Monday, 14 March 2016

Cryotherapy – Application of cold modality for musculoskeletal injuries

Therapeutic application of substances that removes heat from the body and leads to a reduction in tissue temperature is termed as cryotherapy. Cryotherapy causes constriction of the small blood vessels, decreases tissue blood flow, reduces tissue metabolic rate, oxygen consumption, and inflammation and muscle spasm. Common methods of cold application include ice pack, vapo-coolant spray, ice massage and cold whirlpool. Cold application can be used in acute injury, chronic pain, muscle spasm, delayed onset muscle soreness and inflammation.

The cold-induced local anesthetic effect can be obtained via neurologic and vascular mechanisms at the spinal cord level. The temperature of the skin and underlying soft tissues can be decreased with topical cold application. This temperature reduction leads to a decrease in the nociceptor activation threshold and the nerve conduction velocity of the pain signals. The tissue blood flow and cell metabolic rate can be slow down with continuous cryotherapy. Reduced cell metabolism in turn prevent secondary hypoxic injury to the surrounding tissues by restricting the rate of oxygen utilization.

Extra care must be given when applying cryotherapy on patients with advanced diabetes as the diabetic neuropathy may result in serious complications. Peroneal, ulnar, axillary and lateral femoral cutaneous nerve injury after cryotherapy with compression has been reported. These superficial nerves are more likely to be damaged with prolonged cold compression. Other adverse treatment effects include frost bite, Raynaud’s phenomenon, cardiovascular effects and slowed wound healing.

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