Quiz #2 cryo/thermo

Question 1

major transfer of infrared E occurs through what
(other mechanisms of transfer too)

Answer 1

CONDUCTION
convection
radiation
conversion

Question 2

examples of thermal modalities

Answer 2

◦ Cold spray
◦ Cold whirlpool
◦ Contrast bath
◦ Cryo-cuff
◦ Cryokinetics
◦ Fluidotherapy
◦ Gel packs (hot & cold)
◦ Hot whirlpool
◦ Hydrocollator packs
◦ Ice bath
◦ Ice massage
◦ Infrared lamps
◦ Laser
◦ Paraffin bath
◦ Ultraviolet light

Question 3

infrared E: depth of penetration and affects what structures

Answer 3

<1 cm (superficial)
affects cutaneous blood vessels and nerve receptors

Question 4

can we have direct physiological effects with infrared E

Answer 4

NO

Question 5

what are the 2 physiological effects of infrared and explain

Answer 5

Change in subcutaneous circulation (hypothalamus rx; inc temp=inc bf to area) and Stimulation of cutaneous nerve receptors (GCT; analgesia/ reduction of pain)

Question 6

Subepithelial tissue contains sensory receptors responsible for

Answer 6

cold, warm, pain

Question 7

pain is felt at ___ temp

Answer 7

extreme

Question 8

temp receptors respond ___/____ with ___ temp changes

Answer 8

better/quicker, rapid

Question 9

Skin vessels :
Reach maximum constriction at :
Begin to dilate again:
Reach maximum vasodilation:

Answer 9

~ 10°C (50°F)
below ~ 10°C (50°F)
~ 0°C (32°F)

Question 10

cold exposure causes

Answer 10

◦ Cutaneous vasoconstriction
◦ Shivering
◦ Piloerection
◦ Increased epinephrine secretion (increased vascular contraction)
◦ Increase in metabolism and heat production (maintain body temperature)

Question 11

inc bf= inc O2 create what 2 effects

Answer 11

analgesia and relaxation effects

Question 12

what responds to hot and cold to create a dec in m. spasm

Answer 12

GTO, m. spindles and gamma sys

Question 13

heat relaxes m. by:

Answer 13

-Lessening the stimulus threshold of muscle spindles (increased excitability)
-Decreasing the gamma efferent firing rate (decreased contraction signal)
-EMG of muscle at rest with heat is silent, but the slightest movement can cause efferents to fire, making it difficult for the muscle to relax

Question 14

cold relaxes m. by:

Answer 14

◦ Decreasing local neural activity
◦ Decreasing nerve conduction velocity

Question 15

Relationship between tissue temperature change via heat/cold application and physical performance

Answer 15

none

Question 16

effects of cryo on acute inj

Answer 16

◦ Lower temperature
◦ Reduce metabolic rate
Decrease in production of metabolites & metabolic heat (Survive hypoxia, Limits further tissue injury, Best results when combined with compression)
◦ Decrease pain (Decrease reflexive muscle spasm that
accompanies pain)
◦ Promote local vasoconstriction (control hemorrhage & edema)

Question 17

which is Better at treating acute muscle pain DOMS or cryo after exercise

Answer 17

cryo

Question 18

describe analgesia effect in cryo

Answer 18

Decreases velocity of nerve conduction
Cold impulses are more numerous than pain impulses
◦ Gate control theory (CBAN)

Question 19

whats the hunting response cycle

Answer 19

vasodilation : 4-6 min
superficial vasoconstriction: 15-30 min

Question 20

explain ice application to various tissue types

Answer 20

Question 21

describe ice massage

Answer 21

Best for treatment that requires stretching
Works at cooling a muscle faster than an ice bag
Application:
◦ Patient in comfortable, relaxed position
◦ Remove clothing from area, use towels appropriately for run-off
◦ Using circular or longitudinal strokes, apply firm pressure, overlapping strokes by half
◦ Continue application until CBAN is felt (7-10 minutes)

Question 22

describe commercial cold packs

Answer 22

◦ Cold pack should be placed with wet towel
as barrier between pack and skin
◦ Dry towel / wrap can be used to drape the
cold pack as an insulator
◦ Suggested application: 20 minutes on : 20 minutes off 2 hour period
◦ Verbal and visual feedback after 5 minutes (especially during 1st treatment)

Question 23

describe ice packs

Answer 23

◦ Works better at decreasing temperature compared to commercial gel pack
◦ Crushed ice works better than cubed ice at molding to the skin
◦ Create bag with a thin layer of ice: More energy is transferred from melting ice, making it colder
◦ Treatment time depends on treatment area

Question 24

describe cold whirlpool

Answer 24

Best for treatment requiring exercise during cold application
Use appropriate size whirlpool, filling with cold water and crushed ice
Temperature should reach 10-15oC (50-60oF)
For lower extremity, a neoprene toe cap can be used for patient comfort
Treatment time ranges between 7 and 15 minutes
Not to be used during acute and subacute stages of healing due to gravity-dependent position
Additional benefits: Prolonged temperature reduction post treatment, Massaging/vibrating action

Question 25

describe cold spray

Answer 25

◦ Best for treatment requiring: Decrease of spasm following direct trauma, Decrease of trigger points
◦ Vapocoolant should not include cholorofluorocarbons (CFC) or ethyl chloride
◦ Superficial cooling = Gate Control Theory
◦ “Spray and Stretch”: Spray in one direction parallel to muscle (Origin to insertion, Trigger point to referred pain), Static stretch at the same time as application

Question 26

describe contrast bath

Answer 26

Best for treating subacute swelling
Application requires:
◦ Cold container 10-15oC (50-60oF)
◦ Warm container 37-43oC (98-110oF)
◦ Total treatment time ~ 20minutes (Hot:cold ratios vary)
◦ Does not create “pump” effect
◦ Good transition from cryotherapy to thermotherapy

