Lecture 2 (cold modalities) COPY Flashcards
Can coldness be taken away from an object?
No, coldness cannot be added or taken away - temp change is due to removal or addition of heat (makes sens molecules speeding up or slowing down)
Do cooling therapy modalities work via conduction or convexion?
Conduction
What are our 4 cold modalitites?
1) Ice pack
2) Immersion cold / ice bath
3) Cryo cuff (game ready)
4) Ice massage
Define convection
Heat is removed when the skin is in direct contact w/ moving fluid particles
think ice bath
vasocoolanto spray - evaporation
pt recieves heat modalitity and on a different treatment day recieves cold modalitity. On which of those days did it take more time to return to baseline after reciving treatment? Why?
Heat returns to baseline more quickly
this is because w/ cold we have a decrease in BF so temperature exchange happens slower (because blood is waht does temperature exchange. However, w/ heat therapy we have increased BF meaning that temperature change can happen more quickly returning us back to baseline faster (vasodilation).
What increases bloodflow, heat therapy or cold therapy?
Heat
Why would we avoid strength testing immeditely after heat / cold therapy?
Because those results would be skewed and wouldnt be their normal baseline
KNOW: normally musclar performance is reduced w/ the application of cold therapy (due to decreased BF) - however it may be increased within the first 5 minutes of cold treatment (epi/nor)
What returns to homeostasis faster, muscle tissue or adipose?
muscle
How long does it take for fully chilled m tissue to return back to normal after cold treatment
2-3 hours
So we should ice after treatment or they might have reduced BF
KNOW: w/ ice we have reduced proprioception / somatosensory stuff (do to reduced nerve speed velocity)
Should you do balance activities before or after cold treatment?
Before - because the cold treatment will make them lose proprioception aka falling more easily because they don’t know where they are in space
When should you start using ice on injury? Why
24-48 hours after - because thats when we start to have the most edema
analgesic means
reducing pain
Why might ice be good for an injury? Why might it be bad?
Good = decrease swelling
Bad = less blood flow = less healing
What 3 things should we do for edema
Ice
Compression
Elevation
(NOT HEAT)
Should you take anti inflammatory meds for inflammation?
No
We don’t want to impede healing process (unless its too extreme and the inflammatory process is out of contorl)
What happens to peripheral nerves when they get chilled (psychologically)
It takes more to take them to deporlize - which is why they’re numb - they arent firing anymore (can’t sense as much input)
What happens to nerve conduction velocity w/ cold theapy?
Slows it (decreased proprioception)
What happens to pain threshold w/ cold treatment? Why?
Increases
Because we can’t feel as much - so of course it won’t hurt as bad
What happens to motor performance when someone is exposed to cold therapy
Decreases
KNOW: Nerves that are superifical and exposed to ice may experience a nerve block. We don’t want to do this - we want to slow down nerves but not block them.
KNOW: Before applying cold ask “Do you have any disorders or diagnoses that are going to affect your tolerance to cold”
What is raynauds?
Causes distal extremitites to go numb when exposed to mild cold (or stress does this)
Cold therapy contraindications:
* Cold urticaria: Hisamine response w/ cold
* Cryoglobulinemia: Blood thickening proteins released w/ cold
* Raynauds phenomena: vasospasm disorder reduced BF to distal extremities w/ cold / stress
* Paroxysmal cold hemoglobinuria: hemoglobin is lysed from RBCs w/ cold and exreted in urine
Don’t apply cold over:
* regenerating peripheral nerve
* Cirulatory compromise (or PVD) - think even if they sprained their ankle / excessive swelling
* Peripheral vascular disease
Precaustions for cold therapy
* hypertension (might increase BP - have them lie supine)
* Thermoregulatory disorders (cant regulate temp well)
* Cold application over a superficial nerve / open wound (cold will impede healing) / poor sensation (no sinsation would be a contraindcation)
* Very old or very young sensation (reduced ability to thermoregulate)
* Cold aversion (dont like the cold)
Any cold modalitity is good for reducing pain because nerve velocity is lower
Best for reducing swelling = game ready / ice pack w/ compressiong / elevation
BEst cold modality for icnreased ROM = vasocoolant spray
Vaso coolant spray = reduces muscle spasms
KNOW: Improve msucular performance = cold therapy not indicated
What should we do before and after cold modality is applied
Test and re test
Ask about pain level / do girth measurement
If pt has swelling and we want to see how much swelling is there after cold modality what measurement would we utilize?
