Interviews
Physio Andrew Gray of the Dragons speaks with Paul from Cryotek
Start Of Interview
Paul: How has Neurocryostimulation changed the way you treat injuries?
Andrew: It's probably simplified the acute injury management in that we are not grabbing for ice packs all the time after somebody gets hurt. We can apply the Neurocryostimulation (NCS) quickly, then compress them. So we can go freeze (NCS), compress, freeze, compress, freeze, compress.
Paul: When you say "compress", are you bandaging?
Andrew: With elastic bandages or pressure pumps. So it's simplified that. It's not as messy. It's easier.
Paul: And it's quicker?
Andrew: And it's quicker.
Paul: It gives you a lot more control over that acute inflammation cycle?
Andrew: Yes, because we can compress - we can compress a larger percentage of the time whilst still getting the benefit of the ice. That's for acute injuries. For chronic injuries, we use it a lot more right before training, right after training, sometimes early post-operatively if we are getting someone to do some exercise, we use it through training again for pain. We freeze it, freeze a certain part of their knee or their ankle that's giving them some pain so they can continue training. So you can do that without wasting time of having to go and ice someone.
Paul: So you can quickly spray them and they can continue their exercise or rehab?
Andrew: Yes, it streamlines the whole process. It's more efficient.
Paul: What's a good example of how you've changed your treatment protocol when treating an injury with the Cryo One as compared to ice - perhaps a rolled ankle or muscle strain?
Andrew: A good example of that would be an acute cork. So an acute haematoma or an acute small strain because we can quickly reduce the blood flow and get some good vasoconstriction with the Neurocryo and then compress them straightaway. After we have compressed for a time and are happy that we're getting some clotting, we rip the compression off and freeze (NCS) again. So it is far more efficient. Whereas with an ankle being inside an ice bucket and standing up is still pretty good because you want someone to get some movement in their ankle while they've got some weight on it. So ice buckets for ankles are still really good. The Cryo is really good for injuries where you can't put something into a bucket.
Paul: What were you doing last year(2006) when treating a strained muscle or cork -before you had the Cryo One?
Andrew: Last year, initially, we'd (sort of) toss up whether to use a traditional ice pack or compress an acute soft tissue injury- because you're trying to stop it bleeding and make it clot, but you're also trying to reduce the blood flow. So we'd do a little bit either way; we used to ice first and we used to try and compress on top of it or we used to just purely compress and then ice later. But I guess with the Cryo now, we can quickly spray twice, only a minute or so apart, and then compress. So we're getting the best of both worlds.
Paul: How long do you do the compression for before you then treat again?
Andrew: Depending on the size of the injury, somewhere between 5 and 15 minutes. For something that you think is really going to bleed, you might give it a really good squash for 15 minutes to try and get it to clot, or start to clot a little bit. Whereas, if it is something rather small, maybe just 5 minutes of compression and then we'll reapply the Cryo because I think probably the best benefit of the Cryo is to get some rapid vasoconstriction, whereas with compression you're trying to get some clotting, and that's what you want to do after an acute injury, is reduce the blood flow and get it to clot.
Paul: Because of the internal bleeding happening between the muscle tissues?
Andrew: Yes -You can't change the primary damage. The damage is done. But you can minimise the secondary damage which can really reduce the recovery timeframes.
Paul: Have you found by using the Cryo, a player has less pain from the injury and more freedom of movement?
Andrew: If he's got less pain, it is more likely because we can apply the Cryo a number of times and have him compressed more in a shorter period of time. So its greatest gift is its efficiency. It really streamlines the whole process. For minor niggles or muscle soreness, we find we can quickly apply the Cryo to a larger area right under a calf, whereas it might be difficult with an ice pack. To apply the ice pack to several different areas and apply an ice pack properly for 15 minutes to 4 different areas (given that the player probably only has the one ice pack) is probably going to take you an hour. Whereas within the hour, with the Cryo, the guy could have had 5 or so applications of the Cryo, plus a massage, plus a stretching session, plus some compression, plus some light activity. So you get much more value for your time.
Paul: So the recovery times in essence should be shorter with the Cryo than ice?
Andrew:The recovery times should in theory be reduced because you can minimise the secondary damage by use of the
Cryo-One because you're getting more compression, stronger vasoconstriction.
Paul: Plus that effect of the deep vasodilation as well, it gets rid of the enzymes causing the bruising.
Andrew: I've actually found that the bruises form much more quickly with Cryo than ice.
Paul: And they also dissipate much quicker?
Andrew: Yes. I've found that, a small amount of bruising will come up much quicker. So in theory I guess you're accelerating the whole clotting and clean-up process.
Paul: That's what Cryonic-Medical says is happening. We saw that when you treated Mark Gasnier (after the first Kangaroo test against England in 2006), the bruise come out at the end of the session.
Andrew: I've since treated another couple of hip pointers similarly and have had good results. We had a guy who had quite a large hip pointer.
Paul: When you say hip pointer, what do you mean?
Andrew: When there's a contusion to your iliac crest, which is a pretty common injury in rugby league/rugby union. It occurs when you have a knee ,shoulder or an elbow hit you right on your iliac crest.You often miss a game from those. We had a player who had quite a large one 48 hours before a game last week and we applied the Cryo through that evening, the next day and the guy played relatively pain free, which I think is a pretty good improvement because you can often miss a game if you have a bad hit.
Paul: Was it a medium size one?
Andrew: Yes, that's right, it was probably of medium size. He could continue to run after he got the hip pointer but was visibly affected. The worst ones generally have to leave the field. And a minor one a player will tell you about after the game. The medium-sized one that a player gets is clearly visible on the field as it affects their movement and they can often miss the next week if it bleeds considerably.
Paul: A 48 hour turn around for a medium cork?
Andrew: Yes, he was playing in 48 hours.
Paul: That was really good?
Andrew: It was really good.
Paul: So was that first grade or second grade?
Andrew: First grade , it was Tony Caine. He played five eighth for us last week.
Paul: The other week you mentioned that Josh Morris had a similar injury from the City/Country game?
Andrew: He had a medium-size hip pointer again in the City/Country game on the Thursday night and had a lot of Cryo when he returned from Coffs Harbour on the Friday.
Paul: You said you gave him about 12 or 15 treatments?
Andrew: Yes.
Paul: What time period was that in?
Andrew: Within 3 to 4 hours and we were doing it in about 15 minute intervals.
Paul: What were you doing in between the cold treatments?
Andrew: Stretching, massaging, general recovery movements in the pool, all those sorts of things. He is a good example at grade level. He was fit for selection on the Friday but the coach opted to rest him. This was disappointing because we had put so much time into helping him recover. He did a hard training run on the Saturday morning and completed that fine. So he would have been able to play within 24 hours after the injury.
Paul: In the past when you were just using ice for this type of injury, he most likely would have been ruled out or really struggled?
Andrew: Definitely - he more than likely would have struggled. I think it works so well for that kind of injury because they are quite a superficial contusion and are across a large area. So you can apply the Cryo to a large area. Whereas, your ice pack, depending on the size of your ice pack, your contact is only going to be about the size of the palm of your hand.
The other thing with the ice pack is that you're relying on the player to apply the ice pack to the correct spot, whereas with the Cryo I know where it is going.
Paul: You can pinpoint it exactly?
Andrew: Yes.
Paul: What about during matches, have you used it during matches?
Andrew: No, simply because I'm generally the only person that applies the Cryo and I'm running on and off the field, so I can't, but--
Paul: No time?
Andrew: I could see a role for it, but I'm running around assessing whether players are fit to return on the field.
...continued
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