Unit 2 Lecture Flashcards
specific heat
the amount of energy needed to raise the temp of a material by a given number of degrees
materials with a HIGH specific heat take more energy to achieve _____________________________?
the same temp increase than materials with a LOW specific heat
when both materials are at the same temperature, which type (high specific heat or low specific heat) holds more energy?
materials with a high specific heat
what is the specific heat order of the discussed materials from high to low?
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1 water
2 skin
3 muscle
4 human body
5 fat
6 bone
7 air
name the modes of heat transfer
- conduction
- convection
- conversion
- radiation
- evaporation
describe conduction
- energy exchange by DIRECT COLLISION between 2 materials at different temperatures that continues until materials are at the same temperature
surrounding tissues will always heat
what does the rate of heat transfer by conduction depend on?
- TEMPERATURE DIFFERENCE BETWEEN MATERIALS the greater the temp, the faster the rate
- AREA OF CONTACT - the larger the area, the greater the total heat transfer (but rate of temp rise decreases in proportion to tissue thickness)
- THERMAL CONDUCTIVITY - materials with high thermal conductivity transfer heat faster than those with low conductivity
what is the order of materials’ thermal conductivity from high to low?
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1 silver
2 aluminum
3 ice
4 water at 20 degrees C
5 bone
6 muscle
7 fat
8 air at 0 degrees C
which physical agents are associated with conduction?
hot pack
cold pack
paraffin
describe convection
occurs because of direct contact between a CIRCULATING MEDIUM and another material of a different temp * the thermal agent is in motion*
what physical agents are associated with convection?
whirlpools
fluidotherapy
describe conversion
- heat transfer by a NON-THERMAL form of energy into heat/direct contact not needed, but intervening material (ex-US gel) has to be a good transmitter of energy being used
not affected by temp of thermal agent - depends on the power of the energy source - the temperature between the medium and patient may be the same
rate of temperature tissue increase by conversion depends on
- size of area being treated
- size of applicator
- efficiency of transmission of applicator
- type of tissue being treated (superficial or deep)
which physical agent is associated with conversion?
ultrasound (vibration and sound waves)
describe radiation
direct transfer of energy from a material with a higher temp to one with a lower temp no need for contact or an intervening medium
rate of temperature increase by radiation depends on
- intensity of radiation
- size of area or radiation source
- distance of source from treatment area
- angle of radiation to tissue
what physical agent is associated with radiation?
infrared lamp
describe evaporation
a material must absorb energy to evaporate and change from a liquid to a gas/vapor - absorbed in the form of heat which leads to a decrease in temperature
what are the effects of cold?
- hemodynamic
- neuromuscular
- metabolic
describe the hemodynamic effects of cold (2)
1) INITIAL VASOCONSTRICTION - cooling the tissue decreases the production and release of vasodilators (histamine and prostaglandins) which causes vasoconstriction, blood viscosity, and reduced edema, pain, and fever APPLICATION MUST BE LIMITED TO LESS THAN 15-20 MINUTES
2) LATER INCREASE IN BLOOD FLOW - when cold is applied for long periods of time, or when tissue is less than 50 degrees F, cold induced vasodilation may occur
what is Hunting Response?
when tissue temperature causes an alternation between vasoconstriction and vasodilation (most common in distal extremities, so limit application here to 15 minutes or less)
describe the neuromuscular effects of cold (5)
1) DECREASED NCV - decrease in proportion to degrees and the duration of temperature change (examples: ⬇️ after 5 minutes of cooling & return to normal after 15 minutes///// ⬇️ after 20 minutes of cooling & return to normal after 30 minutes)
2) INCREASED PAIN THRESHOLD - stimulation of the cold receptors could provide enough stimulation to fully or partially block pain sensation and increase threshold by pain-gating (causes edema reduction, interruption of pain-spasm-pain cycle, and decreases blood flow to area)
3) ALTERED MUSCLE STRENGTH - increase or decrease depending on duration of intervention and when it’s measured (measure before cold and in the same format each time for best results) *examples - 5mins of cooling = increased isometric strength/////30mins of cooling = decreased isometric strength at first, then an increase 1 hour later that lasts for 3+ hours
4) DECREASED SPASTICITY - temporary prolonged cooling (up to 30 mins) causes a decrease in afferent spindles and GTO activity that lasts 60-90mins
5) FACILITATION OF MUSCLE CONTRACTION - brief application may facilitate a muscle contraction in a flaccid muscle (effort is short-lived)
describe the metabolic effect of cold
cold decreases the rate of all metabolic rates, including those involved in inflammation and healing (recommended to treat inflammatory joint diseases)
name the uses of cryotherapy
- inflammation control
- edema control
- pain control
- modification of spasticity
- symptom management of MS
- facilitation
describe inflammation control (cold)
- decreases pain by decreasing activity of A-Delta’s
- decreases edema by slowing the rate of fluid traveling from the capillaries to the issues
- decreases redness, heat, loss of function
- reduces bleeding by increasing blood viscosity
- can use after exercise to reduced Delayed Onset Of Muscle Soreness (DOMS)
describe edema control (cold)
- vasoconstriction
- increased blood viscosity
- decreased release of histamine
*when applied as soon as possible with PRICE (Protect, Rest, Ice, Compression, Elevation)
describe pain control (cold)
- 10-15mins of application controls pain for 1+ hour(s)
- blocks A-Delta’s/use of pain-gating by stimulating thermal receptors
- decreases muscle spasms by decreasing pain-spasm-pain cycle
- reduces inflammation = reduces pain
describe modification of spasticity (cold)
- decreases in patients with Upper Motor Neuron (UMN) disorders
- brief applications (5mins or less) decrease Deep Tendon Reflex (DTR) almost immediately
- applications for 10-30mins decrease or eliminate clonus and resistance to passive stretching
describe symptom management in MS (cold)
- HEAT EXACERBATES SYMPTOMS!!
