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Ice Therapy: How Good is the Evidence?
Abstract
Ice, compression and elevation are the basic principles of acute soft tissue injury. Few clinicians, however, can give specific evidence based guidance on the appropriate duration of each individual treatment session, the frequency of application, or the length of the treatment program. The purpose of this systematic review is to identify the original literature on cryotherapy in acute soft tissue injury and produce evidence based guidance on treatment. A systematic literature search was performed using Medline, Embase, SportDiscus and the database of the National Sports Medicine Institute (UK) using the key words ice, injury, sport, exercise. Temperature change within the muscle depends on the method of application, duration of application, initial temperature, and depth of subcutaneous fat. The evidence from this systematic review suggests that melting iced water applied through a wet towel for repeated periods of 10 minutes is most effective. The target temperature is reduction of 10-15 degrees C. Using repeated, rather than continuous, ice applications helps sustain reduced muscle temperature without compromising the skin and allows the superficial skin temperature to return to normal while deeper muscle temperature remains low. Reflex activity and motor function are impaired following ice treatment so patients may be more susceptible to injury for up to 30 minutes following treatment. It is concluded that ice is effective, but should be applied in repeated application of 10 minutes to be most effective, avoid side effects, and prevent possible further injury.
... In addition, a 2018 clinical guideline reports that there is no evidence that cryotherapy alone is effective in improving pain, function, or swelling in acute lateral ankle sprains (LAS), but that it improves ankle function in the short term when combined with exercises [8]. Moreover, no consensus has been reached concerning the best cryotherapy protocols or application methods [12,13]. ...
... Demonstrated effects of cryotherapy include significant cutaneous analgesia below 13.6°C, a 10% decrease in nerve conduction below 12.5°C, and a 50% decrease in local metabolism below 11°C [40,41]. In numerous studies looking at the effects of cryotherapy, those goal temperatures have not been reached, [13] contributing to the persistent difficulty in clarifying the clinical usefulness of cryotherapy in health care. In fact, the achieved temperature depends on many factors, such as the cryotherapy method used, the duration of application, the initial skin temperature and the thickness of the subcutaneous fatty tissue, among others. ...
... There are smaller models of NCS devices designed to be transported, but those were not used in this study. NCS nevertheless holds a distinct advantage over ice application: with an application time of less than two minutes, it is much quicker for the patient than the ten, fifteen or even twenty minute application period recommended when using ice [13,44]. ...
Abstract Study design Single-blind parallel group randomized clinical trial. Objectives To compare the effects of neurocryostimulation (NCS) with those of traditional ice application on functional recovery, pain, edema and ankle dorsiflexion range of motion (ROM) in individuals receiving physiotherapy treatments for acute lateral ankle sprains (LAS). Background Ankle sprain is a very common injury and its management is often costly, with important short- and long-term impacts on individuals and society. As new methods of therapy using cold (cryotherapy) are emerging for the treatment of musculoskeletal conditions, little evidence exists to support their use. NCS, which provokes a rapid cooling of the skin with the liberation of pressured CO2, is a method believed to accelerate the resorption of edema and recovery in the case of traumatic injuries. Methods Forty-one participants with acute LAS were randomly assigned either to a group that received in-clinic physiotherapy treatments and NCS (experimental NCS group, n = 20), or to a group that received the same in-clinic physiotherapy treatments and traditional ice application (comparison ice group, n = 21). Primary (Lower Extremity Functional Scale - LEFS) and secondary (visual analog scale for pain intensity at rest and during usual activities in the last 48 h, Figure of Eight measurement of edema, and weight bearing lunge for ankle dorsiflexion range of motion) outcomes were evaluated at baseline (T0), after one week (T1), two weeks (T2), four weeks (T4) and finally, after six weeks (T6). The effects of interventions were assessed using two-way ANOVA-type Nonparametric Analysis for Longitudinal Data (nparLD). Results No significant group-time interaction or group effect was observed for all outcomes (0.995 ≥ p ≥ 0.057) following the intervention. Large time effects were however observed for all outcomes (p
... There are several studies that suggest the cyclical application of ice is beneficial with the pain management of soft tissue injuries (3,8,16,19,26). Kellett (19) suggests "cryotherapy for 10 to 20 minutes, two to four times per day for the first two to three days is helpful in promoting early return to activity." MacAuley (26) and Bleakley (3) had similar findings. ...
... MacAuley (26) and Bleakley (3) had similar findings. MacAuley (26), which was a literature review exploring the evidence in support of ice therapy, concluded "ice is effective but should be applied in repeated application of 10 minutes to be most effective, avoid side effects, and prevent possible further injury." Bleakely (3) explored the difference between the standard 20-minute icing protocol and an intermittent protocol and found that "intermittent applications may enhance the therapeutic effect of ice in pain relief after acute soft tissue injury." ...
... In addition, the application of ice, or cryotherapy, has been found to not only delay recovery, but to also damage tissue in the process (9,20,27,49). The evidence suggests that the application of ice is only necessary if pain reduction is the desired outcome (3,8,16,19,26). Evidence in support of compression and elevation is lacking, as most studies are inconclusive (4,35,51) and fail to establish definitive application guidelines that are supported by research. These findings, along with the public recant from Dr. Gabe Mirkin in 2015 (31), support the premise that the RICE protocol, which is a generally preferred method of immediate treatment for acute musculoskeletal injuries, is a myth. ...
The RICE (Rest, Ice, Compression, Elevation) protocol has been the preferred method of treatment for acute musculoskeletal injuries since its origin in a 1978 publication entitled "Sports Medicine Book" by Dr. Gabe Mirkin. These guidelines have been used by coaches and healthcare providers for over four decades with the intent of expediting the recovery process and reducing inflammation. Although popular, the implementation of this protocol to attenuate the recovery process is unsubstantiated. There is, however, an abundance of research that collectively supports the notion that ice and rest does not enhance the recovery process, but instead delays recovery, and may result in further damage to the tissue. Research in regard to compression and elevation is inconclusive, diluted and largely anecdotal. Definitive guidelines for their application have yet to be purported. As a result of the subsequent research that examined the validity of the protocol, Dr. Mirkin recanted his original position on the protocol in 2015. The objective of this article is to analyze the available evidence within the research literature to elucidate why the RICE protocol is not a credible method for enhancing the recovery process of acute musculoskeletal injuries. In addition, evidence-based alternatives to the protocol will be 1/19 examined. These findings are important to consider and should be utilized by any healthcare professional; specifically, those who specialize in the facilitation of optimal recovery, as well as those who teach in health-related disciplines in higher education.
... A longer cooling period caused an unacceptable discomfort for the participants. A previous review concluded that wet ice is the optimal cooling method with a target temperature between 10 and 15 degrees Celsius [23]. After finishing the cryotherapy, the second test session was started within 30 s. ...
... There is limited evidence on the optimal duration of cryotherapy after a sport injury. Previous reviews concluded that there is consensus that repeated applications of 10 [23] or 5-15 [36] minutes are sufficiently effective and the duration of cooling used here was in line with this. Another limitation of this study is the small sample size. ...
Background
Cryotherapy is a frequently used therapy in the acute treatment of sports injuries, although it has possible negative effects on dynamic postural stabilization.
Research question
What is the effect of cryotherapy on the postural stabilization assessed by imposed platform perturbations?
Methods
Twenty-four healthy participants (15 male, 9 female) performed 2 test sessions (before and after cryotherapy) consisting of 4 trials each. Each trial included 30 seconds single leg stance (SLS) on both legs and 4 testing blocks (2 for each leg) of 30 seconds for the dynamic testing. A single testing block comprised 4 perturbations. After the first session, cryotherapy was applied to the right leg by placing it in ice water at a temperature between 10°C and 12° for 20 minutes.
Outcome measures
We assessed the Center of Pressure speed (CoPs) and the mean force variation for both static and dynamic tests. Additionally, the Time To Stability (TTS) was calculated for the perturbations.
Results
In the static trials there was an interaction between leg and session present for the mean force variation (p = 0.01) with a large η² of 0.24, which shows higher variation of vertical force after application of the cryotherapy on the right leg. During the dynamic trials we found an interaction between leg and session for the TTS suggesting increase of the TTS due to the cryotherapy (p = 0.04), with a large η² of 0.17. No interaction effect was present for the CoPs in the mediolateral and anteroposterior direction (p = 0.62 and p=0.12, respectively).
Significance
Cryotherapy applied to the lower extremity results in a worse postural stabilization when assessed by platform perturbations. This might be the result of an altered balance strategy, due to impaired proprioception from the affected body part. More research is needed to examine the duration of this effect.
Level of evidence
Level 3, associative study
... Cold is usually applied for pain relief, oedema reduction, inflammatory process management, and spasticity decrease [2]. Most clinical studies support its analgesic and anti-inflammatory effects [2,3], although there are different positions regarding cold application time [4][5][6]. Cryotherapy application can decrease deeper tissues temperature at the muscle and joint level, although this depends on the therapeutic modality used [2][3][4]. Cold is applied through different methods, such as ice cups, ice packs, cold baths, hydrocolloid packages (ice pads), cryopressure units, cold wet wraps, or refrigerant sprays [2]. ...
... Furthermore, the decrease in strength obtained in the PC group after the 3 sessions reaffirms the effect of NCV reduction associated with cold. Although strength decrease did not show intrasession changes, there was a decrease when comparing baseline values with those achieved in the third evaluation [2,3,5,15,18,23,40]. ...
... More prolonged cooling for deeper tissues requires direct contacts of the icepack for 15-20 min and can be applied every 2-4 h in the acute phase of the inflammation [23]. Furthermore, the compressive force of the icepack therapy is another critical technique of the therapy [24]. This force improves tissue contact and further increases the transmission of cold and its cooling effect to the deeper tissues [24]. ...
... Furthermore, the compressive force of the icepack therapy is another critical technique of the therapy [24]. This force improves tissue contact and further increases the transmission of cold and its cooling effect to the deeper tissues [24]. We further opined that even if patients applied the icepack therapy, it might have not been effectively applied thereby having less benefit. ...
