Cryotherapy involves applying cold to the body for therapeutic purposes. It can be used to reduce inflammation, edema, pain, and muscle spasms. Various cryotherapy techniques are discussed in the document, including ice packs, ice massage, cold whirlpools, vapocoolant sprays, cryotherapy with compression, whole-body cryostimulation, and the use of cryogenic liquids like liquid nitrogen or carbon dioxide. Contraindications and factors affecting an individual's response to cold are also reviewed.

1. CRYOTHERAPY
SANA MASROOR
MPT 2ND SEM
2018
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2. CRYOTHERAPY
• The term "cryotherapy" was first used in 1908 by A.W. Pusey to describe the treatment of skin lesions with
very low temperatures [Zagrobelny et al. 1999; Jezierski 2006;].
• Cryotherapy is the applications in cold agent for therapeutic purposes.
• Local cold therapy or cryotherapy has been used for centuries to relieve pain symptoms, particularly
in inflammatory diseases, injuries and symptoms of overuse. The effects of local cryotherapy have
accounted for cold-induced analgesia, a reduction in inflammation and a decrease of the temperature
of the joint diminishing the activity of collagenases, which are cartilage destroying enzymes (Harris &
McCroskery 1974).
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3. EFFECT OF COLD
1. Hemodynamic effects
2. Neuromuscular effects
3. Metabolic effects
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4. Chad Starkey; therapeutics Modalitites. 4th edition
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5. Application of ice produce stages of sensation
• Uncomfortable sensation of cold.
• Stinging
• Burning or aching feeling
• Numbness
 Each stage is related to the nerve endings as they temporarily cease to function as a result of decreased blood flow
and decreased nerve conduction velocity.
 After 12-15 minutes the hunting response is sometimes demonstrated with intense cold (10degree Celsius) thus a
minimum of 15 mins are necessary to achieve extreme analgesic effect.
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6. THERAPEUTICS USES
• Inflammation control
• Edema control
• Pain control
• Modification of spasticity
• Symptom management in multiple sclerosis
• Facilitation
• Cryokinetics and cryostretch
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7. REDUCE INFLAMMATION
• Cryotherapy can be used to control acute inflammation and thereby accelerate recovery from injury or trauma (Hocutt JE, 1982).
• Decreasing tissue temperature slows the rate of the chemical reactions that occur during the acute inflammatory response and
also reduces the heat, redness, edema, pain, and loss of function associated with this phase of tissue healing.
• In an animal study it was show that with primary injury to muscle and secondary hypoxic injury to the surrounding tissue was
slowed with five hours of continuous cryotherapy. Slowing the rate of metabolism reduces the rate of oxygen consumption,
subsequent tissue hypoxia, and additional tissue injury (Merrick MA. Et al 1999).
• Inflammatory processes decreases due to a lower production and release of pro-inflammatory substances and/or a higher
production and release of anti-inflammatory compounds (Miller et al., 2010; Lubkowska et al., 2011; Lubkowska et al., 2014;
Lubkowska et al., 2015).
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8. PAIN CONTROL
• Cold-induced analgesia is achieved by lowering the skin temperature.
• Chesterton et al., 2002, reported that to achieve a desirable physiological response (reduction in pain) with cryotherapy
requires that the skin tissue is cooled to specific temperature levels (,13.2˚C) (10% decrease in NCV).
• Cryotherapy induces effects both locally (at the site of application) and at the level of the spinal cord via neurologic and
vascular mechanisms.
• Topical cold treatment decreases the temperature of the skin and underlying tissues to a depth of 2 to 4 cm, decreasing the
activation threshold of tissue nociceptors and the conduction velocity of pain nerve signals (Nadler SF. Et al 2001). This results
in a local anesthetic effect called cold-induced neuropraxia.
• In an experimental study by Amin A Algafly et al., 2007, suggest that cryotherapy can increase PTH and PTO at the ankle and
this was associated with a significant decrease in NCV. Reduced NCV at the ankle may be a mechanism by which cryotherapy
achieves its clinical goals.
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9. EDEMA CONTROL
In RCT study by B. Atintas et al., 2014, showed that microcirculation, edema formation, and histomorphology of superficial
burn has been significantly influenced through immediate cold therapy, however, this alterations are transient and turns to
ineffective after 30 min.
