1. Cryotherapy

2. Cooling of the body’s surface initiates responses: Retrostasis - is the action of fluid being mobilized from the body surface into deeper tissues and internal organs because of vasoconstriction in the skin and subcutaneous tissues

3. Cooling of the body’s surface initiates responses: Hunting Response - body’s attempt to ensure peripheral body parts receive sufficient blood when exposed to cold to prevent tissue damage (frostbite) It occurs if the temperature in a tissue is reduced for 12-15 minutes or has been brought down below 10C. A cold induced vasodilation follows the initial vasoconstriction, and then cyclic periods of vasodilation and vasoconstriction (but the tissue doesn’t return to its initial temperature)

4. Inflammation and Cold Applications One of main uses for cryothearpy is to manage inflammation Functions of inflammation: Dispose of foreign entities(e.g. bacteria) at the injury site Prevent spread of those entities beyond the site Prepare the injured area for repair Key events in inflammation: Vasodilation – increase blood flow(bringing nutrients and cells for repair in; fostering removal of waste products and fluid Increased permeability of blood vessel – allows entry of specific cells needed to defend and repair the tissue

5. Inflammation and Cold Applications Identifying the cardinal signs of inflammation(SHARP) Swelling Heat Altered function Redness Pain Why do we use cold in the acute stage of healing The body’s inflammatory response is usually excessive compared to the injury Cold helps to minimize the inflammatory response by decreasing vasodilation Constricting blood vessels means less blood can escape(open wound) or pool ay the site(contusion) Relieves pain by numbing local nerve endings Note: After inflammation is well established, cryotherapy can still help with reducing pain and decreasing spasm, but will have little effect on the inflammatory response.

6. Factors that Influence the Effects of Cold Temperature Duration Size of treatment area Temperature of the individual Amount of adipose tissue in treatment area

7. Direct Effect of Cold Brief Application Less than 1 minute is stimulating Vasoconstriction followed by vasodilation – refreshes local blood supply and stimulates tissue performance Longer Application Mostly sedative(slowing metabolism, decreasing heart and breathing rates) Induces vasoconstriction and retrostasis, then vasodilation and active derivation

8. Reflex Effects of Cold Cold can be used to reflexively stimulate target organs through retrostasis Brief Application To chest – temp increase breathing rate Over heart – increase HR To hands, face, head – increase mental activity and alertness Enhance digestion, urine production, elimination, immune functioning, muscle tone

9. Reflex Effects of Cold Longer Application To nose and back of neck – vasoconstrict nasal mucosa(aids with nosebleeds) Over heart – decrease HR To scalp – vasoconstriction in head(help relieve migraines) To kidneys – stimulates filtration function To abdomen – stimulates blood flow, motility and absorption

10. Indications for Cold Acute conditions (sprains and strains) Acute soft tissue trauma including contusions Inflammation Edema Muscular pain Muscle guarding, spasms Acute tendonitis Acute bursitis Fractures Post-surgical conditions Headaches, migraines Hemorrhoids RA, OA etc MS Depression After frictions Treat TrPs

11. Precautions Watch for frostnip(1st stage of frostbite) - use an insulator Don’t let a cast get wet Maintain hygiene over open wounds; don’t let open wound get wet Very young, very old, or immunocompromised individuals must be monitored closely BP increases during a full body cold treatment (d/t global vasoconstriction) Watch BP when treating large area or multiple areas Watch for accurate sensation Watch for thermoregulatory disorders

12. Cryotherapy Applications Cool: 13 to 18 degrees Celsius Cold: 0 to 12 degrees Celsius Sensations caused by cold applications(C-BAN) Cold, Burning, Aching, Numbness It is important to inform Px about these stages Numb to the client, cold to the therapist touch

13. Cryotherapy Applications Ice bags/gel packs Simple to use, mould well to body, easy home application Used for acute inflamed soft tissue conditions and recent injuries Apply for 10-20 minutes Ice Massage More aggressive than gel/ice packs Used for localized pain and inflammation (acute ligament/tendon injuries), after frictions, or as TrP treatment Apply for 5-10 min

14. Cryotherapy Applications Compresses Folded layers of cloth(cotton, linen, flannel), well wrung out in cold water and applied to skin Milder local effects, can be tolerated for longer periods For headaches when used on back of neck or forehead (ideally with hot foot bath), used in conjunction with other hot therapies to avoid heating or vasodilation-induced headache, easy for home use, used to achieve reflex effects in organs Foot baths Energizes tired achy feet and legs; unilaterally helps with sprains, intrinsic foot joints, or a contralateral casted leg/foot

15. Tonic Friction Applications: Tonic refers to a “strengthening reaction” Used to prepare body for cryotherapy Also exfoliates skin 1. Light scratching Causes slight contraction of small surface blood vessels 2. Moderate scratching Causes surface vessels to contract initially and then dilate as blood flow returns to skin 3. Strong vigorous scratching Causes hyperemia of skin and increased heat elimination

16. Tonic Friction Applications: Cold mitten friction Trains vascular system to react positively to cold Addresses fatigue and lethargy Stimulates skin after cast removal Reduces fevers CIs - open skin lesions, open sores, recent scar tissue Dry brushing Massage body partially or completely to directly stimulate circulation of skin Brisk, circular, long movements with pressure towards heart Sloughs off dead skin cells Tones skin in preparation for full body tx Should last 5 minutes for full body (until hyperemia results) Brush from lateral to medial CIs - broken skin, inflamed or open lesions, freshly shaven skin, body areas with a lot of hair

17. Tonic Friction Applications: Salt glow Application of slightly moistened salt to body Increases skin circulation and stimulates cutaneous nerves Removes dead cells and softens rough skin 1-2 cups of salt moistened Shower with cool/cold water CIs - open wounds, recent scar tissue, recently shaven skin

18. Home care Plastic bag filled with unpopped popcorn in freezer Bag of frozen vegetables (peas) Frozen juice tin Frozen water bottle Frozen towels Ice cubes in plastic bag