Superficial Cold & Heat Flashcards
Cryotherapy is the use of ____ modalities for therapeutic purposes as an adjunctive tool in rehab of ______ and _____ dysfunctions and is grounded in ______ responses that occur when tissue temp decreases
cold
musculoskeletal and neuromuscular
physiological
Cryotherapy considerations
be mindful of metals in or on the body such as shrapnel, body piercings, jewelry
Change in tissue temp over time: rank which tissues drop from fastest to slowest/most constant:
- Subcutaneous
- Muscle
- Skin
- Skin drops the fastest
- Subcutaneous drops steadily
- Muscle stays relatively constant but does drop slightly
Cryotherapy response factors - clinical considerations (7)
- Temperature differences b/w agent and tissue
- Time of exposure
- Thermal conductivity of tissue
- Type and size of agent
- Total body surface area cooled
- activity level of client
- ability of agent to maintain temperature
Physiological Effects of Cryotherapy
CHANT-M
- Hemodynamic
- Metabolic
- Analgesic
- Neuromuscular
- Cardiovascular
- Tissue Extensibility
Hemodynamic Effects of Cryotherapy
- Vasoconstriction
- increase in vascular smooth muscle tone
- reduction of vasodilating neurotransmitters
- stimulation of dorsal root ganglion - Increased blood viscosity
- Results in decreased blood flow in cooled area
The hemodynamic effects of cryotherapy start with decreased ____ and ____, increased ________ and _____ stimulation
- Histamine & Bradykinin
- Smooth Muscle Tone
- DRG
After increased smooth muscle tone occurs with cryotherapy, there’s increased vaso-____ combined with increased blood ____ which results in an overall decrease in blood ______
vasoconstriction; blood viscosity; blood flow
Metabolic Effects of Cryotherapy include a decrease in _____, ______ and _________
metabolic rate, cellular activity, cellular oxygen demand
Over the metabolic effects of cryotherapy are decreased _______ and ___ in cooled area
inflammation; edema
The analgesic effects of cryotherapy include a decrease in the __ nerve conduction velocity and increased threshold for _____ which causes an overall decreased nociceptive afferent input effect (LESS pain)
peripheral; depolarization
It’s important to be mindful of especially lean patients with cryotherapy because the decrease in peripheral nerve velocity affects both ____ AND _____ nerve conduction velocities, which can subsequently lead to failure (nerve ____)
sensory AND motor NCVs
nerve block
The neuromuscular effects of cryotherapy include (3)
- Muscle Performance Effects
- Proprioception Effects
- Spasticity Effects
Overall, cryotherapy decreases the muscle ____ due to decreased peripheral NVCs and decreased _____ input necessary for reflex integration and neuromuscular control
force; somatosensory
Why should you be mindful of using cryotherapy in populations you are trying to do performance tasks for?
Results in transient performance effects in strength, balance and agility tasks
The effect of spasticity from cryotherapy results from a:
decrease in ___-motor neuron activity
increase in __-motor neuron activity
decrease in sensitivity and activity of the muscle ___
and decrease in reaction to change in muscle ___
gamma-motor
alpha-motor
muscle spindle
muscle length
Cardiovascular Effects of Cryotherapy include whole body cooling from (4)
- Generalized vasoconstriction
- Increased blood pressure
- Decreased heart rate
- Decreased respiration
In cardiovascular compromised patients, you should use caution and
keep the rest of the body warm
The tissue extensibility effects of cryotherapy include (2)
- Decrease in tissue extensibility
2. Increase in tissue stiffness
If a muscle is ____ and _____, you should NOT use cold therapy
shortened; tight
What are the general physiological effects of superficial heating that INCREASE? (5)
- Increased tissue temp
- Increased local metabolism/nutrition
- Increased blood flow/vasodilation
- Increases local swelling
- Increases body temp, respiratory & pulse rates
What are the general physiological effects of superficial heating that DECREASE?
