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Unit 2 > EEI 10/9c Cryotherapy > Flashcards

EEI 10/9c Cryotherapy Flashcards

1
Q

define cryotherapy

A

the removal of heat from a body part to decrease cellular metabolism, improve cellular survival, decrease pain and muscular spasm, and promote vsaoconstriction

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2
Q

what are examples of cryotherapy

A
  • ice/cold gel pack
  • ice massage
  • vapo-coolant spray
  • cold water immersion
  • cryo-cuff/game ready(cold compression)
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3
Q

what are the indications of cryotherapy

A
  1. acute inflammation
  2. analgesic effects
  3. decrease muscle spasm/guarding
  4. delayed onset muscle soreness
  5. muscle disinhibition
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4
Q

why is cryotherapy important for acute inflammation?

A
  • secondary cellular injury may occur if the swelling continues before the use of cryotherapy
  • it helps with decreasing some inflammation
  • it helps with decreasing some pain
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5
Q

why is it important to use cryotherapy for acute or chronic analgesic effects?

A
  • the higher the rate of firing of pain receptors, the more pain.
  • to decrease pain, ice can be used in addition to pain killers
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6
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)
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7
Q

importance of anti-inflammatory benefits of cryotherapy

A

vasoconstriction response decreases the ability of fluid to go to the area and decreases permeability to fluid

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8
Q

gate theory of pain

A

used for analgesic effects of cryotherapy

  • if you have another stimulus in the area that your pain signal is coming from, you can slow down the pain signal with a similar stimulus
  • pain signal is firing quickly, so you can decrease the nerve conduction velocity with the ice pack
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9
Q

importance of muscle disinhibition benefits with cryotherapy

A
  • reverse muscle activation inhibition related to joint swelling/effusion
  • swelling at knee has motor inhibition at certain muscles
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10
Q

decreasing muscle spasms with cryotherapy

A

muscle spindles that are associated with keeping muscles in a spastic state. You can use cryotherapy to try to decrease the spasms of the muscle fibers

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11
Q

edema vs effusion

A

effusion is at the joints

edema is within the ISF

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12
Q

how do we measure swelling?

A
  1. girth measurements
  2. volumeters
  3. sweep test
  4. pitting edema
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13
Q

what is a girth measurment?

A
  • using a tape measure to measure swelling
  • fair to high reliability
  • figure 8 ankle measurement is the most common
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14
Q

what is the purpose of a volumeter?

A
  • used a lot with hand therapists
  • often used for patients who you want to monitor over time, more specific to distal extremities, don’t use with open wounds
  • pros: good accuracy, good reliability
  • cons: time consuming, limited to distal extremities
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15
Q

what is the sweep test?

A
  • assessing swelling as you sweep across the area of swelling
  • 0 no wave produced on downstroke
  • trace is small wave on medial side with downstroke
  • 1+ larger bulge no 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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16
Q

pitting edema test?

A

swelling where there is indentation that requires a rebound

  • 0 no clinical edema
  • 1 slight pitting (2mm depth), immediate rebound
  • 2 somewhat deeper pit (3-4mm) <15s rebound
  • 3 noticeably deep pit (5-6mm), up to 30 sec rebound
  • 4 very deep pit (7-8mm), >20 sec rebound
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17
Q

methods of reducing swelling

A
  1. ice
  2. compression
  3. elevation
18
Q

importance of compression

A
  • decrease inflammatory cytokines
  • decrease capillary leakage
  • increase capillary flow
19
Q

importance of elevation

A

gravity assisted fluid return

20
Q

types of compression

A
  1. bandages and compression stockings

2. intermittent pneumatic compression

21
Q

intermittent pneumatic compression

A

medical devices that include an air pump and inflatable auxiliary sleeves, gloves or boots in a system designed to improve venous circulation in the limbs of patients who suffer edema or the risk of deep vein thrombosis or pulmonary embolism

22
Q

contraindications with using compression

A
  1. uncontrolled heart disease (CHF)
  2. arterial disease
  3. skin abnormalities (healing wounds, fragile skin)
  4. advanced peripheral neuropathy
23
Q

compression bandages

A

Pros: additional anti-inflammatory benefits; inexpensive, re-usable
Cons: requires proper set up(education); time to apply (ACE wrap); may need to be re-applied with change in swelling

