Physyological traumatic injuries, cramps as a preparatory method

 

Physyological Effects:

 – Decreased tissue temperature;

– Decreased metabolic
demand;

 – Vasoconstriction;

– Limitation of edema
(local);

– Control of edema;

– Decreased pain (analgesy).
Physiology: increased pain threshold
and nerve conduction latency promoting analgesia.

– Decreased muscle spasm

– cycle
spasm-ischemia-pain;

– Decreased inflammatory
response;

– Decreased blood
extravasation with decreased release of fibrins in the extracellular
environment, promoting the reduction of collagen production and, consequently,
decreased adhesion formation.

 

Indications:

– General: control of pain
(analgesy) and inflammation;

– Immediate care of acute musculoskeletal
injuries;

 – Reduction of muscle spasm;

– Control of edema;

 – Decreased edema. Indication: associated with compression. But, it is not known
whether compression alone is the best option.

– Reduce downtime;

 – Minimize recovery time;

 

Cryotherapy resources:

1) Ice compress:

 – Method: the best is the crushed ice with the
use of the clean moist towel or the disposable plastic bag.

 – Application technique: dermal cooling
reaching from 21º to 30ºC, with reduction of 6º to 15ºC at the surface
temperature. Application time: 20-30 minutes.

 

2) Gel compress: NOT INDICATED. Reaches temperature below therapy.

 

3) Bags:

– Indication: in the
absence of the ice pack.

– Care: make the bag
asepsis and moisten it before use.

 

4) Ice spray:

– Indications: immediate
care of light traumatic injuries, cramps as a preparatory method for the next
step of care and as an immediate analgesic effect for immediate return to the
sport.

– Attention: prioritizing
the previous evaluation of the injury.

– Method: there is no
standard methodology, since we find ways of applying 3 to 6 strokes in the
direction of muscle fibers up to 10 seconds of local application.

 

 5) Local cryoimmersion:

– Indication: extremities
of body

 – Method: average temperature of 10º to 15ºC
controlled by thermometer, with a maximum time of 30 minutes (tolerance of the
individual). At temperatures below 10 ° C, minimum 4 ° C, the application time
within the tolerance of the individual should be reduced.

 

6) Systemic cryoimersion:

– Indication: in recovery
after intense activities and in the prevention of late muscle pain.

– Method: immersion time of
6 to 20 minutes at temperatures from 6º to 15ºC. The application can occur in
vertical and horizontal postures (there is no consensus).

 

7) Contrast bath:

 – Indication: in reducing edema and increasing
blood flow to increase tissue nutrition to maximize recovery / healing. It is a
pleasant therapy for patients and athletes.

– Treatment start (if
any?): Work at the subacute stage at the first sign of decreased inflammatory
response (stabilization).

 – Method: apply as immersion to extremities
and use of massage with ice + moist surface heat to nearby. Application time of
3/1 (heat / cold), ending with heat in total time of 20 to 30 minutes. Temperatures
used of heat between 38º to 40ºC and of cold between 10º to 15ºC (to prioritize
the lower temperatures).

– It emphasizes: there is
little scientific evidence for the indications. It is suggested to associate
the active exercises.

 

8) Electrical and electrostimulation: NOT INDICATED.

 

9) Intermittent cryocompression:

  – Used
to control temperature with the intention of maintaining tissue cooling. The
compression associated with the elevation should be better evaluated due to the
possible rebound effect.

 – Method: For optimal temperature, follow
manufacturer’s guidelines and observe patient tolerance.

 

 10) Ice massage:

Indicated in situations
where the use of the ice pack is difficult (local). Perform the massage with
constant movements for 15 minutes.

* Time to reapply
cryotherapy (ice): 40 minutes to 2 hours.

 

Precaussions:

 – Skin protection against burns (general). Use
of dermal protection such as petroleum jelly in low temperature immersions.

– Protection of areas of
bony prominences and nerve endings.

– Protect surgical scars,
keep them dry.

– Modifications of time of
application of the cold to the extremities, evaluating the percentage of local
tissue fat and cross section of the injured segment.

 

Counterindications:

– Sensitivity problems
(Raynond syndrome, peripheral vascular disease, diabetes);

 – Individuals with ice allergy;

 – Individuals with cognitive disorders (low
level of understanding). Check the condition of the skin every 5 minutes.

– Indefinite pain,
unspecific or doubtful diagnosis.

 

References:

 

Algafly AA, George KP.The effect of cryotherapy on nerve conduction
velocity, pain threshold and pain tolerance. Br J
Sports Med. 2007 Jun;41(6):365-9

Barnes, L. (1979).
Cryotherapy: Putting injury on ice. Physician and Sportsmedicine. 7(6): 130–136

 

Barnett A. Using recovery modalities between training sessions in elite athletes. Sports medicine. 2006 Sep 1;36(9):781-96.

Chesterton LS , Foster NE, Ross L. Skin temperature
response to cryotherapy. Arch Phys Med Rehabil. 2002
Apr;83(4):543-9.

 

Glasgow P. (2017) Early
management of acute injuries.   Part 1. Module 2. Lecture 3. Retrieved
from: http://learn.sportsoracle.com/diplomas/physiotherapy/2017/ part1/module2/lecture-notes/P1M2%20Lecture%203%20(BW).pdf?t=1514288085
 

 

Herrera E, Sandoval MC, Camargo DM, Salvini TF. Effect of walking and resting after three
cryotherapy modalities on the recovery of sensory and motor nerve conduction
velocity in healthy subjects. Rev Bras Fisioter. 2011
May-Jun;15(3):233-40.

 

Leeder J, Gissane C, van Someren K, Gregson W, Howatson G. Cold water immersion and recovery from strenuous exercise: a meta-analysis. British journal of sports medicine. 2011 Sep
22:bjsports-2011.

 

Mujika I.  Training, recovery and overtraining (2017) Part 1.
Module 3. Lecture 2.

Retrieved from: http://learn.sportsoracle.com/diplomas/physiotherapy/2017/
part1/module3/lecture-notes/P1M3%20Lecture%202%20(B)%206pp.pdf?t=1 514287987

 

Roberts LA, Nosaka K, Coombes JS, Peake JM. Cold water immersion enhances recovery of submaximal muscle function after resistance exercise. American Journal of Physiology-

 

Swenson C, Swärd L, Karlsson J.  Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996
Aug;6(4):193-200.