CRYOTHERAPY - BACK TO BASICS
- by Dr. Robert C. Martin
In a perfectionist profession where a person is only as good as his or her latest effort, it’s easy to feel compelled to be constantly searching for the next magic bullet, the next innovative break-through that will mean a better chance for success. But as exciting as it can be to approach a problem from a new direction, imagination is no substitute for good old-fashioned fundamentals.
Just ask Chuck Amato, head coach of the North Carolina State football team. Even before the Wolfpack beat Florida State and won the Gator Bowl, Amato was known as a defensive genius. He had a gift for disguising defenses, with players positioned in unlikely areas of the field for just long enough to confuse an opposing quarterback, then scooting back to their proper places as the ball was snapped. But in the three games before the Florida State victory, the Wolfpack defense was not good enough leading to a disappointing three game losing streak.
Coach Amato’s defensive schemes were no less ingenious than they had been before. The problem was that his players were not executing fundamental skills.
In healthcare, as in football or any other profession for which expectations are so high that failure is practically unacceptable, practitioners are constantly bombarded with new ideas for taking outcomes to the next level.
And in many cases, a new approach really will improve results – but only if your fundamentals are sound. Even the most advanced treatments will not work without understanding the fundamentals of why it works. Cryotherapy is a perfect example. The practice of cooling an injured body part to speed healing has been around for centuries, but now there are a plethora of options for applying that concept, from gel packs to compression wraps to continuous-flow systems. Applying the right one is the key to success.
Cryotherapy is possibly the most frequently used modality for the treatment of acute musculoskeletal injuries. Unfortunately, it may also be the most misused. Commonly, we apply ice for 15 to 20 minutes every 2 hours, regardless of the type location or severity of the injury.
With trauma, blood vessels are damaged limiting blood flow which reduces oxygen in the tissue. This causes a cascade of bad events such as cell break down and tissue swelling. The effectiveness of cryotherapy is based on the fact that as temperature in body tissue declines the rate of oxygen consumption also decreases. By reducing oxygen needed in damaged tissue fewer cells die thus less swelling and pain.
Not all methods of cold application are the same. Crushed ice packs last longer than recently popular gel packs, cool the body more, and draw four times more heat energy out of tissue. Chemical gel packs may cause frostbite in the first few minutes of application because of its low temperature when removed from the freezer and should be used initially with a protective barrier.
To achieve effective cooling cryotherapy should be applied at least 30 minutes for muscular areas but reduced to 20 minutes around joints and repeated on a 2 hour cycle. Cryotherapy is most effective when initiated within 10 minutes of the initial trauma and accompanied with a compressive wrap and elevation of the injured area above heart level.
Despite the options available today the preferred cryotherapy method for most situations is still the old-fashioned ice pack. Like Coach Amato and the Wolfpack nothing replaces sound fundamentals.