Question 27

describe cold-compression units

Answer 27

◦ Best for application of cold and compression (Acute injury , Post-surgery)
◦ Continuous flow of water and compression helps decrease temperature and swelling

Question 28

describe cryokinetics

Answer 28

◦ Combines cryotherapy and exercise
◦ Can use ice massage, cold/ice packs, ice
immersion
◦ Application:
1. 12-20 minute ice application to reach numbness
2. 3-5 minute exercise period while numbness lasts
3. 3-5 minute ice application to reach numbness
4. Repeat steps 2 and 3 five times
* Exercises should be pain free and progressive (Focus on controlled flexibility and strength)

Question 29

thermotherapy primary goals

Answer 29

INCREASES BLOOD FLOW
INCREASES TEMPERATURE OF MUSCLE, CREATING ANALGESIC EFFECT
BRINGS NUTRITION TO DAMAGED CELLS
REDUCES EDEMA
REMOVES METABOLITES AND OTHER INFLAMMATORY PRODUCTS

Question 30

thermotherapy and subacute inj effects

Answer 30

Helps decrease pain and inflammation via analgesia
◦ Injured area (deep) is cooler than the superficial treated area
* Heat vasodilates the superficial vessels, increasing capillary blood flow, and increasing possibility of edema formation
In later stages of healing, deeper heating is necessary
◦ Diathermies, Ultrasound, warm-up
◦ 1oC temperature increase creates 13% increase in metabolism

Question 31

thermo and metabolic rate

Answer 31

Metabolism and heat increase
◦ Increased intravascular hydrostatic pressure: Arteriolar vasodilation, Increased capillary blood flow & cellular permeability (Increases oxygen, antibodies, leukocytes, necessary nutrients and enzymes, and clearing of metabolites)

Question 32

thermo and m. inj

Answer 32

Produces relaxation & decreased muscle guarding
◦ Relieves pain (via Gate Control Theory)
◦ Produces sedation: Decreases hypertonicity of muscles; Decreases spasticity, tenderness, and spasm
◦ Increases elasticity & decreases viscosity of connective tissue: Decreases tightness in muscles and related structures

Question 33

describe warm whirlpool

Answer 33

Use appropriate size whirlpool, filling with
warm water
Temperature should reach
◦ 37-45oC (98-110oF) for upper extremity
◦ 37-40oC (98-104oF) for lower extremity
◦ 37-39oC (98-102oF) for full body
Treatment time ranges between 15 and 20 minutes
Caution for subacute injuries due to gravity-dependent position
Additional benefits: Massaging/vibrating action

Question 34

describe hydrocollator packs

Answer 34

Moist heat pack
◦ Canvas pouches of petroleum
distillate
Hydrocollator water temperature 77oC (170oF)
6-8 layers of towels as insulator to prevent burns
Application time ~ 15 to 20 minutes
Do not lie on top of hot pack

Question 35

describe paraffin bath

Answer 35

Best for treatment of hands & feet, especially those
suffering from chronic arthritis
Paraffin bath is set to 52oC (126oF)
◦ The mineral oil helps decrease the ambient
temperature of the paraffin (Ratio of mineral oil : paraffin is 1 gallon : 2 pounds)
Application:
◦ Dip extremity in bath for a few seconds,
repeating ~ 6 times
◦ Insulate with plastic bag and towels

Question 36

describe heat wraps

Answer 36

◦ Cloth-like wraps that conform to the body
◦ Made of iron, charcoal, salt, and water (Heat up when exposed to oxygen, Maintain heat for up to 8 hours)
◦ Reaches maximum temperature within 30 minutes of application
◦ Increases tissue temperature to a depth of 2 centimeters

Question 37

describe fluidotherapy

Answer 37

◦ Dry heat modality, using a suspended air stream of natural cellulose
◦ Applies heat, massage, sensory stimulation for desensitization, levitation, and pressure oscillations simultaneously
◦ Compared to water, it does not irritate the skin
◦ Allows for much higher temperatures [43-53oC (110-
125oF)] compared to moist or paraffin heat
◦ PROM or AROM is completed during treatment
◦ Treatment time lasts ~ 20 minutes

Question 38

2 categories of infrared lamps

Answer 38

Luminous
◦ Incandescent, tungsten, quartz red,
and carbon filament lamps
Non-luminous
◦ Not used for therapeutic treatment

Question 39

effects of infrared lamsp

Answer 39

-INCREASES SUPERFICIAL TISSUE (<1MM) TEMPERATURE WITHOUT CONTACT
-MOIST TOWELS COVER TREATMENT AREA
-DRY TOWELS DRAPED AROUND TREATMENT AREA
-LAMP PLACED ~ 20INCHES from pt
-TREATMENT TIME LASTS FROM 15-20 MINUTES

Question 40

indications for cryotherapy use

Answer 40

◦ Acute or subacute inflammation
◦ Acute pain
◦ Chronic pain
◦ Acute swelling
◦ Myofascial trigger points
◦ Muscle guarding
◦ Muscle spasm
◦ Acute muscle strain
◦ Acute ligament sprain ◦ Acute contusion
◦ Bursitis
◦ Tenosynovitis
◦ Tendinopathy
◦ Delayed onset muscle soreness (DOMS)

Question 41

indications for thermotherapy use

Answer 41

◦ Subacute and chronic inflammatory conditions
◦ Subacute or chronic pain
◦ Subacute edema
◦ Decreased ROM
◦ Resolution of swelling
◦ Muscle guarding
◦ Muscle spasm
◦ Subacute muscle strain
◦ Subacute ligament sprain ◦ Subacute contusion
◦ Myofascial trigger point