Girth
Things that we have to document
* Type of cold agent
* Treatment duration
* Treatment site
* Pation positiong
* Compression/Elvation utlized (edema)
* Patient response (skin apperance / change in symptoms /edema [ROM, pain])
* Adverse responses (excessive redness / splotchy skin)
Cold compression units = game ready
Cold modalities:
* Cold pack
* Ice massage
* Vapocoolant Spray
* Cold Compression units (Game ready)
* Ice bath
KNOW: When pt walks in before cold therapy
* Whats your current pain level (pre test)
* Do you have anything that will affect your tolerance to cold (diseases)
* What position is most comfurtable to you
* touch the pts extremity and ask if they can feel it (will let you know if they have sensation in that area) (maybe also touch the cold pack to see if they can feel it?)
* make sure to do a skin check before and after treatment
* check pain level after treatment
How many layers do we need for cold packs? Why?
We really just need 1 layer (towel or pillow case)
Because we want that direct cold application
What kind of cold pack is utlized for shoulder?
cervical (pointy side up)
How long should cold packs be left on pt?
20-30 minutes
If we just want a numbing effect we can do 15-20 minutes - also affected by the amount of sup Q / muscle mass
KNOW: Size of cold pack should match size of treatment area
KNOW: Ice packs / Ice Massage stored in freezer at 32 degrees
KNOW: We can do more than 1 layer w/ ice pack
What kind of pts is ice massage for? whats the point of an ice massage
pts who have small specific point area thats causing them lots of pain
* think small point over muscle (tight band of muscle)
* trigger point
* tendon
Point is to get them to numbness
What is the pts position w/ ice massage?
where ever they are comfertable
What should you tell the pt about the cold massage?
“Our goal is to get you to go numb in this small area”
You’re going to proably feel some cold at first then burning then aching then numbness
How long should ice massage be applied?
No more than 10 minutes (shortest because no layers between ice and skin)
KNOW: Before doing ice massage confirm sensation
KNOW: check RPE before and after ice massage
what is the order of lost sensation?
Cold –> Burning –> Aching –> Numb
How do you apply vapocoolant spray?
be 12-18 inches away and do broad sweeps to avoid spray too much in one spot (causing a cold spot)
* unidirectional sweeps
KNOW: Inspect skin before vapocoolant spray
KNOW: Vapocolant primarily used to reduce protective tone / trigger points
KNOW: Cold compression units can be electric or gravity
KNOW: w/ cold compression units their typical treatment time is 30 minute cycles (don’t want nerve block / chronic cooling)
can be used for hot and cold / compression
no set position pt should be in (but for edema control we want that body as elevated as possible –> defiently not in a dependent position)
make sure to fill unit w/ appropriate amount of ice water
start w/ medium for edema treatment
good temp around 36
Dependent position = gravity pulling it down
* think gravity pulling intersitial fluid down
* We don’t want this for edema treatment
Whirl pool = moving ice bath
Stationary bath = conduction
Whirlpool (moving) = convection
* faster cooling will occur
KNOW: For ice bath you want to fill the bath will well more fluid than is required to cover the distal extremity that has the area (if theres swelling at the ankle i want to cover well passed the ankle)
How long is treatment time for ice bath?
15-20 minutes (A lot of pts won’t be able to make it that long –> we really want to get them to numbness)
If edema is present you want the pt in a non-dependent position (gravity isnt pulling it away from the heart) for ice bath - however this is like impossible
