Modalitites practicle - cold (lab)

Question 1

Why would we want to make sure the person has good circulation before putting ice on them?

Answer 1

Because it slows down blood flow and if blood flow is already slow we wouldnt want to slow it more

Question 2

KNOW: Asses pain level before and after using modality to see if it worked
* if theres swelling take a girth measurement before and after

Question 3

What do we use for swelling?

Answer 3

Ice

Question 4

KNOW: Proprioception is decreased when there is swelling (ice can help bring that down)

Question 5

What are contra indications for cold?

Answer 5

Vascular insufficiency / PVD
Lack of thermal sensation
Cold sensitivity conditions
Regenerating peripheral nerve

Question 6

KNOW: Pain modalitites = hot and cold

If theres swelling use cold / compression / elevation

Question 7

KNOW: We should be assessing the treatment area for sensation, and signs of circculatory compromise

Question 8

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

Answer 8

Place the cold pack in a pillowcase or cover with at least 1 towel layer onto the treatment area

Question 9

KNOW: You can ace wrap the cold pack to hold it to a portion of their body

Question 10

how do you wrap the foot?

Answer 10

Leave ankle and toes out

Question 11

NOTE: We want at least 2 layers of ace wrap when wrapping for compression (more layers = more compression)

Question 12

When should you check the skin for ice?

Answer 12

before and after applicatoin

If they’re ever saying its too cold thats when you take it off, or if its stinging to much

Question 13

how often should you recheck a patient w/ cold?

Answer 13

5 minutes

Question 14

ALWAYS INSPECT SKIN PRIOR TO APPLICATION

Question 15

How long is the treatment time w/ ice pack?

Answer 15

10-15 minutes

Question 16

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)

Question 17

Ice pack = number 1 modalitity cold thing for ice

Ice machine = number 1 modality for swelling

Question 18

Ice masage:
* Can be ice in the bag (direct ice)
* Pen
* Cup of ice

Question 19

How would we check if someone has cold sensitivity?

Answer 19

Ask them

Question 20

Who is most likely to have cold sensitivity?

Answer 20

Spinal cord injuries
Diabetes

Question 21

Why wouldnt we use ice on someone w/ vascular insufficiencys?

How could we tell if they have vascular insufficencies when were doing treatment?

Answer 21

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

Question 22

KNOW: You can really only do ice bath on extremities

Question 23

What two things would we primarily use Ice massage on? Why

Answer 23

Trigger points
Tendinopathys

We would do it on these injuries because they’re smaller and we can more pinpoint them

Question 24

What is a tendinopathy? what intervention would be most likely to be used on it and why?

Answer 24

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

Question 25

NOTE: ice massage is typically used on things more superifical

Question 26

How long is ice massage done on pt?

Answer 26

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)

Question 27

What are the stages of cold therapy?

Answer 27

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)

Question 28

What are the 4 contraindicates for cold?

Answer 28

Vascular insufficincy / peripheral vascular disease

Lack of thermal sensation

Cold sensitvity conditions

Regenerating peripheral nerve

Question 29

W/ ice massage how big should the area be that were covering? Why?

Answer 29

Pretty small, to allow for the numbing to take place

Question 30

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

Question 31

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?

Answer 31

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

Question 32

Pt has lateral eipcondyalgia. What modality should we use? What should we be worried about in this area?

Answer 32

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

Question 33

KNOW: You should be moving the ice massage the entire time to prevent burns

Question 34

KNOW: Ice massage can be done for more than just tendin / trigger points. However its better for superficial more localized things

Question 35

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

Question 36

What is it called to go against the tendin fiber directoin?

Answer 36

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

Question 37

Cryotherapy = Cold therapy

Question 38

Ice bath (not common)

Question 39

How long should someone stay in an ice bath?

Answer 39

15-20 minutes

Question 40

KNOW: Ice baths are good for full limb

Less good for edema because they’re in a dependent position

Question 41

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

Question 42

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

Question 43

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”

Question 44

How often are you assessing skin for an ice bath pt?

Answer 44

every 5 minutes

Question 45

What is the ideal temp for an ice bath?

Answer 45

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.

Question 46

KNOW: Remove all jewlery before doing ice bath

Question 47

KNOW: cold bath pts might get really cold - you can add warm water

NOTE: treatment is 15-20 minutes