Gymna CRYOFLOW ICE-CT User manual

gymna.com
Treatment Guide
Gymna Cryoow ICE-CT

Copyright GymnaUniphy NV, 2014
GymnaUniphy NV
Pasweg 6A, 3740 Bilzen, Belgium
Phone [phone] • Fax [phone]
www.gymna.com • inf[email protected]
Manufacturer:
Uniphy Elektromedizin GmbH & Co. KG
Neuendorfstr. 19b, 16761 Hennigsdorf,
Germany

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Guided Therapy System (GTS) 6
1. Introduction 7
1.1 Denition 7
1.2 History 7
1.3 The notion“thermal shock” 8
2. The Eects of cryotherapy 9
2.1 Local anaesthesia (analgesia) 9
2.2 Anti-inammation 9
2.3 Neurological eects 10
2.4 Vasomotor reactions 10
3. Airow therapy 12
4. Indications/Contra-indications 13
5. General applications 14
5.1 Skin temperature 15
5.2 Thermal shock 16
6. Objective list 17
6.1 Pain relief & RICE concept 18
6.2 Swelling 19
6.3 Spray and stretch treatment 19
6.4 Shockwave therapy 20
Contents

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7. Indications 22
Achillodynia 23
Ankylosing Spondylitis 24
Arthritis 25
Arthrosis 26
Bursitis 27
Cancaneal Spur (heelspur) 2 28
Carpal Tunnel Syndrome 29
Cervicobrachial Neuralgia 30
Epicondylitis 31
Fibromyalgia 32
Frozen Shoulder 33
Lumbalgia 34
Luxation 35
Lymphoedema 36
Morton Disease 37
Muscle Spasm 38
Muscle Strain 39
Osgood Schlatter Disease 40
Patellar Tendinitis (jumpers knee) 41
Plantar Fasciitis 42
Pubalgia 43
Rheumatoid Arthritis 44
Spasticity 45
Sprain 46
Tendinitis 47
Tendon Ruptures 48
Tendovaginitis 49
Trigger Points 50
Vascular Oedema 51
8. References 52
9. Notes 54
Contents

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Guided Therapy System (GTS)
The latest Gymna Cryoow ICE-CT is equipped with an intelligent system for
presetting the parameters and generating useful information. This invention
is called Guided Therapy System or short G.T.S.
After establishing your treatment objective the system automatically selects the
form of treatment and the best parameters. In other words, G.T.S. establishes the
connection between the therapeutic objective and the scientic basis itself.
A device with G.T.S. follows your therapeutic thinking pattern step-by-step and
takes away the need for you to setup technical parameters yourself. This allows
you to pay more attention to your patient.
This treatment guide contains valuable information. The dierent therapy forms
are explained and the eects of the various parameters are extensively decribed.
Patient
Therapist
Evidence
Therapy Objective

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1.1 Denition
Cryotherapy is the therapeutic application of cold that can be obtained in various
ways (with ice, cold water, damp cloth, methyl chloride, carbon dioxide…).
Basically cryotherapy can be divided in three groups “conduction cryotherapy”,
“airow cryotherapy” and “sublimation cryotherapy”. With conduction
cryotherapy cold is transferred via contact on the treated spot whereas this direct
contact is avoided in the two other groups. With sublimation therapy liquid gas
(nitrogen) is used to cool down a spot whereas free surrounding air is used to
cool down the treatment zone in airow cryotherapy.
1.2 History
Cryotherapy has been used in the treatment of traumatology since time
immemorial. The use of ice and snow as therapeutically means was already
mentioned by Hippocrates (460-377 before J.-C.).
Cryotherapy has been used very frequently because of its benecial eects; but
in a completely empirical way.
The method of application of cryotherapy has gone through several evolutions,
of course, but it is especially the improvement of physiological knowledge that
has allowed us to better understand the eects and made it possible to better
determine the various elds of applications and the modes of operation.
1.3 The notion“thermal shock”
In the early seventies various studies showed that, to be really eective in
cryotherapy, a “thermal shock” had to be carried out.
The cold causes a vasoconstriction.The quicker the drop in temperature, the more
ecient the “return-reaction”. "Under normal conditions the skin temperature is
around 34° C. This skin temperature should drop as quickly as possible.
1. Introduction

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Temperature skin
under normal conditions
Temperature skin
with eective cryotherapy
THERMAL SHOCK = DECREASE TEMPERATURE CHANGE IN A MINIMUM OF TIME
35° C
34° C
12° C
7° C

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2. The eects of cryotherapy
2.1 Local anaesthesia (analgesia)
The maximal eect is reached immediately (within 10 to 15 seconds) during the
treatment and it will remain eective, depending on circumstances, from 30
minutes to 3 hours after the treatment has been stopped (the average duration
is one hour).
When the skin temperature goes below 15° C, the coldness has the eect of
slowing down the conduction of nervous impulses. However, one should be
aware of the fact that, in vitro, a temperature below 10° C could cause damage to
the nervous system. In vivo, this limit can be xed between 5 and 7° C. However,
a thermal shock will consist of lowering the skin temperature from 34° C to less
than 15° C, but never reach a temperature lower than 5° C.
Cold will also decrease the irritability of the nociceptors (through depolarisation
of cell membranes).
2.2 Anti-inammation
The importance of inammation, of the permeability of the capillaries and of the
cellular response is directly linked to the temperature of the tissue.
Afastapplicationofcoldcausesadecreaseintheproductionofneurotransmitters,
which are responsible for the inammation. This makes it possible to decrease
the quantity of the substances that cause pain with 70 to 80 %, which results in a
less intense inammatory reaction.
By causing a vasoconstriction (arteriolar and capillary), cold will oppose the
vasodilatation of the inammatory reaction. This vasoconstriction is responsible
for a decrease of the drainage of the blood ow, for a diminution of the hydrostatic
pressure and thus for a reduction of the drainage of liquid. As a result the
plasmaextravasation, responsible for the volume of the oedema, will be limited.
We should draw attention to the fact that cold does not inhibit the drainage of

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the liquids, responsible for the repair of the tissues. Cold will only slow down this
process.This deceleration is compensated largely by the reduction of the harmful
eects of the oedema, which will allow for a much earlier rehabilitation by means
of exercising.
2.3 Neurological eects
As already mentioned, cold can provoke a local anaesthesia (analgesia) provided
that the temperature reaches a level below 15° C. Cold also reduces muscular
spasticity.
It has been established that the amplitude of the reex response during the
stretching of the muscle decreases during and immediately after application
of the cold. This phenomenon is what led Travell to developing the “Spray and
stretch method”. This method provides very good results in spasms during
stretching of the muscle.
2.4 Vasomotor reactions
The cooling down of the tissue causes a fast arteriolar and capillary
vasoconstriction via the reexes (thermoregulation).
In 1930, LEWIS described the changes in the blood ow of the skin, when a hand
is dipped in water of 10 -12° C long enough. The reaction is the result of an axon
reex. Since then many authors described these reactions, although not
everyone follows these conclusions. Today is assumed that the alternation of
vasodilatation and vasoconstriction is caused by a decrease of the anity of the
adrenergic α-receptors. This dierence in conclusions can be explained by the
dierence in circumstances during the experiments.