Cryotherapy
Cryotherapy and thermal therapy: Is it all a lot of hot air? (or Blowing Hot and Cold or You Have To be Cool to be Kind or …)
The application of cryotherapy (the use of cold for the treatment of injury or disease) has a long history, having been used in the ancient Greek and Roman civilizations.1 However, cryotherapy came into broad use in the emergency care of sports injuries at the beginning of the 1970s.2 Its primary objective is to lower the temperature of a tissue and thereby achieve a therapeutic benefit by suppressing the metabolic rate of the tissues. When the metabolism of tissues is suppressed by cooling, tissue damage caused by hypoxia is prevented. In addition, vasoconstriction is induced, which reduces bleeding and oedema in damaged tissues.3
Today the use of cryotherapy is widespread in the medical arena. It is an established method when treating acute soft tissue injuries and as part of the treatment protocol for chronic injuries. Cryotherapy has also been shown to reduce pain effectively and reduce the recovery period in the postoperative period after reconstructive surgery of the joints.4
A rigorously conducted study in humans documents a statistically significant decline in intraarticular knee temperature with the application of cold and compression to the skin. The mechanism includes the cooling effect on the intraarticular environment and synovium.5
Most clinical studies report that the use of cryotherapy has a positive effect on pain reduction. Results of various studies are consistent on the effects on neuromuscular and pain processes while results of studies on cold and blood flow vary considerably. However, it appears that blood flow increases with superficial cold application then decreases when cold is applied to large surface areas.6 Cold increases the pain threshold, the viscosity and the plastic deformation of the tissues but decreases the motor performance. The application of cold has also been found to decrease the inflammatory reaction in an experimental situation. Finally, the application of cold significantly decreases microvascular permeability following striated muscle contusion. Microvascular permeability is increased following a contusion and was significantly reduced following cryotherapy.7
Combined with compression, cold can produce dramatic drops in tissue swelling, because cold initially constricts the walls of blood vessels and compression restricts the amount of blood which can reach an injured body part (another therapeutic intervention, elevation, helps to 'drain' a damaged body region of excess fluid via the lymphatic system).
The proper duration of cold therapy is a topic of much discussion. Traditionally, doctors have recommended applying cold to injured areas for 15-30 minutes at a time, but recent research carried out at the University of Brussels indicates that the permeability of lymphatic vessels decreases after about 10 minutes of cold therapy. Since lymphatic vessels drain fluid away from injured tissues and thereby relieve swelling, the researchers recommend that cold be applied to damaged tissues in no longer than 10-minute intervals. 8
Various methods such as ice packs, ice towels, ice massage, gel packs, refrigerant gasses and inflatable splints are available. Skin, subcutaneous, intramuscular and joint temperature changes depend on application method, initial temperature and application time. Intramuscular temperature continues to drop after the cooling modality has been removed. Cold appears to be effective and harmless and few complications or side effects after use of cold therapy are reported. Prolonged application at very low temperatures should be avoided though, as this may result in frost-bite and nerve injuries.9
Thermal therapy or the therapeutic application of heat is also frequently
utilised in the management of conditions ranging from lower back pain to
dysmenorrhoea.The mechanism by which heat relieves pain remains unclear,
although it is speculated that heat inhibits exhitatory nerve fibres (which, for
example induce muscle cramps), and that heat may cause the release of
endorphins, the powerful opiate-like chemicals which block pain transmission.
Increased blood flow in heated parts of the body, the result of vasodilation, may improve the flexibility of tendons and ligaments, reduce muscle spasms, alleviate pain, elevate blood flow, and boost local cellular metabolism. Due to the vasodilatory effect of heat it is prudent to avoid heating up acutely inflamed tissues as this may aggravete contusion and swelling. The proper tissue temperature for vigorous heating is probably 40 to 45 degrees Celsius (104 to 113 degrees Fahrenheit) and the correct duration of temperature elevation is about five to 30 minutes.10
References
- Licht S: History of therapeutic heat and cold, in Lehman JF (ed): Therapeutic heat and cold. Third edition. Baltimore, MD, Williams and Wilkins, 1982, ppl -34
- Barnes L: Cryotherapy – putting injury on ice. Physician Sportsmed 1979; 7(6): 130 – 136
- Yasumitsu O, Megumi O, Shinya N, et al: The effect of cryotherapy on Intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction. Am J Sports Med. 1999; 27:357-362
- Cohn BT, Drager RI, Jackson DW, et al: The effects of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 1989
- Martin SS, Spindler KP, Tarter JW, et al: Cryotherapy: an effective modality for decreasing intraarticular temperature after knee arthroscopy. Am J Sports med. 2001 May-June; 29(3): 288-91
- Meeusen R, Lievens P: The use of cryotherapy in sports injuries. Sports Med. 1986 Nov-Dec; 3(6): 398-414.
- Deal DN, Tipton J, Rosencrance E, et al: Ice reduces edema. A study of microvascular permeability in rats. J Bone Joint Surg Am. 2002 Sep; 84- A (9): 1573-8
- Meeusen R, van der Veen P, Joos E, Roeykens J, et al. The influence of cold and compression on lymph flow at the ankle. Clin J Sport Med. 1998 Oct;8(4): 266-71
- Swenson C, Sward L, Karisson J: Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996 Aug; 6(4): 193-200
- Superficial Heat and Cold: How to Maximise the Benefits, The Physician and Sportsmedicine. 1994;vol. 22(12), pp. 65-74
© - Search Maestros - Website Marketing
Copyright - Grucox Medical Sports Products ©
