The use of ice or cryotherapy, is a remarkably effective treatment of acute athletic injuries. A variety of treatment forms exist, including ice packs, ice sticks, and vapocoolants (ethyl chloride spray). Chemical packs are a recent development and must be handled with care. The chemicals can occasionally leak and cause local chemical burns. When an ice pack is used, the materials can be brought to a playing field in an ice chest, but the physician must be able to tell patients how to use ice at home. When an ice bag is used, the patient should be instructed to crush the ice cubes, so that the ice bag can be molded around the site of injury. This provides an equal distribution of the cold so as to achieve a more rapid and complete cooling of the area. In fact, there should be an attempt to get the ice around the limb. Thus, two packs may be preferable.
Cold should be applied for about 20 minutes per hour for 24 hours after the injury. The amount of time that the ice is applied will vary with the amount of overlying fat.
It has been stated that compression is the most effective measure to prevent swelling following an acute injury. The use, effectiveness, and rationale of compression have been well documented. After trauma causing damage to tissue and vessels, a number of substances related to the inflammatory reaction are released. These substances cause vasodilation and increase the permeability of blood vessels. This allows for the egress of fluid and cells from the circulation into the surrounding tissue. The serum proteins that are now present in the interstitial tissue can hold large amounts of fluid because of the increase in osmotic pressure outside the vessels. The fluid, known as edema fluid, will restrict blood flow in the area by compressing the tissue and the vessels. In addition to separating tissue structures, the compression of vessels will reduce the local delivery of oxygen to the tissues. Pain is produced by local pressure of the fluid on nerve endings as well as by the distention of tissues. Eventually, healing of the tissue can be delayed because of the physical presence of large amounts of fluid that coagulates into a mass of fibrin, other proteins, and inflammatory cells.
This flow of fluid can be restricted and diminished by compression. This maneuver increases pressure on the tissues to overcome the effect of osmotic pressure, prevents the egress of fluid from vessels, and decreases the amount of material (serum, fluid and protein) that can accumulate in the interstitial tissue spaces. Basically the effect of compression is to reduce the ability of fluid to escape from damaged vessels into the surrounding tissue.
Elevation of an injured limb will also help to reduce swelling by reducing the flow of fluid from the vessels. Gravity is used to counteract intraluminal pressure in the vessels. Elevation cuts down on leakage from damaged vessels and from those that have dilated due to the secondary effect of inflammatory substances released after tissue damage. Elevation also serves the purpose of enforcing rest. If the trauma has been to the lower limb then elevation ensures immobilization.
Bio Compression System’s “BioCryo” System is the ideal state of the art way to treat all of the above (See Products). This system consists of a sequential circulator and an easy zip-on garment providing sequential, gradient compression and cold therapy to any extremity. Two extremities can be treated simultaneously. The system maintains a constant 40°F skin interface temperature for several hours.