Pain perception and QoL are fundamental enquiries patients wants to know regarding trans-alveolar extraction of lower third molar. The current study hopes to compare the influence of co-administration of diclofenac+dexamethasone and icepack on pain and QoL after trans-alveolar surgery of lower third molar. This was a prospective study of patients referred for trans-alveolar extraction of mandibular third molar teeth under local anesthesia. Patients were randomly assigned into Group A (co-administered IM Dexamethasone 8 mg and IM Diclofenac 75 mg in office) and Group B (ice packs extra-orally). Assessment of pain was carried out using the numerical pain rating scale. Validated Arabic version of the 16 item United Kingdom Oral Health Related Quality of Life measure (UK-OHRQoL) was used to evaluate the QoL pre and on the POD's. A total of 78 patients equally distributed into Groups A and B were the study participants. The mean age was 31.6 ± 6.4 years (Group A: 32.5 ± 5.5 and Group B: 30.8 ± 7.2, range 20–48years). The M:F ratio was 1:1.1. Better pain reduction was observed in Group A which became significant (p = 0.019) on POD 3. Domain scores was better in the Group A patients at the body function level (p = 0.016) and personal level (p = 0.013) at POD 1 and body function level (p = 0.044) at POD 3. Overall QoL scores was also better in the Group A with significant difference (p = 0.025) on POD 1. Pain perception, domain and overall QoL scores continues to improves throughout the review period with better improvement in the Group A.
... The times for application duration and measurement minutes were chosen because they have commonly been used for cold-pack application in the literature. 17,20 Since the rectus muscle is widely used with of cold increased ankle-joint stiffness. Similarly, Muraoka et al 10 determined the same results for legs after 60 minutes of a cold-water bath. ...
... and increased again significantly studies of biomechanical properties and with thermal cameras, the research team decided to use that muscle in the study. 17,20,22,24,27,28 Skin temperature. The skin temperature was measured with the help of a noncontact thermal camera, a P45 thermographic camera with high thermal sensitivity (Flir System, ThermaCAM, Täby, Sweden). ...
Context • Cold packs are silica gel packs that are commonly used in clinics. However, the packs are applied for various amounts of time, and the relationship between these times and temperature changes isn't fully understood.
Objectives: The study intended to investigate the acute effects of cold-pack application for different periods of time on the biomechanical properties of the rectus femoris muscle.
Design • The study was randomized, controlled trial.
Setting • The study took place at Acibadem Mehmet Ali Aydinlar University in Istanbul, Turkey.
Participants • Participants were 60 healthy volunteers from the community, aged 18 to 23 years.
Interventions • Participants were divided into four groups with n = 15 in each group. The cold packs were applied on the dominant rectus femoris muscle: (1) for 10 minutes in Group 1, (2) for 12 minutes in Group 2, (3) for 15 minutes in Group 3, and (4) for 20 minutes in Group 4.
Outcome Measures • The outcome measures were the skin temperature, determined using a thermal camera, and biomechanical properties-tone and stiffness and muscle decrement-using a device that delivers a short mechanical impulse to the tissue. Outcomes were measured at baseline before the cold application, immediately post intervention after the cold application, and at 5, 10, 15, 20, and 30 minutes post intervention.
Results: The mean skin temperatures were significantly lower in all groups compared to those before cold application (P < .05), and no significant differences existed between any of the groups (P > .05). Post intervention, while Groups 1 and 2 showed an increase in muscle tone and stiffness and a decrease in elasticity (P < .05), they began to approach their baseline state by the fifth and fifteenth minutes, respectively (P > .05). In Groups 3 and 4, the muscle stiffness increased at all time points (P < .05).
Conclusions: The study showed that the rectus femoris muscle of healthy people becomes stiffer and less elastic as a result of cooling with cold packs that were applied for different time periods. The amount of cold-pack time that minimized the biomechanical corruption of the muscle and provides cooling was 10 minutes. Careful warming up is recommended before and after intense athletic performance, and caution in cooling the skeletal muscle should be exercised.
... Mov Comparison of the effects of standard and intermittent cryoimmersion on stability, pain threshold and tolerance in the ankle region in healthy individuals Cryotherapy can be applied in several ways, such as immersion in cold water [10][11][12][13], thermoelectric cooling [14,15], and ice packs [16], applied from 15 to 30 minutes [17]. Moreover, another study suggested that intermittent application of cryotherapy for 10 min is sufficient to reduce skin and deep tissue temperature to optimal therapeutic levels, promoting analgesia, with ice considered as the safest and most efficient method of application [18]. On the other hand, according to Rupp et al. [19], when the use of ice was compared to immersion in cold water in the gastrocnemius muscle, it was less efficient in reducing the intramuscular temperature during treatment and after 90 min. ...
... On the other hand, according to Rupp et al. [19], when the use of ice was compared to immersion in cold water in the gastrocnemius muscle, it was less efficient in reducing the intramuscular temperature during treatment and after 90 min. Furthermore, in another study, cryotherapy with intermittent application for 10 min was related to a longer maintenance of optimal tissue temperature levels compared to the standard application for 20 min [18,20]. According to Chesterton et al. [21], to obtain a desirable physiological pain reduction response with cryotherapy, it is necessary for the skin tissue to reach temperature levels below 13.6 °C. ...
Introduction:
Cryotherapy is a technique that involves the application of low temperatures in the treatment of acute injuries, with ice being the simplest and oldest therapeutic modality for this.
Objective:
To compare two different cold water immersion protocols (standard and intermittent) on the ankle region of healthy volunteers, we analyzed changes in static postural stability, threshold, and pain tolerance immediately after application.
Method:
This is a quasi-experimental study, controlled clinical trial, and non-probabilistic sampling. The total sample consisted of 40 male patients aged 18 to 30 years. Two different cold water immersion protocols (standard and intermittent) were compared for their effects on pain threshold, tolerance, and static postural stability.
Results:
There were no significant differences between the groups with regards to the stabilometric variables after the application of both protocols (p > 0.05). There was a significant difference in the threshold and tolerance of the two groups after the application of cold water immersion (p < 0.05); however, there were no significant differences between the groups (p > 0.05).
Conclusion:
Both cold water immersion protocols proved to be safe for static postural balance, without showing deficits in stabilometric variables. Regarding the analgesic effect, both were effective and significantly increased the threshold and tolerance of ankle pain after cryoimmersion, without any differences between groups. Thus, intermittent 10-minute cold water immersion is sufficient to generate the same analgesic effect as the standard 20-minute pattern, with no change in static postural stability.
... 12 The gold-standard protocol to measure T sk is through infrared thermal imaging. 18,19 Due to the multifactorial considerations that can affect deeper soft tissues, such as duration, 20 gender, 21 adipose tissue levels, 22 and location of cryotherapy applications, knowing the optimum protocol for reduction in muscle temperature to induce physiological changes can be challenging. Furthermore, inconsistencies in methods across studies consequently implicate the ability to compare outcomes or effects accurately. ...
... Furthermore, inconsistencies in methods across studies consequently implicate the ability to compare outcomes or effects accurately. This said literature clearly displays physiological changes as a result of various cryotherapy applications [20][21][22] and has indicated the importance of exploration of cryotherapy on neuromuscular function. 23 Literature indicates performance deficits as a result of cooling, 2 and these have been attributed with decreases in dynamic contractile force. 1 These conclusions were drawn based on measures of ultrasound shear wave elastography and myoelectrical activity; no output measures of strength were ascertained. ...
Context:
The effect of local cooling on muscle strength presents conflicting debates, with literature undecided as to the potential implications for injury, when returning to play following cryotherapy application.
Objective:
To investigate concentric muscle strength following local cooling over the anterior thigh compared to the knee joint in males and females and the temporal pattern over a 30-minute rewarming period. Design Repeated measures cross-over.
Method:
Twelve healthy participants randomly assigned to receive one location of cooling intervention, directly over either the anterior thigh or knee, returning 1 week later to receive the opposite cooling location. Muscle strength measured via an Isokinetic Dynamometer (IKD) at multiple timepoints (immediately post, 10, 20 and 30 minutes post) coincided with measurement of skin surface temperature (Tsk) using a non-invasive infrared camera (ThermoVision A40M, Flir Systems, Danderyd, Sweden).
Results:
Significant main effects for time (p ≤ 0.001, É32 = 0.126), with pre ice application higher than all other time points (p ≤ 0.05) were demonstrated for both peak torque (PT) and average torque (AvT). There was also significant main effects for isokinetic testing speed, sex of the participant and position of the ice application for both PT and AvT (p ≤ 0.05). Statistically significant decreases in Tsk were reported in both gender groups across all time points compared to pre-intervention Tsk for the anterior thigh and knee (p < 0.05).
Conclusion:
Reductions reported for concentric PT and AvT knee extensor strength in males and females, did not fully recover to baseline measures at 30 minutes post cryotherapy interventions. Sports medicine practitioners should consider strength deficits of the quadriceps after wetted ice applications, regardless of cooling location (joint/muscle) or gender. Keywords Isokinetic dynamometry, cryotherapy, knee, quadriceps, strength, thermal imaging.
... Para Starkey [3] estes benefícios terapêuticos com a aplicação do frio ocorrem quando a temperatura cutânea atinge 13,8°C, diminuindo assim o fluxo sanguíneo local e a 14,4°C ocorreria à analgesia. Enquanto Bugaj apud Kanlayanaphotporn e Janwantanakul [4] afirma que a analgesia começa quando a temperatura diminui para 13,6°C, Leventhal et al. [7] e Auley [25] defendem que o objetivo da crioterapia está em reduzir a temperatura do local aplicado para 10 a 15°C. ...
... Em uma revisão realizada por Auley [25], foi afirmado existir poucas evidências do efeito da gordura subcutânea sobre a temperatura intramuscular, mas que a mesma deve ser considerada durante a aplicação da crioterapia. Myrer et al. [27] avaliaram o efeito da gordura subcutânea sobre o resfriamento da temperatura local, aplicando pacotes de gelo triturado em indivíduos sadios, divididos em grupos de acordo com a espessura da gordura subcutânea: menor ou igual a 8 mm, 10 a 18 mm e 20 mm. ...
Introdução: A crioterapia é um recurso que diminui a temperatura corporal local com finalidades terapêuticas. Uma importante repercussão é a vasoconstrição local, que seria o desencadeador de um possível aumento na pressão arterial (PA). Entretanto, não existem trabalhos que comprovem essa suposição. Nossa hipótese é que os resultados das pesquisas de Cold Pressor Test (CPT) avaliando PA acabaram historicamente fundamentando as precauções da crioterapia em relação a pacientes hipertensos. Objetivo: Realizar uma revisão de literatura a respeito das pesquisas que sustentam a precaução da crioterapia em indivíduos hipertensos e verificar sua relação com estudos que utilizaram o CPT. Material e métodos: Trata-se de uma revisão de literatura que utilizou as bases de dados online Medline, Scielo, Lilacs e Google Acadêmico para a realização da pesquisa. Resultado: Apesar de não serem unânimes, diversas pesquisas que utilizaram o CPT encontraram significativos aumentos da atividade nervosa simpática muscular e da PA em normotensos e hipertensos, entretanto não encontramos estudos que tenham comprovado respostas significativas de PA com o uso da crioterapia, principalmente, em hipertensos. Conclusão: Não existem evidências científicas que comprovem a precaução da crioterapia em indivíduos hipertensos. Além disso, os estudos com CPT não são unânimes em relação aos aumentos pressóricos em indivíduos normotensos e hipertensos.Palavras-chave: crioterapia, hemodinâmica, hipertensão, pressão arterial.
