Cryotherapy uses cold to control inflammation, pain, and edema through various physiological effects. When ice is applied to skin, it conducts heat away requiring significant energy to melt. This initial vasoconstriction preserves heat for 15-20 minutes, but longer applications cause vasodilation. Cold decreases nerve conduction velocity, elevates pain thresholds, and alters muscle force generation depending on duration. Cryotherapy is used to control inflammation and edema after injuries by reducing substances like histamine. Techniques include ice packs, towels, immersion, and sprays. Contraindications include cold hypersensitivity and it should not be used over wounds or impaired healing.

1. Cryotherapy
Priyanka Goyal
M.P.T. 1st year(Orthopedics)

2. What is Cryotherapy?
• Cryotherapy is the therapeutic use of cold to
control inflammation, pain and edema.
• Cryotherapy exerts its therapeutic effects by
influencing hemodynamic, neuromuscular,
and metabolic processes.

3. Physical principles
• When ice is applied to the skin, heat is
conducted from the skin to the ice in order to
melt it.
• The ice requires considerable energy to rise
the temperature of 1g of ice at 0ºC to 1g of
water at 37ºC requires 491 J. Whereas to rise
1g of water at 0ºC to 37ºC requires only 115J.

4. Physiological effects of cold-
• Hemodynamic effects
- initial vasoconstriction for 15- 20 min to
preserve heat.

6. Later increase in blood flow
• When cold is applied for longer period of time
or the tissue temperature reaches to less than
10 ºC produces vasodilation and is known as
cold induced vasodilation (CIVD) and
LEWIS HUNTING RESPONSE.
• Hunting response is mediated by inhibition of
contraction of smooth muscles of the blood
vessel walls by extreme cold.

8. Neuromuscular Effects`
• Decrease nerve conduction velocity
- Greatest effect on conduction by myelinated
and small fibres and the least effect on
unmyelinated and large fibres.
- A- delta fibres, which are small diameter,
myelinated , pain transmitting fibres,
demonstrate the greatest decrease in
conduction velocity in response to cooling.

9. Elevating pain threshold
• Mechanism for this effect include counter
irritation via the gate control mechanism and
reduction of muscle spasm, sensory nerve
conduction velocity, or postinjury edema.
• Stimulation of cutaneous cold receptors by
cold may provide sufficient sensory input to
fully or partially block the transmission of
painful stimuli to the brain cortex and
producing increasing the pain threshold.

10. Altering muscle force generation
• Depending on the duration of the
intervention, cryotherapy can increase or
decrease the muscle strength.
• It has been found that application of ice for 5
min. temporarily increases the muscle
strength and ice used for prolonged periods
(30 min. or longer) reduces the muscle
strength

11. Decrease spasticity
• This effect has been seen after application of
ice for upto 30 min.
• decrease in gamma motor neuron activity,
and later, a decrease in afferent spindle and
golgi tendon organ(GTO) activity.

12. Facilitate muscle contraction
• This facilitate alpha motor neuron activity to
produce a contraction.

13. Decreased metabolic rate
Apply cryotherapy immediately after injury and
during the acute inflammatory phase of
healing to help control bleeding, edema and
pain and to accelerate recovery.
Cryotherapy is not recommended where the
healing is impaired.

14. Uses of cryotherapy
• Inflammation control
• Edema control – cryotherapy controls increase
in capillary permeability by reducing the
release of vasoactive substances such as
histamine.
• Pain control
• Modification of spasticity
• Symptom management in multiple sclerosis

15. Cont-
• Facilitation – by quick icing, it has been
proposed that icing may adversely impact
motor control through dyssynchronization of
the cortex as a result of increased sympathetic
tone.
• Cryokinetics – this involves the application of
ice at injured site to reduce pain before
exercise and to increase range of motion.

16. Cont.
• Cryostretch – application of a cooling agent
before stretching.

17. Contraindications-
• Cold hypersensitivity
• Cold intolerance
• Cryoglobulinemia
• Paroxysmal cold hemoglobinuria
• Raynaud’s disease
• Over regenerating peripheral nerves
• Over an area with circulatory compromise or
peripheral vascular disease

18. Precautions for the use of
cryotherapy-
• Over the superficial branch of nerve
• Over the open wound
• Hypertension
• poor sensation
• Very old and very young patients

19. Application techniques-
• Ice towels
• Ice packs
• Immersion
• Ice cube massage
• Cold compression units
• Ice spray
• The typical sequence of sensation in response to
cryotherapy is as follows 1. intense cold
2. Burning 3. aching 4. analgesia 5. numbness.

20. • Ice packs
• Simple cold packs
• Silica gel packs
• Endothermic reaction /chemical cold packs

21. Ice towel
• Wet towel is used
• Ice towel need to be replaced after 2-3 min.
and total 20 min .of treatment can be given.
• Useful in treating muscle and allows
movement to be performed

22. Ice cube massage
• Slow circular motion for 5-10 min. During this
time the patient will feel cold, burning and
then aching sensation before the part
become numb
• Short strokes should be given

23. Cold compression unit
• Cold water is circulated in a sleeve which is
put over the limb and part of it is inflated at
intervals.

24. Cold/ Ice sprays
• Ethyl chloride was originally used but it is
highly inflammable an thus posses some risks.
• Fluorimethane is now used widely as it is non
inflammable.
• The liquid is sprayed on to the area to be
cooled in series of stroke of about 5s each
with a few seconds interval between each.
• The nozzle is held at the angle of 45 or right
angle from the skin surface

25. Thank you