• Pain on VAS 6.4 ±1.7 in control-group compared to VAS 2.2 ±0.8 in cold-treatment-group (P < 0.05)
• In morphological changes:
RMCM assessment pre post
Epidural thickness • In CG: 42.01 ±3.89 µm
• In EG: 40.82 ±4.02 µm
• In CG: 48.40 ±4.71 µm
• In EG: 41.90 ±3.83 µm
Granular cell size • In CG: 761.2 ±48.8 µm2
• IN EG: 756.2 ±51.4 µm2
• In CG: 798.6 ±55.2 µm2
• In EG: 761.5 ±53.8 µm2
Individual blood cell flow • In CG: 51.78 ±4.61 cells/min
• In EG: 54.19 ±5.42 cells/min
• In CG: 86.09 ±5.40 cells/ min
• In EG: 10.47 ±2.74 cells/min
Functional capillary density • In CG: 6.74 ±0.52 capillaries/ mm2
• In EG: 6.12 ±0.68 capillaries/mm2
• In CG: 8.22 ±0.91 capillaries/mm2
• In EG: 2.42 ±0.38 capillaries/mm2
Altintas, B., Altintas, A. A., Kraemer, R., Sorg, H., Vogt, P. M., & Altintas, M. A. (2014). Acute effects of local cold therapy in superficial burns on pain, in vivo microcirculation, edema formation and
histomorphology. Burns, 40(5), 915-921.
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10. CRYOSTRETCH
• Cold applications can decrease superficial [Zavvos A, et al 2015] and intramuscular
temperatures [Chesterton LS, 2002, Gregson W 2011] as well as muscle pain and
spasm through a temporary inhibition of muscle spindles of the application area
[Larsen CC, et al 2015].
• In a study by Gary R. Brodowicz et al., 1996, concluded that the application of ice
while stretching may provide enhanced short-term improvements in flexibility over
heat or stretching alone.
• Another comparative study on stretching, cryostretching and cryostretching with
hold-relax PNF stretching by Priya Kannan et al., 2011, show that manual stretch
and manual stretch with ice application were found to be more effective in
improving the length of hamstrings muscle among healthy young aged adults
when compared to stretching using PNF hold relax technique with ice application,
and by using the cold with stretching, SLR showed a quicker increase in terms of
knee range when compared to AKE.
Kannan, P., & Winser, S. J. (2011). A Comparison Study of 3 Stretching
Protocols on Hamstrings Length. Indian Journal of, 5(3), 122.
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11. CRYOKINETICS
• Cryokinetic is a combination of cold application to numb the injured body part and graded progressive, active
exercises. Cryokinetics referring to combination of cold and exercise. Ice used to anesthetize the injured part; this took
3 to 20 minutes and was ceased when patient reported numbness. Once numbed the body part was exercised with
active movements, if any discomfort recurred the ice was reapplied (Chad Starkey, 2013).
• The cold reduces the athlete's pain, so early mobilization through exercise can be achieved much sooner than would
normally be possible (Palmer JE, et al 1996).
• In comparative study by H. B. Shiva kumar et al., 2014, indicate that ultrasound therapy with cryokinetics (Group A)
and ultrasound therapy with soft tissue massage (deep friction massage) in (Group B) are significantly effective in
improving VAS, ROM and SPADI.
Shivakumar, H. B., Chanappa, T. S., Reddy, P. K., & Dey, J. (2014). A comparative study between the efficacies of ultrasound therapy with cryokinetics versus ultrasound therapy with soft tissue
massage (deep friction massage) in acute supraspinatus tendinitis. Journal of Evolution of Medical and Dental Sciences, 3(15), 3898-3908.
11

12. Contraindication for superficial cold
ELECTROPHYSICAL AGENTS Contraindications and Precautions: An Evidence-Based Approach to Clinical Decision Making in Physical Therapy CANADA VOLUME 62 NUMBER 5 SPECIAL
ISSUE 2010 ISSN-0300-0508 E-ISSN-1708-8313 12

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19. RELATIVE CONTRAINDICATION
• Areas of impaired sensation that prevent people from giving accurate and timely feedback
• Infected tissues
• Tissue near or over eyes
• Damaged or at-risk skin
• Cold therapy that is intense or applied to a large surface sufficient to produce generalized peripheral vasoconstriction
should be applied with caution to people with hypertension and people with cardiac failure.
