4. Discussion
knee circumference edema reduction, pain, hip abductors, KOA
GROUP B, INFLAMMATION, HYPOXIC, SECONDARY, COLD
To the best of our knowledge, this is the first study that examined the effectiveness of HBE with cryotherapy on functional improvement in patients with KOA. The study showed at 2 and 3 months that improvements in pain, stiffness, difficulty performing a physical function, and balance were associated with HBE along with cryotherapy compared to those patients who received HBE intervention only or no intervention.The effectiveness of HBE, along with cryotherapy, on the functions of patients with KOA, has yet to be examined previously. However, the main effect of this intervention may return to cryotherapy. We applied cryotherapy with HBE intervention to patients because leaving them without physiotherapy interventions is unethical.The effectiveness of cryotherapy on 60 KOA patients was evaluated in a randomized controlled trial (RCT). Incidentally, 30 patients received cryotherapy, delivered as packs of crushed ice in 2 plastic bags (24 × 3 34 × 3 × 0.08 cm), each containing 1 kg of crushed ice. The bags of crushed ice were placed on the knee, covering the medial, posterior, and lateral surfaces, and applied with mild compression for 20 minutes once a day for 4 consecutive days. Instead of crushed ice, the control group used sand-filled sham packs. They did not report a significant difference in pain between the cryotherapy and sham study groups, but function and quality of life were improved.Another clinical trial compared to exercise, cryotherapy, and short-wave therapy in treating KOA grade I. There were 25 participants, ages 58 to 78. For 20 minutes, Group A exercised and received short waves. Group B performed workouts while using ice for 20 minutes, and Group C only exercised. All patients underwent physical therapy at an outpatient facility for ten sessions twice a week, using isometry (stretching and strengthening exercises) for the hip abductors, sural triceps, adductors, iliotibial, and quadriceps, an ergometric bicycle with a proprioception cushion, and, depending on the group, application of short waves or ice. The study concluded that the most appropriate pain relief protocol was a combination of ice and kinesiotherapy. Their research also revealed that using only kinesiotherapy did not affect pain but did improve functional quality, muscular strength, and range of motion.Another RCT compared the efficacy of manual therapy combined with cryotherapy to kinesiotherapy combined with cryotherapy for treating KOA. Cryotherapy and manual therapy were administered to the intervention group (n = 64). The knee joint was subjected to cryotherapy using a cold nitrogen vapor of just 130°C. The patient body surface was 10 cm from the equipment nozzle, and no longer than 3 minutes were allowed. The manual treatment techniques included tibiofemoral distraction, anterior tibial glide, posterior tibial glide, medial and lateral tibia rotation mobilization, and patellofemoral glides.Each session was, at most, 45 minutes. The control group received kinesiotherapy, warming up for 5 minutes, stretching for 5 minutes, strengthening for 15 minutes, and stationary cycling for 5 minutes, combined with cryotherapy (KIN-C group). The study reported that manual therapy combined with cryotherapy reduced pain and improved the quality of life, range of motion, and functional exercise capacity than kinesiotherapy with cryotherapy.A systematic review of 3 RCTsFurthermore, the systematic review included a study that investigated the impact of ice packs on pain when compared to the control group. The treatment with ice packs or control (undetermined period of therapy) was taken 3 sessions a week for 3 weeks. A difference that was almost statistically significant was found, according to the study findings (weighted mean difference = −2.70, 95% CI: −5.52 to 0.12; The third trial measured the efficacy of hot or cold packs compared to the control group. The application of hot or cold (10 sessions of 20 minutes) on the posterior and anterior of the affected knee was measured. The results showed knee circumference edema reduction (In our study, we combined HBE with cryotherapy to evaluate the effects of cryotherapy. The HBE was taken from a previous quasi-experimental study that assessed the impact of HBE on 141 patients (60 years of age or older) with KOA.After 2 months of intervention, the patients who obtained cryotherapy and HBE were significantly better than the control groups. One month after the intervention (without treatment), we measured the effect of cryotherapy and HBE. The effect was visible and significantly better than the control groups regarding pain intensity, joint stiffness, daily function, and balance. These improvements may be attributed to the effect of cryotherapy. However, there may be some hidden confounders that interact with this effect.Cryotherapy may reduce pain and inflammation, as well as local metabolism, which lowers cellular energy needs and, as a result, reduces secondary hypoxic tissue injury.