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Biophysical Agents > Cryotherapy > Flashcards

Cryotherapy Flashcards

1
Q

Cooling

A

removing or abstracting heat

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2
Q

3 ways in which cooling occurs

A

conduction
convection
evaporation

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3
Q

Conduction

A

heat abstraction by direct interaction (contact) of the molecules in the warmer area with those in the cooler area

rapid moving particles (heat) transfer to slower moving particles (cold)

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4
Q

Key feature of conduction

A

body comes in direct contact with the cooling agent, which is stationary

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5
Q

Most common conductive method of cooling

A

ice or cold packs

ice massage

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6
Q

Equation that summarizes the rate of heat transfer via conduction

A

D = Area × k × (T1 – T2)/thickness of tissue

D = rate of heat loss
area = area being cooled
k = thermal conductivity of tissues 
T = temperature
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7
Q

The greater the temperature difference between the skin and the cooling agent…

A

the greater the tissue temperature will change

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8
Q

What factors impact the effect of the cooling agent?

A

temperature difference between the skin and the cooling agent

type of tissue and tissue depth

length of exposure

activity level

ability of the cooling agent to maintain temperature

total surface area being cooled

type and size of the cooling agent

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9
Q

The efficiency of a material or tissue to conduct heat

A

thermal conductivity

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10
Q

What are the immediate local effects of cold?

A

decreased blood flow, tissue temperature and nerve conduction velocity

vasoconstriction

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11
Q

Does heat or cold take longer to return to its original temperature?

A

cold

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12
Q

What is the difference between arterial and venous blood? How do arteries and veins interact?

A

arterial blood coming from the body core is warmer than the venous blood returning from the periphery

normally, as warm blood flows toward the periphery, it passes by the cooler blood in veins that lie right next to the arteries (arteries and veins course through the body next to each other, but blood runs in opposite directions)

there is a countercurrent heat exchange between the warmer arterial blood and the cooler venous blood

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13
Q

What is the difference in applying cold/heat to a muscular patient vs an obese patient?

A

muscular patient has little adipose tissue and more muscle, making it easier to cause a temperature change

obese patient has a lot of adipose tissue and little muscle, making it harder to cause a temperature change

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14
Q

Vasodilated artery

A

heat has been applied and is carrying warm blood

once heat is removed, the vasodilation allows cooler blood to rush into the area, carrying away the heat due to decreased heat exchange and the arteries constrict

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15
Q

Vasoconstricted artery

A

cold has been applied and is carrying cold blood

once cold is removed, the vasoconstricted arteries will slowly dilate as heat exchange slowly increases

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16
Q

What is the relationship between tissue depth and the duration of cold application?

A

deeper tissues require longer duration of cold application to lower the temperature

skin –> subcutaneous tissue (fat) –> muscle

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17
Q

Convection

A

heat abstraction by direct contact between the skin and moving fluid particles

rapid moving particles (heat) transfer to slower moving particles (cold)

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18
Q

Most common convective method of cooling

A

whirlpools

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19
Q

Does heat abstraction occur at a faster rate with convection or conduction given the same medium and same starting temperature? Why?

A

convection

new (cooler) molecules are continually introduced to the skin surface when movement is occurring

when no motion occurs, molecules remain in contact with the skin surface and are warmed via conduction

when a body part is immersed in stationary cold water, the molecules in contact with the skin begin to warm and form a shield around the immersed limb

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20
Q

When is the only instance in which convection methods are cooling are practical?

A

for distal extremities

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21
Q

Key feature of convection

A

body comes in direct contact with the cooling agent, which is in motion

(initial = conduction, motion starts = convection)

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22
Q

Evaporation

A

transition from a liquid state of matter to a gaseous state of matter

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23
Q

Most common evaporative method of cooling

A

vapocoolant sprays

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24
Q

When are vapocoolant sprays used?

A

for temporary pain relief before stretching muscles with active trigger points or muscles with local spasm

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25
Q

When is cold used?