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20. HUMAN FACTOR AFFECTING COLD RESPONSES
• Individual human factors, such as the amount of subcutaneous fat, body size, fitness level, gender and age affect thermal
responses. Leaner subjects have higher skin temperatures and lower muscle temperatures after whole-body cooling than
subjects with more subcutaneous fat (Buskirk & Kollias 1969, Oksa et al. 1993, Keatinge 1961).
• Subcutaneous fat provides a relatively high thermal resistance (Toner & McArdle 1996).
• Kasai et al. 2003, suggested that core temperature is maintained in obese patients because their vasoconstriction threshold to a
low environmental temperature is high.
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21. CRYOTHERAPY TREATMENT TECHNIQUE
• Ice massage
• Commercial Cold hydrocollator packs
• Ice packs
• Cold whirlpool
• Cold spray
• Cold compression units
• Whole body cryotherapy
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22. ICE MASSAGE
• Waylonis, et al. reported surface anesthesia after 4.5 minutes of ice massage over
the calf. Skin temperature had decreased 18" C after 5 minutes.
• Geeta Sharma et al., 2004, provise additional evidence that proprioceptive acuity
in the hamstring muscles (biceps femoris) remains largely unaffected after ice
application to the hamstrings tendon (biceps femoris).
• Ice massage for 20 min of the head and spine in prone lying is effective at
reducing HR and in improving HRV towards vagal dominance in healthy
volunteers (A. Mooventhan et al., 2015).
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23. In study by Matthew Breslin et al.,2015, suggest that an ice bag initially was more effective than the gel pack at reducing skin
surface temperature of healthy knees, with a surgical dressing. Over a 4 h period both gel packs and ice bags were just as
effective at reducing skin surface temperature and at maintaining these lower temperatures
Crushed ice pack and cold pack
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24. WHIRL POOL
COLD WHIRLPOOL
50°F to 65°F (10°C to 16°C). Temperature is increased as the
proportion of the body area treated increases.
• Provides a supportive medium for range of motion exercises
• The water provides resistance to rapid motions
• Agitation and aeration of the water causes sedation, analgesia, and increased
blood flow
• Cold whirlpool treatments result in longer lasting cooling of intramuscular
tissues
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25. • In a study, Motor and Sensory Nerve Conduction Are Affected Differently by Ice Pack, Ice Massage, and Cold Water
Immersion by Esperanza Herrera et al, 2010, 36 healthy subjects one of 3 cold modalities in calf region for 15 min.
• The ice pack was applied directly to the skin and without compression.
• Ice massage was applied by using an ice block of 279 g with dimensions of 8×10×5 cm.
• Water immersion was conducted in an acrylic container of 20×35×30 cm, filled with water and crushed ice until the
water temperature reached approximately 10°C, as reported previously. The temperature of this modality was
measured throughout the intervention, showing an initial mean of 8.9 (1.0)°C and a final mean of 7.8 (1.2)°C.
• The results suggest that cold water immersion, as applied in this study, is the most indicated modality for inducing
therapeutic effects associated with the reduction of motor nerve conduction
Herrera, E., Sandoval, M. C., Camargo, D. M., & Salvini, T. F. (2010). Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water
immersion. Physical therapy, 90(4), 581-591. 25

26. COLD SPRAY/ VAPOCOOLANT SPRAY
• D. E. Page et al, 2010, suggested that vapocoolant spray reduces cannulation
pain than lidocaine, and offers a useful alternative in the emergency
department setting.
• Cryostretch is used for treating trigger points, local muscle spasm, and other
myofascial conditions.
• Vapocoolant sprays are ineffective in the treatment of acute musculoskeletal
trauma. Although the evaporation of the liquid rapidly cools the skin and
produces temporary pain relief, the other physiological effects of cold
application do not occur.
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27. CRYOTHERAPY WITH COMPRESSION
• The meta analysis by Mingzhi Song et al., 2016, suggested that patients who underwent CC had a better analgesic effect than
those who underwent CA at POD2 and POD3; CC had a better effect on swelling at POD1 and POD2.
• In one study it was reveal that the use of CC produced a significant reduction in pain scores at POD2 after arthroscopic ACL
surgery compared to that without cryotherapy (Martimbianco et al. 2014).