... 12 It is recommended that cryotherapy is applied for 20 minutes in the acute stage. 35 All studies that included cryotherapy in the programs mentioned 20 minutes of cold therapy after the exercise session. Laser therapy was found to be effective in the inflammatory phase. ...
Context:
Hamstring strain is a common injury to the lower limbs. Early intervention in the acute phase aids with restoring hamstring function and prevents secondary related injury.
Objective:
To systematically review and summarize the effectiveness of exercise-based interventions combined with physical modalities currently used in athletes with acute hamstring injuries.
Data sources:
Five databases (EMBASE, Medline, Cochrane Library, SPORTDiscus, and Web of Science) were searched from inception to July 2021.
Study selection:
A total of 4569 studies were screened. Nine randomized controlled trials (RCTs) on the effect of therapeutic exercise programs with and without physical agents in athletes with acute hamstring injuries were identified for meta-analysis.
Study design:
Systematic review and meta-analysis.
Level of evidence:
Level 1.
Data extraction:
The studies were screened, and the evidence was rated using the PEDro scale. Nine RCTs with PEDro scores ranging between 3 and 9 were included and extracted pain intensity, time to return to play (TTRTP), and reinjury rate in the study.
Results:
Loading exercises during extensive lengthening were shown to facilitate TTRTP at P < 0.0001 but did not prevent recurrence (P = 0.17), whereas strengthening with trunk stabilization and agility exercise did not reduce the duration of injury recurrence (P = 0.16), but significantly reduced the reinjury rate (P < 0.007) at a 12-month follow-up. The results of the stretching programs and solely physical modalities could not be pooled in the statistical analysis.
Conclusion:
The meta-analysis indicated that a loading program helps athletes to return to sports on a timely basis. Although strengthening with trunk stabilization and agility exercise cannot significantly reduce recovery time, the program can prevent reinjury. The clinical effects of stretching programs and pure physical modality interventions could not be concluded in this study due to limited evidence.
Prospero registration:
CRD42020183035.
... A study by Lowitzsch et al. (1977) found that applying cold application to the skin and causing its temperature to drop to 27°C led to a change in the nerve conduction velocity. When the skin temperature drops to 10-15°C, cell metabolism slows, and the antiinflammatory effect is augmented (Greenstein, 2007;Hubbard et al., 2004;Mac Auley, 2001;Sapega et al., 1988). If the skin temperature drops to 13.6°C or the cold application lasts 20 min, an analgesic effect can then be achieved (Bugaj, 1975;Greenstein, 2007;Lee et al., 1978). ...
Aim and objectives:
To conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after chest tube removal (CTR).
Background:
The act of removing the chest tube often causes pain among cardiothoracic surgery patients. Most guidelines regarding CTR do not mention pain management. The effects of cold application on reducing pain and anxiety after CTR are inconsistent.
Design:
Systematic review and meta-analysis.
Methods:
We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomised controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration's tool was used to assess the risk of bias, Review Manager 5.4 was used to conduct the meta-analysis. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was used for assessing certainty of evidence (CoE).
Results:
Ten RCTs with 683 participants were included in the meta-analysis. The use of cold application could effectively reduce pain and anxiety after CTR. The subgroup showed that a skin temperature drops to 13°C of cold application was significantly more effective for the immediate reduction in pain intensity after CTR compared with control group. The GRADE methodology demonstrated that CoE was very low level.
Conclusion:
Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. Skin temperature drops to 13°C or lasts 20 min of cold application were more effective for immediate reduction of pain intensity following CTR.
Relevance to clinical practice:
In addition to pharmacological strategy, cold application could be used as evidence for reducing pain intensity and anxiety level after CTR.
... Acute lateral ligament ankle sprain is characterized by pain, swelling, bruising, loss of function and loss of movement that can be treated with ultrasound therapy, cryotherapy and ankle taping. To compare the effect of ultrasound therapy and cryotherapy over taping technique in patients with acute lateral ankle sprain have received considerable attention by the research community 8,9,10,12 . ...
The sudden twisting of ankle which overstretches the ligaments to torn or sprain around the ankle joint can lead to pain and swelling. Pain and swelling is one of the major causes of concern in patients with acute lateral ankle sprain while performing physical and daily activity. The study aim was to find the effect of ultrasound therapy and cryotherapy over taping technique among patients with acute lateral ankle sprain. A total of 30 subjects with acute lateral ankle sprain participated in this study. Group A was given ultrasound therapy with cryotherapy for 30 minutes; Group B was given taping technique additional to ultrasound and cryotherapy. Pre and post test was done after 10 sessions of treatment. The outcome was measured for the participants by VAS score. Student’s t-test, Mann Whitney test, Wilcoxon signed rank test were used to analyze data in this study. Group A and B have shown significant improvement after treatment. Comparative study found Group B, had significant changes by ultrasound therapy, cryotherapy and ankle taping technique over the Group A with P<0.001, on reducing pain, swelling and improving earlier active performance. On the basis of the result, the study concluded that treatment with cryotherapy, ultrasound therapy and taping technique is better compared with cryotherapy and ultrasound therapy, and has more effect in reducing pain, swelling and improving earlier active physical performance.
... A study by Lowitzsch et al. [28] found that applying cold application to the skin and causing its temperature to drop to 27°C led to a change in the nerve conduction velocity. When the skin temperature drops to 10°C-15°C, cell metabolism slows, and the anti-in ammatory effect is augmented [27,[29][30][31]. If the skin temperature drops to 13.6°C or the cold application lasts 20 minutes, an analgesic effect can then be achieved [12,27,32]. ...
Background and Objective: Data on the effects of cold application on reducing pain and anxiety after chest tube removal (CTR) are inconsistent. This study aimed to conduct a systematic review and meta-analysis to evaluate the effects of cold application on pain and anxiety reduction after CTR.
Methods: We searched six databases, including Embase, Ovid Medline, Cochrane Library, Scopus, the Index to Taiwan Periodical Literature System, and Airiti Library, to identify relevant articles up to the end of February 2021. We limited the language to English and Chinese and the design to randomized controlled trials (RCTs). All studies were reviewed by two independent investigators. The Cochrane Collaboration’s tool was used to assess the risk of bias, and Review Manager 5.4 was used to conduct the meta-analysis.
Results: Ten RCTs with 623 participants were included in the meta-analysis. The use of cold application could effectively reduce immediate pain and had persistent effects on pain after CTR. There were significant effects of cold application on reducing anxiety. The meta-regression showed that a drop in skin temperature to the 13°C target of cold application was significantly more effective for the immediate reduction in pain intensity compared with receiving up to 20 minutes target of cold application.
Conclusion: Cold application is a safe and easy-to-administer nonpharmacological method with immediate and persistent effects on pain and anxiety relief after CTR. In particular, skin temperature drops to the 13°C target of cold application were effective for immediate reduction of pain intensity following CTR.
... Cryotherapy, in the form of ice, is a mainstay treatment in the management of or rehabilitation from strains, sprains, contusions, as well as fractures, and immediately after acute musculoskeletal soft tissue injury (Barnes 1979;Knight 1985Knight , 1995Meeusen and Lievens 1986;Swenson et al. 1996;Knight et al. 2000;Beiner and Jokl 2001;Bleakley et al. 2004). Ice has traditionally been applied in the immediate stage following injury for its ability to exert an acute local analgesic effect (Mac Auley 2001;Hubbard and Denegar 2004) by inhibiting nerve conduction velocity (Knight et al. 2000;Chesterton et al. 2002;Algafly and George 2007), and to restrict oedema formation (Meeusen and Lievens 1986). Similarly, intermittent cryo-compression therapy has gained popularity and is most commonly implemented in the immediate stages following injury or at the conclusion of an operative procedure for its purported ability to reduce oedema (Chleboun et al. 1995;Meeusen et al. 1998;Block 2010) and restore function (Schröder and Pässler 1994;Dervin et al. 1998;Waterman et al. 2012;Murgier and Cassard 2014). ...
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.
... One idea would be to provide access to ice-packs; the premise being that calves could initiate contact with the pack for immediate pain relief. Cold-therapy is expected to provide some degree of analgesia with minimal delay, as shown in work on humans (Algafly & George, 2007;Auley, 2001), but it is also possible that contact with the pack may be more aversive than any analgesia provided by the cold. ...
Whether they live in our homes, farms or laboratories, many animals are subjected to painful procedures. In humans, pain assessment is mostly done through verbal self report, but the assessment of pain in non-verbal humans and animals remains a challenging task.
Pain can be divided in two main components: a reflex response, and an emotional experience. The focus of pain research has largely been centered around reflex responses when animals (and human neonates until recently) are the ones subjected to pain. The aim of this thesis was to address this gap by developing a method to assess the emotional experience (or ‘affective state’) that dairy calves go through during painful procedures. To do so, the focus of our novel approach was on how animals formed memories of procedures they were subjected to.
In the first chapter, I reviewed the literature on the assessment of emotion in dairy cattle. I highlighted that many measures reflect how aroused animals are rather than whether they are in a positive or negative state (valence), but that measures based on cognition were promising in evaluating valence. In the second chapter, I studied the pain caused by different injection methods by looking at how much milk calves were willing to give up to avoid injections. Although all methods were more aversive than not receiving an injection, intramuscular injections were more aversive than subcutaneous or intranasal. In the third, fourth and fifth chapter, I studied how calves remembered different methods of disbudding (a procedure that prevents horn growth) by looking at how much they would avoid the place where they experienced the procedure. I found that calves remember disbudding as negative and that learned aversion is reduced if calves are provided pain control both during and after the procedure.
In summary, calves showed not to be limited to a ‘knee-jerk’ response to pain. Rather, they formed impactful memories that affected their future behaviour, exhibiting complex emotional processing of pain.
... Several studies revealed a significant decrease of tissue temperature or skin blood flow (Warren et al. 2004;Tomchuk et al. 2010;Bleakley et al., 2012b). Furthermore, cryotherapy was also shown to decrease the inflammatory reaction in an experimental setting (Mac Auley 2001;Schaser et al. 2007). However, no study applying multimodal PRICE principles in a standardized approach focusing on intramuscular perfusion in human athletes has been published yet. ...
