)
for the pack to conform to the body
contours when it is within this
temperature range. The temperature
of a cold pack is maintained by
storing it in a specialized cooling unit
or in a freezer at -5 C (23 F).

80.  Cold packs should be cooled for at
least 30 minutes between uses and for
2 hours or longer before initial use
 Patients can use plastic bags of frozen
vegetables at home as a substitute for
cold packs, or they can make their
own cold packs from plastic bags
filled with a 4:1 ratio mixture of water
and rubbing alcohol cooled in a home
freezer.
 The addition of alcohol to the water
decreases the freezing temperature of
the mixture so that it is semisolid and
flexible at -5 C (23 F ).

81. Ice Packs
 Ice packs are made of crushed ice placed in a plastic
bag.
 Ice packs provide more aggressive cooling than cold
packs at the same temperature because ice has a higher
specific heat than most gels and because ice absorbs a
large amount of energy when it melts and changes
from a solid to a liquid
 More insulation should be used when applying an ice
pack because it provide more aggressive cooling.

82. Ice Massage
 Ice cups or frozen water
popsicles can be used to apply
ice massage
 Frozen ice cups are made by
freezing small paper or
Styrofoam cups of water.

83.  To use these, the therapist holds on
to the bottom of the cup and
gradually peels back the edge to
expose the surface of the ice and
puts it in direct contact with the
patient's skin.
 Water popsicles are made by placing
a stick or tongue depressor into the
water cup before freezing.
 When frozen, the ice can be
completely removed from the cup
the stick used as a handle for
applying the ice.
Ice massage to the lateral
epicondyle with an “ice pop”
wrapped in a paper towel.

84. Quick Icing
 Ice massage can also be used as
a stimulus for facilitating the
production of desired motor
patterns in patients with
impaired motor control.
 When applied f or this purpose
the ice is either rubbed with
pressure for 3 to 5 seconds or
quickly stroked over the muscle
bellies to be facilitated.

85. Quick Icing
 For local control of pain, inflammation,or
edema
 Rub the ice over the treatment area using small,
overlapping circles
 Wipe away any water as it melts on the skin
Continue ice massage application for 5 to 10
minutes or until the patient experiences
analgesia at the site of application

86. Quick Icing
ADVANTAGES
 Treatment area can be
observed during application
 Can be used for small and
irregular areas
 Short duration of treatment
 Inexpensive
 Can be applied to an elevated
limb
DISADVANTAGES
 Too time-consuming for
large areas
 Requires active participation
by the clinician or patient
throughout application

87.  Controlled cold compression units
altemately pump cold water and air into
a sleeve that is wrapped around
patient’s limb
 The temperature of the water can be
set at between 10' and 25 'C (50' to 77
F) to provide cooling.
 Compression is applied by intermittent
inflation of the sleeve with air
Controlled Cold Compression Unit

88.  Controlled cold compression
units are most commonly used
directly after surgery for the
control of postoperative
inflammation and edema
 The application of cold with
compression in this manner has
been shown to be more
effective than ice or
compression alone in
controlling swelling, pain, and
blood loss after surgery and in
assisting the patient in
regaining ROM

89.  Wrap the sleeve around the area
to be treated
 Elevate the area to be treated.
 Set the temperature at 10' to 15
'C (50' to 59 F).
 Cooling can be applied
continuously or intermittenly.
 For intermittent treatment
apply cooling for 15 minutes
every 2 hours.
 Cycling intermittent
compression may be applied at
all times when the area is
elevated.

90. Ice Immersion
 Temp. 50° - 60 ° F
 Time 10-20 min.
 Indications
 Acute Injury or Inflam.
 Acute or Chronic Pain
 Post surgical pain
 Contraindications
 Same as general
Contraindications

91. Vapocoolant spray
 Method of cooling the skin by the
evaporation of a substance sprayed
on the skin
 They do not provide adequate deep
penetration
 Commonly used to reduce muscle
spasm
 The primary action is reduction of
pain spasm sequence secondary to
direct trauma.

92.  Equipment: Fluori-Methane or
Ethy Chloride
 Liquid begins to evaporate &
continues to evaporate when contacts
skin, thus cooling skin briefly
 Technique
 Expose area to be Rx’s
 Eyes should be protected
 Hold bottle in an inverted position at a
30 angle, 18 inches away at a rate of 4
inches(10 cm) per sec.

93. Vapocoolant spray cont.
 Duration Spraying should not exceed 6 sec
 Advantages:
 Immediate reduction of pain
 Can use on joint sprains to relieve pain & swelling
 Can use on thermal burns to decrease pain,
erythema, & blistering

94. Cryokinetics
 The use of cold in conjunction with
movement
 Used to decrease pain and allow for free motion
through the normal ROM
 Initiated when the underlying soft tissue and
bone are intact and the pain is limiting the
amount of function

95. Contrast Therapy
 Alternating cryotherapy and
thermotherapy agents
 Results in vasoconstriction &
vasodilation of blood vessels in
the area
 Thought to be a “Pumping”
action – stimulates venous &
lymphatic return
 Effective transition from cold
to hot therapy
 Use during subacute or chronic
phases to remove edema &
ecchymosis

96. Contrast Therapy
 Most effective treatment time hasn’t been
determined
 Commonly used 3:1 or 4:1 ratio to equal 20
mins.
 4:1 3:2 2:3
C:H C:H C:H
 Treatment may end in either hot or cold –
depends on the stage of the injury
 End in warm – increases tissue temperature for
increased stretch and increased activity

97. Contrast Therapy
 This therapy does not significantly influence
subcutaneous tissues greater than 1 cm.
 Has been shown to increase circulation in both
extremities
 Unclogs vasculature therefore decreases pain
and increases ROM
 Contrast herbs & cold whirlpool (CWP) have
been shown to be more effective than WWP for
DOMS

98. Ice Towels
 Towels containing ice shavings
 Technique:
 Towels thoroughly soaked in water & ice mixture
 Towel wrung out & applied to part; Procedure repeated every
few min
 Duration: 10-15 min
 Advantages:
 Equipment required is available almost anywhere
 Disadvantages:
 Therapist must keep changing towels

99. COLD WHIRLPOOL
 The cold whirlpool is indicated in
acute and sub acute conditions in
which the exercise of the injured
part during a cold treatement is
desired.
 A whirlpool is composed of a
tank that can hold water and a
turbine that provides agitation
and aeration ir order to produce
movement of the water in the
tank. The tank is usually made of
stainless steel, although fiber
glass and plastic tanks are also
available.

100.  A cold whirlpool, at 0" to 26" C (32" to 79" F)
should be used for the treatment of acute
inflammatory conditions of the distal
extremities.
 Low temperatures can be achieved by adding ice
to the whirlpool water
 very low temperatures
 should not be used on large areas due to the
increased risk of tissue damage

102. Cold Whirlpools
 Duration of Tx
 15-20 minutes
 Temp 50° - 60 ° F
 Indications
 Decreased ROM
 Cryokinetics
 Subacute to chronic
inflammation
 Peripheral nerve injuries
(avoid extremes)
 Contraindications
 Acute conditions where
water turbulence would
further irritate area
 Gravity
 Postsutural
 Skin Conditions
 All other
contraindications

103. Questions?