• The dressing of low temperatures on the skin surface effectively enhances the healing of soft tissue injuries (Mejia et al. 2015).
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28. CRYOSTIMULATION
• Contemporary cryogenics has been developing from the end of the 19th century since the liquefaction of oxygen, nitrogen,
carbon dioxide and hydrogen, and also the industrial production and storage of liquid coolants, enabled the development of
cryobiology and the use of extremely low temperatures in medicine.
• The world's first cryogenic temperature chamber was set up in Japan, in 1978.
• Cryostimulation requires making use of a suitable croyogenic liquid as a coolant source. It is based on the use of very low
temperatures (-100ºC and lower) in order to induce a physiological reaction to cold.
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29. Depending on the size of the body area to be treated with cryogenic temperatures, the following types of cryotherapy
may be distinguished:
1. Local cryotherapy (involving a small body area): ventilation with nitrogen vapours (gas temperature at the outlet of the
nozzle can range from -160° C to -196° C), ventilation with a mixture of nitrogen vapours and cooled air (temperature of
the gas mixture varies from -100° C to -178° C), and ventilation with cold air (temperature ranges from -30° C to -34° C).
2. Whole-body cryotherapy (involving the entire body, including the head): cryosauna, two-stage chambers,
cryochamber with cool retention effect; chambers cooled with a mixture of liquid nitrogen vapour and air, or with a
compression cooling system. During low-temperature treatment in a chamber, the cold air cools the whole body.
M. Savic et al., 2013 showed that a decrease in skin temperature after a single 3-min WBC session remains reduced
for more than 30 min.
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30. CRYOGENIC LIQUID
• Cryogens (cryogenic liquids) are those liquids with a boiling point not exceeding 120 K under normal
atmospheric pressure. The following are various types of cryogens and respective temperature ranges:
1. wet cold - water with ice, 0 ° C
2. damp cold - cold air, temperature from -15 º C to -30 º C
3. dry cold– vapours of liquefied gases:
• a. liquid nitrogen vapour: -196 °C
b. carbon dioxide vapour: -75 ºC
• Cryostimulation using dry cold (vapours of liquefied gases: nitrogen, air, carbon dioxide) is also quick,
convenient and much more patient-friendly [Bojek 2006; Rawecka & Rokita 2006]
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31. LOCAL CRYOSTIMULATION
• Local cryotherapy treatment uses usually the following cryogens: liquid nitrogen,
carbon dioxide, cooled air [Sieroń & Cieslar 2003].
• Prior to cryostimulation, the patient should thoroughly dry the body surface to be
subjected to treatment.
• It is most desirable to keep the patient in a standing position or if not possible, in a
sitting or lying position.
• Procedure duration is defined individually for each patient, depending also on the
body structure, muscle mass and fat thickness.
• Cryotherapy is not used for more than about 5 joints at the same time which should
not be longer than 12-15 minutes. The hand, foot and spine are considered as a
single set of small joints [Księżopolska - Pietrzak 1998].
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32. LOCAL CRYOSTIMULATION USE IN
1. Ankylosing spondylitis
In the acute phase of the disease, cryostimulation plays an important role in reducing pain as well as inflammation, allowing for sufficient activity of
the patient during exercises.[Sieroń & Cieslar 2003; Jezierski 2007]
2. Shoulder impingement syndrome
Cryostimulation for patients with shoulder impingement syndrome increases the range of motion in the transverse plane, bending and movement
of external rotation, and a slight effect on straightening and bending in the sagittal plane, abduction and internal rotation [Sieroń & Cieslar 2003;
Lisinski et al. 2005; Boerner et al. 2007].
3. Osteoarthritis
In degeneration of the knee, cryostimulation is performed on the knee joint and thigh muscles. Cooling of the joint is done best in a sitting position
with a bent knee (cold should be first applied on sides, then around the knee cap). [Sieroń & Cieslar 2003; Jezierski 2008; Pasek et al. 2009].