The aim of this randomized controlled laboratory study was to evaluate the role of standardized protection, rest, ice (cryotherapy), compression and elevation (PRICE) therapy on microvascular blood flow in human skeletal muscle. Quantifiable contrast-enhanced ultrasound was used to analyze intramuscular tissue perfusion (ITP) of the rectus femoris (RF) and vastus intermedius (VI) muscles in 20 healthy athletes who were randomly assigned to PRICE or control groups. Baseline perfusion measurements (resting conditions, T0) were compared with cycling exercise (T1), intervention (PRICE or control, T2) and follow-up at 60 min post-intervention (T3). The 20 min PRICE intervention included rest, cryotherapy (3°C), compression (35 mm Hg) and elevation. After intervention, PRICE demonstrated a decrease of ITP in VI (–47%, p = 0.01) and RF (–50%, p = 0.037) muscles. At T3, an ongoing decreased ITP for the RF (p = 0.003) and no significant changes for the VI were observed. In contrast, the control group showed an increased ITP at T2 and no significant differences at T3. PRICE applied after exercise led to a down-regulation of ITP, and the termination of PRICE does not appear to be associated with a reactive hyperemia for at least 60 min after treatment.
... Il a été suggéré que l'augmentation du débit sanguin induite par l'exercice pouvait accélérer la cicatrisation en favorisant l'élimination des débris cellulaires et en augmentant l'apport en nutriments et en O 2 (Mac Auley, 2001). Il apparaît que la réalisation de contractions concentriques de faible intensité n'a pas d'effet néfaste sur la récupération (Weber et coll. ...
The aim of this work was, on the one hand, to study the neuromuscular alterations induced by eccentric exercise which stresses the extensor muscles of the knee and, on the other hand, to study the effectiveness of electro-stimulation (ES) as a means of evaluating, treating and preventing these alterations. The first study in this work consisted of evaluating the contributions of the central and peripheral mechanisms to the reduction in the maximum voluntary contraction observed after eccentric exercise. Low frequency fatigue (LFF) and central fatigue mainly explained the decrease in the voluntary maximum moment after eccentric exercise. The aim of the second study of our work was to compare the results obtained by neurostimulation and ES in the evaluation of FBF after eccentric exercise. The results showed that these two methods of electrical stimulation detected the amplitude of FBF in a similar way. The second part of this work focused on the recovery kinetics of the maximum voluntary moment after eccentric exercise. The third study evaluated the effectiveness of PE and running as recovery modes. These two modalities had no effect on the recovery kinetics of isometric maximum moment, perceived pain and different neuromuscular parameters. Finally, the fourth study of this work evaluated the effectiveness of a prior high-frequency PE session as a protective factor against neuromuscular alterations induced by a repetition of eccentric contractions involving the elbow flexor muscles. PE did not appear to be effective in protecting the neuromuscular system from the symptoms induced by subsequent eccentric exercise. The characteristics of the stimuli used here may explain the lack of efficacy of ES in treating and preventing neuromuscular alterations associated with eccentric exercise.Translated with www.DeepL.com/Translator (free version)
... Bunun için buz torbaları ya da soğuk pedler kolay bulunması ve az maliyetli olması açısından daha çok tercih edilebilecek bir yöntem olabilir. Ancak sistematik derlemelerde (Mac Auley, 2001;Steen, 2005) analjezik etkiyi gösterebilmesi için minimum 10-15 dk uygulanması gerektiği belirtilmektedir. Bu süre yetişkinler için kısa bir süre olabilir ancak çocuklar için uzun bir süredir. ...
... For constructive outcomes, maintaining leg elevation, frequent changes of dressing and bandaging (including readjustment of Velcro V R compression products), and maintaining of temperature of treating room are important. [104][105][106] On-going evaluation of a patient's progress with compression intervention, ensuring the correct pressure is exerted throughout treatment, and acceptance of the treatment by the patient are all relevant. Modification of the intervention may be required in cases of discomfort. ...
Background:
Compression is a common therapy for management of chronic disease, including oedema of the lower limb. Modern compression interventions exert pressure on the lower limb through use of one or more materials which exert pressure against the limb over time. Where these materials are textiles, they range from elastic to inelastic, and are produced using knitting, weaving, or other textile technologies which can be manipulated to control performance properties. Thus, understanding of both the materials/textiles and the human body is needed if the most appropriate compression device and treatment strategy is to be used. Neither is independent of the other. This review aims to enhance understanding of critical textile performance properties and how selection of textiles may affect treatment efficacy when managing chronic oedema of the lower limb.
Method:
Relevant papers for review were identified via PubMed Central® library, and Google Scholar using keywords associated with textile-based treatments of the oedematous lower limb and wider interdisciplinary factors.
Results:
Assessment of the disorder, the severity of oedema, and location of fluid accumulation are required to inform treatment of chronic oedema. While the need to understand the patient is well established (e.g. age, sex, body mass index, skin thickness and colour, patient compliance with treatment), information about preferred compression systems and material structures, and inherent properties of these, is generally lacking.
Conclusion:
Greater detail about materials used (e.g. fabric structure, number and order of layers, fibre content) and patient diagnosis (e.g. underlying cause, severity, location of oedema; patient age and sex; evidence of compliance with treatment; pressure exerted; lower leg shape, size, and properties of the tissue) is needed to facilitate advances in efficacy of compression treatment. Reduced limb swelling with a textile-based treatment occurs simultaneously with changes to the textile itself. Textiles cannot be considered inert.
... Rapid reductions in skin temperature, before muscle and core temperatures can catch up, might result in cold related injury to the skin (Gage, 1979;Wilke and Weiner, 2003;Selfe et al., 2007) because the skin is most prone to irreversible damage. To date, maintaining a reduction in muscle temperature without causing cold related injury to the skin could only be achieved by administering traditional cryotherapy modalities (ice, gel packs, CWI, WBC, etc.) in an intermittent fashion (Mac Auley, 2001). However, Cheng et al. (2017) recently reported intramuscular temperature reductions to approximately 15 • C following a 120-min localized cooling intervention administered to the upper arm, making the case for a prolonged duration of cryotherapy application in order to achieve clinically relevant reductions in intramuscular temperature. ...
Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of three to six hours with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.
... In other work, diminution of skin temperature has been shown to range from 3-6°C (Lim & Kim 1993, Lee 1998, Westhuijzen et al. 2005) and from 10-16°C (Bell & Lehmann 1987, Akgun et al. 2004, Janssen et al. 2005, Kanlayanaphotporn & Janwantanakul 2005. The postcraniotomy skin temperature reduction we observed after cryotherapy is in good agreement with the target temperature reduction of 10-15°C (MacAuley 2001, Greenstein 2007). We did not observe a 'hunting response', defined as repeated vasoconstriction and vasodilatation after lowering tissue temperature >10°C. ...
Aim. To identify the effects of cryotherapy on patient discomfort following craniotomy. Background. Following craniotomy, many patients suffer from unexpected discomfort, including pain, eyelid oedema and ecchymosis. Cryotherapy is regarded as a safe method for managing these postcraniotomy problems. Design. Randomised controlled trial. Methods. A total of 97 Korean patients who underwent elective supratentorial craniotomy were randomly assigned to a cryotherapy or a control group. In the cryotherapy group, ice bags were applied to surgical wounds, and cold gel packs were applied to periorbital areas, for 20 minutes per hour, beginning three hours postoperatively and for three days thereafter. The level of patient pain was measured using the visual analogue scale while the eyelid oedema was measured using the Kara & Gokalan's scale. Ecchymosis was also classified according to its extent. Results. The level of pain three hours after craniotomy was similar in the cryotherapy and control groups (57AE9 vs. 58AE7). Three days after surgery, pain had significantly decreased in the cryotherapy group (p = 0AE021). After adjusting diagnosis by analysis of covariance (ANCOVA) (ANCOVA), pain score did not differ significantly between the two groups. The mean eyelid oedema scores were lower in the cryotherapy group than in the control group (0AE59 vs. 2AE29, p < 0AE001), with ANCOVA ANCOVA showing that cryotherapy had a significant effect on eyelid oedema (p < 0AE001). Pain (p = 0AE047) and eyelid oedema (p < 0AE001) in the cryotherapy group were significantly decreased over time. Ecchymosis were significantly less frequent in the cryotherapy (11/48, 22AE9%) than in the control (26/49, 53AE1%) group (p = 0AE003). Logistic regression analysis showed that cryotherapy affected ecchymosis (p = 0AE001). Conclusion. These results indicate that cryotherapy can control pain, eyelid oedema and facial ecchymosis after craniotomy. Relevance to clinical practice. Cryotherapy, which is both convenient and cost-effective, can be used to prevent postoperative discomforts in a clinical setting.
... An example from the biomedical engineering programme at the University of Lagos, was an engineering graduate student who had experienced football injuries. Cryotherapy emerged from the student's literature review as a treatment for pain (MacAuley, 2001;Hubbard & Denegar, 2004;Mars et al., 2006), and timing of application of this therapy was key to success. After identification of this general problem, the student consulted with local family medicine and orthopaedic doctors who recognised a lack of immediate (on-field) treatment options for football soft tissue injuries. ...
... Icing the elbow is also clinically significant to reduce pain and swelling. Mac Auley [14] suggested that the application of ice through a wet towel for 10 minutes is effective for muscle injury. The target is for reducing the temperature in 10-15º C that prevents further injury also. ...
... An example from the biomedical engineering programme at the University of Lagos, was an engineering graduate student who had experienced football injuries. Cryotherapy emerged from the student's literature review as a treatment for pain (MacAuley, 2001;Hubbard & Denegar, 2004;Mars et al., 2006), and timing of application of this therapy was key to success. After identification of this general problem, the student consulted with local family medicine and orthopaedic doctors who recognised a lack of immediate (on-field) treatment options for football soft tissue injuries. ...
... As a consequence, the extent of the cold induced tissue temperature reduction varies as well. 21 Cold water leads to a significant reduction of conduction and arterial blood flow and a reduced level of muscle soreness at 1, 24 and 48 hours after exercise. [22][23][24] Thereby, cold water immersion is an intervention which is often used as a cooling treatment after physical exercise for supporting recovery or to summary box ► Cooling with menthol was found to be an effective treatment in the postoperative phase as well as during physical therapy. ...
Introduction
Different cooling strategies exist for emergency treatments immediately after sports trauma or after surgery. The aim of this study was to investigate the effects of three cooling regimen during the immediate postoperative phase as well as in the rehabilitation phase.
Methods
36 patients undergoing anterior cruciate ligament reconstruction received either no cooling (control-group, Con, N=12), were cooled with a menthol-containing cooling bandage (Mtl, N=12) or cooled with an ice containing cold pack (CP, N=12). During a 12-week physiotherapy treatment the cross section of the vastus medialis muscle was examined (day—1; 30; 60; 90) and painkiller consumption was documented.
