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Utilización de la Crioterapia en el ámbito deportivo
Abstract
La utilización del frío con fines terapéuticos, lo que se denomina crioterapia, se ha utilizado desde tiempos remotos. En la bibliografía se pueden encontrar estudios en los que se analizan los efectos que produce la aplicación del frío, calor o combinación de ambos (terapia de contraste), sobre funciones biológicas, el dolor, el edema, la inflamación, el flujo sanguíneo. Con este estudio prentendemos describir la utilización del frío. Nos centraremos en la aplicación superficial y su utilidad en las lesiones deportivas. Realizaremos una descripción de los efectos, formas de aplicación, indicaciones, contraindicaciones y aportes de la literatura científica sobre la crioterapia. La metodología utilizada es la revisión bibliográfica de monografías y de bases de datos científicas como Medline, Isi Web of Science, Cochrane Database of Systematic Reviews, Science Direct, haciendo hincapié en la evidencia científica. Conclusiones: La crioterapia en el ámbito deportivo es muy utilizada con diversas finalidades y con resultados cualitativos positivos. Existen efectos en la disminución del dolor, metabolismo, edema, inflamación, espasmo muscular y facilita el proceso de recuperación tras una lesión, permitiendo una pronta vuelta a la actividad deportiva. Existen controversias en los diferentes métodos, técnicas, y frecuencias de aplicación. Para tener una evidencia científica sobre la eficacia de la crioterapia se precisarían realizar más ensayos clínicos radomizados.6
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There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical basis.
Systematic review assessing the evidence base for cryotherapy in the treatment of acute soft-tissue injuries.
A computerized literature search, citation tracking, and hand searching were carried out up to April 2002. Eligible studies were randomized-controlled trials describing human subjects recovering from acute soft-tissue injuries and employing a cryotherapy treatment in isolation or in combination with other therapies. Two reviewers independently assessed the validity of included trials using the Physiotherapy Evidence Database (PEDro) scale.
Twenty-two trials met the inclusion criteria. There was a mean PEDro score of 3.4 out of of 10. There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery. There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.
Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.
OBJECTIVE: To search the English-language literature for original research addressing the effect of cryotherapy on return to participation after injury. DATA SOURCES: We searched MEDLINE, the Physiotherapy Evidence Database, SPORT Discus, the Cochrane Reviews database, and CINAHL from 1976 to 2003 to identify randomized clinical trials of cryotherapy. Key words used were cryotherapy, return to participation, cold treatment, ice, injury, sport, edema, and pain. DATA SYNTHESIS: Original research, including outcomes-assessment measures of return to participation of injured subjects, was reviewed using the Physiotherapy Evidence Database (PEDro) Scale. Four studies were identified and reviewed by a panel of certified athletic trainers. The 4 articles' scores ranged from 2 to 4 on the PEDro scale, which has a maximum of 10 points. Two of the articles suggested that cryotherapy speeds return to participation after ankle sprains. However, these authors failed to provide in-depth statistical analysis of their results. A confounding factor of compression as part of the treatment prevented interpretation of the effects of cryotherapy in 1 article. CONCLUSIONS: After critically reviewing the literature for the effect of cryotherapy on return-to-participation measures, we conclude that cryotherapy may have a positive effect. Despite the extensive use of cryotherapy in the management of acute injury, few authors have actually examined the effect of cryotherapy alone on return-to-participation measures. The relatively poor quality of the studies reviewed is of concern. Randomized, controlled clinical studies of the effect of cryotherapy on acute injury and return to participation are needed to better elucidate the treatment responses.