4. Rheumatoid arthritis
A single cryostimulation of a specific part of the body takes about 3 minutes and has both analgesic and anti-inflammatory effects. Therefore
cryostimulation should be immediately followed by physical exercise [Sieroń & Cieslar 2003; Straburzyńska - Lupa et al. 2005; Krawczyk -
Wasilewska et al. 2007; Jezierski 2007]. 32

33. WHOLE BODY CRYOSTIMULATION
• Whole-body cryotherapy (WBC) has become a popular mode of cryotherapy. This involves exposure to extremely cold dry air (usually
between −100°C and −140°C) in an environmentally controlled room for short periods of time (typically between 2 and 5 minutes).
• It was originally developed to treat chronic medical conditions, such as multiple sclerosis and rheumatoid arthritis (Hirvonen Heet al., 2006)
WBC is increasingly employed by athletes.
• There are many types of chambers available in the market, and the choice depends on the design of the chamber, one room or two, the
number of persons undergoing treatment at the same time, type of coolant.
• The choice of chamber is often also related to economic considerations.
1. Two-stage cryogenic chamber
This type of chamber consists of one or two vestibules where the temperature is approximately -60°C, and a main chamber in which the
temperature is maintained within the range -110°C to -160°C (depending on the coolant).
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35. 2. Cryochamber with cool retention effect:
• This chamber is cooled with a mixture of liquid nitrogen and liquid oxygen in the proportions of atmospheric air. The air is
pumped from the external tank and sprayed by specially prepared nozzles. Three to four people may stay in this
cryochamber at the same time.[Cholewka & Drzazga 2005].
3. Cryobarrel (cryosauna)
• This is a cabin for one person. The patient is immersed in the cold vapours up to the arms, breathing air from the room
with the head is located outside the reach of extremely low temperatures.
• It has a swinging door which opens under the pressure of the body, and contact with the patient is very good. Liquid
nitrogen or liquid air is used to generate the coolant.
• The cryosauna has many advantage: low cost of use, good contact with the patient, easy assembly. [Księżopolska-
Pietrzak 1998]. 35

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37. 4. Cryochamber with a compressor cooling system
• This chamber with a compressor system uses air as a coolant. The chamber consists of two vestibules with a
temperature of -10°C and -60°C, and the chamber proper with a temperature of about -100°C.
• It can be mounted either indoors or outdoors (the chamber is isolated from the ground).
• This type of chamber has all the elements necessary for the safe performance of cryostimulation - additional
emergency exit, visual and audio contact with the operator.
• All parameters are monitored by a computer. The chamber can be used in group therapy [Migaj 2005].
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38. WBC EFFECTS
• Effect on tissue temperature
Bleakley, C. M., Bieuzen, F., Davison, G. W., & Costello, J. T. (2014). Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open access journal of sports medicine, 5, 25.38

39. • Inflammatory biomarkers
Pournot et al., 2011, found lower concentration of C-reactive protein at 24, 48, 72, and 96 hours post-exercise in a
group treated with WBC.
Ziemann et al., 2012, showed an enhanced cytokine profile within the WBC group, with lower levels of TNFα.
• Muscle damage
There was evidence from three studies that WBC does not affect markers of muscle damage after exercise. These studies
found few differences between WBC and control groups in creatine kinase, lactate dehydrogenase, and aspartate
aminotransferase during recovery from exercise-induced muscle damage (EIMD),(Fonda B et al., 2013) intense
running(Hausswirth C et al., 2011) or 5 days of moderate-intensity tennis training (Ziemann E et al., 2012).
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40. • Oxidative stress
Miller et al., 2012, examined oxidative stress and antioxidant function using a group of nonexercising participants. The
results showed an increase in antioxidant status associated with WBC.
Mila-Kierzenkowska et al., 2009, examined antioxidant status in Olympic kayakers. Results showed an attenuation of
oxidative stress as measured by lipid peroxidation in the WBC group over the course of a 10-day training bout. It is shown
that superoxide dismutase and glutathione peroxidase found lower in the WBC.
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42. THERAPEUTIC USE OF WBC
• Lorenzo Bettoni et al., 2013, found positive effect of WBC on QOL and reside improvement in pro- and anti- inflammatory
mediators. VAS and Global health status and fatigue severity scale also improve in patient with fibromyalgia.
• Agata Stanek et al., 2015, reported that whole-body cryotherapy procedures have beneficial influence on ankylosing spondylitis
patients through decrease of BASDAI and BASFI index, pain intensity, and improvement of some spinal mobility parameters.
