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
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
3
Q
indications: cold modalities
A
- when acute inflammatory response is active
- before ROM exercises
- after physical activity to reduce cell metabolism
4
Q
cold modalities
A
- cryotherapy - application of cold modalities (32-65deg)
- local response: vasoconstriction, decreased metabolic rate, decreased inflammation, decreased pain
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
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
7
Q
intra-articular temp decrease
A
- temp of skin over joint decrease proportional to decrease within joint
- r=.65
8
Q
intramuscular temp decrease
A
-continue to decrease for up to 30 min after remove of modality
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
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
11
Q
sensations w/ cold application
A
- cold, burning, aching, numbness
- analgesia - after 18-21min cold application
12
Q
colds effects on injury response process
A
- acute injuries - reduction cell metabolism (limits amt secondary injury)
- rarely contraindicated
13
Q
colds effects: cellular response
A
- slows cell metabolism
- reduces rate of damaging cellular reactions
- helps keep cell viable
14
Q
colds effects: inflammation
A
- suppresses inflammation
- reducing release of inflammatory mediators
- decreasing prostaglandin synthesis
- decreasing capillary permeability
- decreasing creatine kinase activity
15
Q
colds effects: blood & fluid dynamics
A
- arteriole vasoconstriction
- increased blood viscosity
- reduced blood flow
16
Q
colds effects: edema formation & reduction
A
-limits formation of edema - reducing cell metabolism - limiting amy secondary hypoxic injury
17
Q
colds effects on: nerve conduction
A
-decreases rate nerve impulses are transmitted & increases the depolarization threshold to initiate response
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
cold related injury
- 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
contraindications: use of cold modalities
- 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
precaution: use of cold modalities
- over carotid sinus
- over areas of infection
- near eyes
- cardiac involvement
- respiratory involvement
- hypertension
28
heat modalities
- transfer of thermal energy
- chemical action associated with cell metabolism
- mechanical action as found w/ therapeutic ultrasound
- electrical/ magnetic currents in diathermy devies
29
thermotherapy
- superficial - heats larger area of tissue, limited depth
| - deep - diathermy, greater depth
30
magnitude & duration of temp increase
- 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
tissue rewarming: heat
- 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
therapeutic temp benchmarks: heat
- 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
heats effects on injury response process
- 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
heats effect on: cellular response
- each increase 18deg in skin temp, cells metabolic rate increases by factor 2/3
- increased cellular metabolic rate - arteriolar dilation & increased capillary flow
35
heats effect on: inflammation
- 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
heats effect on: blood fluid dynamics
- blood flow increases soon after heat application
- vasodilation occurs
- viscosity of blood decreases
37
heats effects on: edema formation & reduction
- limb volume increases
- edema increases - capability to remove is greater
- increased capillary pressure forces edema & harmful metabolites from injured area
38
heats effects on: nerve conduction
- increase rate chem reaction & cell metabolism - increased nerve conduction velocity
- sensory & motor nerve functions enhanced
39
heats effect on: pain control
-decreasing mechanical pressure on nerve endings - reducing muscle spasm - resolving ischemia - increases pain threshold
40
heats effect on: muscle spasm & function
- reduces muscle spasm - decreasing sensitivity of muscles secondary gamma afferent nerves
- decreased blood viscosity - increased nerve conduction - increases muscle function/strength
41
heats effect on: elasticity
-collagen rich tissue (tendon, muscle, fascia) heated to 104-113 for 5 min - can be physically elongated (plastic deformation)
42
exercise as heating agent
- moderate/intense exercise increases intramuscular temp 4deg
- moderate heating occurs over larger cross-sectional area & deeper in muscle
43
contraindications & precautions to heat application
- acute injuries
- neurovascular deficits
- sleeping/unconscious patients
- thrombophlebitis
- tumors
- closed infection
- pregnancy
- history cardiac failure
- hypertension
44
contrast of heat & cold application
- 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
