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Advanced MSK - physio > thermotherapy & cryotherapy > Flashcards

thermotherapy & cryotherapy Flashcards

1
Q

how does heat transfer take place within tissues?

A

primarily by conduction and convection - however it depends on the thermal properties of the tissue

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2
Q

what are the neuromuscular effects of heat?

A

-increased nerve conduction velocity
-changes in muscle strength
-decreased pain - pain gate theory

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2
Q

what are the physiological effects of heat?

A

-vasodilation -increases blood flow locally & systemically

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3
Q

what are the metabolic effects of heat?

A

-increased metabolic rate eg enzyme activity, cell motility, protein synthesis

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4
Q

what happens to the tissue if you apply the heat pre stretching?

A
  • it increases the length of the tissue
    -decreases the risk of tissue tearing
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5
Q

what are the therapeutic effects of heat?

A

-pain relief - pain gate mechanism
-increase in joint ROM

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6
Q

why is there pain relief with heat?

A

-due to the pain gate mechanism
-placebo effect
-decreased muscle spasm
-decreased nerve conduction velocity

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7
Q

what are examples of indications for the use of heat?

A

-pain relief
-promote healing eg STIs but not in first 48 hrs
-improve ROM
-placebo
-relaxation

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8
Q

list some adverse effects of thermotherapy

A

-burns
-fainting
-bleeding if recent injury

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9
Q

list some contraindications for heat use

A

-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

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10
Q

list some precautions for heat

A

-pregnancy - around abdominal area etc
-poor circulation
-poor thermal regulation
-cardiac impairment
-metal in area
-over open wound

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11
Q

compare superficial vs deep heat

A
  1. superficial - eg hot pack, hydrotherapy - raises temp of the superficial area and increases circulation
  2. deep - eg diathermy continuous ultrasound, infra-red etc - heating in deeper tissues and increase in muscular circulation
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12
Q

what should the temp of moist hot packs be?

A

between 40-42 degrees

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13
Q

why are electric heat packs a risk?

A

as they do not cool during application - patient could be at risk of a burn

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14
Q

what is the role of heat in physio practice?

A

-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

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15
Q

how do you check skin sensation for temperature?

A

-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

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16
Q

how do you apply the heat pack?

A

-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

17
Q

what are the advantages of using heat?

A

-easy to use
-relatively safe
-short use of clinicians time
-can be used over large areas

18
Q

what are the disadvantages of using heat?

A

-poor contact with small or contoured areas
-limited in positioning patients
-hot pack must be removed to observe treatment area

19
Q

what is cyrotherapy in physiotherapy?

A

the use of local body cooling for therapeutic purposes

20
Q

what does the drop in temperature of the body part depend on?

A

-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

21
Q

what are the physiological effects of cold?

A

-initial decrease in blood flow
-immediate vasoconstriction (decreases rate of blood flow)

22
Q

what are the haemodynamic effects of applying ice?

A

-vasodilation can occur when cold applied for longer periods

23
Q

how long should you apply cold packs if you want to prevent vasodilation?

A

15 mins

24
Q

what are the neuromuscular effects of cold packs?

A

-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

25
Q

what happens with muscle strength when applying ice?

A

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

26
Q

why does ice decrease spasticity?

A

decreases gamma motor neuron and Golgi tendon organ activity

27
Q

what affect does ice / cooling have on metabolism?

A

it decreases the metabolic rate

28
Q

what are the therapeutics effects of cold?

A

-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

29
Q

what does POLICE mean?

A

Protection
Optimal
Loading
Ice
Compression
Elevation

30
Q

what are examples of contraindications of cooling/ ice?

A

-arteriosclerosis
-raynauds disease
-2-3 days post steroid injection
-peripheral vascular disease over the extremity

31
Q

what are examples of precautions of cooling / ice?

A

-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

32
Q

what are examples of adverse effects of ice / cooling?

A

-ice burn symptoms within 2 hours - tender, swollen and bright red
-tissue death resulting from freezing of tissue
-temporary / permanent nerve damage
-unwanted vasodilation

33
Q

what are some examples of methods of application of ice?

A

-ice packs / cold packs
-coolant sprays
-cold compression units
- ice massage
-ice towels

34
Q

are cold packs of crushed ice in plastic bag better?

A

crushed ice in plastic bag - more aggressive cooling effect

35
Q

how do you apply ice?

A

-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

36
Q

what are ice baths used for?

A

-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

37
Q

what are cold compression units?

A

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

38
Q

what are vapocoolant sprays used for?

A

-can be used pitch side and used as part of stretch and spray treatment of trigger points

39
Q

what factors does using heat or cold depend on?

A

-patients sensitivity / preference
-oedema
-pain
-spasm
-stage of inflammation (ie how soon after injury)
-ease of use
-area being treated

40
Q

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?

A

-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

41
Q

case 2 - pt w/ fibromyalgia, complains of low back and neck pain 5/10, reduced ROM in back and neck.. heat or ice?

A

heat - will help pain and ROM, no evidence of swelling etc

Advanced MSK - physio (23 decks)

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