24
Q

ACE wrapping principles

A
  • pressure greater distally to proximally, to push swelling upward instead of downward
  • no circumferential measurements (doesn’t guide the fluid in a specific movement)
  • over-lap by 1/2 width
  • secure with tape (no sharp pieces)
25
Q

other measures of reducing swelling

A
  • ICE: Ice, Compression, Elevation
  • RICE: Rest, Ice, Compression, Elevation
  • PRICE: Protection, Rest, Ice, Compression, Elevation
  • POLICE: Protection, Optimal Loading, Ice, Compression, Elevation
26
Q

cryotherapy and pain

A
  • cryotherapy decreases pain because decreasing the temperature of the nerves associated with pain signalling can decrease the neural signalling and decrease the amount of perceived pain
  • Gate control theory, neural signal coming from ice pack and from pain receptors, so there is only so much they can get past the CNS
27
Q

Methods for pain control management

A
  • intra-articular injections
  • Regional nerve blocks
  • IM/IV injections
  • Oral medications
  • Cryotherapy/compression
  • Mobilization/weight-bearing
28
Q

Cryotherapy and RCT

A

cryotherapy reduced pain post op for ACL reconstruction. 6/10 decreased pain with cryotherapy

  • when cryotherapy used with compression, cryotherapy only was better
  • no adverse effects in the study**
  • low risk
  • decrease in pain medication intake!
29
Q

cryotherapy used to decrease muscle inhibition

A
  • effusion in knee joint can decrease the effects of the quad muscle activation
  • used as a tactic to stimulate the muscle and allow for further healing
30
Q

when would you not want to use cryotherapy?

A

Contraindications:

  1. Cold urticaria (allergies)
  2. raynauld’s disease
  3. cryoglobulinemia
  4. paroxysmal cold hemoglobinuria
  5. impaired circulation (peripheral vascular disease and blood clot)
  6. open wounds

Precautions:

  1. sensory deficits
  2. hypertension
  3. elderly patients
  4. rheumatoid conditions
31
Q

raynauld’s disease

A

cold fingers/toes
color changes in skin in response to cold or stress
Numb, prickly feeling or stinging pain upon warming or stress relief.
whitening in response to temperature change

32
Q

cryoglobulinemia

A

blood disorder that results in thickening of the blood from abnormal proteins associated with blood anemia or myeloma

33
Q

paroxysmal cold hemoglobinuria

A

blood disorder that results in antibodies attacking RBCs a result of going from cold to warm temps

34
Q

methods for energy transfer

A
  • radiation: infrared waves, no physical contact (microwave/short diathermy)
  • conduction: two objects in contact (distinct temp difference)
  • convection: more rapid; medium moves across the body leading to temperature variations (water or air/whirlpool)
  • conversion: change of another energy form into heat (ultrasound using sound wave to warm up tissue)
  • evaporation: heat loss with transfer of liquid to gaseous state (vapor cooling spray)
35
Q

types of cryotherapy

A
  • Ice Packs
  • ice massage
  • ice and compression
  • water immersion
  • contrast bath
  • vapo-coolant spray
36
Q

ice packs as a means of cryotherapy

A
  • typically 10-20 minutes, frequency is TBD
  • not directly on skin
  • long enough for desired cooling effects
  • pros: inexpensive
  • cons: frost bite, blistering
37
Q

Ice and compression

A
  • cryo-cuffs/game ready, intermittent compression units
  • cold water flow creating therapeutic effects
  • offers compression; less risk of frostbite
  • requires more expensive equipment, more difficult set up, little carryover to home
38
Q

ice massage

A
  • frozen water cup rubbed over localized area in circular motions
  • 5-10 minutes
  • used on muscle bellies, tendons, bursa, and trigger points
  • inexpensive, good carry over to home
  • superficial use (not for deep structures)
39
Q

water immersion

A
  • used for distal edema and pain relief
  • 10-20 minutes
  • longer cooling temperature after removal
40
Q

contrast bath

A
  • alternates cold/hot temps
  • vasoconstriction/vasodilation alternating effects
  • variable ratios reported between cold/hot temperatures
41
Q

vapo-coolant spray

A
  • fluoromethane cools skin prior to muscle stretching

- ROM trigger point: muscle passively stretched (spray 2-3 times; trigger point, myofascial pain)

42
Q

stages of cryotherapy

A
  1. cold
  2. pain, stinging, burning
  3. aching, burning discomfort 4. numbness

Unit 2 (31 decks)

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