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cryotherapy versus heat for acute neck spasm
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cryotherapy versus heat for acute neck spasm - April 26, 2005 7:14:00 PM
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ZEAL
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From: FLORIDA
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H i friends ,
need some inputs and opinions ...regarding this case.
A patient 32 male with ACUTE SPASM of neck / trapezius (upper )...which modality will be your first choice of treatment for first 72 hrs.; heat or cold ?
I know to some of you it might seem to be very fundamental question but still please answer it...personally when i get such a case i automatically choose cryo...because of its possible benefits at this stage.
1) But does anybody of you (physical therapist)would rather recommend heat instead of ice in this stage for acute spasm? if yes please explain it.
2)All of you who would go for ice like me please list their reasons for this treatment .
your opinions are valuable .
thanx in advance
zeal.
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 4:28:00 AM
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JLS_PT_OCS
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Go with what the patient can tolerate.
I don't know about you, but anything cold on my neck does NOT make me want to relax.
It also would probably not help this protective reaction the patient is having, ie spasm.
All discussions of inflammation and basic science aside, what would YOU do if somebody put an ice pack on YOUR neck?
I would scream like the little pansy that I am. :)
I would choose heat here, also with estim for palliative treatment. Start on gentle mobs and AROM ASAP.
Good luck.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 5:23:00 AM
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Alex Brenner PT MPT OCS
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Zeal,
When I was a new graduate I would apply ice to these until one time I strained my neck diving for a softball in left field. I treated myself with an ice pack on the back of the neck and it was frickin painful so I switched to heat and it actually felt better. Since then I have kind of disregarded what we learned in school with the inflammation stage/process and gone with what makes the patient feel better. Sometimes it is ice, most the time it is heat.
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Alex Brenner, PT, MPT, OCS
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 6:35:00 AM
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MPT
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I really don't think that ice and heat play a big roll in the "healing process." In most cases the temperature change won't get deep enough to affect the injured area. So for problems like these I go with what makes the patient feel better.
I can only think one guy who just loved ice on his neck. It would be 30 below outside and about 10 below inside and he still wanted ice on his neck!
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 7:06:00 AM
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Diane
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Probably a combination, alternating cold and hot.
The point of using cold or heat is to neuromodulate through the nocioceptors in the skin, not to get a thermal change deep in the tissues. In other words the effect is at the skin.
Skin nocioceptors can only report three things: thermal, chemo or mechano related info. Thermal is one way to go, mechanoreceptors are another (light hands-on); you might be able to stimulate the chemoreceptors by using one of the many OTC consumer mentholated products out there on the skin..
I'd pick ice (or at least something relatively colder than body temp) over heat, simply because of the likelihood of interneural swelling and or C fiber biochemicals causing a bunch of nocioception out at the periphery, and cold having a greater likelihood of improving drainage of that stuff out of the nerves instead of creating more trouble by adding more blood pooling to an already swollen or biochemically "sick" nerve with heat. If you use contrast packs therefore, start and end with cold, use each temp for just a minute or two, and keep switching.
What's the matter with you guys who don't like ice on your necks! :) Haven't you ever heard of counterirritation? Or maybe none of you have ever had a neck spasm. Ice can feel really good when it blocks the less lovely sensation of "pain". It doesn't have to be on for long to do its job. Put it on through a dry teatowel or something. A turtleneck sweater. Whatever.
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 9:16:00 AM
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JLS_PT_OCS
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Actually my opposition to ice on the neck, like Alex's, does come from personal experience.
However, i didn't try it with a turtleneck sweater on, maybe that was the difference. Would plaid pants help, too?
:) Just kidding.
Diane makes an interesting point about contrast, hadn't thought of that...
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 10:22:00 AM
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hmgross
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What I have found (I have a chronic problem with my neck, can flare up fairly quickly)is using a cold gel pack not an ice bag. I would stay away from the heat as Diane suggested. It will temporarily "feel good" but may keep you in that inflammed painful state. A warm microwave pack may be OK if there is muscle tension/strain but I found it will irritate the true neck spasm. As chronically tight/stiff as my neck can be at times, I have only had a few episodes of very painful spasm.
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 11:41:00 AM
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Randy Dixon
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I've found that when I get a "crick in the neck", ice resolves it pretty quickly. The heat feels good but does nothing to help. I think the normal theory about cold and heat explains that. I actually like the feeling of cold now, since I associate it with feeling better. I prefer direct ice massage.
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 11:49:00 AM
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SJBird55
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That question really isn't an easy one to answer. When you say "spasm" what exactly do you mean? And, what is the cause for the complaint of "spasm?"
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 12:55:00 PM
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JSPT
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I would agree with SJBird55 and Jason. Find the reason for the muscle spasm and then address it. Based on my limited experience, if some mechanical correction does need to be made, moist heat and e-stim are more likely to relax the patient and the structures you are working on.
I doubt the success of treatment will hinge on deciding to use ice vs. heat. Whichever facilitates patient comfort seems to work best. Good question though; I see ice used improperly just about everyday.
