This document discusses cryotherapy, or the therapeutic use of local cold application. It provides details on the physical principles, indications, contraindications, physiological effects, therapeutic effects, techniques of application including immersion, ice towel, ice pack, and ice cube massage methods. Cryotherapy is used to reduce pain, inflammation, swelling and muscle spasm through vasoconstriction, decreased nerve conduction velocity, and reduced cell metabolism. Precautions must be taken to avoid dangers like frostbite.

1. RUDRA MISTRY
1st Year BPTH
YMT College Of Physiotherapy
CRYOTHERAPY

2. INTRODUCTION
It Is A Therapeutic Use Of Local
Cold Application For The
Treatment Of Various Diseases And
Disorders.

3. PHYSICAL PRINCIPLE
• When Ice is applied to the skin , heat is conducted
from the skin to the ice in order to melt it.
• To change its state the ice requires considerable
amount of energy i.e LATENT HEAT OF FUSION.
• Cryotherapy uses conduction & evaporation as
method of heat transfer .

4. INDICATIONS
● Acute pain
● Chronic pain
● Neck pain
● Low back pain
● Muscle strain
● Spasticity
● Myofascial trigger points
● Muscle gaurding
● Muslce spasm
● Acute ligament sprain
● Acute muscle strain
● Acute contusion
● Bursitis
● Tendonitis
● Tenosynovitis
● DOMS
● Tenis elbow

5. 1) Absolute Contraindications
 Allergy / Hyposensitivity To Cold
 Impaired Sensations
 Raynaud's Disease ( Arterial Spasm
Leading To Possible Ischaemic
Neurosis )
 Circulatory Insufficiency
 Peripheral Vascular Disease
 Open Wounds After 48 Hours
 Local Infection
CONTRAINDICATIONS

6. 2) RELATIVE CONTRAINDICATIONS
Very young or very old patients
Severe hypertension
Diabetic patients
Regenerating peripheral nerves
Skin rashes
Cardiac & respiratory involvement
Suspected fractures

7. PHYSIOLOGICAL EFFECTS
1) CIRCULATORY RESPONSE
• The Initial Response Of Skin To Cooling Is An Attempt
To Preserve Heat And Accomplished By An Initial
Vasoconstriction . This Homeostatic Response Has The
Effect Of Allowing The Part To Become Very Cold.
• After A Short Period , The Alternate Period Of
Vasodilatation And Vasoconstriction Is Called Lewis
Hunting Reaction .
• This Initial Phase Of Vasoconstriction Helps To Reduce
The Blood Flow , Limits Swelling And Tissue Damage.
• This Alternate Period Helps In Removing The
Metabolic Waste Products Like Lactic Acid And It Also

8. 2) NEURAL RESPONSE
• The skin contains primary thermal receptors . Cold
receptors are more than warm receptors .
• The cold receptors respond to cooling by a
sustained discharge of impulse , the rate of which
increases with further cooling . The rate of
conduction of nerve fibres in a mixed peripheral
nerve is reduced by cooling .
• The fibres affected by gradual cooling are A delta (
myelinated ) and eventually at very slow
temperature the B and C fibres ( non – myelinated )
are affected
• Synaptic transmission can also be delayed . This
effect is helpful in treating pain & hypertonicity .
• The cold receptors are stimulated in the midbrain

9. 3) DECREASE IN BODY
TEMPERATURE
• Cold causes fall in body temperature
4) DECREASE IN CELL METABOLISM
• Cooling of tissues decreases metabolic
activity & hence the energy of oxygen
requirement of cell gets reduced and it
reduces inflammation and swelling .

10. THERAPEUTIC EFFECTS
• PAIN RELIEF : It Reduces Pain , Nerve
Conduction Velocities & Raises Pain Threshold .
• MUSCLE SPASM : It Reduces Muscle Spasm.
• It Reduces Inflammation And Swelling .
• TRAUMA : Cryotherapy Is One Of The Effective
Physical Agents In Treatment Of The Acute
Injuries . Reduces Pain .
• MUSCLE TONE : It Helps To Reduce The
Muscle Tone & Spasticity In Hypertonic
Patients.
• .

11. SPASTICITY
• It Is The Pathological State Of Increased
Muscle Tone Resulting From Damage To
The Upper Motor Neuron . The Small
Anterior Horn Cells From The Higher
Control Extrapyramidal System & Fires
Spontaneously At An Increased Rate.

12. SPASM
• It Is The Normal Response To Injury Or Pain & Is
Manifested As An Increase In Muscle Tone On A
Specific Area With The Apparent Aim Of Limiting
Movement & Further Damage. However The Amount
Of Spasm Is Exceeding & The Sustained Contraction Of
Muscles Will In Turn Start To Produce Pain , Often
Resulting In More Spasm.

