Some of the most difficult patients Doctors of Chiropractic face in full-time practice are the cases of severe brachial neuritis, sciatica, torticolis, and hot discs (disc protrusions and bulged, slipped, herniated, or ruptured discs are treated synonymously, for they all refer to the nucleus pulposis slipping postero-lateral inside the annulus fibrosis), to name a few. Each of these conditions can demonstrate high levels of intractable pain, with INFLAMMATION. Pain injuries that are so excruciating can not only make patients difficult to handle during examination and X-rays, but they are difficult to treat, especially with manipulation, while the patient is in the acute stage.
Unless electrotherapy, or the DC’s selection of other in-office treatment, can substantially reduce the patient’s pain, Long Term CryoTherapy (LTCT) should be used. Written instructions should be given to the patients so they can apply the process at home. This will begin to mitigate the pain and inflammation. More often than not, this allows the Dr. to take control of the situation in severe cases.
As we all know, inflammation has four cardinal signs. They are HEAT, REDNESS, SWELLING, and PAIN. They always appear together with the same intensity as the severity of the pain. Therefore, the more extreme the pain becomes, the more redness, heat, and swelling will develop. The good news is that if you remove one of these signs the other 3 will be removed as well.
How Long Does It Take To Stop Pain?
This is where LTCT fits into a DC’s practice. Pain will dissipate in the same proportion as the calories that are absorbed. CryoTherapy can remove the heat by absorbing the calories out of the body in a safe, effective, convenient, low-cost way. The deeper the pain, the longer CryoTherapy must be used in order to absorb the calories out of the painful area. To do this, the cold application needs to be applied for HOURS. That is why I refer to this as “Long Term CryoTherapy” (LTCT).
LTCT consists of using an 11" ice cap filled with ice and a little water to start the melting process. This type of cold pack will have a temperature of 34 to 40 degrees Fahrenheit, and is perfectly safe. This is the most probable ideal therapeutic temperature. It will not cause frostbite even if it is applied 24 hours a day. Frostbite can only occur when the skin temperature is brought down BELOW 32°F. For this reason, using gel packs, whose freezing point may well be below32°F, is not safe.
This type of cold pack will have a temperature of 34 to 40 degrees Fahrenheit, and is perfectly safe.
A logical question might be, “Why would gel packs freeze the skin when ice packs do not?” The answer is, when pure water freezes, the temperature of ice never gets below 32°F. Once water freezes it becomes inert and will not become colder. It stays at that temperature even if the ice is in a deep freezer where the temperature is below zero. Gel packs contain chemicals whose freezing point may be as low as -10°F. Therefore, if placed in a freezer where the temperature is 15°F, the gel would take on a temperature of 15°F.
If these gel packs were used one after another, on the same area, it could then bring the skin temperature below 32°F, which could then burst the skin cells (frostbite) that freeze at 32°F. Skin cell walls bust because the high water content in the protoplasm continues to expand when the temperature drops from 39°F to 32°F. That’s why water frozen in an ice tray expands to produce a lip or hump on the ice cube just before it freezes.
The goal is to lower the injured body area to 40°F or lower for a prolonged period of time to reduce and absorb the heat, and do the job above 32°F. Then the swelling, redness and pain will begin to disappear.
The above 4 disorders, mentioned above in paragraph one are not, by far, the only inflammatory conditions. There are many hundreds of conditions that exhibit INFLAMMATION. Conditions like surface trauma, first and second degree burns, brush burns, myo-fascitis, insect bites and other superficial injuries usually only require CryoTherapy for a short period of time. Topical CryoTherapy sprays and ointments usually suffice to reduce the heat from these surface inflammations and do help to promote healing. However, more cold power is needed if the surface injury is severe. The time required for surface inflammation could be for as little as 20 minutes to 2-3 hrs, depending on the extent of the injury.