REFERENCE: Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251-261. CLINICAL QUESTION: What is the clinical evidence base for cryotherapy use? DATA SOURCES: Studies were identified by using a computer-based literature search on a total of 8 databases: MEDLINE, Proquest, ISI Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL) on Ovid, Allied and Complementary Medicine Database (AMED) on Ovid, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register (Central). This was supplemented with citation tracking of relevant primary and review articles. Search terms included surgery,orthopaedics,sports injury,soft tissue injury,sprains and strains,contusions,athletic injury,acute,compression, cryotherapy,ice,RICE, andcold. STUDY SELECTION: To be included in the review, each study had to fulfill the following conditions: be a randomized, controlled trial of human subjects; be published in English as a full paper; include patients recovering from acute soft tissue or orthopaedic surgical interventions who received cryotherapy in inpatient, outpatient, or home-based treatment, in isolation or in combination with placebo or other therapies; provide comparisons with no treatment, placebo, a different mode or protocol of cryotherapy, or other physiotherapeutic interventions; and have outcome measures that included function (subjective or objective), pain, swelling, or range of motion. DATA EXTRACTION: The study population, interventions, outcomes, follow-up, and reported results of the assessed trials were extracted and tabulated. The primary outcome measures were pain, swelling, and range of motion. Only 2 groups reported adequate data for return to normal function. All eligible articles were rated for methodologic quality using the PEDro scale. The PEDro scale is a checklist that examines the believability (internal validity) and the interpretability of trial quality. The 11-item checklist yields a maximum score of 10 if all criteria are satisfied. The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales (Chalmers Scale, Jadad Scale, and Maastricht List). Two reviewers graded the articles, a method that has been reported to be more reliable than one evaluator. MAIN RESULTS: Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles' scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects' baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist's administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression. CONCLUSIONS: Based on the available evidence, cryotherapy seems to be effective in decreasing pain. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.
The principal objective of this article is to claim the importance of a suitable physical therapy treatment during the acute phase of an injury. For this, I'm going to explain some techniques to reduce de period ofconvalescense of the patient
Physiotherapy is a science, their techniques are based in the physiology, anatomy and neurology of the human body
For accurate this article, I have divided it in both chapters strongly connected, the physiophatology and the treatment. Taking this as a base, I explain the advantage of every techniques and their practic application.
We reviewed the English language medical literature on soft tissue injuries of the ankle published between 1966 and 1993. There were 150 articles reviewed of which 84 dealt substantially with ankle soft tissue injuries. The papers were analyzed for quality and it was found that there were significant weaknesses throughout the literature. This related particularly to randomization, blinded assessment, and outcome measures. The results of the treatment of 32,025 patients were reported in 84 studies. We were unable to gather sufficient data from these studies to perform a statistical analysis of the different forms of treatment. Our conclusions were that nonsteroidal antiinflammatory drugs shortened the time period to recovery and were associated with less pain. Active mobilization appeared to be the treatment of choice. Studies also showed that cryotherapy was of benefit and diapulse may be helpful. There was insufficient evidence to conclude that enzyme treatment, topical gels, ultrasound or diathermy, joint aspiration of injection were of benefit. Overall the literature would substantiate active mobilization following ankle sprains with judicious early use of nonsteroidal antiinflammatory drugs and the use of cryotherapy and diapulse in the treatment of ankle injuries. Our study suggests further investigations need to be carried out into the effectiveness and outcomes following alternative forms of therapy for ankle injuries.
We report the results of an outcome study that used visual analog scales to evaluate the efficacy of cryotherapy in the postoperative shoulder. This prospective study included 50 consecutive patients admitted to the hospital for at least one night after anterior shoulder stabilization, rotator cuff repair, or total shoulder replacement. The patients were randomized: 25 were fitted with a cryotherapy device in the operating room, and 25 were not. Otherwise, postoperative treatment was identical for the two groups, including types of analgesic agents given. Visual analog responses were converted to numeric values by simple measurement techniques. The scales assessed pain, comfort, sleep, analgesic use, and overall satisfaction. On the night of the operation the pain was less severe and occurred less often in the cryotherapy group. Those in the cryotherapy group slept better on the night of the operation and perceived the need to use pain medicine less often in comparison with those in the noncryotherapy group. By postoperative day 10 patients in the cryotherapy group reported their shoulders hurt less often and with less severity. Swelling was less, and shoulder movement hurt less during rehabilitation, enhancing the rehabilitative effort. Cryotherapy offers a number of benefits for care of patients in the immediate postoperative period.
