Thermal Agents: Cold Flashcards
1
Q
What is Cryotherapy?
A
- The application of cold modalities that
have a temperature between 32 and 65
degrees - Heat is removed from the body and
absorbed by the cold modality mostly by
conduction or convection
2
Q
Effects of Cold Application
A
- Decreased Cell Metabolism
- Blood Vessel Changes
- Reduction in inflammatory response
- Decreased Pain
- Decreased Muscle Spasm
3
Q
Effects of Cold Application: Decreased Cell Metabolism
A
- Decreased leukocyte activity
- Decreased O2 consumption
- Both decrease magnitude of secondary
damage since leukocyte activity is
decreased and chance of Hypoxia is
reduced
4
Q
Effects of Cold Application: Blood Vessel Chnages
A
- Local vasoconstriction
- Decreased permeability
~ Controls hemorrhage and edema
formation (edema more than
hemorrhage)
5
Q
Effects of Cold Application: Reduction of Inflammatory Response
A
- Reducing the release of inflammatory
chemical mediators: PG (pain and
swelling), LT (swelling), and HT (pain and
swelling) leads to:
~ Decreased pain
~ Decreased capillary permeability and
vasodilation
> Both decrease edema formation
6
Q
Effects of Cold Application: Decreased Pain
A
- Decreased chemical mediators (PG and
HT) - Decreased excitability of free nerve
endings - Decreased nociceptor/receptor
conduction velocity
7
Q
Effects of Cold Application: Decreased Muscle Spasm
A
- Breaking the pain-spasm-stasis cycle
~ Decreases the pain component
~ Addresses pain due to stasis/hypoxia
by decreasing metabolism - Decreases nerve conduction velocity of
the afferents and efferents associated
with the muscle spindle
8
Q
Does cryotherapy fully stop inflammation?
A
- NO!
- Injury is still present so the body will
continue to initiate an inflammatory
response
~ Chemical mediator production is
decreased, but still continues - Magnitude of certain factors are
decreased
~ Secondary damage
~ Edema
~ Pain
9
Q
Cooling Factors: Rate of Cooling
A
- Depends on difference between the
temperature of the modality and the
tissues treated - The greater the difference, the more
rapid the rate of transfer
10
Q
Cooling Factors: Depth of Cooling
A
- Related to treatment duration
~ The longer the treatment, the greater
the depth of cooling - Heat is drawn out of the different tissue
layers
~ Each layer has to cool to create a
temperature gradient
> Adipose can make this process
more difficult
11
Q
Cooling Factors: Type of Modality
A
- Ice pack and ice massage
~ Produce the greatest temperature
gradient
~ Effect of compression wrap
> Increases the magnitude of
temperature drop
• Improved contact
• Compression of tissues
~ Covering ice pack
> Decreases the energy absorbed
from environment
> Increases energy absorbed from
body
~ Cold whirlpool
> Less of a gradient, but still cools
muscle effectively due to
increased cooled surface area
12
Q
Cooling Factors: Effect of Decreased Activity Following Treatment
A
- Intramuscular temperatures continue to
drop for 5-10 minutes
~ Epidermis layers are still cold post-
treatment
~ Effects of muscle cooling will last
20-60 minutes
13
Q
Sensations Associated With Cryotherapy
A
- Cold
- Burning (pain)
- Aching (pain)
- Numbness
~ Usually after 18-20 minutes
14
Q
When/how often can/should cryotherapy be used?
A
- Right after any activity during the acute
stage
~ 2-4 days
~ Helps with pain, swelling, and
secondary damage - Double the time of application for time
off or for every 2 hours
~ 15 minutes on, 30 minutes off
15
Q
If a body part has edema, should you use cryotherapy to get rid of it?
A
- NO!
- Edema leaves via the venous and
lymphatic systems (lymphatic more than
venous)
~ Large, permeable vessels are what’s
needed to move edema
~ Cryotherapy does the opposite - The best way to get rid of edema is to
modify the concentration gradient/
osmotic pressure OR physically push the
edema into and through the venous and
lymphatic systems
~ Cryotherapy alone doesn’t do this
~ Compression can help to change
the concentration gradient - Heat is the best way to get rid of edema
after 2-4 days of injury
~ If re-injury occurs, the inflammatory
process resets - Ice is the best way to limit/prevent
edema during the first 2-4 days
16
Q
Cryotherapy Indications
A
- Acute injury/inflammation: 2-4 days
- Acute or chronic pain
- Spasm: decrease pain = decrease pain
17
Q
Cryotherapy Contraindications
A
- Cardiac or respiratory disease/disorder
- Uncovered wounds
- Circulatory insufficiency
- Cold allergy
~ Hives, Edema, and joint pain - Lack of sensation
- Advanced diabetes: poor circulation
- Raynaud’s Syndrome
~ Over reaction to cold that causes
vessels to overly constrict
18
Q
Special Considerations: Cold induced neuropathy
A
- Special care at the sites of superficial
nerves
~ Common peroneal
~ Ulnar nerve
~ Avoid compression at these sites
~ Can cause nerve damage which will
lead to sensory and functional
damage - Frostbite
~ Occurs when tissue temperature falls
below freezing
~ Usually not a factor unless using re-
usable or chemical packs
19
Q
Cold Packs
A
- Types
~ Plastic bags filled with ice: no layer
needed because body will eventually
raise temperature of ice (melt)
~ Reusable cold gel packs: needs layer
between skin and pack
~ Controlled cold therapy unit: game
ready
~ Chemical cold packs: needs layer
between skin and pack
20
Q
Ice Massage
A
- For use on small regularly shaped areas:
muscles, tendons, bursa, or trigger points - Not best for acute injuries because
there’s no compression - Tissue temperatures aren’t reduced at
the same magnitude as other forms of
cold application because it’s small and
constantly moving - Manages pain with sensory input and
output
21
Q
Ice Immersion/Cold Whirlpool
A
- Intensity of cold is greater with ice
immersion because of the large surface
area treated
~ Due to convection effect
~ A thermopane (insulating layer of
water) can’t develop - The limb is placed in a gravity dependent
position that can increase edema - Can further decrease pain through the
massaging and vibrating effect of the
water
22
Q
Cryokinetics
A
- The use of cold in conjunction with
movement to improve motion by
eliminating or reducing the influence of
pain - Used when bone and soft tissues are
intact - Cons:
~ Numbs area and pt. and clinician
won’t be able to feel/know if they’re
causing secondary damage
~ Causes nerves to slow down and
produces no output/input
23
Q
Cold vs. Heat
A
- Cold
~ More penetrating and their effects last
longer than heat
~ Causes vasoconstriction resulting in a
decreased amount of relatively warm
blood arriving to warm area
~ Should be used acutely for
inflammation - Heat
~ Causes vasodilation that delivers
relatively cool blood to area while
warmer blood is transported away
~ Should be used subacutely or
chronically
24
Q
How to know where the inflammatory/healing process is…
A
- Does the area feel warm?
- Is the injured area sensitive to light
moderate touch? - Does the swelling increase over time or
with activity? - If no to all questions, heat is safe
- If yes to any question, cold is most likely
indicated
25
Q
Contrast Therapy
A
- Same indications as heat with emphasis
on edema and hematoma removal (non-
acute) - Alternating immersion in warm and cold
water causing a cycle of vasoconstriction
and vasodilation - Procedure
~ Ratios of more Thermotherapy than
Cryotherapy are commonly used
> 3 minutes: 1 minute
> 4 minutes: 1 minute
~ More acute injuries end with cryo
~ More subacute or chronic end with
thermo
