Cryotherapy (Greek kryo: cold), also known as cold therapy, is one of the procedures of physical medicine and consists of both local and systemic application of cold for therapeutic purposes. The main areas of application of cryotherapy are traumatology (the science or study of injuries and wounds, including their therapy) and rheumatology (the science or study of the development, treatment, and prevention of rheumatic diseases).
Indications (areas of application)
- Postoperative local tissue irritation (e.g., swelling).
- Regeneration measure after sports
- Traumatic arthritis – joint inflammation after injury.
- Rheumatoid arthritis – joint inflammation in the context of an infectious, metabolic (metabolic) or autoimmune rheumatic disease.
- Gouty arthritis – Gout is a metabolic defect that results in painful secretion of crystals of uric acid in different parts of the body, but especially in the joints.
- Activated osteoarthritis (joint wear).
- Hematomas (bruises)
- Contusions (bruises)
- Distorsions (sprain)
- Acute periarthritis – irritation and inflammation in the soft tissue area at a joint.
- Tendovaginitis (tendonitis).
- Periostosis – reactive widening of the periosteum.
- Bursitis – bursitis
- Edema treatment or prophylaxis
- Painful muscle tension in the area of the lumbar spine.
- Local burns
- Post-apoplexy hemiplegia – hemiplegia following a stroke.
- Cerebral paresis – paralysis caused by damage to the central nervous system (brain).
Contraindications
- Cold allergies
- Circulatory disorders
- Acute pyelonephritis (inflammation of the renal pelvis)
- Acute cystitis (cystitis)
The procedure
The aim of the application of cold is the withdrawal of heat from the tissues to be treated. The effect is generally based on vasoconstriction (vasoconstriction), muscle relaxation (reduction of internal muscular tension) and analgesic effect (pain reducing). Cold has the following physiological effects on tissue structures and tissue processes:
- Blood vessels – vasoconstriction (vasoconstriction).
- Cell metabolism – decrease in metabolism.
- Capillary permeability (permeability of smallest blood vessels) – reduction of permeability (this reduces mainly edema (water retention in tissues)).
- Tissue inflammation – weakening of inflammatory processes.
- Nerve conduction velocity – decrease in nerve conduction velocity.
- Muscle tone – short-term increase and long-term decrease in muscle tone.
- Muscle contractility – decrease in muscle contractility.
- Synovial fluid viscosity (“synovial fluid”) – increasing the viscosity of the “synovial fluid”.
Basically, the short-term use of cold therapy must be distinguished from long-term use, as they are characterized by a different effect:
- Short-term application (about 10-15 minutes): the result is vasoconstriction with decreased local blood flow in both superficial and deeper muscle layers. After removal of the cold source, reactive hyperemia (short-term increased blood flow to the tissues) occurs in a wave-like pattern. This rewarming can be followed, for example, with thermography.
- Long-term use (about 1-2 hours): the persistent cold significantly reduces blood flow, with simultaneous antiphlogesis (metabolic attenuation) and restriction of enzymatic processes. This is especially helpful in cases of inflammation due to increased metabolism (metabolic rate). Muscular tone increases for a short time, then the muscles are detonated for a long time. At a skin temperature of +15 °C, there is complete analgesia (insensitivity to pain) due to a reduction in nervous activity. There is also an inhibition of edema and bleeding, an increase in blood pressure and heart rate, as well as an increase in the viscosity of the synovial fluid and venous pressure.
The application of the cold stimulus can take place in several ways. The following cryotherapeutic measures are used:
- Ice immersion bath: immersion of the body in cold water (6-12 °C).
- Cold water bath: Immerse individual body parts, such as hands or feet in cold water (10-15 °C).
- Ice pack: massages, packs or dabs.
- Ice compresses (1-3 °C)
- Chemical compress (cold development by reaction of two chemical components; 0 °C).
- Frozen brine compress
- Packs of frozen gel bags (silicate mass; -15 to -20 °C).
- Evaporative cooling by liquids such as chloroethyl
- Whole body cold exposure in a cold chamber for about 1-3 minutes (-60 to -120 °C; by nitrogen, carbon dioxide or cold air).
The application of these different methods differs in temperature, duration of application and place of application. If it is a long-term local application of a cold stimulus, for example, by a pack, it must be bedded on a dry intermediate layer and not directly touch the skin. In addition, the rest of the body should be kept warm, e.g., with wool blankets, to minimize the risk of hypothermia and cold. The patient first experiences a cold sensation followed by a burning or stabbing pain (1st cold pain). Analgesia (insensitivity to pain) follows after 7-8 minutes, which can lead to another stabbing pain (2nd cold pain). For this reason, the attending physician or therapist should always be within reach of the patient. The exact course of cryotherapy depends on the method and indication.
Benefits
Cryotherapy is a versatile procedure that is most effective for musculoskeletal injuries as a simple cooling treatment. In addition, more complex applications of the cold stimulus are possible and can have a lasting effect. The therapy should be performed by an experienced therapist.