13. • The Mechanisms By Which Cold
Reduces Spasticity And Spasm
Are :
1) Reduced Velocity Of Nerve
Conduction
2) Depressed Sensitivity Of Receptors
Such As Muscle Spindle

14. TECHNIQUE OF APPLICATION
 PREPARATION OF APPARATUS
The Type Of Cold Which We Are Going To Apply Should Be Pre-
checked The Temperature .
 PREPARATION OF PATIENT
Nature And Reasons For The Cold Treatment Are Explained To The
Patient. Rule Out The Contraindications In Treatment Area , Especially
Cold Urticaria , Anaesthetic Skin .
 INSTRUCTIONS TO PATIENT
The Patient Is Briefly Explained What Is The Treatment Procedure &
They Have To Inform Us If Any Pain / Discomfort Is Encountered.
 METHOD OF APPLICATION
Inspect The Skin Periodically ( Every Few Minutes) During The
Treatment. Note The Onset Of Vasoconstriction & Vasodilation .

15. IMMERSION METHOD
• It Involves Placing Of Body Part Into The Mixture Of Ice
And Having A Range Of 10 – 15 Degree Celcius .
• It Is Useful For Injuries Having An Irregular Surface .
• A Tub Or Bucket Is Filled With 50% Ice And 50% Water
And Is Used For Cooling Large And Irregular Shaped
Areas.
• Distal Extremities Like Ankle & Foot Are Usually
Immersed In The Ice Solution
• This Method Is Given For 10 Minutes.
• When Treating Any Deep Structures , The Treatment
Duration Should Be Increased As The There Is More
Amount Of Adipose Tissues.

16. ICE TOWEL METHOD
• This Is A Popular Method Of Application Because There Is Least
Danger Of Producing An Ice Burn .
• Prepare The Bed By Removing The Blanket And Sheets And Cover It
With Waterproof Material.
• Adequate Exposure Of Part To Be Treated Is Necessary .
• Prepare The Ice Solution By Filling A Bucket Or Large Bowl With 2
Parts Of Flanked Or Crushed Ice To One Part Of Water . A Terry
Towel Is Immersed In This Mixture .
• Surplus Water Is Being Wrung From One Towel Then Apply It To
The Part To Be Treated .
• The Towel Are Changed When They Have Been In Position For At
Least 30 Seconds But Not Longer Than 2 Minutes.
• In Presence Of Swelling , It Is Permissible To Elevate The Limb &
Completely Surround The Joint.
• When Treating Spastic Muscle , Towel Are Applied Along The Length
Of Muscle From Its Origin To Its Insertion .

17. ICE PACK METHOD
• Crushed or flanked ice may be placed inside a specially made terry
towel bag or an ice towel folded into an appropriate shape .
PREPARATION OF BED
• A gutter will be positioned below the part to be treated . A gutter is
made of polythene sheet , folded and placed on bed . The ice melts &
directly flows into the gutter formed preventing the floor from getting
dirty & causing discomfort to patient .
• The treatment is given for 10 – 20 minutes .
PREPARATION OF PATIENT
• Part to be treated is exposed and put in a comfortable position over
the prepared gutter .
• A vegetable or nut oil is spread over the skin on which ice pack is
placed . This is to prevent ice burn.

18. APPLICATION
• The Wet Ice Pack Is Placed On Top Of The Part To Be
Treated . The Pack Should Never Surround The Limb As
This Will Put Pressure On One Aspect Of Limb And
Could Reduce The Circulation Locally.
• A Reduced Circulation Would Prevent Normal
Circulatory Response To Cooling Which Will Lead To Ice
Burn . Pack May Be Left In Position For 10 – 20 Minutes.

19. ICE CUBE MASSAGE
• This Can Be Used In Home Also And Is Useful In Small Departments
And Wards . It Is A Useful Method Of Application As It Does Not
Require An Ice Machine .
PREPARATION
• A Large Block Of Ice E.G. Water Frozen Into A Yoghurt Pot . It Has One
End Wrapped In A Towel , The Other End Left Free . The Patient Is
Adequately Exposed And Supported .
APPLICATION
• Massage Is Given In A Circular Manner Over The Treatment Area.
Applying Only Minimal Pressure To The Part.
• Maximum Time Of Application Is 10 Minutes . Useful In Bed Sores .
This Is Repeated For 3-4 Times.

20. WINDING UP
• Remove the cold application and dry the skin. Inspect one
more time
DANGERS
• Frost Bite
• Length Of Treatment
• Tissue Death
• Over The Main Branch Of The Nerve
• Over An Open Wounds
• Patient With Poor Sensation And Mentally Retarded