Cryotherapy Spray & Stretch for Sports Injuries, Pain & Trigger Points

This technique might be the single most effective non-invasive method for deactivating trigger points. So why isn’t it used more often? 

Calf Trigger Points

Spray and Stretch is one of those strange trigger point treatment techniques that are extremely effective, but somehow under-used.

It could be because it’s simply not taught widely nowadays, or that it’s just somehow become unfashionable.

What are the health benefits of cryotherapy?
Benefits of cryotherapy
  • Reduces migraine symptoms. …
  • Numbs nerve irritation. …
  • Helps treat mood disorders. …
  • Reduces arthritic pain. …
  • May help treat low-risk tumors. …
  • May help prevent dementia and Alzheimer’s disease. …
  • Treats atopic dermatitis and other skin conditions.
What happens during cryotherapy?
Cryotherapy warms your core, shrinks pores, and pushes blood to the surface of your skin. Blood and lymph flow, two of the most important things in your body, are greatly affected by cryotherapy. The process also flushes toxins, such as lactic acid, to help stimulate healing.




The spray and stretch technique, Cryotherapy is a learned modality that can quickly alleviate acute pain and restricted range of motion due to muscle trigger points. The application of a vapor coolant acts as a counterirritant to myofascial pain due to muscle spasms and trigger points.

What is the spray and stretch, Cryotherapy technique?
Stretch and spray are other methods of treating cervical myofascial pain (see the images below). This technique is performed using a vapor coolant spray applied to the affected muscle after it has been placed in the passive stretch.

Studies have Confirmed Positive Results

  • Decreases pain sensation to allow the muscle to be stretched.
  • Helps inactivate trigger points, relieve muscle spasms and reduce referred pain.

Hans Kraus (1941), who was the first to describe the technique of spray and stretch using ethyl chloride spray, used the technique for treating aches and sprains in circus performers.

Since then, a number of coolant techniques have been developed to treat almost all trigger points.

These often appear to have a myorelaxant effect within a few seconds of application. A number of studies have confirmed positive results.

In fact, a 1998 study (Simons) summarised this technique as the “single most effective non-invasive method” for deactivating trigger points.

Ethyl chloride spray is highly flammable, toxic, and is considerably colder than is necessary. It is volatile and has even accidentally killed several patients and doctors.

Vapocoolents, such as a Fluori-Methane spray, are a safer alternative, although being a fluorocarbon, it may affect the ozone layer.

The recommended product (and sorry no, we don’t sell it) is Gebauer’s “Spray and Stretch”, as it is nontoxic and nonflammable.

Machine-based products, such as Cryonics CRYO+, are also gaining popularity. These products are far more predictable and controllable.

The Physiological Basis for these Products is a Type of “Thermal Shock”

Research has indicated that these techniques work partly on the hypothalamus.

The rapid skin cooling challenges the autonomic reflex pathways and forces a local homeostatic response, which may have a therapeutic action.

A skin cooling of the skin by 2–5 degrees is enough to cause this reaction. The following beneficial effects have been suggested in a number of studies:

  • Analgesic
  • Anti-inflammatory
  • Vasomotor
  • Myorelaxant

Spray and Stretch Contraindications

  • Allergy to cold
  • Raynaud’s syndrome
  • Disorders of skin sensitivity
  • Cryoglobulinaemia

Spray and Stretch, Cryotherapy Technique

The basic spray and stretch technique is quite straightforward, as it does not require the same precise localization of trigger points as for needling or injection.

Instead, you need only locate and identify the affected host muscle to release its fibers. However, it is advisable first to locate the trigger point by palpation.

Doing this tends to help reassure the patient as to the efficacy of this “unusual” approach.

Spray and Stretch Procedure
  1. Spray: This is a distraction for the more important second step. The spray is aimed out of the inverted bottle nozzle at 30 degrees to the skin in a fine jet over a distance of about 20–50 cm (aim at an area rather than a single spot).
  2. Stretch: This is the therapeutic component of the technique. While two to three sweeps of spray are applied to the affected/host muscle, the muscle is gently extended to its full stretch length.

