Cryotherapy Flashcards
Where do you see the effects of cold
systemic and localized
what kind of effect does cold have
hemodynamic on circulation of blood (cold applied for greater than 15 min and below 1 C leads to vasodilation) reduces local metabolic activity of underlying tissue slows n conduction reduces muscle spasms and guarding analgesia reduce edema changes in mm strength neuromuscular inhibition/facilitation herapeutic effects
Time lengths of inhibition and facilitation
inhibition= prolonged facilitation= short term
What are the effects of cooling dependent on
type of agent
duration
mm to adipose ratio
depth of tissue to be treated
what is the most predictable and effective way to apply cold
ice/water bath
Why is icing less effective w/ obese pts
adipose is an insulator and doesn’t conduct energy well
How to transmit cold
conduction
convection
evaporation
What is superficial cooling used with most often
neuromuscular and musculoskeletal conditions
acute injury
When is superficial cooling most effective
when used as a prep or adjuct method to therapy
What are the purposes of superficial cooling
analgesia
lower edema
decrease muscle spasms
What are the 4 stages of sensation
- intense cold sensation and hyperemia (skin reddening)
- Burning
- Deep ache
- Analgesia
Wha are stages 1-3 like
painful and uncomfortable
What are biophyscial effects dependent on
time of exposure
method used
conductivity of the tissue
How long should it take to progress through all 4 stages
10 min with ice massage but no set time to advance through stages
What are the first n fibers to be affected by cold
small, myelinated pain fibers
Why are the small fibers affected first
they are myelinated and fatty so they dont conduct and are the 1st t be affected
How long does it normally take for changes in conduction velocity to occur
5 min
how long does it in conduction velocity take to reverse the effects
15 min
Increased duration of application leads to
increase in time it takes for conduction velocity to return to normal
(use this time for ther. act.)
(pain protective purpose is decreased during this time so use caution)
What is the immediate respone to cooling
Vasoconstriction
how long does vasoconstriciton continue in cooling
15 min
What happens after 15 min of vasoconstriction
vasodilation
What is the process of vasoconstriction to vasodilation called
hunting response
How to treat pt with acutre trauma
combine cold, elevation, and compression
Price acronym for acute traum
Pressure Rest ice Compression Elevation
What should you never apply cold to
Skin graft
Why should you never apply cold to a skin graft
slows metabolic reactions of inflammation and healing proces
what kind of cold do you use for post surgical pts
less intense (cold pack, ice bag)
how long to ice for post surgical ts
3-4x/day
20-30 min
What to combine with cold for post durgical pts
compression and elevation
What does elevation of the superficial temp of the injured area do
lowers risk of infection
prevents more severe trauma
What do muscle spasms lead to
pain and decreased ROM
how does cold decrease muscle spasms
through the muscle spindle mechanism
What do you combine cold with for muscle spasms
static positional stretch o r contract relax technique
How long to cool for muscle spasms
10-20 min
How long to col for muscle spasticity
up to 30 min
followed by 10-20 min for tone to decrease
How long will cold reduce spasticity for
approx 1 hr
What does cooling do to muscle activity
decreases FM ability
what is inaccurate after coolin
measuring grip or pinch
What should be the 1st PAM choice after acutre injur
cold (esp w/ edema)
How to apply cold after acute injury
20-30 min per 2 hr period for 1st 6-24 hrs
What to use cryotherapy for
acute/subacute inflammation acute/chronic pain secondary to muscle spasms Acute swelling myofascial trigger points muscle guarding muscle spas acute mm/lig strain acute contusion bursitis tenosynovitis arthritic flare up spasticity delayed mm onset soreness postexercise to maintain longation
what is important in cold packs
conformity
what can cold packs be combine with
elevation
how much surface area to cover with cold packs
from orgin to insertion
what is ice massage used for
to anesthitize an area
trigger points
What will impede effectiveness of ice massage
adipose tissue
what area is ice massage used for
small localizzed area
What are cold/ice water immersion baths used with
compression wrapping and compression garments
What are cold/ice water immersion baths used for
digital and hand injuries (use generally up to mid thigh)
What is the water temp for immersion bath
35-75
What do immersion baths help do
reduce edema
What do ice towels contain
ice chips or are dipped in ice water
how ofter to change ice towes
every 5-6 min
What do ice towels work for
spasticity
how to apply ice towel
circumferentially cover extremity
What is a cold compression unit
refrigerated units that circulate coled air and water through a sleeve
When to use cold compression units
post surgical
musculoskeletal injuries
What is vapocoolant spray used for
trigger points
How to use vapocoolant spray
spray entire length of mm un unidirectionl motion w/ passive stretch
Cryotherapy precautions
careful/frequent skin monitoring
never place directly on skin
never place longer than 20 min
vapocoolant sprays can freeze on contact
protective sensation is removed during numbness
in distal extremities, too much cold can lead to edema
monitor BP (cold can increase it)
avoid in those w/ poor circulation, hypersensitivity to cold
avoid directly over wounds 2-3 wk post injury
avoid prolonged placement over superficial nerve
Cryotherapy contraindications
skin grafts deep open wounds raynauds disease cold urticaria cryoglobulimemia history or presence of frostbite impaired sensation inability to verbalize sensation med condition which vasoconstriction will aggravate symptoms peripheral vascular disease hypersensitivity to cold skin conditions
Any form of cryotherapy should never be what
Used for longer than one continuous hour
What is cold urticaria
cold hypersensitivity or cold allergy
Reactions from cold urticaria
Wheals sneezing dysphasia increased HR Decreased BP Syncope
What is cryoglobulinemia
blood becomes gel like
cold reaction= abnormal collection of blood proteins that form a gel in small vessels that leads to tissue ischemia or gangrene
Things you see in Raynaud’s disease
Pallor cyanosis Rubor numbness tingling buring sensation in digits
Where does Raynauds occur
in distal extremities
what is raynauds phenomenon associated with
Carpal Tunnel
thoracic outlet
frost bite
traumatic injuries
Where does raynauds only occur in
cooled extremity
What to document in cryotherapy
tx parameters (purpose for use) duration site of application method used patient comments response to tx (4 stages) any change in occu performance
What is the general rule fro cryotherapy
apply cold for 10-20 min max