Results
A significant reduction in the cross section area 30 days after surgery was observed in CP and Con (Mtl: −3.2±1.7%, p=0.14, CP: −8.8±4.3%, p<0.01, Con: −7.2±8.1%, p<0.05). After 90 days of therapy, a significant increase in muscle cross section area was observed in Mtl (Mtl: 4.6%±6.1%, p<0.05, CP: 1.9%± 8.1%, p=0.29, Con: 3.3%±9.4%, p=0.31). The absolute painkiller consumption was lower for Mtl (25.5±3.7 tablets) than for CP (39.5±6.9 tablets) or Con (34.8±4.2 tablets).
Conclusion
We observed a beneficial effect of cooling by a menthol-containing bandage during the rehabilitation phase. Reduction of muscle cross section within 30 days after surgery was prevented which highly contributed to rehabilitation success after 90 days of therapy. Painkiller consumption was reduced with Mtl.
... [9,17,18] Intermittent local cold therapy is historically used as rehabilitation adjunct after musculoskeletal injury to relieve pain and reduce inflammation. [19][20][21][22][23][24][25][26] [42,43] resulting in a higher pain threshold. [44][45][46] While clearly beneficial for symptomatic relief after injury, little is known about the effects of local hypothermia on the regenerative process of healing skeletal tissue and the above phenomena of "surfers ear" implores the exploration of this question. ...
A new bone healing strategy is reported, which is based on localized cold. A murine bone healing model was used, in which an unicortical defect was surgically created bilaterally within the femurs. After daily immersion in an ice bath for 28 days, a large increase in bone regeneration within a femoral cortical defect compared to the non-treated limb was observed. Bone regeneration mechanism within the defect upon cold was studied
at 1 and 4 weeks using micro CT and immunohistochemical analysis and compared to the contralateral limb controls. The more advanced healing stage of the bone structure combined with the increase vascular channel density for the cold treated group matched with an increased expression of VEGF, and a greater number of CD34+ stained cells in the early phase of repair in the cold group. This indicates an elevation in tissue angiogenesis secondary to VEGF expression in the cold group potentially via a temporary vasoconstriction of the local vasculature leading to a temporary state of relative hypoxia. Local cold therapy may be an unrecognized tool with which to accelerate bone regeneration. The absence of observed systemic or local side effects and enhanced bone healing indicates further study is warranted to develop potential clinical protocols.
... • L'application de glace, plusieurs fois par jour durant environ 10' est souvent conseillée (34) . L'appréciation du froid est subjective et certains patients peuvent ne pas le supporter; d'autant que des troubles de la sensibilité peuvent subsister et perturber la perception de ce dernier. ...
Introduction: among the most frequent fractures, the fracture
of the distal end of the radius (BDU) particularly affects
children and the elderly. Its prevalence is growing; several factors
are responsible for this, including the life expectancy and
increasing activity of the elderly.
Any physiotherapist may have to treat this pathology and must
therefore know the key points, even though the indication for
rehabilitation is not systematic.
Development : conservative treatment remains the most favored
approach for the management of a stable fracture in an
elderly person. However, surgery, which generally shortens the
period of immobilization, is becoming increasingly popular.
The objective of the rehabilitator is to minimize the deleterious
effects that this «forced rest» can induce by educating her/his
patient and accompanying her/him on her/his recovery journey.
Discussion : to limit complications, minimizing immobilization
is paramount, just as it is essential to master the risks and priorities
of the rehabilitation. Though not always necessary, therapeutic
education is a required step for most patients.
In practice, though some techniques have been scientifically
proven, others have been less investigated and deserve more
research.
Conclusion : the prevalence and economic impact of the distal
radial fracture are considerable. Early detection of «at risk»
patients could reduce complications, as could evaluating the
rehabilitation process.
Finally, to empower a patient and make her/him an actor in
her/his rehabilitation, thus reducing the costs of the treatment,
every intervener must use and master an essential tool:
therapeutic education.
... A systematic review has revealed the studies testing cold application durations ranging from 15 to 30 minutes [12]. Another systematic review has reported evidences indicating the temperature decrease in the first 10e20 minutes [15]. A reduction of 10 to 15 C in perineal temperature because of cold pad application performed for 10e20 minutes is considered ideal to achieve an analgesic effect [3,16]. ...
Purpose:
Perineal pain developing during the postpartum period affects women's relationships with their families and infants. The aim of this study was to determine the efficacy of cold gel pad application for relieving perineal pain and possibly increasing mothers' comfort after vaginal delivery.
Methods:
This experimental randomized controlled study was conducted in the postpartum department of obstetrics and gynecology hospital. A total of 200 mothers were included in the study. Cold gel pads were applied to the perineum of mothers in the experimental group for 20 minutes in the postpartum first 2 hours and 4 hours after the first application. All the data were collected by using an information form, the visual analog scale, and the postpartum comfort questionnaire.
Results:
In the experimental group, the first visual analog scale score was 6.73 ± 1.68; after cold gel pad application, the pain levels decreased to 2.59 ± 1.20 in both primiparous and multiparous mothers. In addition, the postpartum comfort questionnaire score increased from 2.58 ± 0.14 to 2.69 ± 0.14 in the second assessment after the cold gel pad application and the difference was statistically significant (p < .001).
Conclusion:
The application of the cold gel pad to the perineum relieved perineal pain and increased postpartum comfort in all the women. The pain felt by the women during the recovery and the daily activities decreased. Postpartum perineal pain adversely affected daily activities such as lying down, sitting, and walking; infant care, breastfeeding, and urination; and comfort levels of the postpartum women.
... Injuries are a common occurrence in sports and can range from contusions, strains, and sprains to dislocations, concussions, and fractures. Several studies have revealed that cryotherapy is a common form of treatment during the acute phase of a soft tissue injury because it helps prevent secondary response and is beneficial to the healing process (Arnheim and Prentice, 2000;Hubbard and Denegar, 2004;MacAuley, 2001b;Merrick. 2002;Thompson et al., 2003). The previous studies explain the physiological factors that occur due to cryotherapy and why it is useful during the initial treatment of a soft tissue injury. ...
Background
Pain control is very important to ensure the comfort of patients and increase their quality of life.
Objectives
The purpose of this randomized controlled trial was to examine the effects of cold therapy in patients with chest tube before deep breathing and coughing exercises.
Methods
The study participants were patients with chest tubes, who were treated at a training and research hospital in Turkey between May 2, 2017, and October 24, 2019. Seventy patients participated in the study in accordance with the inclusion criteria. The intervention group, patient identification form, and visual analogue scale were used to collect data. Cold therapy was applied for the intervention group before deep breathing and coughing exercises, and not for the control group.
Results
The pain rates of the intervention group participants were lower (3.31) after the deep breathing and coughing exercises, than the rates (4.24) before the exercises (p<0.01). The pain rate (5.29) among the control group participants after the deep breathing and coughing exercises was significantly higher than those before (3.47) the exercises (p<0.01).
Conclusions
The study revealed that cold therapy before deep breathing and coughing exercises effectively relieves pain in patients with chest tubes.
Purpose
To compare the clinical effectiveness of cryotherapy after anterior cruciate ligament reconstruction using 2 different wound dressings, conventional postoperative gauze dressings and polyurethane semipermeable transparent film dressings.
Methods
In total, 60 patients who had undergone arthroscopic anterior cruciate ligament reconstruction with an autogenous patellar tendon were assigned to 2 groups. The surgical wound was covered with 5 sheets of gauze with an elastic bandage (control group) in 30 patients and film dressing was used (film group) in the remaining 30 patients. Silicone drainage catheters were inserted at the intercondylar notch, beside the distal outlet of the tibial tunnel for 2 days. After 1 hour of cooling using the device, the knee was chilled with an ice bag every 2 hours until the next morning. The severity of pain was evaluated by the number of times an analgesic, 50 mg of diclofenac sodium suppositories, had to be administered in the 24 hours after surgery. The amount of drainage during the following 2 days, the range of motion at 21 days, the change of hemoglobin concentration at 1 and 7 days, and C-reactive protein (CRP) at 1 and 7 days were examined.
Results
The number of patients who used an analgesic was 18 in the control group and 7 in the film group (P = .003). The amount of drainage was 165.2 ± 72.9 mL in the control group and 289.7 ± 77.6 mL in the film group (P < .001). The postoperative CRP value was 0.77 ± 0.65 mg/dL at 1 day in the control group and 0.39 ± 0.42 mg/dL in the film group (P = .009). No statistical difference was seen for hemoglobin concentration at 1 or 7 days, CRP at 7 days or range of motion at 21 days.
Conclusions
In this study, we found that film dressing enhanced the effect of cryotherapy with respect to pain control, wound drainage, and inflammation immediately after surgery compared with traditional gauze dressing with elastic wrap.
Level of Evidence
III, case–control study.
Ice plays an important role in the human life. In this research, the Biblical verses dealing with the ice are described. The description, the characteristics, the microbiology, the health effects, including the application of ice for therapeutic purposes, and adverse reactions are examined.
In the recent years, the diagnostic possibilities have been validated through scientific research and have shown medicinal value in the diagnosis of the various dimensions related to ice.
This research has shown that the awareness of the ice has accompanied human during the long years of our existence.
Cold therapy has been used regularly as an immediate treatment to induce analgesia following acute soft-tissue injuries, however, a prolonged ice application has proved to delay the start of the healing and lengthen the recovery process. Hyperbaric gaseous cryotherapy, also known as neurocryostimulation, has shown the ability to overcome most of the limitations of traditional cold therapy, and meanwhile promotes the analgesic and anti-inflammatory effects well, but the current existing studies have shown conflicting results on its effects. Traditional cold therapy still has beneficial effect especially when injuries are severe and swelling is the limiting factor for recovery after soft-tissue injuries, and therefore no need to be entirely put out to pasture in the rehabilitation practice. Strong randomized controlled trials with good methodological quality are still needed in the future to evaluate the effects of different cryotherapy modalities.
Aim
To review the effect of different intramuscular injection (IMI) techniques on injection associated pain, in adults.
Methods
The review protocol was registered on PROSPERO (CRD42019136097). MEDLINE, EMBASE, British Nursing Index and CINAHL were searched up to June 2020. Included studies were appraised and a meta-analysis, where appropriate, was conducted with a random effects model and test for heterogeneity. Standardised mean difference (SMD) with a 95% confidence interval in reported injection pain (intervention cf. control) was reported.