A

in the management of acute trauma

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26
Q

Why is cold used in the acute stages of injury?

A

arteriolar vasoconstriction reduces bleeding

decrease in metabolism and vasoactive agents (histamine and kinins) reduces inflammation and outward fluid filtration

pain threshold is elevated, decreasing pain

possible: reduction in muscle spasm

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27
Q

What is the immediate response of the blood to cold?

A

vasoconstriction (cutaneous reflex) of the arteries due to an increase of tone/contraction in smooth muscle, causing decreased blood flow

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28
Q

Why is cold used in acute trauma?

A

to decrease bleeding

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29
Q

What is the immediate response of the blood to heat?

A

vasodilation (cutaneous reflex) of the arteries due to an decrease of tone/contraction in smooth muscle, causing increased blood flow

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30
Q

What are the effects of evaporation on tissues?

A

very minor decrease in skin temperature

decrease in motor neuron activity

negligible effects on deeper tissues

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31
Q

What happens to neurotransmitters and metabolites when cold is applied?

A

vasodilating neurotransmitters and metabolites are reduced

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32
Q

What happens to neurotransmitters and metabolites when heat is applied?

A

vasoconstricting neurotransmitters and metabolites are reduced

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33
Q

What is viscosity? What affect does it have on blood flow?

A

resistance to blood flow

increased = more resistant to flow

decreased = less resistant to flow

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34
Q

What happens to the viscosity of blood flow when cold is applied?

A

increased blood viscosity = more resistance to flow

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35
Q

What happens to the viscosity of blood flow when heat is applied?

A

decreased blood viscosity = less resistance to flow

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36
Q

Why is cold the modality of choice in the first 24-48 hours following an injury?

A

decreases the movement of fluid into the interstitial space due to vasoconstriction (reduces edema)

decrease in metabolism and vasoactive agents (decreases inflammation and microvascular permeability)

decrease in pain due to increased pain threshold

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37
Q

How is post-traumatic edema controlled by cold in the first 24-48 hours following an injury?

A

decrease in fluid filtration into the interstitial space

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38
Q

What happens to inflammation, pain and metabolism when applying cold 24-48 hours after an injury?

A

all decrease

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39
Q

What happens to intramuscular pressure in the first 24-48 hours after injury when applying cold?

A

decreases

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40
Q

What type of cooling is best 24-48 hours after an injury?

A

moderate cooling

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41
Q

What should cooling be combined with 24-48 hours after an injury?

A

compression and elevation

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42
Q

When is the dependent position appropriate? When is it inappropriate?

A

not ideal for acute injuries, but more appropriate in the later stages of healing

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43
Q

Why effect does cold have on peripheral nerves?

A

lowers nerve conduction velocity, therefore increasing pain threshold (synapses are impeded or blocked, leading to challenges with depolarization), decreasing patient’s pain to help them move better

changes in the nerve might be a mechanism for decreasing pain

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44
Q

What effect does cold for a short duration have on muscle performance?

A

no effect or a slight increase in muscle performance

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45
Q

What effect does cold for a long duration have on muscle performance?

A

significant decrease in muscle performance due to decreased strength, proprioception and agility

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46
Q

What effect does cold have on the neuromuscular system?

A

decreases spasticity (only temporary)

helps with the management of some neurological conditions

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47
Q

Spasticity reduction with cold may occur through at least two mechanisms. What are these mechanisms?

A

decrease in gamma motor neuron activity through the stimulation of cutaneous afferents

decrease in afferent spindle discharge by direct cooling of the muscle

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48
Q

Cold has been used to decrease spasticity prior to performing what activities?

A

motor control activities

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49
Q

What does the amount of nerve conduction velocity decrease caused by cold application depend on?

A

the length of exposure to cold and the amount of cold

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50
Q

What effect does prolonged or extreme cold, such as frostbite, have on nerve conduction?