When to Use Spray and Stretch

  • Young children
  • Needle-shy patient
  • Immediately after trigger point injection
  • Post-hemiplegic—stroke rehabilitation
  • Immediately following major trauma, e.g. fracture or dislocation
  • After whiplash injury
  • In a patient with myofascial trigger points and hyperuricemia (excess uric acid)
  • Chronic or inhibition-resistant trigger points
  • Attachment trigger points

Spray and Stretch Tips

  • Locating the central trigger point which causes a precise referred pain pattern is recommended, as it gives the patient a rationale for accepting treatment. Make sure the patient has recently eaten, as hypoglycemia aggravates trigger points.
  • Provide a warmish surgery/room.
  • Use a blanket to cover the body and areas not being cooled, as muscle warmth is more conducive to muscle relaxation.
  • Remember to cover the eyes where appropriate.
  • Do not aim at a single spot, as this can burn or cause urticaria.
  • Do not force a stretch.
  • If the patient is apprehensive, ask them to focus on their breathing.
  • Test the range of motion before and after the spray and stretch technique. Make sure that the muscle to be treated is fully relaxed and support it where possible—treatment can be performed sitting, side-lying, prone, or supine.
  • To achieve a full stretch, you should anchor one side of the muscle, and move the other (passively).
When should cryotherapy be used?
Cryotherapy can help with muscle pain, as well as some joint and muscle disorders, such as arthritis. It may also promote faster healing of athletic injuries. Doctors have long recommended using ice packs on injured and painful muscles.

Quick Summary

If you are not familiar with Spray and Stretch, we suggest giving it a try.

The chances are that you will be amazed at the results. It’s certainly not the only way to release trigger points, and it’s not the best option in all cases but, as stated above, it is fantastically effective in certain situations, especially when treating young children.

What is a Modern cryotherapy chamber?

A Cryotherapy chamber is an individual, tube-shaped enclosure that covers a person’s body with an open-top to keep the head at room temperature.[6] This is a specific type of low-temperature treatment used to reduce inflammation and painful effects.[7] It was developed in the 1970s by Japanese rheumatologist Toshima Yamaguchi[8][9] and introduced to Europe, the USA, and Australia in the 1980s[10][11] and 1990s. WIki
Cryotherapy Uses Thermal Imaging Technology

Spray and Stretch Technique for Myofascial Pain

Many of you may recall the name of Janet Travell. She was President Kennedy’s personal physician. It was Dr. Travell that developed the spray and stretch technique used today for trigger point therapy. The term “trigger point” was coined in 1942 by Dr. Janet Travell to describe a clinical finding related to a discrete, irritable point in the skeletal muscle or fascia. Trigger Point Therapy is safe and effective in improving myofascial pain syndromes such as headaches from referred muscle dysfunction, tennis elbow, frozen shoulder, TMJ, fibromyalgia, and any muscle dysfunction that may be encountered through injury or overuse. Mainstream clinical research has shown that trigger points are often responsible for headaches, muscle weakness and pain, restricted range of motion, tearing, sweating, salivation, dizziness, and blurred vision. We have found that using a combination of the spray and stretch technique with acupuncture and chiropractic techniques has been able to help many acute and chronic disorders that may be recalcitrant to conventional medicine.

What Causes Trigger Points?

Normal, healthy muscles do not have trigger points. After experiencing trauma, such as a fall, car accident, joint sprain, or abnormal excessive exercise, the muscles can develop trigger points. Trigger points may also develop in muscles that are chronically overloaded by poor posture, especially while working, or repetitive muscle movements such as sitting at a computer all day. Structural discrepancies, like uneven legs and pelvic bones, may produce chronic mechanical stress that activates trigger points. This is why Travell prescribed left heel lifts for all of Kennedy’s shoes

How does the Spray and Stretch Technique Work?

As described by Dr. Travell, when spraying the skin surface the sudden drop in skin temperature is thought to produce temporary anesthesia allowing the muscle to be passively stretched to inactivate or break down trigger points in the muscles. The spray and stretch technique uses a vapor coolant as a counterirritant to myofascial pain due to muscle spasms and trigger points. Using the spray and stretch technique decreases the pain sensation and helps in relieving muscle spasms and referred pain. Thus the spray and stretch technique can help in alleviating acute pain and restricted range of motion due to muscle trigger points associated with myofascial pain syndromes.

