What does Cold Do? What is Cryotherapy?
Pain and muscle spasms are common responses to injury. Tendons and ligaments are tissues that connect muscles and bones to each other and to other tissues. The basic building material of muscles, tendons, and ligaments is a protein called collagen. Under normal conditions, collagen acts like a rubber band: It stretches when tension is applied (as when we pull a rubber band) and returns to its normal length when the tension is released. However, when the collagen is stretched too far, it tears. In this tearing process, blood vessels are torn and blood cells and fluid escape into the spaces among the muscle fibers. This is sometimes visible on the surface of the skin as a swollen, bruised area.
Cold applied to the area decreases the flow of this fluid into the tissues and slows the release of chemicals that cause pain and inflammation. Cold decreases feeling in an area by reducing the ability of the nerve endings to conduct impulses. It may also reduce pain by "countering" the injury. For example, you might counter the pain of a sore tooth by pinching yourself hard in the leg.
Cold also decreases the activity of cells to reduce swelling and internal bleeding at the site of acute injury. Cooling the deep tissue also reduces muscle spasm by reducing the muscle's ability to maintain a contraction (contractility).
Because cold reduces bleeding and swelling within injured tissue, it is best used in the first 48 hours after an injury and usually longer after a surgery. However, cold therapy (cryotherapy) is not for everyone. Cryotherapy should not be used on persons who:
- Have circulation problems
- Are unconscious (such as your local politician)
- Are unable to respond or cannot feel cold (for example- someone after a stroke; with a neuropathy; or who has paralysis of a limb)
- Are allergic to cold (yes, some people develop a rash and blisters to cold)
What are the types of Cryotherapy?
Since the ice age, humankind has used cryotherapy to their advantage. Cryotherapy can be as simple as using a few ice cubes wrapped in a towel and applied to your skin, or can be as advanced as a microchip controlled personal cooling unit. Each type has its benefits and limitations. We will try to give you some background on each technique in order to allow you to make the best choice to relieve your pain and restore your function.
This technique uses simple bags such as a plastic bag, a hot water bottle, chemical cold packs or frozen vegetables. Technique- Dry the area first. Apply a dry terry cloth towel over the area to prevent direct contact of the ice to the skin. Apply your choice of cold to the area for no more than 20 minutes. The skin will pass through four stages of sensation in 10-15 minutes. These sensations in order are: 1.) Cold 2.) Burning 3.) Aching 4.) Numbness ** Cold therapy should be stopped once the skin feels numb.
Ice massage is another cryotherapy technique. Place clean tap water into a foam cup and place in your freezer until it is completely frozen. Peel back a small amount of the top of the cup and massage this onto area of pain using constant circular motion. DO NOT hold the ice in one area for more than 3 minutes since this may cause frostbite. ** Cold therapy should be stopped once the skin feels numb.
The Advantages of these two techniques:
- Easily available materials found in most homes.
- Usually inexpensive.
- Quick application with little preparation.
- Good for minor injuries that only require cold therapy for a day or two.
The Disadvantages of these techniques:
- The ice easily falls off the joint. It is difficult to keep the ice in place
- The ice quickly melts and can create a mess especially if in bed.
- Ice is applied to limited surfaces of the joint.
- No compression is applied.
- Can only be applied for short periods of time (10-20 minutes).
- Very frustrating to use for more major injuries or after surgery for the above reasons.
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