Results
29 studies were included in the systematic review and 20 studies in the meta-analysis. 13 IMI techniques were identified. 10 studies applied local pressure to the injection site. Of these, applying manual pressure (4 studies, SMD = -0.85[-1.36,-0.33]) and Helfer (rhythmic) tapping (3 studies, SMD = -2.95[-5.51,-0.39]) to the injection site reduced injection pain, whereas the use of a plastic device to apply local pressure to the skin (ShotBlocker) did not significantly reduce pain (2 studies, SMD = -0.51[-1.58,0.56]). Acupressure techniques which mostly involved applying sustained pressure followed by intermittent pressure (tapping) to acupressure points local to the injection site reduced pain (4 studies: SMD = -1.62[-2.80,-0.44]), as did injections to the ventrogluteal site compared to the dorsogluteal site (2 studies, SMD = -0.43[-0.81,-0.06]). There was insufficient evidence on the benefits of the ‘Z track technique’ (2 studies, SMD = -0.20[-0.41,0.01]) and the cold needle technique (2 studies, SMD = -0.73[-1.83,0.37]) on injection pain. The effect of changing the needle after drawing up the injectate on injection pain was conflicting and warming the injectate did not reduce pain. Limitations included considerable heterogeneity, poor reporting of randomisation, and possible bias in outcome measures from unblinding of assessors or participants.
Conclusions
Manual pressure or rhythmic tapping over the injection site and applying local pressure around the injection site reduced IMI pain. However, there was very high unexplained heterogeneity between studies and risk of significant bias within small studies.
The goals of rehabilitation in patients suffering from acute or chronic pain are variable but the foundation of rehabilitation focuses on functional and analgesic improvement. Patients can have pain for a multitude of reasons and a proper diagnosis is essential in directing the appropriate rehabilitation protocol. Physical Medicine and Rehabilitation specialists use a comprehensive approach in diagnosing and managing patients with acute and chronic function limiting or painful conditions. A vast majority of patients will present for evaluation of low back, neck, or joint pain. Rehabilitation-based therapies include therapeutic exercise, physical and occupational therapy, modalities, manual therapies, and bracing. Ideal treatment is likely to be multimodal to include both rehabilitation therapies and other treatments such as oral medications, topicals, and possibly interventional procedures which may assist in facilitating participation in rehabilitation treatments. It is also important to address both the psychological and behavioral aspects of pain in addition to the physical impairments. Instituting a multidisciplinary, multimodal treatment plan can give sustainable improvements in pain and function.
Background:
Perineal trauma is common during childbirth and may be painful. Contemporary maternity practice includes offering women numerous forms of pain relief, including the local application of cooling treatments. This Cochrane Review is an update of a review last updated in 2012.
Objectives:
To evaluate the effectiveness of localised cooling treatments compared with no treatment, placebo, or other cooling treatments applied to the perineum for pain relief following perineal trauma sustained during childbirth.
Search methods:
We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (7 October 2019) and reference lists of retrieved studies.
Selection criteria:
Published and unpublished randomised and quasi-randomised trials (RCTs) that compared a localised cooling treatment applied to the perineum with no treatment, placebo, or another cooling treatment applied to relieve pain related to perineal trauma sustained during childbirth.
Data collection and analysis:
Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies. Data were double checked for accuracy. The certainty of the evidence was assessed using the GRADE approach.
Main results:
We included 10 RCTs that enrolled 1233 women randomised to the use of one cooling treatment (ice, cold gel pad, cooling plus compression, cooling plus compression plus (being) horizontal) compared with another cooling treatment, no treatment, or placebo (water pack, compression). The included trials were at low or uncertain risk of bias overall, with the exception that the inability to blind participants and personnel to group allocation meant that we rated all trials at unclear or high risk for this domain. We undertook a number of comparisons to evaluate the different treatments. Cooling treatment (ice pack or cold gel pad) versus no treatment There was limited very low-certainty evidence that cooling treatment may reduce women's self-reported perineal pain within four to six hours (mean difference (MD) -4.46, 95% confidence interval (CI) -5.07 to -3.85 on a 10-point scale; 1 study, 100 participants) or between 24 and 48 hours of giving birth (risk ratio (RR) 0.73, 95% CI 0.57 to 0.94; 1 study, 316 participants). The evidence is very uncertain about the various measures of wound healing, for example, wound edges gaping when inspected five days after giving birth (RR 2.56, 95% CI 0.58 to 11.33; 1 study, 315 participants). Women generally rated their satisfaction with perineal care similarly following cooling or no treatment. The potential exception was that there may be a trivially lower mean difference of -0.1 on a five-point scale of psychospiritual comfort with cooling treatment, that is unlikely to be of clinical importance. Cooling treatment (cold gel pad) + compression versus placebo (gel pad + compression) There was limited low-certainty evidence that there may be a trivial MD of -0.43 in pain on a 10-point scale at 24 to 48 hours after giving birth (95% CI -0.73 to -0.13; 1 study, 250 participants) when a cooling treatment plus compression from a well-secured perineal pad was compared with the placebo. Levels of perineal oedema may be similar for the two groups (low-certainty evidence) and perineal bruising was not observed. There was low-certainty evidence that women may rate their satisfaction as being slightly higher with perineal care in the cold gel pad and compression group (MD 0.88, 95% CI 0.38 to 1.38; 1 trial, 250 participants). Cooling treatment (ice pack) versus placebo (water pack) One study reported that no women reported pain after using an ice pack or a water pack when asked within 24 hours of giving birth. There was low-certainty evidence that oedema may be similar for the two groups when assessed at four to six hours (RR 0.96, 95% CI 0.50 to 1.86; 1 study, 63 participants) or within 24 hours of giving birth (RR 0.36, 95% CI 0.08 to 1.59). No women were observed to have perineal bruising at these times. The trialists reported that no women in either group experienced any adverse effects on wound healing. There was very low-certainty evidence that women may rate their views and experiences with the treatments similarly (for example, satisfied with treatment: RR 0.91, 95% CI 0.77 to 1.08; 63 participants). Cooling treatment (ice pack) versus cooling treatment (cold gel pad) The evidence is very uncertain about the effects of using ice packs or cold gel pads on women's self-rated perineal pain, on perineal bruising, or on perineal oedema at four to six hours or within 24 hours of giving birth. Perineal oedema may persist 24 to 48 hours after giving birth in women using the ice packs (RR 1.69, 95% CI 1.03 to 2.7; 2 trials, 264 participants; very low-certainty). The risk of gaping wound edges five days after giving birth may be decreased in women who had used ice packs (RR 0.22, 95% CI 0.05 to 1.01; 215 participants; very low-certainty). However, this did not appear to persist to day 10 (RR 3.06, 95% CI 0.63 to 14.81; 214 participants). Women may rate their opinion of treatment less favourably following the use of ice packs five days after giving birth (RR 0.33, 95% CI 0.17 to 0.68; 1 study, 49 participants) and when assessed on day 10 (RR 0.82, 95% CI 0.73 to 0.92; 1 study, 208 participants), both very low-certainty.
Authors' conclusions:
There is limited very low-certainty evidence that may support the use of cooling treatments, in the form or ice packs or cold gel pads, for the relief of perineal pain in the first two days following childbirth. It is likely that concurrent use of several treatments is required to adequately address this issue, including prescription and non-prescription analgesia. Studies included in this review involved the use of cooling treatments for 10 to 20 minutes, and although no adverse effects were noted, these findings came from studies of relatively small numbers of women, or were not reported at all. The continued lack of high-certainty evidence of the benefits of cooling treatments should be viewed with caution, and further well-designed trials should be conducted.
The aim of this chapter is to provide an overview of the most common, evidence-based techniques and approaches used by physical therapists to evaluate and treat patients with pain. The first section on evaluation includes examination techniques, prognosis, and patient diagnosis/classification. The second section on treatment presents management strategies linked to a pain mechanism classification scheme of nociceptive, neuropathic, or nociplastic pain. Specific recommendations from clinical practice guidelines are included for the physical therapy management of spinal pain, lower extremity osteoarthritis, radiculopathy, carpal tunnel syndrome, fibromyalgia, and complex regional pain syndrome, type I.
While implantable medical devices offer tremendous potential for treating a myriad of diseases and disorders, there are many situations in which such devices are only needed for short time periods, with extended presence or surgical removal leading to a host of undesired complications. To address this concern, researchers are working to develop implantable circuitry that eventually disintegrates. Prior work in this area leveraged known bioresorbable materials, but the lifetime of circuits formed from such materials is determined upon fabrication, and on‐demand, triggered disintegration is not possible. To better match the lifetime of an implanted device to the status of the condition it is monitoring or treating, it would be advantageous to be able to noninvasively trigger disintegration at a particular time, avoiding situations in which the device lifetime is either too short or too long. Thus, to enable implantable circuitry with wireless capabilities that can disintegrate upon external stimuli, thermoresponsive transient RF antennas are formed that exhibit stable wireless response in warm aqueous environments but disintegrate and irreversibly lose functionality when cooled below a critical temperature. Antennas are formed by embedding patterned networks of silver nanowires in a thermoresponsive polymeric binder, which maintains network conductivity in warm solution but disintegrates and releases the nanowires when solution temperature drops. Mild sintering enhances electrical properties of the conductive nanowire network and antenna response while maintaining the capability for disintegration. To reduce the undesired effects of swelling, devices are sandwiched between two parylene films. These thermoresponsive transient devices represent an important step toward the realization of wireless medical implants whose disintegration can be triggered at any time by an external cooling stimulus.
Importance
Cryotherapy is one of the simplest and oldest therapeutic methods used to alleviate acute soft tissue trauma and muscle soreness. However, inconsistent outcomes have been reported due to inconsistent protocols.
Objective
To determine if various cryotherapy methods lead to enhanced recovery in athletes and identify optimal methods and protocol for short-term recovery in athletes.
Evidence review
PubMed/MEDLINE and SPORTDiscus databases were searched from 1 April 1950 to 31 December 2018. The search algorithm used was: (Icing OR Ice Therapy OR Cryotherapy) AND (Athlete OR Sports) NOT (Case Reports). Inclusion criteria was human clinical studies with level 1–4 evidence, a cohort of at least 20 athletes, who were followed to determine the effect cryotherapy had on performance, pain and/or recovery were included. Abstracts, reviews, case reports and conference proceedings were excluded. Seven studies investigating the effect cryotherapy recovery were included. Manual extraction and compilation of demographic, methodology, functional and biochemical outcomes from the studies were completed. Non-randomised trials were assessed using the Methodological Index for Non-Randomised Studies and the randomised were assessed using Oxford quality scoring system.
Findings
Decreased pain or muscle soreness was seen with cold water immersion(CWI) when compared with passive recovery. Other outcome variables assessed (biomarkers, functional tests) did not reveal consistent findings. Longer icing times (>10 min) were associated with detrimental effects in muscle power and activity.
Conclusions and relevance
Duration is the critical variable in conventional cryotherapy, with prolonged icing leading to immediate detriment in muscle power and activity. Thus, we recommend using ice cryotherapy following exercise for no longer than 10 min for pure hypoalgesia. CWI had a greater benefit on recovery than passive recovery. Furthermore, CWI has a more beneficial effect on recovery in the first 24 hours following exercise versus immediately postrecovery. We recommend using a protocol to include immersion times of 11–15 min in 11°C–15°C (52°F–59°F) water.
