Cold Modalities Flashcards
Conduction
Heat loss or gain through direct contact
-dependent on temp difference b/w 2 surfaces; time of exposure
ice massage, cold packs, cold spray, ice immersion, contrast baths, paraffin bath, cryo cuff
Convection
Heat loss or gain through movement of fluid or air b/w regions of unequal temp
-dependent on differences in temp, time, size of area
Whirlpool, fluidotherapy
Radiation
emission of energy
- may be emitted from a source (heat lamp) absorbed by body
- infrared lamps, laser, UV lamps
Conversion
changing from one energy form into another
-US: converts acoustic energy to thermal energy
US, diathermy
Cryotherapy
describes application of cold modalities that have a temp range b/w 32-65 F
-heat removed from body and absorbed by modality of choice
What are thermal agents?
represent a transfer of heat energy to or away from tissue—unidirectional
Fundamental principle of heat transfer?
one object must have a higher temperature than the other
What factors effect depth and duration of treatment?
subcutaneous tissue thickness–primary limiting factor
external towel insulating used
use of a compression wrap
depth of target tissue–diminish with depth
Effects of adipose tissue
as adipose thickness increases, the cooling time required to produce a standard temp effect increases
Ice and compression
better changes in tissue temperature reduction
elastic wrap more effective at reducing intramuscular tissue temp–acute injuries
Primary rationale for use of cryotherapy
to lower metabolic rate of a tissue
most beneficial effect of cold application is the reduction of secondary metabolic injury by suffocating cells’ need for oxygen.
Tissue metabolic rate
each 1.8F decreases in tissue temperature results in 13% decrease in tissues metabolic rate
Cellular Response effects from Cold Mods
decrease in cell metabolism resulting in decrease need for oxygen
Blood and fluid dynamics effects from Cold Mods
vasoconstriction
decreased blood flow to area
decreased hydrostatic pressure
decreased capillary permeability:decreases edema formation lessening mechanical pressure on nerves reducing pain
Inflammation effects from Cold Mods
decrease inflammation
decrease release of inflammatory mediators
decreased prostaglandin synthesis
decreased capillary permeability (histamine)
Nerve conduction effects from Cold Mods
decreased afferent NCV
decreased threshold of afferent nerve endings
Muscle Spasm effects from Cold Mods
decrease sensitivity of muscle spindle
—relaxes muscle and spasm relieved
How does Cold Mods affect pain perception & transmission
interrupts pain transmission (stimulates large diameter A-beta nerve fibers)
decreases nerve conduction velocity
reduces muscles spasm
reduces or limits edema
Indications for Cold Modalities
acute injury or inflammation
acute or chronic pain
post-surgical pain and inflammation
acute or chronic muscle spasm
Contraindications to Cold Modalities
Cold allergy Cardiac or respiratory involvement PVD/circulatory insufficiency uncovered open wounds advanced diabetes Raynaud's phenomenon prolonged application over superficial nerve
R.I.C.E.
Rest-protect area from further injury
Ice
Compression- decreased pressure gradient b/w arteries and tissues (distal to proximal)
-improves heat transfer to modality
Elevation- decreased hydrostatic pressure and improve venous and lymphatic return
What will you feel during cold application?
Cold
Burning
Aching
Numbness
*Doesn’t always occur in this order; repeated use lessens effects
Frostbite
usually due to whole body exposure or immersion
**Cold packs can cause these so be mindful
S&S of Frostbite
fading of redness normally associated with cold application, white pallor skin, extreme pain, unresponsive or slow responding nail beds
–injury risk increases once skin temp reaches 55F
Cold Packs: types
plastic bags fileld with ice
reusable gel packs
controlled cold therapy units-cryo cuffs
chemical or instant cold packs
Cold pack insulation layers
use if:
blood flow to area is compromised
nerve or cold intolerance
raynaud’s phenomenon
Ice Packs
most commonly used
–flaked and crushed ice works bests, cubed also used but doesn’t conform as easily
when combined with compression wrap, greater decreases in skin temperature~ 20 min
at rest skin temp can remain below pre-app level for over an hr
greater decrease in jt vs muscle
How to make ice pack?
Fill bag, squeeze air out, twist and tie at top
Advantages of ice bag
quick and easy
effective transmission of cold (quickest to cool skin)
conforms to body parts
athletes can take them to go
Disadvantages of ice bags
ice machines are expensive
ice bags add up in price
ice machines=lots of space
Cold Compression Therapy Units
combines static external compression with cold application—ankles, knees, shldrs
less tissue cooling compared to ice pack
need to keep body part elevated
Advantages of CCT
RICE principle
Reusable
Circumferential compression
Disadvantages of CCT
Price to purchase
Set up
Can mainly only treat extremities
Tx parameters
15-30 min
Be careful of frostbite because it can be used on and off continuously
example: game ready
Reusable cold packs
stored in freezer
silica, water, and antifreeze component
Advantages of reusable cold packs
cost effective due to reuse
Disadvantages of reusable cold packs
risk of frostbite
poor conformity to body contours
break open easily
instant cold packs
two chemical separated in pack when barrier is broken chemical reaction occurs
Adv. of instant cold packs
portable in med kits
small and can be wrapped on easily on sidelines
Disadv of instant cold packs
one time use
looses cooling properties quickly
chemicals are caustic to skin
expensive over time
Ice Massage
delivered to small evenly shaped areas
Indications for Ice Massage
muscle spasm/strains contusions minor injuries to localized areas subacute injury or inflammation chronic pain
Adv. ice massage
convenient for pt to perform in ATR or home
cost effective
time effective
Disadv. ice massage
can not effectively cover large areas
messy
not effective in reducing swelling due to lack of compression. (wrap and elevate after treatment to reduce swelling)
How does ice massage work?
stimulates large diameter nerves inhibiting transmission of pain
fill cups with ice and freeze
tx area=no larger than 3x size of cup
5-10 min
may be painful or counterproductive with acute injury
Contraindications Ice Massage
where pressure is contraindicated suspected fractures uncovered open wounds circulatory insufficiency cold allergy
Ice Immersion (Ice buckets)
temp range of 40-50F
very uncomfortable due to immersion of fingers and toes
-cold penetrates to bone level due to small circumference of digits
nail beds sensitive to cold
Ice Immersion effects on injury response cycle
same as general effects of cold
intensity of cold is greater secondary to greater surface area in contact with cold
hydrostatic pressure w/in capillaries is increased in limb due to dependent position–use AROM
As you increase area being treated:
increase the water temperature
prevents hypothermia
you wouldnt do full body immersion at 45 F
Indications for ice immersion
acute injury or inflammation
acute or chronic pain
post-surgical pain and edema
Contraindications ice immersion
cardiac or respiratory involvement uncovered open wounds circulatory insufficiency cold allergy anesthetic skin adv. diabetes
Whirlpools
effective to apply heat/cold to irregularly shaped areas
energy transferred via convection
cryokinetics
use of cold modalities with mvmt
used to improve ROM while decreasing pain
allows inflammatory response to be more effective
Whirlpools indications
decreased ROM
subacute or chronic inflammatory conditions
PVD
Peripheral nerve injuries
Whirlpool contraindications
very acute conditions where turbulence of water would cause pain/irritation
Fever (hot whirlpool)
Pts require postural support
Cryostretch indications
trigger points
muscle spasm
decreased ROM
acute pain
Cryostretch contraindications
allergy to spray acute and or post surgical injury open wounds normal cold contraindications contraindications to passive stretching