Trigger Points

Trigger points are tender and irritable spots located in muscles and tendons, that when activated, refer to painful sensations (including aching, throbbing, burning, and even itching) to distant areas of the body.

The hundreds of known trigger points are beyond the scope of this article but can be found in resources such as the monumental texts by Travell and Simons: […] The Trigger Point Manuals: Volumes 1 & 2 (which cover the upper and lower body respectively).

The most frequently used techniques to diminish trigger point activity include the following:

    • Trigger point pressure release (also known as “ischemic compression”)
    • Chilling techniques (including ice, and spray, and stretch)
    • Dry or wet needling (acupuncture or trigger point injection)
    • Muscle energy stretching techniques
    • Superficial Moist heat (as from a hot pack)
    • And a host of other techniques way beyond the scope of this article.

One of the authors (Keats) a massage therapist specializing in Neuromuscular Therapy, primarily uses the trigger point pressure release method as it has been shown in scientific research to be one of the most effective methods for deactivating noxious trigger points. However, performing this type of therapeutic modality requires a thorough knowledge of anatomy and a high level of palpatory skill in order to locate the trigger points.

Does stretching help trigger points?
Keep in mind that trigger points can be a response to mental as well as physical stress. Adjust your routine to include aerobic exercises that engage neck and shoulder muscles. A set of jumping jacks stretches, or swimming can stretch and warm the trapezoid muscles, easing muscle tension.
How often can you massage trigger points?
Use your fingers (or tools like foam rollers and massage balls) to press firmly into the trigger points. Repeat for three to five minutes, ideally as often as five or six times per day. “It needs to be part of the daily routine,” Dr. Adams says.
Do trigger points ever go away?
Your trigger points may not go away on their own, but that doesn’t mean you have to put up with them forever. Trigger point injections (TPI) can provide immediate relief from muscle knots.
How do you break up a muscle knot?
Following are some things you can do to help break up the knots and find relief.
  1. Rest. Allow your body to rest if you have muscle knots. …
  2. Stretch. …
  3. Exercise. …
  4. Hot and cold therapy. …
  5. Use a muscle rub. …
  6. Trigger point pressure release. …
  7. Physical therapy.
Do muscle relaxers help trigger points?
Pain management practitioners and even experts in internal medicine will recommend muscle relaxers such as Robaxin, Flexeril, or even Soma in attempts to diminish muscular pain in the shoulders or low back that may or may not be associated with the presence of trigger points.
Why do trigger points hurt so much?
These knotted fibers restrict the fresh blood supply needed by the muscle cells. In addition, there is often a shortening of the muscle fibers to protect itself from further injury. When pressed, the area “triggers” and contracts causing the pain.
Why do I have so many trigger points?
Most points occur because of muscle overuse, muscle trauma (injury), or psychological stress. Trigger points often arise from sustained repetitive activities, like lifting heavy objects at work or working on a computer all day. No single factor is responsible for the development of myofascial trigger points.
How do you release a trigger point?
The original way is through trigger point release which involves using a squeeze grip or a tool where direct pressure on the trigger point for 30-120 seconds according to research can release and soften a nodule, once released the muscle tissue needs to be moved throughout its full range of motion.
more info at:
Therapeutic Swedish Massage, Sports Massage Therapy in Santa Barbara, Goleta
*Disclaimer: This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider.
Please consult your healthcare provider with any questions or concerns you may have regarding your condition.
The information provided is for educational purposes only and is not intended as a diagnosis, treatment, or prescription of any kind. The decision to use, or not to use, any information is the sole responsibility of the reader. These statements are not expressions of legal opinion relative to the scope of practice, medical diagnosis, or medical advice, nor do they represent an endorsement of any product, company, or specific massage therapy technique, modality, or approach. All trademarks, registered trademarks, brand names, registered brand names, logos, and company logos referenced in this post are the property of their owners.

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