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Unit 2 > Cryotherapy/Swelling (10/9c-d) [Examination/Intervention] > Flashcards

Cryotherapy/Swelling (10/9c-d) [Examination/Intervention] Flashcards

1
Q

What is cryotherapy?

A

The removal of heat from a body part to decrease cellular metabolism, improve cellular survival, decrease inflammation, decrease pain and muscular spasm, and promote vasoconstriction

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2
Q

Examples of cryotherapy

A 
Ice/cold gel pack
Ice massage
Vapo-coolant spray
Cold water immersion
Cryo-cuff/Game-ready
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3
Q

Indications for cryotherapy

A

Acute inflammation
- reduces secondary cell damage

Analgesic effects (acute/chronic)

Decrease muscle spasm/guarding
- spasticity management

Delayed onset muscle soreness
- muscle disinhibition

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4
Q

Physiology Behind Cryotherapy Use

A

Anti-inflammatory benefits
- vasoconstriction response

Analgesic effect
- gate theory of pain

Relaxation of muscle spasm
- inhibition of nerves/muscle spindles

Muscle disinhibition
- reverse muscle activation inhibition related to joint swelling/effusion

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5
Q

Measuring Swelling - Girth Measurements

A

Using tape measure to assess the girth of swelling in an area

Most common is Figure of 8 measurements
- wrap tape measure around body part in figure 8 fashion

Fair to high reliability

Tools needed: Tape measure

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6
Q

Measuring Swelling - Volumeters

A

Using water to assess swelling in distal extremities (EX: hand, foot)

Fill volumeter tank with water, place extremity in tank, measure how much water is displaced

Pros — Good accuracy and reliability, Able to use when swelling is very diffuse

Cons — Time consuming, Limited to distal extremities, messy

Tools needed: Volumeter, Water

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7
Q

Measuring Swelling - Sweep Test

A

Sweep hands around the knee, see how fluid moves around

SCALE
0 = no wave produced with downstroke

Trace = small wave on medial side with downstroke

1+ = larger bulge on medial side with downstroke

2+ = Effusion returns to medial side after upstroke

3+ = Fluid cannot be moved out of medial knee

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8
Q

Measuring Swelling - Pitting Edema

A

SCALE
0 – no clinical edema

1 – slight pitting (2 mm depth), immediate rebound

2 – somewhat deeper pit (3-4 mm), < 15 sec rebound

3 – noticeably deep pit (5-6 mm), up to 30 sec rebound

4 – very deep pit (7-8 mm), > 20 sec rebound

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9
Q

Compression - Physiology

A

Decrease inflammatory cytokines

Increase capillary flow

Lower capillary leakage

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10
Q

Compression - Types

A

Compression bandages

Compression stockings

Intermittent pneumatic compression

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11
Q

Compression Bandages- Pros/Cons

A

PROS

  • Additional anti inflammatory benefits
  • Inexpensive
  • Reusable

CONS

  • Requires proper setup (education)
  • Time to apply (ACE wrap)
  • May need to be reapplied with change in swelling
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12
Q

ACE Wrap Principles

A

Pressure greater distally to proximally

No circumferential measurements

Overlap by 1/2 width

Secure with tape (no sharp pieces)

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13
Q

Compression - Contraindications

A

Uncontrolled heart disease (CHF)

Arterial disease

Skin abnormalities (healing wounds, fragile skin)

Advanced peripheral neuropathy

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14
Q

Elevation provides gravity assisted ___ ___

A

fluid return

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15
Q

Why replace rest with optimal loading?

A

to promote early recovery, when appropriate

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16
Q

Evidence - Cryotherapy decreases pain

A

Decreased temperature of peripheral nerves

  • decreased neural signal
  • decreased perceived pain

Gate control theory of pain
- large diameter neurons are activated in the spinal cord → blocks perceived pain

Cryotherapy better than no cryotherapy in 50% of trials (and no adverse effects in any study)

Cryotherapy/compression > cryotherapy

17
Q

CPGs about cryotherapy

A

Clinicians should use repeated intermittent applications of ice to reduce pain, decrease the need for pain meds, and improve weight-bearing following acute ankle pain

18
Q

Evidence - Cryotherapy decreases muscle inhibition

A

Moderate-quality evidence in support of cryotherapy + exercise to improve quadriceps arthrogenic muscle inhibition

19
Q

Cryotherapy - Contraindications

A

Cold urticaria/allergies

Raynaud’s disease

Cryoglobulinemia

Paroxysmal cold hemoglobinuria

Impaired circulation

  • peripheral vascular disease
  • blood clot

Open wound

20
Q

Cryotherapy - Precautions

A

Sensory deficits

Hypertension

Elderly patients

Rheumatoid conditions

21
Q

Methods of Energy Transfer

A 
Radiation
Conduction
Convection
Conversion
Evaporation
22
Q

Energy Transfer - Radiation

A

infrared waves, no physical contact

23
Q

Energy Transfer - Conduction

A

two objects in contact, usually with distinct temp difference

EX: ice pack or heat pack

24
Q

Energy Transfer - Convection

A

more rapid; medium moves across the body leading to temperature variations

EX: whirlpool

25
Q

Energy Transfer - Conversion

A

change of another energy form into heat

EX: ultrasound

26
Q

Energy Transfer - Evaporation

A

heat loss with transfer of liquid to gaseous state

EX: vapocoolant spray

27
Q

Cryotherapy - Ice Packs

A

Typically 10-20 minutes, frequency TBD

  • not directly on the skin
  • long enough for desired cooling effects
  • for deeper cooling, don’t apply directly to skin so they can tolerate longer duration

Benefits – inexpensive, somewhat constant temperature

Negative side effects — frostbite, blistering

28
Q

Cryotherapy - Ice and Compression

A

Cold water flow creating therapeutic effects

Benefits — offers compression, less risk of frostbite

Negatives — requires more expensive equipment, more difficult set-up, little carryover to home

EX: cryo cuffs, GameReady, intermittent compression units

29
Q

Cryotherapy - Ice Massage

A

Frozen water (cup) rubbed over localized area in circular motions

  • typically for 5-10 minutes
  • typical uses - muscle belly, tendon, bursa, trigger points

Benefits — inexpensive, good carryover to home

Negatives — superficial use (not deep structures), can get messy

30
Q

Cryotherapy - Water Immersion

A

Used for distal edema and pain relief
- about 10-20 minutes

Longer cooling temperature after removal

Contrast bath

  • alternates cold/hot temperatures
  • vasoconstriction/vasodilation alternating effects
  • variable ratios reported between cold/hot temperatures
31
Q

Cryotherapy - Vapocoolant Spray

A

Fluoromethane – cools skin prior to muscle stretching

ROM/trigger point

  • muscle passively stretched
  • spray 2-3 times
  • trigger point/myofascial pain
32
Q

Patient Stages of Cryotherapy

A

Cold

Pain, stinging, burning

Aching, burning discomfort

Numbness

Unit 2 (27 decks)

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