Cold Flashcards
cold
- •Heat abstraction
- –Heat moves from the body to the cooling agent
- •Skin
- •Underlying tissues
- •Therapeutic Use
- –Inflammation Control
- –Decrease Edema formation- acute edema
- –Decrease pain
- –Decrease spasticity
- •RICE- rest,ice, compression, elevate
mode of tansfer
¢Conduction
Ice packs
Ice massage
Ice baths
¢Convection
Ice whirlpool
Controlled-Cold Compression Units
¢Evaporation
Vapocoolant sprays-spray trigger point/knot. It distracts nerve signals. Type of blocking.
Misters
Sweat
Amount of cooling & depth
•Correlates with
–Time of exposure
–Amount of body exposure
–Type of cooling agent
- Cold affects temperatures of tissues to a greater depth than superficial heat
- Temperature gradient between a cold modality and the skin is much larger than heat
- Recovery to baseline more prolonged than with heat- bc of constriction of vessels-decrease BF
- Hemodynamic
- Neuromuscular
- Metabolic
Hemodynamic Effects of Cold
•Immediate vasoconstriction
–Stimulate Cutaneous Thermo receptors—
–Arterioles & venules constrict: smooth muscle contraction
–Reduced blood flow
–If core cooling, systemic vasoconstriction
- Shivering/piloerection
- Increase in blood pressure
–Persists as long as cooled <15-20minutes
•Cold Induced Vasodilation (CIVD)
–Prolonged exposure: >15min or <10C (50 F)
–Hunting response—cyclical vasoconstriction/vasodilation
- Occurs primarily in the distal extremities and apical areas
- Circulatory anastomoses
- Increase blood viscosity
–Lower temps cause blood to become thicker
–Moves slower
•Increase blood pressure
–Constriction of blood vessels
•
•Tissues that have been cooled take longer to warm up than heated tissues take to cool down
Neuromuscular Effects
Peripheral Nerve Effects
◦Decreases nerve conduction speed
◦Longer duration, slower conduction
Motor and sensory
5 minutes= recovery of 15 minutes
20 minutes = recovery of 30 minutes or longer
◦Raises pain threshold
Counter irritant to pain signals
Decreases edema
◦Can cause neuropraxia
Generally prolonged exposure over superficial nerves
Muscle Strength Effects
◦Moderate to long exposure
Decreases isometric muscle strength initially
Muscle strength increases during recovery
◦Test strength BEFORE cryotherapy and before heat. Don’t test mm strength after hot or cold
◦
Decrease Edema
Metabolic Effects
•Metabolism
–Decreases all metabolic activity
–Decreases production of cartilage degrading enzymes
–Decrease vasodilator release (histamine/prostaglandins)
Uses
•Control Inflammation and Edema
–Cold: treatment of choice first 24-48 hours
- Decreases fluid infiltration due to vasoconstriction
- Decreases inflammation
- Decreases pain
- Decreases metabolic rate
- Apply up to 20 minutes at least 1 hour apart
–RICE
•Cold used with compression/elevation
–Not effective for edema caused by immobility or poor circulation= not for a chronic situation- because cold on already edemous tissue will become jello grows arms
Control Pain
◦Immediate effect
◦10-15 minute tx = relief for 1-2 hours
Delayed Onset Muscle Soreness
◦Muscle spasm and exercise induced soreness
◦In conjunction with stretch
Decrease Edema
Precautions
Hypertensive patients
◦Monitor & discontinue if elevates
Impaired circulation
Thermoregulatory problems—very young or old
Over an open wound
Over superficial nerves
◦Especially peroneal at knee and radial at elbow
People with aversion to cold
Poor sensation or cognition
If not improving after 2-3 treatments, try something else
Contraindications
Cold induced urticaria
◦Hypersensitivity to cold
◦Wheals, raised and itchy a NO NO
Raynaud’s phenomenon
◦Vasospastic disorder
◦Attacks precipitated by cold
Cryoglobulinemia
◦Abnormal blood protein
◦Accumulate when cold
◦Multiple myeloma, infections
chronic liver disease, lupus
Paroxysmal cold hemoglobinuria
◦Hemoglobin released from blood
◦Found in urine
Over an area with Compromised circulation
Cold intolerance
Over regenerating peripheral nerves
Adverse Effects of Cryotherapy
◦Tissue damage
If tissue reaches 15C (59F)
◦Tissue death/Frostbite
If tissue reaches -10C (>39F)
Place wet towel between source & skin
◦Nerve blocks
Cold Packs
–Usually filled with gel or saline/gelatin and covered with vinyl
–Semi-solid conforming pad at temp between 32-41F
–Cooling Units/Freezer: 23F (-5C)
–Cool packs 30 min between use (2 hours prior to initial use)
–Application: 10-20 min, 30 min for spasticity
–Cold Pack: moist or dry
–Ice Pack: dry
•Home Program
–Bag-O-Peas
–Freeze 4:1 mix of water/rubbing alcohol
–Ice Packs: Crushed Ice (More aggressive: Ice has higher specific heat)
•Advantages
–Easy to use
–Inexpensive
–Not time consuming for therapist
–Low level of skill required to apply
–Cover moderate/large areas
–Can elevate extremity : RICE
•Disadvantages
–Can’t see area being treated
–Weight of pack may not be tolerated
–Contour may not be possible for small/contoured areas
–Long tx time compared to ice massage
Ice Massage
- Ice cups or Frozen Popsicles
- Provide circular massage with ice
–5-10 min
•Stages of Treatment
–Cold
–Burning
–Aching
–Numbness
•Advantages
–Treatment area can be observed
–Beneficial for small/irregular area
–Duration is short
–Inexpensive
–Can elevate extremity: RICE
•Disadvantages
–Doesn’t work well with large areas
–Active participation: client or patient
Vapocoolant Sprays
•Fluori-Methane and ethyl chloride
–Now more environmentally safe products
•Spray and Stretch, Pain Ease, Instant Ice
–Travell: Trigger Points
–Counterirritant to cutaneous afferents—reduction in motor neuron activity which decreases resist to stretch
- Rapid cutaneous cooling
- Advantages
–Brief duration of cooling
–Localized
•Limited Use
Controlled Cold Compression Unit and Immersion
Controlled Cold Compression Unit•
Alternate pumping air and cold water
- Intermittent inflation of the sleeve
- Combines cold and compression
- Used postoperatively- units sent home with patients
- Ice baths
–Immersion for 10-20 minutes or until anesthesia if used for pain
–Temp: 32-67F (0-19C)
•Depends on body part and duration of treatment
–Advantages
- Circumferential cooling
- Home program
–Disadvantages
•Dependent position
Contrast Baths
- Alternate between warm and cool bath
- Temp: Warm 100-110F (38-43C)
Cool 55-65F (13-18C)
- Vascular exercise
- Alternating vasoconstriction/dilation
- Advantages
- Stimulates healing, promotes circulation
- Disadvantages
–Dependent position
–Follow precautions/contraindications for both heat and cold (although to a lesser extreme due to temps used and counter balance)
