2. Ben, Trina, Jake, Levi

3. Instructions Click on any highlighted word to go to that subject. Click on the picture of the House to take you back to the main Objectives slide. Click on the picture of the modality to bring you back to the modality Title slide. Click on the Video Link to play video when available. Click on the speaker to listen to an explanation of the slide.

4. OBJECTIVES History Characteristics Methods of Cryotherapy Evidence Based Research Review Questions References

5. HISTORY The Egyptians used cold to treat injuries and inflammation as early as 2500 BC. Ancient Greeks and Romans used cold applications of snow and natural ice to treat a variety of medical problems. Many books and articles were written about cryotherapy in the early 19 th century. By 1835 the application of cold compresses to inflammed wounds was a common treatment option. The first commercially viable ice machine was patent- -ed in 1850 by a Florida physician Between 1845 and 1851, Dr. James Arnott of Brighton, England described the benefits of local cold application in the treatment of numerous conditions, including headaches and neuralgia.

6. HISTORY By 1881, cold compresses were a recognized addition to treatment after surgery. But in the 1930s, the common treatment for acute injuries was hot compresses combined with soap suds or epsom salts. Medicine books began advocating cold treatments again for acute injuries by the 1940s. In the early 1960s, athletic trainers were arguing the benefits of heat vs. cold applications for initial treatments of athletic injuries. Cold was almost used universally by sports medicine practitioners for immediate care by the 1970s. Beginning in the 1980s through the 21 st century, great efforts have been made to expand the theoretical basis for the use of cold applications in acute injury management.

7. CHARACTERISTICS Physiological Affects 1. Decreases local tissue temperature 2. Decreases metabolic activity 3. Decreases nerve conduction velocity 4. Causes vasodialation 5. Decreases leukocytes 6. Decreases cell permeability 7. Decreases lymphatic and venous drainage 8. Decreases muscle spindle depolarization 9. Decreased muscular force production Therapeutic Effects 1. Decreases perception of pain (analgesic) 2. Slows the acute inflammation process and limits edema formation. 3. Decreases muscle spasms.

8. Types of Cryotherapy Whirlpool Ice massage Cold Compression Therapy Unit Ice packs

9. Whirlpool Methods of application Indications Contraindications Precautions Recommendations for use Proper use of agent

10. Methods of Application Whirlpools are effective for treating large irregular shaped areas. Patient submerges whole body or body part in the whirlpool after having turned on the turbine. Once treatment is over, patients will then remove self from the whirlpool, dry off, then turn off the turbine. The whirlpool must be plugged into a GFI to prevent electrical surges. Water temperature will be set at 50-60 degrees or 65-80 degrees for full body emersion.

11. INDICATIONS Large irregular areas Muscle atrophy Muscle soreness

12. CONTRAINDICATIONS Open wounds Circulatory insufficiency Cold allergy Cardiac or respiratory problems

13. PRECAUTIONS

14. RECOMMENDATIONS FOR USE

15. PROPER USE OF AGENT

16. ICE MASSAGE Methods of application Indications Contraindications Precautions Recommendations for use Proper use of agent

17. METHODS OF APPLICATION Used to deliver cold treatments to small, evenly shaped areas. Used in cases involving muscle spasm, contusions, and other minor injuries limited to a well-localized area. The patient may be able to administer self-treatment either at a clinical setting or as part of a home treatment program.

18. INDICATIONS Subacute injury or inflammation Muscle strains Contusions Acute or chronic pain

19. CONTRAINDICATIONS Cases in which pressure on the injury is contraindicated. Suspected fractures Uncovered open wounds Circulatory insufficiency Cold allergy and/or hypersensitivity Anesthetized skin

20. PRECAUTIONS In some injuries, the pressure of the massage may be contraindicated.

21. RECOMMENDATIONS FOR USE Most effective for injuries involving muscle spasm, contusions, and other minor injuries limited to a small localized area. This method of cold application is convenient, practical, and time efficient, providing cold treatments in situations in which there is no ready access to an ice machine.

22. PROPER USE OF AGENT Place patient in position of comfort, elevate if necessary Tear the cup from the bottom or top Rub hand over the top of the block Inform patient you are applying the agent Apply using circular or longitudinal strokes, moving 5- 7 cm/s. Treatment time of 15-20 minutes or until patient experiences an analgesic effect or other desired therapeutic effect.

23. Cold Compression Therapy Methods of application Indications Contraindications Precautions Recommendations for use Proper use of agent

24. METHODS OF APPLICATION Applied 24 to 72 hours after acute injury of surgery. Cuffs come for specific areas of the body, i.e. shoulder, ankle, and knee Provides a cooling effect with compression and elevation for post surgery patients.

25. INDICATIONS Acute Injury or Inflammation Postsurgical pain and edema

26. CONTRAINDICATIONS Cardiac or Respiratory Problems Uncovered Open Wounds Circulatory Insufficiency Cold Allergy or Hypersensitivity Anesthetized Skin

27. PRECAUTIONS Avoid applying too much pressure Avoid applying over large superficial nerves, could cause cold induced neuropathy

28. RECOMMENDATIONS FOR USE Recommended for postsurgical patients for home use. Can be used for 24 to 72 hours post surgery.

29. PROPER USE OF AGENT

30. ICE Packs Methods of application Indications Contraindications Precautions Recommendations for use Proper use of agent

31. METHODS OF APPLICATION Apply to affected area 15 to 20 minutes at a time several times a day Prolonged ice application beyond 1 to 2 days has been shown to impair healing.

32. INDICATIONS Use of an ice pack is in the acute phase of a soft tissue injury. Cooling will help prevent swelling. Ice packs are also useful to minimize or prevent increased inflammation or pain. The depth of anesthesia with an ice pack is generally considerably less than with an ice massage.

33. CONTRAINDICATIONS Severe reactions to cold are rare and are related to hypersensitivity reactions. Cold is contraindicated for patients who have developed hypertension during cold treatment or have a cold allergy (hives, joint pain) or cryoglobulinemia. Cold should not be applied to areas of reduced skin sensitivity, or in patients who have Raynaud’s syndrome or sickle cell anemia. Cold can further impair local blood flow in people who have peripheral vascular disease.

34. PRECAUTIONS Prolonged exposure will lead to freezing of tissue. A number of cases of peripheral nerve injury from cryotherapy have been reported. Injury sites have included the peroneal, lateral femoral cutaneous, and supraclavicular nerves

35. RECOMMENDATIONS FOR USE Decreases or reduces swelling Decreases inflamation Decreases muscle spasm Decreases pain Decreases vasoconstriction Decreases secondary tissue damage

36. PROPER USE OF AGENT When applying an ice pack, never do so directly onto the skin unless you are using crushed ice. 15-20min intervals several times a day During the first 24 to 72 hours after an injury be sure to avoid any form of heat at the injury site, avoid movement and do not massage the injured area as these will increase the bleeding, swelling, and pain.

37. EXAMINATION OF EVIDENCE BASED RESEARCH

38. REVIEW QUESTIONS 1. Name 3 contraindications of Cryotherapy? 2. Who do you think put the picture of the crack on their slide?

39. REFERENCES