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At PHYSIOLAB®, we want to create a better understanding of repair, allowing tailored treatments depending on where you are in your recovery phase. From post injury to inflammatory, proliferation and remodelling, each specific phase requires a tailored approach to reduce oedema, pain and improve range of movement. By leveraging data and analysing it, we can expand knowledge as to when protocols should be adjusted for maximum efficacy. In this way, we can quantify recovery, making treatment faster and more effective than ever before. The below carousel details the research that has been done into Cryotherapy and intermittent compression, looking closely at how it aids swelling reduction, pain management, DOMS (Delayed Onset Muscle Soreness) and improves range of movement.

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OEDEMA (SWELLING)

Stöckle et al (1997) studied the effects of intermittent compression and continuous cryotherapy. They found that after 24 hours, intermittent compression showed the largest reduction in swelling, with continuous cryotherapy second. After 4 days, intermittent compression and continuous cryotherapy were roughly equal (74% and 70% reduction respectively).

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PAIN

Cooling is used to provide vasoconstriction to reduce bleeding and provide analgesia. Cooling can increase pain threshold levels and pain tolerance levels, which was accompanied by a decrease in nerve conduction velocity (Algafly and George, 2007). Thus cooling can help to decrease pain. Following a total knee arthroplasty, patients who received cryotherapy combined with IPC required less narcotic analgesia, tended towards a greater distance walked in the 6 minute walk test and felt more satisfied with their treatment regimen (Su et al, 2012).

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DELAYED ONSET MUSCLE SORENESS (DOMS)

Muscle soreness can be induced by increased blood lactic acid levels. Using thermography and analogue scales of pain, a randomised trial showed cooling was effective at reducing both blood lactate levels and DOMS compared to the control group, who received no therapy (Adamczyk et al, 2016). A further study showed heat or cold applied after exercise was significantly better to prevent elastic tissue damage. This demonstrated both cold and heat were efficacious in reducing muscle damage after exercise (Petrofsky et al, 2015).

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RANGE OF MOVEMENT

Range of movement following a total knee arthroplasty (TKA) at discharge and 3 weeks post-operatively was significantly improved using cooling and compression as opposed to epidural anaesthesia (control.)   Higher haemoglobin levels occur because cold helps to mitigate bleeding, and recovery is quicker because cold reduces pain, making exercise easier. The acute inflammatory response is also dampened (Kullenberg et al, 2006).

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CAR INSTITUTE STUDY

We worked with the Barcelona CAR institute to examine the cooling effect of PHYSIOLAB®. Using highly sensitive temperature probes (± 0.1°C) in the thigh of a healthy subject, the following measurements were taken during the purge sequence and then over a 30 minute treatment period of 6°C. The graph above demonstrates the rapid skin cooling effect of PHYSIOLAB®, followed by effective deep muscle cooling over the course of the 30 minute period. Please view the study brief to read the full results.

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THE PHASES OF HEALING

Our bodies go through different stages of recovery and healing. The above table indicates what is advised for each phase of healing and these are explained below:

Immediate Post-Injury Phase

Cooling is used to provide vasoconstriction to reduce bleeding and provide analgesia. Cooling can increase pain threshold levels and pain tolerance levels, which was accompanied by a decrease in nerve conduction velocity.  Thus cooling can help to decrease pain.

Inflammatory Phase

Compression is used to reduce swelling and improve function.Intermittent Pneumatic Compression (IPC) improves vascularity.  This leads to better blood flow to the injury site, along with nutrients and oxygen, which promotes faster healing. Mechanical loading can be increased, which stimulates fracture repair. Nitric Oxide is generated, which increases blood flow and an increase in mediators stimulates the healing process. These create an environment for faster functional improvement.

Proliferation Phase

Warming is used to aid vasodilation of the tissues, ensuring oxygen and nutrients reach the injury site. The use of compression is continued to improve function. Adding heat, alongside standard pharmacologic treatment of a non-steroidal anti-inflammatory drug, can also have objective benefit for lower back pain.

Remodelling Phase

Warming is used to increase tissue pliability and improve joint and muscle range of movement leading to improved function. Thermotherapy is also effective at reducing pain at the injury site during the sub-acute stages of soft tissue repair. Better results were demonstrated with thermotherapy than with standard analgesic drugs for reducing lower back pain during a randomised controlled trial (RCT.)

 

REFERENCES

Adamczyk A, Krasowska I, Boguszewski D, Reaburn P (2016) The use of thermal imaging to assess the effectiveness of ice massage and cold water immersion as methods for supporting post-exercise recovery. Journal of Thermal Biology,60: 20-25. 

Algafly, A.A. & George, K.P. (2007) The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med.41(6), 365-9

Dahl, J., Li, J., Bring, D. K. I., Renstrom, P. & Ackerman, P. (2007). Intermittent pneumatic compression enhances neurovascular in growth and tissue proliferation during connective tissue healing:  A study in the rat. J Orthop Res25, 1185–1192.

Dehghan M, Farahbod F (2014). The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study.

Journal of Clinical and Diagnostic Research, 8(9): LC01-4.

Khanna, A., Gougoulias, N. & Maffulli, N.  (2008). Intermittent pneumatic compression in fracture and soft-tissue injuries healing.  Br Med Bull., 88(1), 147-56 

Kullenberg, B., S. Ylipää, et al. (2006).  ”Postoperative Cryotherapy After Total Knee Arthroplasty:  A Prospective Study of 86 Patients.” J Arthroplasty21(8): 1175-1179. 

Nadler, S. F., Weingand, K. & Kruse, R. J. (2004).  The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner.  Pain Physician, 7, 395-39.

Nadler, S. F., Steiner, D. J., Erasala, G. N., Hengehold, D. A., Hinkle, R. T., Beth Goodale, M., Abeln, S. B. & Weingand, K. W.  (2002).  Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain.  Spine, 27(10), 1012-7.

Petrofsky JS, Khowailed IA, Lee H et al (2015). Cold Vs. heat after exercise – is there a clear winner for muscle soreness. Journal of Strength and Conditioning Research, 29(11): 3245-3252.

Stöckle, U., Hoffmann, R., Schütz, M., von Fournier, C., Südkamp,  N. P. & Haas, N. (1997). Fastest reduction of posttraumatic oedema: continuous cryotherapy or intermittent impulse compression? Foot Ankle Int., 18(7), 432-8.

Su, E. P., Perna, M., Boettner, F., Mayman, T., Gerlinger, W., Barsoum, W., Randolph, J. & Lee, G. (2012).  A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery. J Bone Joint Surg BrNovember, 94-B, 153-156.