A

nerve conduction can be blocked due to possible nerve damage

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51
Q

What effect does cold for a short duration have on muscle strength?

A

may increase muscle strength

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52
Q

What effect does cold for a long duration have on muscle strength?

A

may decrease muscle strength

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53
Q

What testing should we avoid after cold application and why?

A

MMT because the effects of cold last for several hours and could result in an error in measurement

must be careful with activity, as there is a risk of injury due to decreased muscle strength

CONSIDER WHAT YOU WILL DO WITH PATIENTS AFTER APPLYING ICE

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54
Q

What effect does cold have on connective tissues?

A

increases the viscosity of connective tissues, leading to increased stiffness of connective tissues

55
Q

Should you give ice to a patient with arthritis? Why or why not?

A

may increase complaint of joint stiffness because cold causes increased stiffness of connective tissue

56
Q

When ice may not be appropriate in treatment?

A

if the main goal is stretching

57
Q

When is cold the modality of choice?

A

the first 24-48 hours after an injury (in the acute phase following trauma)

58
Q

What are the most common applications of cryotherapy?

A

after MSK trauma or for post-surgical (orthopedic) swelling and pain

59
Q

Why is cold beneficial after MSK trauma and for swelling and pain after orthopedic surgery?

A

decreases edema, reduces pain, causes muscle relaxation and decreases the pain-spasm-pain cycle

60
Q

How is cold able to help patients have MSK trauma and surgery?

A

pain and muscle/spasm guarding: counterirritation, increased nociceptor threshold of excitation, decreased muscle activity and decrease in pain to allow for stretching or movement

61
Q

What are the primary goals when using cold therapy?

A

limit edema

reduce pain

facilitate muscle relaxation

limit secondary hypoxic tissue injury

62
Q

What are the clinical indications for cold therapy

A

acute MSK trauma

pain and muscle spasm

myofascial pain syndrome

63
Q

How is acute musculoskeletal trauma managed?

A

PRICE: 20-30 minutes several times per day

64
Q

PRICE

A 
Protection
Rest
Immobilization
Cold 
Elevation
65
Q

What should you take into consideration when applying ice over casts and bandages?

A

cold might need to be kept on for a longer duration (especially fiberglass casts)

66
Q

What effect does cold have on delayed onset muscle soreness (DOMS)?

A

might reduce DOMS

67
Q

The sensory, motor, and autonomic symptoms caused by myofascial trigger points

A

myofascial pain syndrome

68
Q

Trigger points

A

areas when pressed causes radiating pain

69
Q

Why should caution be observed when cold is applied to an area of neural tissue or superficial nerves?

A

there is a high risk of nerve injury or damage, such as neurapraxia and axonotmesis

70
Q

Neurapraxia

A

temporary nerve damage that feels like the affected area is “falling asleep”

removal of the cooling agent will help

71
Q

What types of inflammatory conditions warrant the use of ice?

A

tendonitis, bursitis and tenosynovitis

72
Q

What types of sprains warrant the use of ice?

A

acute muscle and ligament sprains

73
Q

With what types of pain should ice be used?

A

acute or chronic pain

74
Q

Why should ice be used with patients have have myofascial pain syndrome?

A

to treat trigger points

75
Q

What must we consider prior to using cryotherapy?

A

accessibility and availability, the body part and its size of area and whether compression/elevation is required

76
Q

What must we consider in a patient’s PMH before using cryotherapy?

A

the time since the injury and if they have hypersensitivities to cold

77
Q

How long should you avoid excessive stresses to the area post-cold treatment? Why?

A

1-2+ hours

the analgesic effect of cold could give patients a false sense of security

78
Q

What should you do if a patient has hypersentivities to cold?

A

discontinue the use of cold

79
Q

What are the normal sensory changes that occur in response to cold?

A

cold –> burning –> arching –> numbness

80
Q

What is the normal response of the skin when exposed to cold? Why?

