2 - HOT AND COLD Flashcards
What are the 3 factors that affect the body’s response to heat and cold?
- MEDIUM being applied
- CONDUCTIVITY of the tissue
- LENGTH OF TIME OF EXPOSURE
What factors do heat and cold both decrease?
Muscle guarding
pain perception
What factors are increased by heat and decreased by cold?
Collagen elasticity,
Blood flow,
Capillary permeability
Edema
Metabolic rate
What factors are increased by cold and decreased by heat?
Joint stiffness
How does heat protect against secondary cell death?
By increasing capillary permeability
Why is cold so good for pain management?
Gate control theory of pain - cold slows the conduction velocity of the C fibres
The case FOR ice:
C-fibres are unmyelinated and can be frozen out very fast.
- With every 1 degree drop in temperature you cool a nerve, the conduction velocity is decreased
- At 4 degrees - you knock out C-fibres completely
Evidence for ice
Ice has a better ability to decrease swelling than heat
Significant improvement in function vs. functional training
use of ice shown to maintain cell viability after injury by decreasing the metabolic demands of the healing tissue
At what temperatures are C-fibres completely knocked out?
4 degrees
POLICE:
P rotect
O ptimal
L oading
I ce
C ompression
E levation
PEACE & LOVE
Protect
Elevate
AVOID ICE & NSAIDS
C ompression
E ducation
L oading
O ptimism
V ascularization
E xercise
The case against ice:
The inflammatory phase of healing is necessary for athletes to go through
Evidence against ice:
One early ice treatment slowed tissue-level healing in inflammatory phase
- By day 7 everyone caught up in the ice group / no difference
What is Dave’s opinion on ice vs. no ice?
- pain can significantly decrease function sometimes
- it’s better to knock down pain and increase function early on
What is happening at the tissue level in the inflammatory phase?
- red, hot swelling, painful, local loss of function
- primary damage and secondary damage
- increased metabolic demand
Treatment goals in the inflammatory phase
Protect injured tissue
Palliate pain
Optimize the healing environment
Evidence for protection
interventions that shield, unload, and/or prevent joint movement for various periods support protection
- animal models show short periods of unloading are required after acute soft tissue injury
Evidence for compression
Decreases local edema
- makes it more available to spread throughout body: prevent it from organizing and creating a mass
Should you sleep with a tensor on? Why or why not?
NO - instruct your patients to take the tensor off when they sleep.
- Elastic bandage pulled to max tension decreases blood flow by 95%
