Modalitites practicle - cold (lab) Flashcards
Why would we want to make sure the person has good circulation before putting ice on them?
Because it slows down blood flow and if blood flow is already slow we wouldnt want to slow it more
KNOW: Asses pain level before and after using modality to see if it worked
* if theres swelling take a girth measurement before and after
What do we use for swelling?
Ice
KNOW: Proprioception is decreased when there is swelling (ice can help bring that down)
What are contra indications for cold?
Vascular insufficiency / PVD
Lack of thermal sensation
Cold sensitivity conditions
Regenerating peripheral nerve
KNOW: Pain modalitites = hot and cold
If theres swelling use cold / compression / elevation
KNOW: We should be assessing the treatment area for sensation, and signs of circculatory compromise
You get the cold pack to put over somebodys lumbar spine for pain. You get the ice pack out of the freezer. What is the next thing you do
Place the cold pack in a pillowcase or cover with at least 1 towel layer onto the treatment area
KNOW: You can ace wrap the cold pack to hold it to a portion of their body
how do you wrap the foot?
Leave ankle and toes out
NOTE: We want at least 2 layers of ace wrap when wrapping for compression (more layers = more compression)
When should you check the skin for ice?
before and after applicatoin
If they’re ever saying its too cold thats when you take it off, or if its stinging to much
how often should you recheck a patient w/ cold?
5 minutes
ALWAYS INSPECT SKIN PRIOR TO APPLICATION
How long is the treatment time w/ ice pack?
10-15 minutes
Game Ready
make sure its full of ice
Power on
Temp around 36 degrees
15-30 minutes (shoot for around 20 minutes)
There is a cycle time because we don’t want it to get too colrd
Moderate pressure (medium - start here especially if theres swelling in the area)
NOTE: We can use this without swelling by turning off the pressure
Dial is the temperature setting
top left is pressure
will beep when starting
Can you lay them down?
often run after sugery (calm down swelling / numbing effect)
* often run 2 - 3 hours (but were doing it for like 15 minutes)
Ice pack = number 1 modalitity cold thing for ice
Ice machine = number 1 modality for swelling
Ice masage:
* Can be ice in the bag (direct ice)
* Pen
* Cup of ice
How would we check if someone has cold sensitivity?
Ask them
Who is most likely to have cold sensitivity?
Spinal cord injuries
Diabetes
Why wouldnt we use ice on someone w/ vascular insufficiencys?
How could we tell if they have vascular insufficencies when were doing treatment?
Because the blood already has a hard time moving through the body - so making it cold would slow it down even further.
Splotchy patches on their skin would indicate vascular insuffiecency
* red would be normal –> splotching is bad
* its especially bad if you’re like soaking someones leg and you start to notice the splotching going up the extremeity
KNOW: You can really only do ice bath on extremities
What two things would we primarily use Ice massage on? Why
Trigger points
Tendinopathys
We would do it on these injuries because they’re smaller and we can more pinpoint them
What is a tendinopathy? what intervention would be most likely to be used on it and why?
Tendinopathy = swelling of the tendin
Useing Ice because it decreases swelling
Using ice massage (which is like the pen) because it an more pinpoint it
NOTE: ice massage is typically used on things more superifical
How long is ice massage done on pt?
No more than 10 minutes
However, were really just looking for them to go through all the stages of cold therapy (cold –> burning –> aching –> numbing)
What are the stages of cold therapy?
Cold –> Burning –> Aching –> Numbing
We want to get the numbing stage to decrease pain
* Ice massage is great for tendinopathys because theres normally significant pain along w/ them so this helps because of the numbing effect
* Tendinopathies are also quite taut –> so stretching them while doing the ice massage is also an option (because they’re numb)
What are the 4 contraindicates for cold?
Vascular insufficincy / peripheral vascular disease
Lack of thermal sensation
Cold sensitvity conditions
Regenerating peripheral nerve
W/ ice massage how big should the area be that were covering? Why?
Pretty small, to allow for the numbing to take place
KNOW: The really good thing about ice massage is that we can do other EX while were doing it.
The reason I would pick it is because it can pinpoint a small area (tendinopathy / trigger points
You’re ice massaging behind someones knee and they say they have a dull aching pain thats traveling down their leg. What is it and what should you do?
You’ve proably numbed a peripheral nerve. Lay off that area - thats not the goal of ice massage
Symptoms of ice massage should be very localized
Pt has lateral eipcondyalgia. What modality should we use? What should we be worried about in this area?
Ice massage = pinpoint area
Should be worried about numbing the radial nerve
NOTE: we could even do eccentrics while the numbing is going on - they wouldnt feel the pain w/ the motion yet were still getting it in
KNOW: You should be moving the ice massage the entire time to prevent burns
KNOW: Ice massage can be done for more than just tendin / trigger points. However its better for superficial more localized things
KNOW: For ice massage move in line w/ the muscle fibers down the tendin
Cross friction runs perpendicular to the m fibers on the tendin
* Bad for pain dominent
* if there was no pain involved maybe try this but its a lot more agressive
What is it called to go against the tendin fiber directoin?
Cross friction
much more uncomfertable and more agressive (better when pain is not involved and were trying to push the muscle)
* Helps change the fiber orientation
Cryotherapy = Cold therapy
Ice bath (not common)
How long should someone stay in an ice bath?
15-20 minutes
KNOW: Ice baths are good for full limb
Less good for edema because they’re in a dependent position
For cold modalitites we would do them after when were worried about swelling / pain after the EX
we would do ti before if we want to limit the pain / swelling before exercise so that we can exercise more efficently
KNOW: before ice bath assess the skin for sensation, signs of circulatory compromise (splotching) and be mindful of superficial nerves
No wheeping wounds (white fluid coming out of it) / open wounds
Always explain to the pt what the cold modality is for / dose
“its going to burn a little bit at first but our goal is to make it numb” - “ I want to do some functional activity while your numb to kind of stifle off some of that pain and get you moving”
How often are you assessing skin for an ice bath pt?
every 5 minutes
What is the ideal temp for an ice bath?
50-64 degrees (can be as low as 30) - the cooler the better
If they can’t tolerate it you can always add warm water to it.
KNOW: Remove all jewlery before doing ice bath
KNOW: cold bath pts might get really cold - you can add warm water
NOTE: treatment is 15-20 minutes
