Cryotherapy For Orthopaedic Pain Management

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“The human body has been designed to resist an infinite number of changes and attacks brought about by its environment. The secret of good health lies in successful adjustment to changing stresses on the body.” – Harry J. Johnson

The science that you already know is being applied to your orthopaedic treatment. I’m sure we all remember a time when a frozen bag of peas was great therapy for a bruise. The utilization of cold treatments for pain management is technically known as cryotherapy. During medical treatment, cold therapy is applied in conjunction with other treatments, in order to create a customizable pain management plan. 

During medical treatments technologies such as ice packs, coolant sprays and even ice baths, are frequently utilized in healing injuries, or for post surgical treatments. These remedies are very effective in managing pain and swelling in the body, which are side effects of the injury. As part of the body’s healing mechanisms, swelling is part of the immune system’s actions towards healing the pain point. Many orthopaedic conditions are healed via the utilization of the R.I.C.E  method that consists of Rest, Ice, Compression, and Elevation. 

High Ankle Sprain 

Accounting for approximately 15% of all ankle related injuries, the high ankle sprain  or syndesmotic ankle sprain (SAS) occurs when there’s a sprain of the syndesmotic ligaments that connect the two bones in the higher ankle region. These bones are the tibia and the fibula. Located just above the ankle, the high ankle sprain is induced when there is an external twist of the leg, and is often induced by physical tackles.  

Extremely common among hockey players and football players, the high ankle sprain is a prime candidate for a chronic condition, which must be dealt with, or else it can degenerate over time. Because the fibia and the tibula are vertical bones, a counter twist ninety degrees to the plane of the leg is extremely detrimental to the stability of the joint. With such an external twist, as the ligaments become displaced, the patient will experience pain in the upper ankle region. Often unrecognized till long after a game, it is critical for sufferers to identify when there is an unusual sensation in the region. 

What is compromised in the external twist is the anterior inferior tibio-fibular ligament, which supports the tibia and the fibula, and enables the upper ankle mortise joint to stabilize, and support the body. The severity of damage to the ligament is variable, with the worst condition being a complete rupture, depending on how aggressive the rotation was. Consultation with an orthopaedic surgeon will clarify the path of treatment. For preliminary relief, apply the RICE method.

Symptoms of a High Ankle Sprain

Consult with your foot and ankle surgeon, if you are experiencing chronic pain in the upper ankle. In the preliminary stages of a high ankle sprain, you may experience the following:

  1. Pain above your ankle, right between your tibia and fibula. 
  2. Pain during motion, especially when strenuous activity such as climbing or descending stairs is experienced. 

You will be able to maneuver with a high ankle sprain, but if you’ve experienced a fracture in the upper ankle region, you will find it extremely difficult to apply pressure to the affected foot. 

Early Treatment Options

Consult with your foot and ankle surgeon, if you suspect that you have a high ankle sprain. If you can, apply a brace to stabilize the joint, until the area can be carefully assessed by a specialist. Utilizing technology such as a CT scan or an MRI image, the internal portions of the ankle will be assessed, in order to identify the severity of the injury. In the interim however, you are allowed to utilize the standardized RICE procedure, in order to facilitate appropriate pre-treatment. The acronym RICE stands for: Rest, Ice, Compression and Elevation. 

 Application of Cold Therapy

Ice is a healing agent, if it is applied in an appropriate manner. Ice does ease pain, but it can also induce a condition known as frostbite that causes damage to the nerves and the skin, if it is too intense. Prior to the application of ice to your skin, ensure that you have a protective coating such as a cloth or towel. The protective layer will be able to transfer the cold to the healing site via convection. 

During your treatment, do not prolong the application of the ice to the treatment area. At best, apply the cold compression in 10-20 minute intervals. You can do this several times per day, and the site will be able to heal optimally. The RICE method is best coupled with other treatments such as pain medicine and rehabilitation exercises that restore the pain site. 

Surgical Applications of Cryotherapy

During the treatment of severe osteoarthritis, one healing option is the utilization of cryotherapy after a total knee arthroplasty (TKA). TKA is an effective therapy in the treatment of osteoarthritis, but patients often experience postoperative pain that is alleviated by the application of cryotherapy. The post operative sensations often experienced by patients include pain, bleeding, edema and limited movement. Cryotherapy is considered a promising method for the treatment of TKA. The ability of cryotherapy to counter the adverse effects of the postoperative TKA pain is noticeable. It is anticipated that the recovery time can be improved with the appropriate application of the treatment. 

Cryotherapy via its impact on the patient’s intra-articular temperature, reduction in nerve conduction velocity and impacts on vasoconstriction and blood flow, naturally enables the pain site to control its healing mechanisms.

Treatment Options

Although you may create your own ice packs for treatment, there are more sophisticated cryotherapy systems that are available on the market. You may not always need the most expensive things in order to sustain your health, so consult with your orthopaedic surgeon in order to identify which system will work for you in your healing. 

Article References: 

  1. University of Rochester: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=134&contentid=95
  2. Thermoteck: https://www.thermotekusa.com/pages/Medical-Professionals/94

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Dr. Gordon Slater

Dr. Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions.

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Dr Gordon Slater is a highly-skilled surgeon specialising in foot and ankle conditions and sports injuries. Dr Slater is one of the first foot and ankle surgeons in Australia to adopt minimally invasive surgical techniques. He routinely uses MIS to treat a range of conditions, including bunions. MIS  has many advantages including shorter operating times, reduced post-operative pain, reduced risk of infection, minimal scarring and better cosmetic outcomes.

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