The application of crushed ice or hydrogenated silicate, a micro-crystalline substitute has been used as a method to treat posttraumatic and postoperative irritations of the locomotor system for a long time. Closed systems using pumps can be viewed as further development as they enable continuous, water-free cooling of operating areas. The analgetic effect of postoperative cold therapy was evaluated in a prospective clinical trial, including 312 patients after total knee or hip arthroplasty. Conventional cold packs, consisting of microcrystalline silicate were compared to a continuous applicable closed system. Continuous cryotherapy resulted in a depression of skin temperature to 12 degrees C, whereas intermittent cooling only caused a mean temperature decrease of 1 degree C. Clinically continuous cold application leads to a more than 50% decrease of analgetic demands in both, systemic and regional application (p < 0.001). This observation was found in a significant correlation with patient's pain sensation as well as primary range of motion. Intermittent cryotherapy was found to be ineffective in postoperative pain relieve in hip- and adequate in knee arthroplasty patients. We could not report an influence on postoperative blood loss, as discussed in previous reports.
Cryotherapy has historically been used as a treatment following knee surgery. In the literature, there is little evidence of beneficial effects which support this practice. This study examined the effects of cryotherapy treatments on 45 subjects following minor arthroscopic knee surgery. Subjects were randomized to one of two treatment groups and the assessor remained blind to treatment group allocation. Subjects performed a 1-week home program of either cryotherapy and exercises or exercises alone. One week following surgery, a statistically significant difference was found between the groups for the affective dimension of the McGill pain questionnaire, medication consumption, compliance, and weight-bearing status. No significant differences were found between the groups for other outcome variables. These results indicate that the addition of cryotherapy to a regime of exercises following arthroscopic knee surgery produced benefits of increased compliance, improved weight-bearing status, and lower prescription medication consumption.
Efforts to minimize the morbidity of anterior cruciate ligament (ACL) reconstruction include the use of cryotherapy and/or compressive dressings in the immediate postoperative period. We undertook the present study to determine if the alleged benefits of the Cryo/Cuff, which combines these modalities, are more attributable to its compressive effect rather than cold application. Seventy-eight patients admitted for primary endoscopic ACL reconstruction using a bone-patella tendon-bone autograft were randomized to receive Cryo/Cuff compressive dressings postoperatively. Forty subjects (Group 1) had the cuff applied with continuous circulating ice water using the Autochill device, while 38 others (Group 2) received the cuff with room temperature water. Cases were performed as inpatients and all subjects were administered intravenous morphine postoperatively via a patient-controlled infusion pump for the first 24 postoperative hours. At baseline, the groups were well matched in age, sex, duration of symptoms, operative time, and associated meniscal surgery. No significant difference between groups was detected with respect to length of hospitalization, Hemovac knee drainage, oral and intravenous narcotic requirement, or subjective pain as measured by a visual analog scale. No apparent complications related to the use of the Cryo/Cuff dressings were noted. The clinical effect of the Cryo/Cuff in this study was not influenced by the use of continuous ice water vs. room temperature water. Further study should focus on variations in compression to evaluate the clinical impact of this device.
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.
The use of cold treatment to limit edema, decrease pain, and induce effective muscle relaxation in soft tissue injuries is widespread.
To compare the efficacy of a novel cold gel with that of a placebo gel in patients with a soft tissue injury.
Prospective randomized double-blinded controlled study.
Seventy-four patients with sports-related soft tissue injury were randomly assigned to active cold gel (Ice Power) or placebo gel groups. The gel was applied four times daily on the skin for 14 days. Clinical assessment was made after 7, 14, and 28 days with use of visual analog scale ratings.
Pain scores decreased from 59 to 30 during the first week, to 14 by the second, and to 7 by the end of study in the cold gel group. In the placebo group, pain scores decreased from 58 to 45, 26, and 13, respectively (significant difference). Patient satisfaction with treatment was 71 in the cold gel group and 44 in the placebo group (significant difference). Disability decreased significantly more rapidly in the cold gel group.
Cold gel therapy provided an effective and safe treatment for sports-related soft tissue injuries.
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