Cryotherapy-Putting Injury on Ice

The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.

Physiological response to water immersion: a method for sport recovery?

Recovery from exercise can be an important factor in performance during repeated bouts of exercise. In a tournament situation, where athletes may compete numerous times over a few days, enhancing recovery may provide a competitive advantage. One method that is gaining popularity as a means to enhance post-game or post-training recovery is immersion in water. Much of the literature on the ability of water immersion as a means to improve athletic recovery appears to be based on anecdotal information, with limited research on actual performance change. Water immersion may cause physiological changes within the body that could improve recovery from exercise. These physiological changes include intracellular-intravascular fluid shifts, reduction of muscle oedema and increased cardiac output (without increasing energy expenditure), which increases blood flow and possible nutrient and waste transportation through the body. Also, there may be a psychological benefit to athletes with a reduced cessation of fatigue during immersion. Water temperature alters the physiological response to immersion and cool to thermoneutral temperatures may provide the best range for recovery. Further performance-orientated research is required to determine whether water immersion is beneficial to athletes.

The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction

The objective of this study was to elucidate how cryotherapy after anterior cruciate ligament reconstruction affects intraarticular temperature and clinical results. A prospective and randomized study was performed on 21 knees of 21 patients. The ligament reconstruction was performed by single-incision arthroscopy using autogenous hamstring tendon. On completion of the surgery, thermosensors were implanted in the suprapatellar pouch and the intracondylar notch, and the intraarticular temperature was monitored while the joint was cooled. Cooling was performed in one group at 5 degrees C (N = 7) and in another at 10 degrees C (N = 7), for 48 hours. A control group (N = 7) did not undergo cryotherapy. The cooled groups showed three temperature phases: a low-temperature phase immediately after the ligament reconstruction, followed by a temperature-rising phase and a thermostatic phase. The control group had no low-temperature phase and immediately entered a thermostatic phase. During the low-temperature phase in the treated groups, the temperature of the suprapatellar pouch and of the intercondylar notch were significantly lower than the body temperature. The pain score and the number of times an analgesic had to be administered were both significantly lower in the 10 degrees C group than in the control group. Blood loss was significantly less in the 5 degrees C group than in the control group.

Cryotherapy in sports medicine

The use of cryotherapy, i.e. the application of cold for the treatment of injury or disease, is widespread in sports medicine today. It is an established method when treating acute soft tissue injuries, but there is a discrepancy between the scientific basis for cryotherapy and clinical studies. Various methods such as ice packs, ice towels, ice massage, gel packs, refrigerant gases and inflatable splints can be used. Cold is also used to reduce the recovery time as part of the rehabilitation programme both after acute injuries and in the treatment of chronic injuries. Cryotherapy has also been shown to reduce pain effectively in the post-operative period after reconstructive surgery of the joints. Both superficial and deep temperature changes depend on the method of application, initial temperature and application time. The physiological and biological effects are due to the reduction in temperature in the various tissues, together with the neuromuscular action and relaxation of the muscles produced by the application of cold. Cold increases the pain threshold, the viscosity and the plastic deformation of the tissues but decreases the motor performance. The application of cold has also been found to decrease the inflammatory reaction in an experimental situation. Cold appears to be effective and harmless and few complications or side-effects after the use of cold therapy are reported. Prolonged application at very low temperatures should, however, be avoided as this may cause serious side-effects, such as frost-bite and nerve injuries. Practical applications, indications and contraindications are discussed.

Treatment of Ankle Sprains With External Compression and Early Mobilization

In brief: Edema associated with the inversion ankle sprain can be minimized by using a U- shaped compression pad held in place against the soft tissue around the fibular malleolus by an elastic wrap or tape. Control of edema allows earlier mobilization of the ankle joint, which reduces recovery time and permits the earliest possible return to sports participation. Factors to be considered in the construction of a compression pad include shaping, firmness, and conformability to the contours of the ankle and foot. Optimal results are obtained through continuous use of a U-shaped pad beneath an adjustable form of compression for as long as the potential for edema exists.

External Compression for Controlling Traumatic Edema

In brief: External compression is widely advocated for treating acute sports injuries. However, the rationale for using it is seldom discussed. Maintaining joint function and reducing pain and secondary hypoxic tissue death lead to more rapid and complete recovery of edema associated with sprains and strains. Poorly managed edema may contribute to the development of restricted range of motion, muscle atrophy, reduced ligament tensile strength, and joint laxity-all of which predispose an athlete to reinjury. The mechanism of action of external compression in controlling edema may be explained on the basis of its effect on capillary filtration and lymphatic drainage.

Review of physiological effects of cryotherapy

The purpose of this work is to provide the physical therapist with the research documented conclusions that he would find if he were to review the literature on the physiological effects of cold therapy. The conclusions are that the results of the studies reviewed were consistent in describing reductions in musculoskeletal pain, spasm, connective tissue distensibility, intramuscular temperature, nerve conduction velocity, and spasticity (except the initial seconds of application). Other conclusions are that the results of the studies reviewed were inconsistent in describing the changes in swelling, blood flow, heart rate, blood pressure, intraarticular temperature, rheumatoid arthritis, monosynaptic reflex, and the muscle spindle.J Orthop Sports Phys Ther 1983;5(2):66-73.

Cryotherapy in ankle sprains

This study assesses recovery from ankle sprains. Thirty-seven final participants were categorized according to the severity of their injury and the use of cryotherapy (15 minutes, one to three times per day) versus heat therapy (15 minutes, one to three times per day) for a minimum of three days. Therapy commenced either less than one hour, from one to 36 hours, or greater than 36 hours after traumatic event. Sprains were graded into five categories based on severity of the injury, but only two categories, subject to conservative treatment, are considered in this study. The study showed that cryotherapy started within 36 hours after the injury was statistically more effective than heat therapy for complete and rapid recovery. Patients in a group with Grade four sprains (unable to bear weight because of pain) reached full activity in 13.2 days compared to 30.4 days in a group using cryotherapy initiated 36 hours after injury or to 33.3 days in a group using heat therapy. Therefore, early use of cryotherapy, continued with adhesive compression, is an effective treatment of ankle sprains yielding earlier complete recovery than late cryotherapy or heat therapy.