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 1:18:00 PM
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nari
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I agree with JSPT - addressing the cause of the spasm is more useful, but 5 minutes of ice or heat, depending on preference can help a bit, to promote less nociceptive effects. Contrast Rx, as Diane suggests, can also be useful but can be time consuming, I feel. If your patient is up in the air and distressed, I would tend to ice, but if the reaction was "*?!!**" (non verbal, of course) then heat would be better.
Old fashioned Mckenzie and touch can also work extremely well, even first off, followed by heat perhaps...
Nari
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Re: cryotherapy versus heat for acute neck spasm - April 27, 2005 3:14:00 PM
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jma
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Agree with the combo of cold and heat, starting with cold then heat then cold. No need to leave heat on long enough to increase the inflammation already present
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Re: cryotherapy versus heat for acute neck spasm - April 28, 2005 9:11:00 AM
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MPT
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JSPT, well said. I have never felt that ice/heat were that instrumental in getting a patient better. Whatever gets them relaxed/comfortable enough for me to work on them is what I will use.
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Re: cryotherapy versus heat for acute neck spasm - April 28, 2005 6:44:00 PM
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ZEAL
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thanx guys for all these inputs .......as a matter of fact by spasm i just mean protective spasm simply of trapezius which is a result of occupation stress wrong posture accompanied sometimes with strain....which i very commonly encounter in my patients ....i have always been sucessfull with my ice regime ...its right patient complain about pain which ice arises during initial minutes of RX but as it starts its numbing action ......they are happy! ...also I choose ice during first 72 hrs.becus of obvious reasons with respect to inflammation....which are very true practically also.Also ice does good job in reducing tone ..good to dec. spasm....and inflammation does increase by heat during first 72 hr. i have witnessed this.Contrast is a very good option too.
the reason i am curious is an orthopaedician recently was suggesting me to put only heat on acute neck spasm as he thought that ice cannot dec. SPASM.
still would like to know more reasons why prefer ice during acute stage.
I also think heat at this stage is kind of temporary relief/soothing option infact sometimes it flares the condition.
correct me if i am wrong in my assumptions somewhere.
Zeal.
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Re: cryotherapy versus heat for acute neck spasm - April 29, 2005 3:29:00 AM
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Shill
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Hey all, as Zeal pointed out,
This is an ACUTE spasm. The chemical stuff is in there wreaking havoc. There are plenty of old, fairly decent studies showing benefit of ice over no ice, or heat in acute pain or swelling, despite the fact that it may not be initially comfortable. These were NOT done on the neck, but its the best we have, and probably better than anecdotal reports.
Sloan J, Hain R, Pownall R (Arch Emerg Med 1989)
Heat vs ice on acute ankle sprain
Heat took 14.8 days to return to full activity after grade 3 sprain, ice took only 11 days.
Heat took 30.4 days to return to full activity after grade 4 sprain, cold took 13.2 days.
Hocut et al (Am Journ Sports Med 1982)
Ice on acute ankle sprain of all grades,
Mean recovery time 9.7 days for cryotherapy
Mean recovery time 14.8 for non cryotherapy.
Decreasing metabolic demand of the tissues acutely (through cold) is thought to decrease the secondary hypoxic injury. Id love to elaborate on this, but not only have I run out of time, but I also have no idea where this little tidbit comes from, other than a modality review course entitled Therapeutic Modalities, an evidence based practice, which I went to last week.
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Re: cryotherapy versus heat for acute neck spasm - April 29, 2005 5:13:00 AM
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JSPT
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With respect to cryo/heat, I'm not sure that studies of ankle sprains correlate well with muscle spasm. The effects of heat/ice on a joint with a capsule, ligaments, synovial fluid, etc., may be quite different than a muscle.
Just thinking/typing out loud, here; physiology is not my strong suit!
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JS
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Re: cryotherapy versus heat for acute neck spasm - April 29, 2005 8:12:00 AM
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jma
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Nice reference. This should be followed up with other extremities involved for future studies.
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Re: cryotherapy versus heat for acute neck spasm - May 7, 2005 5:46:00 AM
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carleenej
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I agree with Schill.
Although the ankle was the joint studied, cryotherapy to the upper trap is not just treating the muscle, but adjacent c- & t-spine joints, reducing their metabolic demand, as well as decreasing nerve conduction velocity, along with a little gate theory (esp. if ice is uncomfortable ).
I commonly use cryotherapy for these reasons treating acute torticollis in adults, in conjunction with IFC, supportive positioning, and active progressive rotation to the painful barrier. At least this combination has worked with moderate success for me, but as with everything, I am still looking for a better solution.
Has anyone used acupuncture for acute ms. spasm?
~Liz
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Re: cryotherapy versus heat for acute neck spasm - May 7, 2005 8:12:00 AM
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chiroortho
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What about pulsed US and/or IF? Deeper penetration, no heat generation, no discomfort for the patient? I'm not the biggest fan of US, but this is one area that I think it might be useful for patients.
As for counterirritation, if this is what we're after why not just tell the patient to use a counterirritant cream on their own?
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