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therapeutic techniques > therapeutic heat & cold > Flashcards

therapeutic heat & cold Flashcards

1
Q

thermal modalities

A
  • transfer energy(heat) to/from tissues, through exchange of kinetic energy
  • greater temp gradient - more rapid exchange of energy
  • heat exchange: conduction, convection, radiation, evaporation, conversion
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2
Q

indications: heat modalities

A
  • control inflammatory reaction in subactute/chronic stages
  • encourage tissue healing
  • promote venous drainage
  • reduce edema and ecchymosis
  • improve ROM before physical activity, rehab
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3
Q

indications: cold modalities

A
  • when acute inflammatory response is active
  • before ROM exercises
  • after physical activity to reduce cell metabolism
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4
Q

cold modalities

A
  • cryotherapy - application of cold modalities (32-65deg)

- local response: vasoconstriction, decreased metabolic rate, decreased inflammation, decreased pain

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5
Q

magnitude & duration temp decrease

A
  • skin first to lose heat, underlying tissues, adipose tissue, fascia, muscle
  • time between treatments - 1:2-1:6
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6
Q

skin cooling

A
  • depth related to treatment duration, size of treatment area
  • longer treatment - greater depth & temp decrease
  • larger area being cooled - deeper cooling occurs
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7
Q

intra-articular temp decrease

A
  • temp of skin over joint decrease proportional to decrease within joint
  • r=.65
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8
Q

intramuscular temp decrease

A

-continue to decrease for up to 30 min after remove of modality

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9
Q

tissue rewarming: cold

A
  • skin- rewarmed by air, absorbed heat from underlying tissues, warm blood flow to area
  • subcutaneous tissues rewarm by drawing heat from underlying tissues
  • deeper tissues rewarm by warm blood & increased cell metabolism
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10
Q

therapeutic temp benchmarks: cold

A
  • blood flow decreases soon after cold modality applies
  • lymphatic vessels unaffected until 59deg
  • tissue temp reach 50-59deg to max decrease in cell metabolism
  • neurological changes - skin temp decrease 9deg
  • max analgesia obtained - skin temp 58 deg
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11
Q

sensations w/ cold application

A
  • cold, burning, aching, numbness

- analgesia - after 18-21min cold application

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12
Q

colds effects on injury response process

A
  • acute injuries - reduction cell metabolism (limits amt secondary injury)
  • rarely contraindicated
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13
Q

colds effects: cellular response

A
  • slows cell metabolism
  • reduces rate of damaging cellular reactions
  • helps keep cell viable
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14
Q

colds effects: inflammation

A
  • suppresses inflammation
  • reducing release of inflammatory mediators
  • decreasing prostaglandin synthesis
  • decreasing capillary permeability
  • decreasing creatine kinase activity
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15
Q

colds effects: blood & fluid dynamics

A
  • arteriole vasoconstriction
  • increased blood viscosity
  • reduced blood flow
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16
Q

colds effects: edema formation & reduction

A

-limits formation of edema - reducing cell metabolism - limiting amy secondary hypoxic injury

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17
Q

colds effects on: nerve conduction

A

-decreases rate nerve impulses are transmitted & increases the depolarization threshold to initiate response

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18
Q

colds effect on: proprioception & joint position sense

A

-interrupt transmission & perception of pain & may affect proprioception, balance, agility, joint position sense

19
Q

colds effect on: pain control

A
  • removing chemical & mechanical pain triggers by reducing inflammation & limiting swelling
  • interrupting nerve transmission & decreasing nerve conduction velocity
20
Q

colds effect on: muscle spasm

A
  • suppressing the stretch reflex
  • reducing the threshold of afferent nerve endings
  • decreasing the sensitivity of muscle spindles
21
Q

colds effect on: muscle function

A

-decreased nerve conduction velocity - decreased sensitivity muscle spindles - increased fluid viscosity – decreased ability to perform rapid muscle movements & obtain max force