Most all spinal pain conditions, including brachial neuritis, sciatica, disc conditions, subluxations, bursitis, neuritis, tendonitis, osteitis, and, surprisingly enough, peritonitis, colitis, enteritis (Crohn’s Disease), appendicitis, cystitis, and many other words ending in ‘itis’ are 1 to 6 inches deep in the body. Almost all of these conditions respond well to LTCT to reduce the inflammation, as long as LTCT is applied long enough to abate the pain. The time required for LTCT should be constantly applied from 4 hours to 24 hours a day. It may take one or several days to eliminate the pain in acute cases, because many of the above conditions are 3-6 inches in depth. Using ice packs with only ice and water takes about 2 hours to lower the body temperature about 10°F at 2 inches in depth, without lowering skin temperature below 32°F.
Now, this is the very big news–never before published to my knowledge. When using LTCT on inflammation, the chance of infection is almost ENTIRELY ELIMINATED. Logical thinking proves it, and this is why: Bacterial growth is slowed down by lowering temperatures; which is why laboratory chemists place Petri dishes containing bacteria in an incubator at 99°+F. This is, of course, to grow the bacteria at their optimum temperature in order to accelerate their growth. Bacterial growth is practically non-existent below temperatures of 50°F or less. A good illustration of lower bacterial growth is why we place a steak in a 40°F refrigerator. Better yet, we place meat in a freezer to slow bacterial growth even more to make it last for months. Moreover, we all can relate to stories of people dying on a glacier in the North or South Poles only to be found many years later totally preserved. Why? Because of little or no bacterial growth to destroy the body. So, deductive reasoning would guide us to conclude that CryoTherapy DOES reduce bacterial growth by lowering temperatures, and thereby stopping infections.
WHAT A SURPRISING BENEFIT it is to know that just by using ice therapy the DC can control and STOP INFECTION in its tracks. A chiropractor can be confident that from the moment the LTCT is applied, bacterial growth will begin to reduce, and the body has a chance to recover more rapidly. Many inflammations that get too hot will accelerate bacterial growth and become infected if it remains that way for a prolonged period of time.
Relieving pain can certainly enhance any DC’s practice, and preventing or stopping the advancement of infection is certainly a big bonus.
How to Implement LTCT in a D.C.’s Office
Provide an instruction sheet, a lumbar belt, and 1 or 2 ice caps for your patients in acute pain to apply at home. The lumbar belt should be used to apply the ice pack to the patient’s low back. Application to the cervicals can be convenient also, by using a bath towel (folded lengthwise in thirds, draped over the neck with the ice pack placed underneath. Tie the two ends of the towel in front above the chest with 2 or 3 rubber bands, which prevent choking of the throat). For both areas the patient can mill around freely while being treated. For other areas of the body, use the most practical way to fasten the ice pack. The ice pack will last up to 2 hours and has to be recharged with more ice for extended treatment.
There are several kinds of ice bags (caps) on the market. There is the type that is made of cloth on the outside and rubberized inside. It’s been our experience that this type will crack and leak after several uses. The FAULTLESS CO. makes the blue rubber-ish textured type that almost never leak, and may last 10 years or more. The 11" Faultless ice cap can be purchased at nearly any drug store or can be bought wholesale at Bodyline Comfort Systems and sold to your patients.
If you wish to know more about LTCT, call Bodyline @ 800-874-7715 and ask for one free “Ice Magic” booklet and a sheet that instructs patients on its use, which you may copy to hand out to all patients. Also, visit the Bodylines website @ www.bodyline.com.
John W. Fiore, DC, attended Purdue University, majoring in Chemistry, Physics, and Biology graduating from Lincoln College in 1954. Practiced together with his brother for 40 years and invented the “Back-Huggar” in 1968, and the “Neck-Huggar” in 1982, and founded Bodyline Comfort Systems in 1968. Served five years as secretary of Florida Chiropractic Association. Author of “Discaltic Aberrations of the Spine” (Disc Theory of Chiropractic) published in the 1974 Edition of the Journal of Clinical Chiropractic.