By Andrew Morgan BPE/BEd Sports Medicine 15 UNIT II: CARE, PREVENTION AND REHABILITATION OF ATHLETIC INJURIES – CRYOTHERPAPY By Andrew Morgan BPE/BEd

Cryotherapy CRYO = ICE THERAPY = TO TREAT

Cryotherapy Applying cold to an injury is widely used in the field of Sports Medicine. Ice is the simplest, and safest immediate measure for relieving pain, decreasing internal bleeding, bruising and inflammation (swelling).

Cryotherapy Vasoconstriction This is the narrowing of blood vessels. Ice causes the blood vessels in the area to vaso-constrict. This reduces the amount of blood that flows to the injured area.

Cryotherapy Physical principles When a cold object is applied to a warm object, heat is abstracted. In terms of Cryotherapy, the most common method for cold transfer is through conduction. In most cases the longer the cold exposure, the deeper the cooling. At 3.5 degrees Celsius muscle temp. can be reduced as deep as 4cm.

Cryotherapy Cooling is dependent on type of tissue. Tissue with high water content such as muscle, is an excellent cold conductor. Fat is a poor conductor.

Cryotherapy Physiological Effects of Cold Vasoconstriction occurs after 15 minutes or less at a temp. of 10 degrees celsius or less. Reflex action of the smooth muscles. If cold is continuously applied for 15-30 minutes, vasodilation occurs for a 4-6 minute period. Hunting Response occurs, this is a slight temp. increase, a reaction against tissue damage.

Cryotherapy – skin response to cold Table courtesy of Arnheim Cryotherapy – skin response to cold Stage Response Estimated time after initiation 1 Cold sensation 0-3 minutes 2 Mild burning, aching 2-7 minutes 3 Relative, cutaneous (skin) anesthesia 5-12 minutes

Cryotherapy – Physiological Variables of Cryotherapy Table courtesy of Arnheim Cryotherapy – Physiological Variables of Cryotherapy Variable Response to cryotherapy Muscle Spasm Decreases Pain Perception Blood Flow Decreases up to 10 minutes Metabolic Rate Collagen Elasticity Joint Stiffness Increases Capillary Permeability Edema* *swelling as a result of collection of fluid in connective tissue Controversial

Cryotherapy The first 48-72 hours after injury are crucial for controlling inflammation and secondary injury. This does not mean an injury should stop receiving ice treatment after 3 days. In the knee joint, for example, blood can enter the capsule and can cause more damage to the structures inside the capsule.

Cryotherapy Application of Ice 10-20 minutes will give desired vasoconstriction. Beyond 15 minutes may experience “hunting response”. Apply ice intermittently with 40 minutes off to allow for tissue to return to normal body temperature.

Cryotherapy Application of ice contd. Crushed ice is best. Although sometimes you are forced to improvise – ice cubes, snow… Frozen vegetables work very well.

Cryotherapy Application of ice contd. Wrapped in a towel or put in a plastic bag is the best way to ice the skin. Avoid direct contact if at all possible. Complete immersion in cold water or ice water also works very well.

Cryotherapy Cryotherapeutic Methods Ice massage: Freeze water in a foam or paper cup, remove foam an inch from top of cup, use a tongue depressor as a handle, have a towel handy to absorb water. Use over small muscle area – tendons. Rub on athlete’s skin in overlapping circles (10-15cm area) for 10 minutes, once analgesia is reached, athlete can start to engage in exercise or stretching.

Cryotherapy Cold or Ice Water Immersion: Depending on the body part, a wide variety of containers can be used. Ice temperature should be around 10 degrees C. When a large area of the body needs cooling, i.e ankle “rollover”, ice immersion is usually the best method. 10-15 minutes in the ice bath, 45 minutes off, repeat three times. The comfort of the athlete must be considered at all times. Skin temp. rarely gets below 15 degrees C.

Cryotherapy Vapocoolant Sprays: Most popular is fluori-methane, a non-flammable, non toxic substance, under pressure in a bottle it gives off a fine spray when emitted. Reduces muscular spasm and increase ROM (range of motion). Also a treatment for trigger points – wait till sports massage unit for more info. Care must be taken however to avoid frostbite. Application: 1.Hold at 30 degree angle, 12 to 18 inches from skin. 2. Spray entire length of muscle from proximal to distal attachment. 3. Cover the skin at a rate of 4 inches per second, apply the spray 2 or 3 times as a gradual stretch is applied.

Cryotherapy Precautions… Be careful with chemical cold packs and sprays, as they can cause frostbite and tissue damage. Ice can be placed on any part of the body except the eye.

Cryotherapy Other Considerations: Watch out for cold allergies, some people break out in hives. Nerve palsy – ice was on for too long and affects nerves close to the surface of the skin.

Cryotheryapy