- Decreased pain
- Decreased muscle spasm
- Decreased blood pressure
- Reduced skin resistance
- Reduced joint stiffness (prepares for exercise)
- Sedation of nerve endings (similar to #1)
What are the big 3 in the Normal Healing Process? (hint: IPR)
- Inflammation
- Proliferation
- Remodeling
Inflammation
redness, warmth, pain, swelling, loss of function
Proliferation
48-72 hours after injury
Remodeling
can last over a year
In the Normal Healing Process, when should you use heat?
AFTER 72 hours because you do not want to agitate the inflammation period (better to use cold therapy)
Vasodilation results from 3 proposed factors, which are
- Axon Reflex
- Release of Chemical Mediators (like histamine, prostaglandins)
- Local Spinal Cord Reflex
In the metabolic effects of superficial heating, the metabolic rate ___ 2-3x for each ___deg C rise in tissue temperature
increases; 10
In the metabolic effects of superficial heating, oxygen uptake ____ in the tissues to gain ___ nutrients available for tissue healing
increases; more
In the neuromuscular effects of superficial heating, the elevation of pain threshold causes an ____ effect which reduces ____
analgesic; pain
In the neuromuscular effects of superficial heating, the altered nerve conduction velocity ___ pain due to muscle spindle firing rates ____ and GTO ______
decreases; decreasing; increasing
Thermal Gate Theory states
that if the sensation pathway gate is closed, the perception of pain is decreased (pain relief)
In perception of temperature, the sensation is carried by which tract?
(hint: sensation is key word!)
Anterolateral (spinothalamic)
In the anterolateral tract, the fibers that mediate include
- Somatic Pain
- Visceral Pain
- Crudely Localized Touch
- Temperature
In the perception of temperature, what are the 2 primary fiber types? Describe overall characteristic
- Types III
- C fibers
*Slow conducting, non-myelinated
Gate control mechanism states that there is a _____ in non-myelinated ___ fiber activity which inhibits the nociceptive signals in the spinal cord
decreased; C
In the connective tissue specifically, what are the superficial heating effects (4)?
(____ elasticity; ____ viscosity; ____ stiffness; ____ flexibility)
- Increased elasticity
- Decreased viscosity
- Decreased joint stiffness
- Increased muscle flexibility
In connective tissue superficial heating, plastic deformation is
residual elongation of connective tissue AFTER the stretch is applied and THEN released
In connective tissue superficial heating, permanent elongation is (3)
(hint: constant ___ + rapid ____ + constant ____ = permanent elongation)
- Constant Load - of enough magnitude
- Rapid Stretch - by a period of holding in that position
- Constant Rate - of stretching using a slow, steady stretch
What are the variables in superficial heating that need to be considered?
- Extent of temp. rise
- Rate energy is added
- Volume of tissue exposed
- Composition of tissue
- Capacity of tissue to dissipate heat/vascularity
- Compression
What is the therapeutic range for superficial heat?
104-113F
What temperature should you NOT exceed for risk of burn?
113F
What temperature is the minimum required for heat therapy (anything less is too cool and considered non-therapeutic)?
104F
The therapeutic range for superficial heat is reached within how many minutes?
8-10 minutes
Within how many minutes do the muscles reach thermal equilibrium?
30 minutes
What are the main advantages of superficial heat (3)?
- Decrease in pain, stiffness, muscle spasms
- Increase in tissue extensibility
- Good for subacute AND chronic care
What are the main disadvantages for superficial heat? (3)
- May cause increased swelling; burn risk
- Decreases BP and CO; HR may increase
- Not appropriate for everyone
What are the main advantages for cold therapy? (3)
- Decreased pain, inflammation, swelling and muscle spasms
- May prevent FURTHER swelling (esp. after injury)
- Good for ACUTE care
What are the main disadvantages of cold therapy? (4)
- Increased stiffness/Decreased tissue extensibility
- Increased BP, decreased HR and respiration
- Decreased strength and proprioception
- Not appropriate for everyone