- use cooling vests
describe facilitation (cold)
- rapid application (quick icing) to facilitate motor response in a flaccid muscle
not commonly used and may yield unreliable results
cryokinetics
1) cooling to a point of numbness shortly after an injury for up to 20mins
2) exercise for 3-5mins until sensation returns
3) re-cool to point of analgesia
4) repeat 5 times
used with athletes
cryostretch
cooling agent applied, then stretching - allows for improved stretch, decrease in muscle spasm, and increases ROM
adverse effects of cryotherapy
- tissue death
- temporary or permanent nerve damage
name the application techniques of cryotherapy
- cold pack
- ice pack
- ice massage
- controlled cold compression unit
- vapocoolant sprays
describe cold packs
- form to body well and can be made at home
- for pain, apply 10-20mins
- stored in cooling units (2hrs before first use & 30mins between patients)
- can use a damp towel to increase rate of cooling
- 23 degrees C
describe ice packs
- ice in a bag/need to use insulation
more aggressive cooling than cold packs
describe ice massages
- good for small areas
- cheap to make
- cools quickly
- CBAAN
describe cold compression units
often used post-op
- pump water and air into a sleeve (water temp can be adjusted, and compression comes from an inflation of air)
describe vapocoolant sprays
- use spray in parallel strokes with muscles, and follow by immediate passive stretch
may use over trigger points or after trigger point injections - rewarm skin, then move through AROM
what are the effects of heat?
- hemodynamic
- neuromuscular
- metabolic
- altered tissue extensibility
describe the hemodynamic effect of heat
- vasodilation - increased blood flow to the treatment area and to surrounding tissues
superficial - increased blood flow to skin
deep - increased blood flow to skeletal muscle
describe the neuromuscular effects of heat (3)
1) CHANGE IN NVC - increased nvc and conduction of sensory and motor neurons (2 meters/second for every 1 degree C or 1.8 degrees F increase in temperature)
2) INCREASED PAIN THRESHOLD - direct and immediate decrease in pain by pain-gating/later and prolonged decrease in pain by decreasing ischemia and muscle spasms
3) CHANGED IN MUSCLE STRENGTH - strength and endurance decrease during initial 30 minutes after heat, but strength recovers and increases over the next 2 hours
describe the metabolic effect of heat
- increased metabolic rate - rate of endothermic reactions and enzymatic activity increases which could accelerate healing
be careful because it could also increase the rate of destructive processes
describe the altered tissue extensibility effect of heat
- increased collagen extensibility - increased extensibility means a maintained increase of length/less force is needed to obtain new length & there is a decreased risk of tissue tearing
*plastic deformation - heat applied to capsule, tendon, ligament, and scar tissue BEFORE prolonged stretching (most of new length is maintained after cooling)
*elastic deformation - tissue stretch without healing/loss will occur
list the uses of thermotherapy
- pain control
- increased ROM and decreased joint stiffness
- accelerated healing
describe pain control (heat)
- pain-gating
- improved healing
- decreased muscle spasm
- reduced ischemia
- altered NCV/transmission
- to treat certain acute injuries
describe increased ROM and decreased joint stiffness (heat)
- increased soft tissue extensibility
- max increase in length if tissue is between 104-113 degrees for 10-15mins, and low-load & prolonged stretch is applied while heating and after cooling
do not let tissues cool before stretching
describe accelerated healing (heat)
- increased circulation
- increased enzymatic rate
- increased availability of oxygen to the tissue
- increased nutrients to the tissue
- increased waste removal
list the application techniques of thermotherapy
- hot pack
- paraffin
- fluidotherapy
describe hot packs
- stored in hot water 158-167 degrees (2hrs before first patient and 30mins in between)
- provides superficial heat (applied for approximately 20mins)
- 6-8 layers of insulation (layers can be added during treatment, but not removed)
describe paraffin
- 6:1 or 7:1 mix of paraffin and oil
- heated to 126-134 degrees
- has low specific heat and conductivity - can go directly on skin
- dip 6-10x, wrap with plastic, cover with towel for 10-15mins
describe fluidotherapy
- dry heating agent - transfers heat through convection,
- 100-118 degrees
- 20 minute session
- cabinet with hole, body part “floats” inside - heated air moves through corn cob particles
