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PHTY2240 > PRAC ICE > Flashcards

PRAC ICE Flashcards

1
Q

Ice

A
  • Cooling the body surface with ice is a transfer of energy away from that region
  • Lowers local tissue temperature
  • Extent of temperature changes in the tissues depends on the rate and amount of heat energy removed
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2
Q

RICER

A
  • Rest
  • Ice
  • Compression
  • Elevation
  • Referral
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3
Q

Physiological changes

A
  1. Blood flow
  2. Metabolism
  3. Peripheral nervous system
  4. Motor system
  5. General effects
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4
Q
  1. Effect on blood flow
A

 Inital vasoconstriction of cutaneous blood vessels (skin blanches)
 restriction of blood flow to minimise heat loss
 autonomic response from stimulation of
thermoreceptors in the skin
 direct effect of smooth muscle in arterioles
 dramatic reduction in blood flow through skin

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5
Q

Effect on blood flow cont.

A
  • After 5‐10 mins ‐ vasodilation occurs which may last 15 mins
  • then vasoconstriction
  • termed “hunting reaction” (vessel ‘hunts’/oscillates around its mean constriction)
  • serves to protect tissues from damage
  • occurs more readily in the face, buttocks, hands, feet, olecranon
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6
Q

Reduction in muscle blood flow:

A

• Response of muscle blood flow less dramatic than skin
• Increased blood viscosity and vasoconstriction reduce blood flow in
muscles
• How deeper tissues are cooled will depend on overlying adipose tissue.
• Adipose tissue insulates deeper structures against temperature change
• The location of the tissue being targeted therefore affects the time of application
• Very superficial eg 5‐8 minutes
• Deeper tissue may require longer 10‐20 minutes (and even longer
applications eg ice for 20 mins then a new pack for another 20 mins)

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7
Q
  1. Reduction in metabolic rate:
A
  • Van’t Hoffs law
  • After injury,there are two sources of damage:
  • Primary injury – causes cell death and disruption of micro architecture including blood supply
  • Secondary hypoxia and post trauma enzyme activity
  • Survivingcellsmaybeatriskofhypoxicdeathastheymaybedeprivedof oxygen supply.
  • Reduced metabolic rate and rate of necrotic enzyme release and activity at lower temps enhances the survival of these cells
  • Reduced metabolic rate‐less O2requirement
  • In addition,reduction in oedema reduces secondary damage
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8
Q
  1. Effect on the peripheral nervous system:
A
  • Strong sensory stimulus activates cold receptors (Aβ and Aδ fibres) – gives pain relief via gating
  • Reduces conduction velocity of peripheral nerves particularly Aβ and Aδ fibres
  • Strong cold sensation  endorphin and encephalin release
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9
Q
  1. Effect on the motor system:
A
  • Long applications of ice (>30 mins) ‐ reduces muscle strength
  • Cooling reduces motor skills and coordination
  • Reduction in nerve conduction
  • Short applications (< 10 mins) increase isometric muscle strength and endurance
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10
Q
  1. General effect
A
  • dec. bleeding via constriction and viscosity
  • dec. by limiting oedema and pain nerve irritants
  • dec. metabolic rate and hence secondary cell necrosis • dec. joint effusion / oedema
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11
Q

Therapeutic uses

A

Acute soft tissue injuries
• Acute inflammatory joint effusion
• Post‐surgery
• Reduces muscle spasm(due to pain relief)
• Muscle spasticity
• Reflex inhibition of muscle activity
• Affects muscle spindle by prolonged cooling
• Increase viscosity which may diminish rapid stretch reflexes
• Muscle strengthening
• Facilitates a muscle contraction (brief application)
• Short application‐ increase isometric strength
• Chronic inflammation,oedema and joint effusion
• OA/RA in chronic phases
• Long immersions (30 mins) for chronic oedema
• Ice and compression for joint effusion

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12
Q

other uses

A

• Ice massage for pressure sores
• Ice and stretching (in conjunction with Trigger point therapy – Travell
and Simmons)

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13
Q

Methods of application

1. Ice packs

A
  • Ice pack – crushed ice
  • Commercial ice packs
  • Single use – endothermic chemical reaction • Reusable gel packs
  • Ice wraps
  • Ice gels
  • Ice sprays
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14
Q

Ice packs cont….

A
  • Flaked ice is folded into a damp towel
  • Can use plastic bag inside the towel
  • Protect bony prominences
  • Frozen peas cool the skin more than gel packs (Chesterton et al 2002) – cheaper and more environmentally friendly.
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15
Q

ice pack types

A

conventional - 15mins 3.4 > 30mins 6.9˚c
gel pack: 15mins: 1.8˚ >30mins: 4.4˚c
chemical pack: 15mins:1.6˚ >30mins: 2.9˚

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16
Q
  1. Ice bucket or bath
A
  • Useful for distal extremities
  • Immerse between 5‐15 mins.
  • Use with caution for too much cooling • May need to remove at intervals
17
Q
  1. Ice massage
A
  • small areas eg tendon
  • small circular motion
  • can also be used to stimulate muscle contraction
18
Q
  1. Contrast baths
A
  • Hot and cold water baths
  • Hot = 40‐45°C, 3‐4 mins
  • Cold = 15‐20°C, 1 min
  • To reduce swelling, pain
19
Q
  1. Spray and stretch
A
  • Travel and Simmons 1993
  • Myofascial techniques and trigger point therapy • Vapocoolant spray
  • Passive sustained stretch
20
Q

Contraindications

A

Circulatory insufficiency
Exacerbation of existing condition
• Cold Sensitivity
• Vasospasm e.g. Raynauds disease – excessive vasoconstriction in the digital arteries
triggered by cold.
• Cryoglobinaemia
• An abnormal protein is present in blood.
• Can form a precipitate at low temperatures that blocks vessels and causes ischaemia
• Not common but associated with Systemic lupus (SLE) and Rheumatoid (RA)
• Cold Urticaria • ‘cold allergy’
• Cold causes release of histamines from mast cells – local weal and erythema
• Sometimes systemic symptoms such as lowered BP and raised PR

21
Q

Precautions:

A
  • Unable to communication
  • Sensory loss (thermal or anaesthetic)
  • Note, sensation test
  • If sensory loss, also check capillary return and skin reaction after 5 mins of application
  • Emotional and psychological features
22
Q

danger/precautions

Ice BURNS

A
  • Mild form causes erythema and tenderness for 2‐3 hours after ice
  • Severe form ‘ice burn with fatty necrosis’ shows bruising as well and tenderness may last for up to 3 weeks
  • Cause is usually from large piece of uncrushed ice directly held against the skin
  • Avoid using solid, uncrushed ice application eg. ice cubes or ice bricks
  • Always use a damp towel or cloth between ice source and skin
  • Rare in the clinical setting but need to monitor
23
Q

Sensation testing prior to cold therapy

A

Ice reaction test
• Ice cube massage for 30 seconds OR
• Apply ice pack and check for local response after 5 minutes
• Examine for excessive redness, inflammatory weal or systemic reaction including increased blood pressure or heart rate.

24
Q

Heat or cold??

A
  • Stage of inflammation
  • Collagen extensibility
  • Muscle spasm
  • Muscle contraction
  • Area to be treated
  • Ease of use
  • Patient preference

PHTY2240 (12 decks)

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