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Cyclotherm
What is cyclotherm? 1
Cyclotherm is a device which can heat or cool
the skin surface by means of varying the temperature of a circulating fluid. This system is able to apply a temperature up to 40°C and down to 1°C and vary it between these limits at a rate of approximately 13°C per minute. A flexible applicator, in which fluid circulates, is held in contact with the tissue surface. The device can be programmed to apply predetermined temperatures for pre-set times for thermotherapy, cryotherapy and, perhaps most usefully, thermal contrast therapy Construction 2
It comprises a water reservoir to which water
is added and that is then connected, via an insulated tube, to a sleeve or sealed bag-like unit. The water circulates through the bag which covers the area being treated. Depending on the unit, the water is kept at a thermostatically preset temperature (controlled temperature flow) or flaked ice is added to the water in the reservoir so water at or close to 0°C is circulated. The water is either pumped through continuously by an electric pump (continuous flow) or is circulated by flushing it back through the reservoir every 15 minutes or so (intermittent flow) Physiological effects Heat : Increase circulation Increase metabolism Increase inflammation (↑ phagocytosis and wound healing) Decreased pain (analgesic effect) general sedative effect that promotes relaxation, effective for general soreness, aches, pain, but not as effective as cold application in removing acute injury pain Decrease muscle spasm Cold : On cutaneous blood vessels There is immediate vasoconstriction of cutaneous blood vessels, this restricts the blood flow in the skin so that heat loss is minimised On muscle blood flow Cooling provokes vasoconstriction in all vascular smooth muscles and the increased viscosity leads to reduced flow of blood Lowered metabolic rate Reduced O2 uptake On PNS Cold applied to the skin provides a strong sensory stimulus by stimulating cold receptors Effects seen on PNS due to reduced nerve conduction: reduction of Pain Hypertonicity
Muscle strength – variable effect
Therapeutic uses Heat : Therapeutic heat is most effective in decreasing general soreness and in preparing soft tissues for stretching and joint mobilisation To increase blood flow to the injured body part; during this process blood also delivers nutrients to that area and carries metabolites and other waste products, thereby increasing the rate of healing of the injury Cold : Applied to recent injuries Limits bleeding by vasoconstriction and increased blood viscosity Pain relief Reduces the conduction of cutaneous nociceptive fibres Reduces muscle spasm Reduces muscle spasticity Facilitates muscle contraction Therapeutic effects of thermal contrast therapy 3 Facilitates a mild tissue temperature increase Stimulates circulation Increases circulation in the contralateral extremity due to the crossover phenomenon Produces increased blood flow to the involved area Produces hyperemia by alternating vasodilatation and vasoconstriction of the superficial blood vessels Relieves stiffness and pain Reduces necrotic cells and aids healing Reduces inflammation and pitting edema Decreases stasis and scar tissue Improves range of motion Provides a transition for tissue accommodation between immediate cryotherapy and later thermotherapy treatment Indications Heat Connective tissue contracture (2 weeks or longer) resulting from immobilisation must be treated with heat followed by stretching and mobilisation Sub-acute joint sprains (4-14 days post injury) that remain sore but allow the patient to exercise should be treated with heat before exercise and with cold afterward Cold Immediate care of acute injuries Facilitating exercise during rehabilitation of orthopaedic injuries Muscle spasm with cold and stretching is relieved faster than with heat and stretching Contraindications Vasospasm or any kind of vascular disorders such as arteriosclerosis Cryoglobinaemia – abnormal protein present in blood, which precipitates at low temperatures, blocking blood vessels and causing local ischaemia Cold urticaria – cold causes release of histamine from mast cells leading to local erythema and sometimes symptoms like lowered BP and raised pulse rate Special care with: Cardiac disease Hypertension Malignancies Loss of sensation Infection Benefits 2
Continuous-flow cryotherapy has been proved
to decrease pain, inflammation, swelling, blood loss, and narcotic usage in the postoperative setting. Complications 2
Complications include frostbite, chronic pain,
and loss of digits. Continuous-flow cold therapy should be discontinued when capillary refill time is greater than 5 seconds. There is some evidence that the additional compression of a brace or strap over a flow bag can increase the risk of skin damage. References
1. Low and Reed – 3rd edition
2. Low and Reed – 4th edition: Continuous flow cryotherapy units 3. J. William Myrer , 1994 – Contrast Therapy and Intramuscular Temperature in the Human Leg Thank You
The Cold Plunge Cryotherapy Book: Diving Into the Healing Powers of Cold Water Exposure Therapy - Guide to Boosting Wellness Through Stress Reduction, Improving Sleep, and Increasing Energy