Level of evidence
Level III.
The wrist and hand comprises 27 bones with complex joint accessory movements to produce fluid motion. The wrist and hand are the most distal link in the kinetic chain involved in precision and finishing all strokes. Tennis involves repetitive use of the hand and wrist while holding a racquet, which may potentially contribute to pain and injury. Like other racquet sports, injury to the wrist can prove challenging to rehabilitate. A thorough history, clinical examination, and diagnosis are required to determine prognosis and determine a treatment plan to comprehensively rehabilitate a wrist and hand injury. Contributing factors need to be addressed to prevent recurrence of injury, which may include local or proximal musculoskeletal deficits, biomechanical or technique inefficiencies, or equipment including string tension and type, grip size and type, and racquet weight distribution. This chapter will focus on the rehabilitation of wrist injuries.
SUMMARY
The effect of recovery strategies after aerobic and anaerobic sport performance
The nature of physical load in sport games puts great demands not only on players’ fitness level but also on the need to cope with repeated short actions performed with maximum intensity. Moreover, the constantly increasing volume of training load and competitions requires athlete’s recovery as quick as possible, which plays a very important role in athlete’s sport performance. In spite of this, the recovery process is one of the least understood and examined factors of the sport training.
The purpose of the research was, based on the theoretical background and our own research, to contribute to the knowledge of the effect of the selected recovery strategies on athletes’ recovery processes after aerobic and anaerobic load using monitoring the dynamics of changes in lactate level and indicators of the repeated performance. The implementation of research activities was supported by the funds from VEGA scientific project No. 1/0622/15 titled „The effect of regeneration on recovery of the body after aerobic and anaerobic load in sport “.
The first chapter deals with the summary of theoretical knowledge in the chosen research reality. The authors analyse the issue of the response of a body on physical load in sport both generally and specifically in terms of the observed attributes of fatigue. In the next part of this chapter, the authors characterize recovery strategies, the effect of which was examined in the empirical part of the treatise. At the end of the first chapter, the authors provide the reader with the characteristics of physical load of athletes in sport games, among whom the effect of recovery strategies was observed in the empirical part.
In the second chapter, the authors specified the research problem when formulated the aim of the research as well as research tasks in order to achieve it.
In the third chapter, the design and overall organization is described, including the methods used for examination, collection and evaluation of research data. From the methodological perspective, the research was designed as a three-group multi-factorial experiment. The subjects participating in the research were the players of three sport games, namely soccer, basketball and volleyball in the category of cadets. The research was carried out in two stages. In the first stage, the authors observed the effect of the selected recovery strategies (massage, local cryotherapy, active movement and static stretching) and passive recovery on recovery processes after aerobic load using Yo-Yo intermittent recovery test (level 1) and in the second stage, which took place in at least two weeks, after anaerobic load using Wingate test. The level of recovery processes was assessed based on kinetics of blood lactate and implementation of the repeated performance immediately after the recovery phase.
The fourth chapter is a detailed description of the collected data and it is continuously followed by the fifth chapter, in which the authors examined causal relationships between the obtained results and compared them with results of other authors. The obtained empirical data showed that active movement recovery appeared as the most effective strategy in relation to the lactate metabolism after both aerobic and anaerobic load, whereas the passive recovery and local cryotherapy belonged to the least effective. However, these results are unambiguous in the case of monitoring the effect of recovery strategies on restoration of aerobic and anaerobic performance in the motor performance tests used. Nevertheless, static stretching and local cryotherapy applied immediately before the performance led to a decrease in performance rather than to a recovery.
The conclusions point to the need for further investigation and searching for optimal time intervals and intensity of active movement recovery. An inseparable part of further research activities in this field should be searching for non-invasive options to monitor recovery of the body after physical load.
Key words:
Fatigue. Blood lactate kinetics. Lactate clearance. Lactate metabolism. Active movement recovery. Massage. Cryotherapy. Passive recovery. Repeated performance.
Superficial local cryotherapy is frequently and safely used for pain relief following musculoskeletal injury or disease. However, serious skin complications have been reported in adults following inappropriate application. Skin burns following superficial local cryotherapy have not been previously reported in children.
The consequences of inappropriate use of various forms of cryotherapy in four children following sport injuries are presented. They were all primarily misdiagnosed with a soft tissue injury. The incorrect usage was due to the high severity of the local symptoms and signs. They were all referred with partial thickness skin burns. Diagnosis on referral indicated a bone injury in all of them. The value of the initial clinical examination is emphasized considering that fractures, including physeal injuries, are more common than ligamentous lesions, and the high incidence of the radiographically occult acute injuries in children. The use of superficial local cryotherapy following injuries in children should always follow the rules of proper usage and should be avoided in cases that the clinical examination cannot exclude a potential sprain or fracture to prevent further ligament, joint or bone damaging.
Context:
Ice, compression, and elevation, or ICE, is a widely used treatment for acute musculoskeletal injuries. The effects of ice and compression on tissue temperatures have been established, but whether elevation during cryotherapy affects temperature change has not. Elevation has potential to alter local perfusion and thereby alter the balance of heat loss/heat gain, potentially impacting tissue cooling during cryotherapy.
Objective:
To measure the effect and interaction of ice, compression, and elevation on intramuscular temperatures. We hypothesized that elevation would not have an effect on intramuscular tissue temperature.
Design:
Randomized crossover study design.
Setting:
University athletic training facility.
Patients or other participants:
A total of 15 healthy volunteers (age 20.93 [1.67] y) provided informed consent and participated.
Interventions:
Participants completed 8 treatment conditions: no treatment (control), ice only (I), compression only (C), elevation only (E), ice and compression (IC), ice and elevation (IE), compression and elevation (CE), or ice, compression, and elevation (ICE). All conditions were tested on each participant with a minimum of 48 hours between each condition. Intramuscular temperatures were recorded every 30 seconds during a 1-minute preapplication, 30-minute treatment, and 20-minute postapplication period.
Main outcome measures:
The temperature difference between the mean treatment temperature and the mean preapplication temperature was compared across each measurement depth and treatment condition.
Results:
Non-ice treatments (control, C, E, and CE; means 33.4, 34.5, 33.7, and 34.6, respectively) had warmer intramuscular temperatures than any treatment that included ice (I, IC, IE, and ICE; means 28.4, 19.8, 28.0, and 19.3, respectively). There were no differences between IC and ICE (means 19.8 and 19.3, respectively). Ice alone was different from everything (Control, C, E, IC, CE, and ICE) except IE Conclusions: Elevation does not appear to play a role in temperature changes during cryotherapy treatments.
Durch lokalen Wärmeentzug, der Kälte- oder Kryotherapie, kommt es zu einer raschen Abkühlung von Haut und Subkutis und zu einer verzögerten Abkühlung in tiefer liegenden Gewebsschichten. Da Haut und Subkutis schlechte Wärmeleiter sind, dauert es etwa 20 min, bis eine Temperatursenkung von 5 °C in einer 2 cm tief liegenden Muskelschicht erreicht ist. Deshalb wird zwischen Kurzzeit-, intermittierender und Langzeitanwendung unterschieden. Um die Körperkerntemperatur zu erhalten, kommt es in der Peripherie initial zur Vasokonstriktion und in der Folge reaktiv zur wiederholten Vasodilatation. Die Schmerzschwelle wird bereits nach kurzer Zeit erhöht. Eine Langzeitanwendung von 20–30 min bewirkt eine Entzündungshemmung im akuten Stadium, eine lokale Stoffwechselreduktion, die Abnahme der Nervenleitgeschwindigkeit und Erregbarkeit von Muskelspindel und Golgi-Sehnenorgan, eine Reduktion des Muskeltonus und eine zunehmende Steifheit des Bindegewebes und der Gelenke. Die lokale Körpererwärmung auf 40–45 °C bewirkt eine Zunahme der Durchblutung, der Dehnbarkeit des Bindegewebes, der Nervenleitgeschwindigkeit, der Permeabilität von Zellmembranen, eine Muskelentspannung und eine Abnahme der Gelenksteifigkeit. Wärmeanwendungen über die Hautoberfläche bewirken hauptsächlich eine Erwärmung von Haut und subkutanem Fettgewebe. Eine direkte Erwärmung tiefer liegender Gewebe wird durch Kurzwellen-, Dezimeter-, Mikrowellen- und Ultraschalltherapie erreicht. Zusammenfassend sind bei lokal schmerzhaften Muskelverspannungen sowohl Wärme als auch Wärmeentzug zur Behandlung geeignet. Bei akuten Entzündungen, neurogener Spastik, nach Traumen oder Verbrennungen ist Kryotherapie indiziert, zur Besserung der Gelenksteifigkeit und Dehnbarkeit des Bindegewebes Wärmetherapie.
Physicians who cover sporting events frequently encounter facial injuries. These injuries include contusions, hematomas, abrasions, lacerations, ruptured tympanic membranes, and fractures. For most physicians covering events, the diagnoses and decisions on returning athletes to play must be made without many of the diagnostic tools available in the office, such as radiographs, nasopharyngoscopes, or CT scans. As a result, physicians must rely on focused histories and thorough physical examinations to make their diagnoses and ultimately determine if injured participants can continue in their respective events.
Schouderklachten komen in de dagelijkse praktijk veel voor. In 1994 bleek uit een onderzoek van Lamberts dat van iedere 1000 nieuwe patiënten per jaar ongeveer 10 tot 25 patiënten de huisarts bezoeken met schouderklachten. De prevalentie in de algemene bevolking bedraagt 100 tot 160 per 1000 (nhg 2003). In de groep van aandoeningen van het bewegingsapparaat blijken patiënten met schouderklachten na lagerug- en nekklachten, het meest frequent naar de fysiotherapeut of specialist verwezen te worden (De Bruijn 2001a).