22
Q

colds effect on: inhibited muscle

A
  • increase motoneuron pool excitability

- nerves active & contribute muscle contraction

23
Q

effects of immediate treatment

A
  • Rest - limits scope of the original injury by preventing further trauma
  • Ice - decreases cell metabolism to reduce the need for oxygen in the injured area
  • Compression - decreases the pressure gradient between blood vessels and tissues
  • Elevation - force of gravity acting on the elevated extremity encourages venous & lymphatic return
24
Q

cryokinetics

A
  • involves the use of cold therapy in conjunction w/ movement & used to improve ROM by eliminating or reducing element of pain
  • more pronounced macrophage retain, quicker hematoma resolution, increased vascular growth, faster regeneration of muscle & scar tissue, increased tensile strength of healed muscle
25
Q

cold related injury

A
  • can increase risk of cold related injury during treatment
  • decreased skin temp & amy pressure used to secure ice pack
  • cold & pressure associated with compression wrap can traumatize superficial nerves
26
Q

contraindications: use of cold modalities

A
  • circulatory insufficiency
  • deep vein thrombosis
  • cold hypersensitivity/cold urticaria
  • anesthetic skin
  • chronic wounds
  • uncovered open wounds
  • peripheral vascular disease
  • raynaud phenomenon
  • lupus
  • hemoglobinemia
  • cold induced myocardial ischemia
27
Q

precaution: use of cold modalities

A
  • over carotid sinus
  • over areas of infection
  • near eyes
  • cardiac involvement
  • respiratory involvement
  • hypertension
28
Q

heat modalities

A
  • transfer of thermal energy
  • chemical action associated with cell metabolism
  • mechanical action as found w/ therapeutic ultrasound
  • electrical/ magnetic currents in diathermy devies
29
Q

thermotherapy

A
  • superficial - heats larger area of tissue, limited depth

- deep - diathermy, greater depth

30
Q

magnitude & duration of temp increase

A
  • temp gradient causes modality to lose heat & body to gain heat
  • max therapeutic benefits occur when skin temp rapidly increases
  • if intensity too great, duration exposure too long - burns
31
Q

tissue rewarming: heat

A
  • skin, subcutaneous adipose tissue temps rapidly decrease following removal of heating agent
  • heat loss to surrounding air
  • superficial intramuscular temps remain elevated for 30 min after end of treatment
32
Q

therapeutic temp benchmarks: heat

A
  • 106deg - release oxygen 2x greater baseline temp
  • enzymatic activity increase - 102-122
  • 104-113 - plastic deformation of collagen rich tissues
  • protein damage - tissue temp over 113
33
Q

heats effects on injury response process

A
  • increased cell metabolism & rate of inflammation
  • if heat applied too soon - increase huber cells injured/destroyed - hypoxia
  • increasing inflammatory rate - extend acute & subacute inflammatory stages
34
Q

heats effect on: cellular response

A
  • each increase 18deg in skin temp, cells metabolic rate increases by factor 2/3
  • increased cellular metabolic rate - arteriolar dilation & increased capillary flow
35
Q

heats effect on: inflammation

A
  • accelerates inflammation
  • soft tissue repair facilitated through accelerated metabolic rate & increased blood supply
  • blood flow must be increased - removal of cellular debris & increase delivery of nutrients for healing tissues
36
Q

heats effect on: blood fluid dynamics

A
  • blood flow increases soon after heat application
  • vasodilation occurs
  • viscosity of blood decreases
37
Q

heats effects on: edema formation & reduction

A
  • limb volume increases
  • edema increases - capability to remove is greater
  • increased capillary pressure forces edema & harmful metabolites from injured area
38
Q

heats effects on: nerve conduction

A
  • increase rate chem reaction & cell metabolism - increased nerve conduction velocity
  • sensory & motor nerve functions enhanced
39
Q

heats effect on: pain control

A

-decreasing mechanical pressure on nerve endings - reducing muscle spasm - resolving ischemia - increases pain threshold

40
Q

heats effect on: muscle spasm & function

A
  • reduces muscle spasm - decreasing sensitivity of muscles secondary gamma afferent nerves
  • decreased blood viscosity - increased nerve conduction - increases muscle function/strength
41
Q

heats effect on: elasticity

A

-collagen rich tissue (tendon, muscle, fascia) heated to 104-113 for 5 min - can be physically elongated (plastic deformation)

42
Q

exercise as heating agent

A
  • moderate/intense exercise increases intramuscular temp 4deg
  • moderate heating occurs over larger cross-sectional area & deeper in muscle
43
Q

contraindications & precautions to heat application

A
  • acute injuries
  • neurovascular deficits
  • sleeping/unconscious patients
  • thrombophlebitis
  • tumors
  • closed infection
  • pregnancy
  • history cardiac failure
  • hypertension
44
Q

contrast of heat & cold application

A
  • cold penetrates deeper than heat
  • heat - vasodilation
  • cold - vasoconstriction
  • effects of cold last longer after modality is removed
  • cold reduces ants inflammatory mediators & cell by products released
  • heat assists in removing cellular waste
  • cold used in earlier stages
  • transition to heat in mid/late proliferation stage

therapeutic techniques (6 decks)

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