A

hyperemia

oxygen not dissociate as freely from hemoglobin at lowered temperatures, therefore the blood passing through the venous system is highly oxygenated, giving a red color to the skin

81
Q

Reactive hyperemia

A

redness of the skin due to the delivery of warm blood to the surface

82
Q

In general, how long is cold applied to tissues? What is the expected response?

A

20-30 minutes, intermittent (some them use 10 minutes on and then 10 minutes off)

numbness and redness

83
Q

Why should could be applied intermittently?

A

to avoid or reduce the occurrence of any adverse responses to nerves or blood vessels

84
Q

For small areas, what cooling agent is recommended?

A

ice massage

85
Q

If there is concern about edema in distal extremities, what cooling agent is recommended?

A

cold compression

86
Q

When cooling around a joint or larger muscle mass, what cooling agent is recommended?

A

an ice pack secured with an elastic bandage or weighted to provide compression

87
Q

When is cold ALWAYS the appropriate choice?

A

in the acute phase of injury

88
Q

How do you know a patient is having a hypersensitivity to cold?

A

hives or wheals will appear on the skin

89
Q

Should cold be applied over areas of nerve regeneration or compromised circulation?

A

NO

90
Q

What are the precautions of using cold?

A

absent or decrease thermal sensation (could also be a contraindication) – over an area of poor sensation

thermoregulatory disorder

altered cardiorespiratory status (angina, HTN, CAD and transient changes in BP)

over a superficial nerve

individuals with poor cognition

over an open wound

in a very young or very old person

persons with aversions to cold

91
Q

Cold can impede the healing process. What should be take precaution with?

A

putting ice over a healing wound

92
Q

What are the contraindications of using cold?

A

compromised peripheral circulation (PVD)

over an area of circulatory compromise

cold sensitivity symptoms

over a regenerating peripheral nerve

93
Q

Cold uticaria

A

local and systemic reactions –>

local: in response to local cold application, patients develop wheals characterized by red, raised borders and blanched centers that are warm to the touch ; mast cell deregulation causes histamine to be released into the area, causing increasing capillary permeability, leading to redness, swelling and wheal formation (hives or itching)
systemic: flushing of the face, sharp drop in BP, increase HR and syncope/lightheadedness

94
Q

Cryoglobulinemia

A

disorder characterized by the presence of cryoglobulins, abnormal blood proteins that precipitate and form a gel when exposed to low temperatures

results in the aggregation of serum proteins, which can lead to ischemia or gangrene

associated with multiple myeloma and certain types of viral and bacterial infections, chronic liver disease, RA and SLE

95
Q

Raynaud’s phenomenon

A

a vasospastic disorder that can be either idiopathic, from trauma, SLE or Berger’s disease

smoking and caffeine can also worsen the frequency and intensity of the symptoms

cycles of pallor, cyanosis, rubor, and normal color of the digits may be accompanied by numbness, tingling, or burning

attacks are precipitated by exposure to cold or by emotional stress

96
Q

Paroxysmal cold hemoglobinuria

A

can occur following local or general exposure to cold

hemoglobin (found in RBCs) is released from lysed red cells and appears in the urine

97
Q

How does tissue depth impact the length of cold application?

A

the deeper the tissue, the longer time it takes for the tissue to cool

98
Q

What are ice packs typically composed of?

A

crushed or cubed ice and water

water can sometimes include alcohol, gel or chemicals

99
Q

What is recommended for any agent that has the ability to reach temperatures below 30° F?

A

the use of a towel over the skin

wet the towel with lukewarm or room-temperature water to make it more comfortable for the patient and to promote thermal conduction (will transfer cold more efficiently than a dry towel)

100
Q

What is the cost of using a towel with a cooling agent?

A

it will decrease the effectiveness of the cooling agent

101
Q

When are ice packs used?

A

in combination with acute edema management

102
Q

Why is ice the most effective type of cold?

