thermotherapy & cryotherapy Flashcards
how does heat transfer take place within tissues?
primarily by conduction and convection - however it depends on the thermal properties of the tissue
what are the neuromuscular effects of heat?
-increased nerve conduction velocity
-changes in muscle strength
-decreased pain - pain gate theory
what are the physiological effects of heat?
-vasodilation -increases blood flow locally & systemically
what are the metabolic effects of heat?
-increased metabolic rate eg enzyme activity, cell motility, protein synthesis
what happens to the tissue if you apply the heat pre stretching?
- it increases the length of the tissue
-decreases the risk of tissue tearing
what are the therapeutic effects of heat?
-pain relief - pain gate mechanism
-increase in joint ROM
why is there pain relief with heat?
-due to the pain gate mechanism
-placebo effect
-decreased muscle spasm
-decreased nerve conduction velocity
what are examples of indications for the use of heat?
-pain relief
-promote healing eg STIs but not in first 48 hrs
-improve ROM
-placebo
-relaxation
list some adverse effects of thermotherapy
-burns
-fainting
-bleeding if recent injury
list some contraindications for heat use
-acute injury - inflammation, bleeding, recent STI - 48-72 hours
-impaired / absent sensation
-infected tissue or open wounds
-local malignancy in the area
- unable to communicate/ co-operate / understand
-acute dermatitis
list some precautions for heat
-pregnancy - around abdominal area etc
-poor circulation
-poor thermal regulation
-cardiac impairment
-metal in area
-over open wound
compare superficial vs deep heat
- superficial - eg hot pack, hydrotherapy - raises temp of the superficial area and increases circulation
- deep - eg diathermy continuous ultrasound, infra-red etc - heating in deeper tissues and increase in muscular circulation
what should the temp of moist hot packs be?
between 40-42 degrees
why are electric heat packs a risk?
as they do not cool during application - patient could be at risk of a burn
what is the role of heat in physio practice?
-application of heat within physio consult is not the best use of time etc
-heat can be included in self management for home use
-however- sensations & contraindications should be checked and the patient should be shown how to use heat pack in session
how do you check skin sensation for temperature?
-2 test tubes of water at different temps cold - 15-20 degrees, hot 40-45 degrees
-avoid temps above these as they test pain not heat
-test at different parts of the area being treated
-give clear instructions to patient
how do you apply the heat pack?
-remove clothing / jewellery from area
-inspect area
-check thermal skin sensation
-wrap hot pack in cover and 4-8 layers of towels
-warning / explanation to the patient that they should be comfortable warm and not hot or burning
-apply hot pack to area for 20 minutes
-provide pt w/ call bell
-check after 5 mins
-at end of treatment - should have mild erythema (red skin) in area
what are the advantages of using heat?
-easy to use
-relatively safe
-short use of clinicians time
-can be used over large areas
what are the disadvantages of using heat?
-poor contact with small or contoured areas
-limited in positioning patients
-hot pack must be removed to observe treatment area
what is cyrotherapy in physiotherapy?
the use of local body cooling for therapeutic purposes
what does the drop in temperature of the body part depend on?
-temperature difference between skin and coolant
-thermal conductivity eg muscle has high conductivity compared to fat
-size of area to be treated
-length of time cold is applied
-depth of tissue
what are the physiological effects of cold?
-initial decrease in blood flow
-immediate vasoconstriction (decreases rate of blood flow)
what are the haemodynamic effects of applying ice?
-vasodilation can occur when cold applied for longer periods
how long should you apply cold packs if you want to prevent vasodilation?
15 mins
what are the neuromuscular effects of cold packs?
-decreased nerve conduction velocity - when cooling is applied for more than 5 mins
-increased pain threshold due to gate theory
-changes in muscle strength
-decrease spasticity
what happens with muscle strength when applying ice?
reduction in strength and endurance when you apply cold
-gradually recovers and increased above pre cooling strength over next 2 hours
-may effect performance if return to play eg in sport after application of ice
why does ice decrease spasticity?
decreases gamma motor neuron and Golgi tendon organ activity
what affect does ice / cooling have on metabolism?
it decreases the metabolic rate
what are the therapeutics effects of cold?
-used to reduce swelling / inflammation
-used immediately
-acute injury - 48-72 hours
POLICE
-chronic inflammatory problems
-post exercise to reduce severity of DOMS
-pain relief - gate theory
what does POLICE mean?
Protection
Optimal
Loading
Ice
Compression
Elevation
what are examples of contraindications of cooling/ ice?
-arteriosclerosis
-raynauds disease
-2-3 days post steroid injection
-peripheral vascular disease over the extremity
what are examples of precautions of cooling / ice?
-cardiac disease and altered BP
-poor skin sensation
-over an open wound
-skin sensitivity
-directly over a superficial main branch of a nerve
-over anterior neck
what are examples of adverse effects of ice / cooling?
-ice burn symptoms within 2 hours - tender, swollen and bright red
-tissue death resulting from freezing of tissue
-temporary / permanent nerve damage
-unwanted vasodilation
what are some examples of methods of application of ice?
-ice packs / cold packs
-coolant sprays
-cold compression units
- ice massage
-ice towels
are cold packs of crushed ice in plastic bag better?
crushed ice in plastic bag - more aggressive cooling effect
how do you apply ice?
-remove nothing / jewellery etc from area
-inspect area
-check sensation
-wrap cold pack in damp towel
-warning / explanation to patient - ie it might go a bit numb etc
-apply to area 5-15 mins
- maximum benefit - POLICE approach (compression, elevation etc)
-check patient after 5-6 mins
what are ice baths used for?
-used following play eg rugby or marathon running
-used to reduce the effect of DOMs and lactic acid build up
-facilitates recovery
-10-15 mins
what are cold compression units?
units that pump cold water and air into a sleeve wrapped around patients limb
-set between 10-25 degrees
-15 mins every 2 hours
-can be used post op
what are vapocoolant sprays used for?
-can be used pitch side and used as part of stretch and spray treatment of trigger points
what factors does using heat or cold depend on?
-patients sensitivity / preference
-oedema
-pain
-spasm
-stage of inflammation (ie how soon after injury)
-ease of use
-area being treated
a 42 year old woman w/ RA x 2 years, knees and hands most affected, currently in flare up and pain is 8/10, loss of knee extension 15 degrees, difficulty making fist due to pain and swelling .. is ice or heat better to use?
-depends on patient assessment
-due to difficulty making fist due to pain and swelling - ice may be good to use to reduce swelling
-swelling may be reducing knee extension
case 2 - pt w/ fibromyalgia, complains of low back and neck pain 5/10, reduced ROM in back and neck.. heat or ice?
heat - will help pain and ROM, no evidence of swelling etc