cryotherapy precautions
- hypertension
- impaired sensation/mentation
- too young or too old
- over an open wound
- over a superficial main branch of a nerve
cryotherapy contraindications
- cold hypersensitivity
- cold intolerance
- cryoglobulonemia
- paroxysmal cold hemoglobinuria
- Raynaud’s disease
- nerve damage
- circulatory problems
thermotherapy precautions
- pregnancy
- cardiac insufficiency
- poor thermal regulation
- poor circulation
- metal in the area
- over an open wound
- edema
- acute injury
- topical irritants on the area
- demyelinated nerves
thermotherapy contraindications
- recent or potential hemorrhage
- thrombophlebitis
- impaired sensation/mentation
- malignancy
- infrared irradiation of the eyes
ROM
amount of motion that occurs when 1 segment of the body is moved in relation to an adjacent segment
AROM
active range of motion
muscle contracts to move the joint
PROM
passive range of motion
movement produced by an external force with no muscle contraction
normal PROM > AROM when…
motion is limited by lengthening/soft tissue approximation (example - elbow flexion)
aka - when the joint can be pushed just a little bit further by an external source than by itself
PROM and AROM will be equal when…
motion is limited by bone (example - elbow flexion)
AAROM
active assisted range of motion
movement that’s accomplished by using assistance from and outside source
capsular pattern
specific and predictable combination of motion loss caused by shortening of a joint capsule
noncapsular pattern
motion loss combination that doesn’t follow the capsular pattern
contractile sources of motion restrictions
- muscle
-musculotendinous junction - tendon
- tendinous interface with bone
noncontractile sources of motion constriction
anything that isn’t a contractile source
list the pathologies that can cause motion restriction
- contracture
- edema
- adhesion
- mechanical block
- spinal disc herniation
- adverse neural tension
- weakness
describe contractures
- when tissues around the joint shorten due to immobilization or lack of use (permanent)
- can occur in contractile and non-contractile units
describe edema (motion restriction)
- intraarticular edema - execessive fluid forms inside joint capsule/limits AROM and PROM in capsular pattern
- extraarticular edema - fluid gathers outside of joint capsule/limits ROM but not in capsular pattern
describe adhesions
- abnormal joining of 2 parts to each other
- may occur between different types of tissue
describe mechanical block
- motion blocked by bone, fragment of cartilage, or tears in disc/menisci
- extra bone formed in or around the joints
- loose bodies lead to locking
describe spinal disc herniation
- discal matter can be trapped in a facet joint
- disc can compress a spinal nerve root
- loss of disc height
- bony changes in the intervertebral foramen
describe adverse neural tension
- the presence of abnormal responses from PNS structures because of nerve damage
- damage can be caused by trauma, disease, ischemia, inflammation, adhesions, etc.
- common areas: where nerves pass through tunnels, pass through IV foramina, points where nerves branch, or where the system is mostly fixed (dura at L4)
describe weakness
when muscle contraction can’t be achieved to move the joint through its ROM
most common
what are some qualitative measures of motion?
- soft tissue palpation
- end-feel
- accessory motion testing
resisted muscle testing
patient contracts muscle against resistance that’s strong enough to prevent movement
passive accessory motion
- looks at:
- ligament lengthening
- motion of joint surfaces
- tightness of joint capsule
precautions for motion techniques
- an infection or inflammatory process in or around the joint
- fragile bone disease
- hypermobile joints
- joints prone to subluxation
- in painful conditions where severity of symptoms could be reproduced
- immediately after injury where soft tissue has been disrupted
- excessive bone growth
- diagnosed with hemophilia
- in region of a hematoma
contraindications for motion techniques
- in a region of an unhealed fracture or dislocation
- immediately after surgical procedures
neural tension testing
placing patient in a position to intentionally stress the nerves
(+) = reproduced symptoms
(-) = didn’t reproduce symptoms
treatments for motion restriction
- stretching and passive stretching
- motion
- surgery
how can physical agents help to increase motion?
- increase soft tissue extensibility
- control inflammation
- decrease or control pain
- facilitate motion
