The use of cold therapy in acute sports injuries as well as in the rehabilitation of the injured athlete has become a generally accepted treatment method. Various cooling modalities are used to apply cold to the injured area, e.g. ice packs, ice towels, ice massage, frozen gel packs, ethyl chloride and other vapocoolants, chemical reaction devices and inflatable splints using refrigerant gas. Most clinical studies report that the use of cryotherapy has a positive effect on pain reduction and on the recovery of various injuries. When the physiological processes produced by cryotherapy are examined in experimental situations, some of these reactions differ from expectations. Skin, subcutaneous, intramuscular and joint temperature changes depend on application method, initial temperature and application time. Intramuscular temperature continues to drop after the cooling modality has been removed. Results of various studies are consistent on the effects on neuromuscular and pain processes. Results of studies on cold and blood flow vary considerably, however it appears that blood flow increases with superficial cold application and decreases when cold is applied to large skin surface areas. Motor performance is affected by temperature with a critical temperature being around 18 degrees C, above and beneath which muscle performance decreases. There is also a critical temperature for the application of cold with inflammation and oedema increasing at temperatures below 15 degrees C. Precautions should be taken because prolonged application at very low temperatures could have deleterious effects.

Background.Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema.Patients and methods.The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation.Results.Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema.Conclusions.Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings.

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BackgroundCentral sensitization has recently been documented in patients with knee osteoarthritis (OAk). So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of tens on osteoarthritis of the knee. The purpose of this study is to explore the pain inhibitory effect of burst tens in OAk patients and to explore the prognostic value of central sensitization on the pain inhibitory effect of tens in OAk patients.MethodsPatients with knee pain due to OAk will be recruited through advertisements in local media. Temporal summation, before and after a heterotopic noxious conditioning stimulation, will be measured. In addition, pain on a numeric rating score, WOMAC subscores for pain and function and global perceived effect will be assessed. Patients will be randomly allocated to one of two treatment groups (tens, sham tens). Follow-up measurements will be scheduled after a period of 6 and 12 weeks.DiscussionTens influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of centrally sensitized OAk patients may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of tens. To increase treatment effectiveness it might be interesting to identify a subgroup of symptomatic OAk patients, i.e., non-sensitized patients, who are likely to benefit from burst tens.Trial RegistrationClinicalTrials.gov: NCT01390285