Control of the Inflammatory Response

Question 1

Introduction

Different pneumonics representing the principles for controlling the inflammatory response?

Answer 1

• ICER
• PRICE
• RICE
• PIER

Question 2

Introduction

Four principles representing the same four components

Answer 2

• Ice
• Compression
• Elevation
• Rest and Restricted Function
• (and Protection)

Question 3

Cold Application

How does cold application work?

Answer 3

Cold application works by limiting swelling and bleeding as well as reducing local tissue metabolism

Question 4

Cold Application

By doing this (applying cold) - purpose?

Answer 4

By doing this, cellular damage is limited and if it is limited initially, it does not have to be repaired later

Question 5

Cold Application

Recovery is?

Answer 5

Thus recovery as well as return to activity may be accelerated

Question 6

Cold Application

Uses alone? In combination results are?

Answer 6

There is some debate as to which of the four components of the ICER principle are most effective alone, however when used in combination, the results are synergistic

Question 7

Raynaud’s Phenomenon/Disease

What is it?

Answer 7

Raynaud’s phenomenon or disease is an allergic reaction to cold application

Question 8

Raynaud’s Phenomenon/Disease

Presents with?

Answer 8

It varies from individual to individual but presents with pain, numbness and tingling and varying degrees of cyanosis

Question 9

Raynaud’s Phenomenon/Disease

What is usually affected?

Answer 9

The extremities are usually affected

Question 10

Raynaud’s Phenomenon/Disease

What is the mechanism?

Answer 10

The exact mechanism is unknown

Question 11

Cryokinetics

What is it?

Answer 11

Cryokinetics is a combination of cold application and active exercise

Question 12

Cryokinetics

What is it used for?

Answer 12

It is used primarily for joint sprains

Question 13

Cryokinetics

What phase is it used in?

Answer 13

It is used in the sub-acute or fibroblastic phase

Question 14

Cryokinetics

Cold serves to?

Answer 14

Cold serves to decrease pain, allowing exercise to occur much earlier than normal

Question 15

Cryokinetics

Sets?

Answer 15

There are usually 3-5 alternating sets of ice and exercise

Question 16

Cryokinetics

What does the progressive exercise do?

Answer 16

It is the progressive exercise which helps re-establish neuromuscular functioning

Question 17

Penetration of Cold

Answer 17

Deeper than heat

Question 18

Penetration of Cold

Surface vs deeper?

Answer 18

Surface temperature decreases rapidly while deeper tissue takes more time

Question 19

Penetration of Cold

Decreased penetration in which areas?

Answer 19

There is decreased penetration in areas with more adipose tissue

Question 20

Cold Application

Factors Affecting Penetration

Answer 20

• Cold medium applied (crushed ice, cold immersion, ice pack)
• Length of exposure (the longer ice is applied, the deeper it will penetrate)
• Type of tissue (muscle vs fat)

Question 21

Cold Application

Physiological effects of cold

Answer 21

• Decreases inflammation
• Decreases pain
• Decreases circulation
• Decreases secondary hypoxic injury
• Decreases metabolism
• Decreases spasm
• Increases tissue stiffness

Question 22

Sensations Felt With Cold Application

Knight

Answer 22

• Pain (thermoreceptor and nociceptor activation)
• Warming (Hunting Response)
• Aching
• Numbness

Question 23

Sensations Felt With Cold Application

Prentice/Arnheim

Answer 23

• Cold
• Burning
• Aching
• Numbess

Question 24

Compression

Following injury?

Answer 24

Following injury, compression is applied immediately and maintained for a minimum of 24 hours

Question 25

# Compression Difference from ice (unlike)?

Answer 25

Unlike ice, which should be applied on and off, compression should be applied continuously

Question 26

# Compression Types of compression?

Answer 26

* Elastic wraps * Compressive pads * Braces * Tape etc.

Question 27

# Compression Hydrostatic reaction

Answer 27

The amount of force or pressure against a surface

Question 28

# Compression Osmotic pressure

Answer 28

Pressure which develops in a solution as a net result of osmosis into that solution

Question 29

# Compression Starling's Law

Answer 29

The rate and direction of fluid exchange (between the blood and interstitial fluid) is determined by hydrostatic and osmotic pressures

Question 30

# Rationale for Compression In normal tissue, what does fluid do?

Answer 30

In normal tissue, fluid constantly passes between the vascular system and the extracellular spaces

Question 31

# Rationale for Compression What happens if the balance of these forces is upset by trauma?

Answer 31

If the balance of these forces is upset by trauma, fluid will begin to accumulate in the tissue, around the injury

Question 32

# Rationale for Compression In injured tissue, it is the accumulation of fluid around the injury site that:

Answer 32

* Compounds the extent of tissue damage * Delays healing through congestion and oxygen deprivation contributing to secondary hypoxic injury * Fluid accumulation beneath damaged tissue (ligaments, tendons) may cause separation of the torn fibers leading to healing by secondary intent

Question 33

# Rationale for Compression Accumulation of fluid in and around the injury site causes?

Answer 33

The accumulation of fluid in and around the injury site causes complications

Question 34

# Rationale for Compression What does compression help facilitate?

Answer 34

Compression helps facilitate healing by helping to better line up the torn tissue

Question 35

# Rationale for Compression Compression decreases and minimizes?

Answer 35

Compression decreases pain and minimizes the pain/spasm cycle

Question 36

# Rationale for Compression Compression also decreases pain by?

Answer 36

Compression also decreases pain by the gait control theory

Question 37

# Rationale for Compression Bleeding?

Answer 37

Compression decreases bleeding

Question 38

# Rationale for Compression Inhibits?

Answer 38

Compression inhibits seepage of fluid into the interstitial spaces and forces swellling to areas of low hydrostatic pressure away from the injury site

Question 39

# Elevation Should be above the level of?

Answer 39

Elevation should always be above the level of the heart

Question 40

# Elevation Done at what time?

Answer 40

This is usually done at the same time as icing and compression

Question 41

# Elevation How does it help?

Answer 41

Elevation helps to decreases swelling by facilitating lymphatic drainage and decreasing capillary hydrostatic pressure which limits bleeding

Question 42

# Rest and Restricted Function Helps to ensure?

Answer 42

Rest and restricted function helps ensure healing with minimal complications

Question 43

# Rest and Restricted Function Limit or prevent?

Answer 43

This should limit or prevent the continuation of the inflammatory response