Objective. To compare cooling of skin, subcutaneous fat and muscle, produced by an icepack, at rest and after short-duration exhaustive exercise. Methods. Eight male subjects were studied. With the subject supine, hypodermic needle-tip thermistors were inserted into the subcutaneous fat and the mid-portion of the left rectus femoris, to a depth of 1 cm plus the adipose thickness at the site, and a temperature probe was placed on the skin overlying the needle tips. A pack of crushed ice was applied for 15 minutes and temperatures were recorded before, during, and for 45 minutes after icepack application. Thereafter, subjects underwent a ramped, treadmill, VO2max test, an icepack was applied after temperature probes were inserted into the right leg and measurements were made as before. Results. After the treadmill run, skin (Sk), subcutaneous (SC) and muscle (Ms) temperatures (mean ± standard deviation (SD)) were 0.9 ± 1.3, 1.0 ± 0.7 and 1.3 ± 0.8°C higher than at rest. After 15 minutes of icepack cooling, temperatures fell in the exercised limb by 22.7 ± 1.5°C (Sk), 13.5 ± 4.2°C (SC) and 9.3 ± 5.5°C (Ms) and in the control limb by 20.7 ± 2.9°C (Sk), 11.4 ± 2.0°C (SC) and 8.7 ± 2.6°C (Ms). The reductions in temperature were significant in both the control and exercised limbs. Forty-five minutes after icepack cooling, muscle temperature was still approximately 5°C lower in both the rested and exercised muscle (p < 0.001). Individual variations in response to cooling were noted. Conclusions. Cooling of superficial muscle occurs after high-intensity exercise. The degree of cooling is not uniform. This may be due to differences in the sympathetic response to cooling, influencing haemodynamic and thermoregulatory changes after exercise. This needs further investigation. South African Journal of Sports Medicine Vol. 18 (3) 2006: pp. 60-66
The objective of this study is to determine whether a cryotherapy protocol of 10 min of ice on, 10 min of ice off, then 10 min of ice on again results in a longer period of ankle cooling compared to single applications for either 10 or 20 min. The criterion is the length of time the ankle is maintained within an acceptable therapeutic range of under 20 °C and a preferred therapeutic range of under 15 °C. The assumption is made that a longer cooling period is desirable, given the current understanding that cooling limits secondary tissue degradation adjacent to trauma induced inflammation. The design is a laboratory controlled application of a standardised wet-ice pack for 10 min, then 10 min of interim recovery followed by a second 10 min of application to a normal right ankle of informed, consenting volunteers. Measurement of skin temperature is by infrared telethermography. The result is a reduction in ankle skin temperature to an acceptable therapeutic range of under 20 °C for 63 min, and to a preferred therapeutic range of under 15 °C for 33 min. These times are longer than those obtained by single applications of either 10 or 20 min. The conclusion is, this protocol is an improved clinical protocol for cryotherapy to the ankle. We caution that the application of cryotherapy by this protocol in a field situation be seen as a contraindication to a sport player returning to the field. We recommend further studies of this protocol on human ankles post exercise and post trauma.
In brief: Cryotherapy, a common treatment method for sports injuries, could result in peroneal nerve palsy. In this case a 26-year-old basketball coach who sustained a hamstring strain applied ice circumferentially around his knee on two occasions for one hour each. He subsequently suffered a severe peroneal neuropathy with weakness of the ankle, ankle evertors, and toe dorsiflexors. Electromyographic studies showed axonotmesis three months after the injury. Four months after the injury the patient was still recovering. This case demonstrates the importance of using cryotherapy cautiously.
Cheap, simple, safe, and effective, ice therapy after soft-tissue injury can cut weeks off of recovery time-but almost nobody uses it.
Therapeutic options for the management of disabling degenerative joint disease (DJD) of the knee include pharmacological and non-pharmacological measures. An alternative treatment modality such as a cold/compression (Cryo/CuffTM; Aircast Inc., Summit, New Jersey, USA), therapy can be safely and effectively used to control pain, swelling and stiffness. We report the results of Cryo/Cuff therapy in 131 patients with DJD of the knee. Cryo/Cuff therapy provides subjective, symptomatic relief, enables the patients to return to their desired level of activity and can delay a possible surgical intervention. We suggest Cryo/Cuff therapy as a first-line treatment alternative for active patients with symptomatic DJD of the knee because of its relative low cost and high compliance level.
Sports medicine practioners must be prepared to aggressively treat musculoskeletal trauma with both therapeutically sound and time efficient regimens. Thorough early treatment is essential for prevention of further trauma, for an expedient recovery, and for the earliest possible return to activity. The present study sought to evaluate the efficacy of rapid pulsed pneumatic compression along with cold in the amelioration of the acute symptoms associated with lateral ankle ligament sprains. Active range of motion and volumetric measures of ankle edema were made before and after 20-minute compression treatments on a series of 19 acute grade I lateral ankle ligament sprains. The number of treatments required before initiation of rehabilitation exercise ranged from one to eight with a mean of three. Rapid pulsed pneumatic compression along with cold is a safe and therapeutically sound method of controlling pain, loss of motion, and edema associated with this common injury. J Orthop Sports Phys Ther 1982;4(1):39-43.
A standard form of ice pack was applied to the shaved lateral surface of the thighs of anesthetized sheep and temperatures of the underlying tissues were measured by thermocouples inserted to various depths down to 4 cm as well as on the skin surface. An ice pack was applied for a single 20 minute period followed, in some sheep, by a second application 20 minutes later. This procedure was repeated a week later, immediately after physical trauma had been applied to the same area of the thigh. Temperature changes were depth dependent; after a single treatment, temperatures rose rapidly at first but after 2 hours did not regain pretreatment values; during a second application, the temperatures of the deep tissues continued to fall whereas the superficial tissue fell again to similar values as on the first application; temperatures did not fall as much after trauma and this was attributed to an increase in blood flow through the tissues. J Orthop Sports Phys Ther 1986;8(6):294-300.
Presented at the Sports Physical Therapy Section Team Concept Meeting, December 1990, Orlando, FL. Local blood flow to the calf of human subjects during the application of therapeutic modalities was estimated using impedance plethysmography. The modalities compared included ice massage, ice pack, ultrasound, hot pack, ice massage and ultrasound, and hot pack and ultrasound. It was found that neither ice pack nor ice massage significantly decreased blood flow compared to the control. The hot pack caused a significant increase in blood flow during application. Ultrasound was found to significantly increase blood flow up to 45 minutes following application. The use of hot packs prior to the ultrasound treatment did not significantly enhance the effect of ultrasound. It was concluded that neither ice massage nor ice pack treatments would decrease blood flow. Ultrasound may be beneficial in increasing blood flow during rehabilitation. Treatment with a modality prior to ultrasound will not enhance the effect on blood flow. J Orthop Sports Phys Ther 1991;13(1):23-27.
This study was done to determine the effects of a 30-minute cold water bath on intramuscular temperature and plantar flexion strength, immediately after treatment and during a 3-hour posttreatment recovery period. Twenty persons were tested twice, receiving treatment once and serving as controls once. Measurements were taken prior to the treatment period, immediately after treatment and then every 30 minutes for 3 hours. The dominant leg was submerged in water at 10 C for 30 minutes. Plantar flexion strength was measured with a cable tensiometer and intramuscular temperature was measured with a hypodermic thermistor probe. Intramuscular temperature significantly decreased immediately posttreatment on the experimental days and then increased significantly during the recovery period. Significant increases in strength were noted during the recovery period. A definite relationship exists between intramuscular temperature and plantar flexion strength.
Cooling treatment with 'Cryogel' is compared with the use of crepe bandaging in patients with recent ankle sprains. All patients were followed up regularly and the results appears to favour cooling when it is used in the early period of treatment. Cooling reduced oedema, pain and disability, and shortened the recovery period.
Despite the widespread use of ice packs in conjunction with ace bandages, padded ace bandages and compression dressings in the management of acute soft tissue trauma and sprains, the role of these barriers in the conduction of cold has not been adequately evaluated. Thermal probes were secured to both ankles of 62 healthy volunteers. The selected barrier was applied bilaterally and 500 g of chipped ice in a plastic bag was placed over the barrier on the right ankle for 30-45 minutes. A significant reduction in temperature of the right ankle was noted in all groups except in the padded ace group. The most rapid decrease in temperature was noted during the first 2 minutes of treatment. During the first minute, the surface temperature decreased an average of 22 degrees C (ace), 3.8 degrees C (dry washcloth), 5.2 degrees C (no barrier) and 5.4 degrees C (damp washcloth). After 10 minutes, the mean rate of cooling was 0.1-0.2 degree C and was approximately the same in all four groups. The Scheffe procedure indicated three homogeneous subgroups at 30 minutes: no barrier, damp washcloth; ace, dry washcloth; and padded ace. These findings question the clinical usefulness of the application of cold over padded aces and compression dressings and the use of a damp washcloth to 'protect' the skin from frostbite.
This paper gives an account of the management of acute and chronic soft tissue injuries emphasizing the beneficial effects that may be obtained from the early application of ice therapy and its important contribution to management. The results obtained with this method are superior to those previously achieved by methods based on heat and massage. The experience with ice and the previous standard therapies leaves little doubt that the use of ice applications can achieve considerable improvement in results.
Based on clinical evidence, cryokinetics (alternating cold and exercise) is replacing heat modalities as the preferred therapy for rehabilitation of traumatic musculoskeletal injuries in athletes. Theories have been advanced to explain the clinical successes of cryokinetics, but little scientific data have been collected. Strain gauge plethysmography was used to measure blood flow to the ankle of 12 uninjured male subjects. A repeated measures design was utilized with each subject being tested under six experimental conditions: 1) heat packs, 2) cold packs, 3) control, 4) heat-exercise, 5) cold-exercise, 6) control-exercise. Exercise consisted of 5 three-minute bouts (3.5 mph) interspersed with heat, cold, or control throughout a 45-minute period. Non-exercise, heat and cold were administered for 25 minutes each, followed by 20 minutes without treatment. Instantaneous blood flow was measured regularly during non-exercise periods, estimated during exercise, and total flow was computed by integrating over the 45 minute treatment-post treatment period. Total flow (ml flow/100 ml tissue/min) was greater/p. less than .0002) during cold-exercise than during heat treatments. Contrary to some theories, there was neither cold-induced vasodilatation during, nor a reflex vasodilatation following, the 25-minute cold application. These data suggest that during cryokinetics, exercise causes the increased blood flow, and that cold applications function only to allow active motion in a painful joint.
Using the radiocarpal ligament of the domestic pig as an experimental model the effects of ice therapy were studied. The results indicate that application of ice causes: (1) Increased subcutaneous swelling to injured or uninjured soft tissue; (2) A diminution of histological evidence of inflammation in injured ligamentous tissue.
Cryotherapy is a therapeutic modality frequently used in the treatment of athletic injuries. In very rare circumstances, inappropriate use in some individuals can lead to nerve injury resulting in temporary or permanent disability of the athlete. Six cases of cold-induced peripheral nerve injury from 1988 to 1991 at the Sports Medicine Center at Duke University are reported. Although disability can be severe and can render an athlete unable to compete for several months, each of these cases resolved spontaneously. Whereas the application of this modality is typically quite safe and beneficial, clinicians must be aware of the location of major peripheral nerves, the thickness of the overlying subcutaneous fat, the method of application (with inherent or additional compression), the duration of tissue cooling, and the possible cryotherapy sensibility of some individuals.