• E. Miller et al.,2016, found that WBC sessions induced a significant improvement in the functional status and in the feeling of
fatigue and the changes observed in HF patients were significantly greater than those observed in LF patients.
• Nugraha et al., 2015, this study showed the 3-min WBC exposures (one per day) at -65°C and at -5°C in a cryochamber result in
pain relief in subject with chronic low back pain.
• Katarzyna Dulian et al., 2015, demonstrates that 10 sessions of the whole body cryostimulation (3 min at 110 degree C) caused
the rise of irisin concentration in obese men. The obtained data confirm our initial hypothesis that exposure to extremely cold
environment might induce muscle shivering and consequently irisin release from the muscle.
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43. • WBC is primarily used to alleviate inflammation, swelling and pain in, e.g., arthritis (Fricke 1989, Wichmann & Fricke
1997) and osteoarthritis (Metzger et al. 2000) and to reduce spasticity in clinics for some neurological diseases.
• Another study demonstrated increased ANS activity, predominantly of the parasympathetic branch, after a single
exposure of WBC and PBC (Hausswirth et al., 2013). The study involved 40 healthy men who received a single 3-min
WBC exposure at -110°C and a single 3-min PBC exposure at -160°C. The results showed that WBC had a greater effect
on ANS.
• Joanna Rymaszewska et al., 2008, 26 subject (18–65 years old) with depressive and anxiety disorders (ICD-10), received
standard psychopharmacotherapy. The study group was additionally treated with a series of 15 daily visits to a
cryogenic chamber (2–3 min, from –160°C to –110°C). Finding of this study suggest a possible role for WBC as a short-
term adjuvant treatment for mood and anxiety disorders.
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44. Adverse effect of cryotherapy
• Inhibit muscle function
• Ice burn
• Cryotherapy‐induced nerve injuries
• Generalized cooling and decrease in core temperature
• Reduced ROM
• Frost bite
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45. REFERENCES
• Chad Starkey; therapeutics Modalitites. 4th edition.
• Altintas, B., Altintas, A. A., Kraemer, R., Sorg, H., Vogt, P. M., & Altintas, M. A. (2014). Acute effects of local cold therapy in superficial burns on pain, in vivo microcirculation, edema formation and histomorphology. Burns, 40(5), 915-
921.
• Kannan, P., & Winser, S. J. (2011). A Comparison Study of 3 Stretching Protocols on Hamstrings Length. Indian Journal of, 5(3), 122.
• Shivakumar, H. B., Chanappa, T. S., Reddy, P. K., & Dey, J. (2014). A comparative study between the efficacies of ultrasound therapy with cryokinetics versus ultrasound therapy with soft tissue massage (deep friction massage) in acute
supraspinatus tendinitis. Journal of Evolution of Medical and Dental Sciences, 3(15), 3898-3908.
• ELECTROPHYSICAL AGENTS Contraindications and Precautions: An Evidence-Based Approach to Clinical Decision Making in Physical Therapy CANADA VOLUME 62 NUMBER 5 SPECIAL ISSUE 2010 ISSN-0300-0508 E-ISSN-1708-
8313
• Herrera, E., Sandoval, M. C., Camargo, D. M., & Salvini, T. F. (2010). Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Physical therapy, 90(4), 581-591.
• Breslin, M., Lam, P., & Murrell, G. A. (2015). Acute effects of cold therapy on knee skin surface temperature: gel pack versus ice bag. BMJ open sport & exercise medicine, 1(1), e000037.
• Herrera, E., Sandoval, M. C., Camargo, D. M., & Salvini, T. F. (2010). Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Physical therapy, 90(4), 581-591.
• Song, M., Sun, X., Tian, X., Zhang, X., Shi, T., Sun, R., & Dai, W. (2016). Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis. Springerplus, 5(1), 1074.
• Cameron, M. H. (2017). Physical Agents in Rehabilitation-E Book: An Evidence-Based Approach to Practice. Elsevier Health Sciences.
• Dulian, K., Laskowski, R., Grzywacz, T., Kujach, S., Flis, D. J., Smaruj, M., & Ziemann, E. (2015). The whole body cryostimulation modifies irisin concentration and reduces inflammation in middle aged, obese men. Cryobiology, 71(3),
398-404.
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