Modalities Ch. 12 Flashcards
what is cryotherapy
use of ice for therapeutic functions
cryotherapy beyond immediate care
misconceptions
awesome for immediate care
useful beyond immediate care
cryotherapy techniques
-5 major categories
immediate care post-immediate care surgical adjunct cryosurgery miscellaneous techniques
post-immediate care cryotherapy
- primary benefit
- why start therapeutic exercise as early as possible?
primary
-decrease pain
-decrease muscle spasm
why start earlier?
-proper exercise speeds the healing process
-lack of exercise may result in permanent injury
post-immediate care precautions
too vigorous exercise may result in permanent disability
optimum healing depends on balance between
-returning to full normal function as quickly as possible
-protect injury from overstress and further injury
major cryotherapeutic techniques used during post-immediate care
cryokinetics - exercises cryostretch connective tissue stretch cold compression devices contrast baths
what happens when cold is applied
decreased temperature tissue destruction effonts on inflammation decreased metabolism decreased and increased pain decreased muscle spasm
temperature change and gradients
immediately after cold application, heat begins moving from the tissue into the cold device
tissue destroyed with severe cooling
–4 to -94 F
tissue is usually cooled to a surface temperature of 33-50F
decreased temperature
gradient continues when the cold modality is removed
deep tissue continues to cool after the modality is removed
-as a result of the gradient and heat conduction
temperature gradients within the modality
shake cold packs and stir water baths every 5 min. to break up gradient
effects on inflammation
many think one benefit of acute injury cryotherapy is to decrease inflammation
probably not true for two reasons
-inflammation is necessary for resolution of the injury
-little research has been done on the acute inflammatory response
decreased metablolism
direct relationship between tissue temperature and metabolism
effects on pain
cold is the most effective and underused physical modality for pain
clear evidence
by numbing a muscle or joint, active exercise can be used earlier in the rehabilitation process
three types of pain
cold pain
residual pain
reinjury pain
cold temp
no physiological reason related to increased healing
can be adapted to
efforts to minimize cold pain during immersion
development of neoprene toe cap -eliminates toe pain, which accounts for 50% of pain during immersion refraining from using cryokinetics -unfortunate -pain is both temporary and short lived using warmer water -treatment is less effective
decreased muscle spasm
muscle spasm is not muscle cramping
muscle cramp
seizes
-contracts really strongly
muscle spasm
muscle tightness
adhesions in the muscle
how muscle spasms are decreased
decreased by cold applications
-specific mechanism unknown
three mechanisms suggested
three mechanisms of muscle spasms relief
decreasing nerve conduction
breaking pain-spasm-pain cycle
removing cause of spasm
when is using cold to diminish muscle spasm effective?
when combined with stretching
-cryostretch
cryostretch technique
cold application until numb
combination of static stretch and isometric contraction
re-numb
increased tissue stiffness
cold tissue more stiff so more resistant to movement
some feel this contraindicates exercise after cryotherapy, fearing tissues will tear
-fine motor skills are hindered, but gross motor movement is not
decreased arthrogenic muscle inhibition
reverse injury-induced inhibition
may facilitate muscle activity above normal
circulatory response
increased and/or decreased blood flow proposed
artitrary explanations for an increase in blood flow
confusion a result of inappropriate application of CIVD concept
ample evidence that cryotherapy decreases blood flow
CIVD
Cold-Induced Vasodilation
popular thought
some claim that CIVD increased blood flow more than heat
increased rate of healing
owing to exercise, not cold
- exercise increases blood flow far more than either heat or cold
- exercise stimulates healing in other ways as well
conclusions
no increase in blood flow
purpose of cold applications post-immediate care is to facilitate rehab
exercise improves healing
physiological effects
memorize page 226 - table 12.1
recovery cryotherapy
used often to help athletes recover after activity
scientists struggle explain why the technique is beneficial
-technique is gaining momentum
recovery cryotherapy methods
whole body cryotherapy (WBC)
cold water immersion (CWI)
both techniques were first used for immediate care
why use recovery therapy?
anecdotal
psychological benefit
looking for every advantage to improve performance
problems, precautions, and contraindications
frostbite chilblains nerve palsy cold hypersensitivity/allergies vasospastic disorders cold-induced pain
frostbite
cell damage, blood vessel damage
cold modality left on >1 hour or combined with pressure
gel packs
chilblains
inflammatory condition caused by mild frostbite
- reddish purple skin that is swollen and may burn or itch
- resolves in a fwe days or weeks
- no permanent damage
nerve palsy
most common during treatment of the later fibular head
controversy over actual cause: cold, compression or combination
recommendation: be careful when applying cold and compression to areas where large nerves are superficially located
peroneal, ulnar nerves
cold hypersensitivity/allergies
many forms
most common is cold urticaria - allergic anaphylactic reaction
causes wheals to form soon after the treatment which subside in 10-30 minutes
treatment
-antihistamine
-avoid precipitation conditions
-use alternate method
severity of reaction lessens with further cold therapy
vasospastic disorders
improper dilation
ischemic necrosis
Raynaud’s Phenomenon: local functional changes in peripheral circulation as a result of Raynaud’s disease or other condition
skin turns pale or cyanotic, then red - may go back and forth
cold-induced pain
some athletes simply cannot tolerate pain of cold therapy, especially immersion
do not force therapy; try alternate methods
contraindications
specific diseases -Raynaud's -cold hypersensitivity -cold urticaria cardiac and respiratory disorders compromised or impaired local circulation or innervation (anesthetic skin) uncovered open wounds infection advanced diabetes lupus - immune system disorder
precautions
no application >1 hour
major superficial nerves
be careful when applying a commercial ice pack more than 5-10 minutes
do not apply a gel ice pack under an elastic bandage
be careful when athlete is performing exercises that cause pain following cold applications
be careful when using cryotherapy when treating a person who
-is hypertensive
-is paralyzed
-has coronary artery disease
-has a rheumatoid condition
progression of cold sensation
cold, pain, tingling, numbness
or
cold, burning, aching, analgesia
potentially due to…
-differing conduction velocities of different nerve types
or
-nerve endings as they temporarily cease to function resulting from decreased blood flow
cold therapy causes analgesia - not anesthesia (loss of sensation)
better word is hypalgesia (decrease in pain)
cryokinetics
cold + movement
commonly used for acute sprains to greatly reduce rehab time
systematic combination of cold-induced hypalgesia and progressive, graded exercise
application of cryokinetics
numb the body part -immersion preferred and most common -may also use ice massage, ice packs use pain as a guide exercise the body part -only while area is numb activity should be progressive -begin with simple ROM
cryokinetics and numbness
numbness usuallylasts 2-5 minutes
re-numb area, repeat exercise
repeat about 5 times
contrast bath
alternating immersion in hot and cold water baths
supposedly causes alternating vasodilation and vasoconstriction
sort of creates a pump
contrast bath flaws
edema reduction
-picked up by lymphatic system which does not have vasoconstriction/vasodilation
tissue temperature change
-not very significant
capillaries and lymph vessels do not vasodilate
cryokinetics more effective
lymphedema pumps
pump forces air or chilled water into sleeve, applying pressure to the joint
sleeve intermittently inflates and deflates
changes in pressure force lymphatic and venous drainage from extremity and reduce edema
cryokinetics is preferred for edema reduction
-“pump rate” is greater with cryokinetics
cryokinetics offers additional benefits of active exercise
application types
ice bags cold gel packs chemical cold packs ice immersion cold whirlpool ice massage Cryo Cuff GameReady