A

it must undergo a phase change from solid to liquid, which causes greater heat extraction than when no phase change is required

103
Q

Why is an ice pack safe to apply directly to the skin?

A

temperature of the ice pack upon contact with the skin is typically just under 32°F

104
Q

Commercial gel packs

A

usually contain a silica gel and are available in a variety of sizes and shapes to contour to the area to be treated

105
Q

How long and at what temperature should ice packs be stored prior to use?

A

should be stored at 23 degrees F for at least 2 hours before use

106
Q

What is the purpose of using a towel related to hygiene?

A

for infection control purposes when reusing a cold pack

107
Q

What often is used to secure an ice pack?

A

a strap

108
Q

How long do ice packs last?

A

15-20 minutes

109
Q

What is the benefit of adding alcohol to an ice pack? What does this mean?

A

the mixture can reach temperatures colder than just using ice

always use a towel with these ice packs

110
Q

Ice packs activated by squeezing or hitting them

A

chemically activated by squeezing or hitting them against a hard surface

usually marketed for first aid and designed for one-time use only

NOT marketed for general use

111
Q

Where and when is ice massage usually performed?

A

over a small treatment area (muscle belly, tendon, bursa over trigger points or before deep pressure massage)

112
Q

What is used to perform ice massage? How is it applied

A

a cup or cube of ice

113
Q

When are vapocoolant sprays used?

A

to treat trigger points (acts as a local anesthetic) and induce relaxation of tight muscles before stretching

114
Q

How is vapocoolant used to treatment trigger points?

A

“Spray and Stretch” technique

the patient is positioned comfortably and the muscle containing the trigger point is placed on passive stretch

spraying is done in unidirectional sweeps along the muscle (proximal to distal) over the trigger point areas and over the areas of referred pain while maintaining and gently increasing the passive stretch (spray 12-18 inches away from the skin)

repeat spraying and rewarming

115
Q

What is the downside of using vapocoolant spray?

A

very little to no actual cooling or decreased temperature

116
Q

Cold compression devices

A

allow for manual circulation of cold water through a cuff that is applied over an extremity

sleeve provides come compression to treat edema

117
Q

When are ice baths most practical?

A

when cooling distal extremities

118
Q

When are ice baths NOT practical?

A

if the distal extremity needs to be elevated

119
Q

What do ice baths ensure?

A

direct circumferential contact

120
Q

What is the typical water temperature of an ice bath?

A

50-65 degrees F

121
Q

What is the downside of using an ice bath?

A

can be uncomfortable and at the least tolerated

122
Q

The lower the temperature range of the ice bath…

A

the shorter the duration of ice bath usage

123
Q

Commercially available cold gels or creams

A

give the perceived sensation of cold (most of these gels use chemicals)

124
Q

Whirlpool temperature guidelines

A

very cold: 34-55 degrees F

cold: 55-65 degrees F
cool: 65-80 degrees F

125
Q

Contrast bath

A

alteration of hot and cold applications

126
Q

Contrast bath temperatures

A

96-110 degrees F and 50-65 degrees F

127
Q

Contrast bath ratios

A

3:1 or 4:1 Hot:Cold Ratio

128
Q

When are contrast baths used?

A

for the control of edema (slight rise in temperature without additional accumulation of edema)

129
Q

What is the problem with contrast baths?

A

produce little to no “pumping action” although this was the original premise

little research support, but used clinically

130
Q

What is a good alternate to contrast baths? When can this be considered?

A

cryokinetics

if movement is allowed

131
Q

Cryokinetics

A

technique that combines the application of cold with exercise

132
Q

What is the goal of cryokinetics?

A

to numb the body part with cold application

once numb, have the patient perform the exercise (or WB) to treated the injured body part

can repeat with cold application, numbness and exercise

133
Q

When should cryokinetics be avoided?

A

if immobilization (PRICE) is the goal during periods of acute injury

Biophysical Agents (1 decks)

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