Ch 13 - Cryotherapy Application for Postimmediate Care

when to start subacute care cryotherapy

• begin once secondary injury stops

• usually within 24 hours

local numbing w cryotherapy (3)

• ice water immersion

• ice massage

• ice bag (occasionally)

ice water immersion (5)

• NOT submersion

• need large enough container

• ice → water

• goal is 0-1 C

• warmer water not numb as effectively

important notes for ice water immersion (3)

• give patient choice at beginning

• subsequent bouts will become less painful

• toe cap help minimize pain

ice massage (3)

• slowly stroke muscle w ice pop

• discontinue when numb

• adding a plate weight w inc numbness

techniques for subacute care cryotherapy (4)

• cryokinetics

• cryostretch

• contrast bath

• connective tissue stretch

cryokinetics

combo of cold application and active exercise

• typ 5 bouts of exercise w numbing in b/w

cryokinetics advantages (2)

• cold dec pain = active exercise

• exercise = reduces swelling, promotes healing and RTP

cryokinetics disadvantages (2)

• pain during inital session

• cold can be messy

indications to use cyrokinetics

1st degree sprains of ankle or fingers

contraindications to use cyrokinetics (3)

• 2nd or 3rd degree sprains / multiple structures involved

• any exercise or activity that causes pain

• use of ice on a pt who is hypersensitive to cold

precautions to use cyrokinetics (3)

• use pain as a guideline

• don’t allow pt to limp

• may be inc in pain 4-8h post treatment

preapplication - cryokinetics (6)

• explain sensations

• benefits of Tx outweight temp pain

• remove clothing as necessary

• equipment prep

• use ice massage if can’t immerse

• usually 10-20 mins stop regardless

application tasks - cryokinetics (3)

• as long as numb for exercise

• reapply ice until numb again

• exercise-ice-exercise-ice (5 bouts)

cryokinetic exercise order

all exercises must be graded

• begin w ROM exercises (active) non-weight bearing → active

• progress through inc levels of difficulty

• full sport activity is final level

when to begin with cryokinetics

within 30 mins if first0degree sprain

frequency of cryokinetics

2 to 3 x per day

cryokinetics & cryostretch - instructions to give pt

• leave w same joint support u came with

• if after few hours support is not needed, discontinue using it

• be active, as long as pain free

• may feel pain 4-8 h post, ice for 30 mins

cryostretch

• most strains/contusions result in ms spasms or tightness

effects of cryostretch (3)

• ice dec pain and ms spasms

• static stretching overcomes stretch reflex

• relax after maximal ms contraction is greater than before contraction (PNF)

cryostretch advantages (2)

• combo procedure more effective than sum of 3 individ components

• ice inexpensive, exercise free

cryostretch disadvantages (2)

• ice is painful to some (but not as painful as ice immersion)

• melting ice can be messy

cryostretch indications (3)

• any ms w residual low grade ms spasms

• 1st degree ms strain

• a ms stiff from prolonged disuse (immobilization)

cryostretch contraindications (2)

• any exercise that causes pain

• use of ice on person who is hypersensitive to cold

cryostretch precautions (3)

• don’t allow pt to gut out pain

• may be inc in pain 4-8 h post

• isometric contractions begin and end gradually

cryostretch application (3)

• 3 sets of 2 65s bouts of exercise w 20s rest b/w bouts

• stretch to ms limits and hold 20s (i.e 20s on, 5 of)

• stretch until ms pain / tightness is felt than back off until pain disappears

cryostretch frequency

2 to 3x per day

cryostretch length of application

5 bouts of exercise per Tx session