Superficial Cold- Therapeutic Procedures – Flashcards
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Physiological effects of cryotherapy (7):
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1. Decreased pain 2. Decreased or slow inflammatory process through decreased metabolic activity 3. Decreased metabolic rate (decreased hypoxic injury) 4. Decreased bleeding/hemmorrhange & edema (due to vasoconstriction) 5. Local decrease in spasticity due to decreased neural firing 6. Endorphins may be released 7. Decreased muscle spindle activity (decreased response to stretch)
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How does cryotherapy effect neuromuscular?
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Decreased muscle spasm and motor unit excitability. Decreased pain and decrease in sensitivity of muscle-spindle afferent fibers to discharge. Decreased reaction to stretching, may facilitate stretching.
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How does cryotherapy decrease spasticity?
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Cold can decrease the amplitude of deep tendon reflexes and the frequency of clonus. Cold facilitates the alpha-motorneuron activity and decreases gamma-motorneuron firing. In order for spasticity to be reduced, the reduction in gamma activity should be proportionally greater than the increase in alpha activity.
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What are two ways cryotherapy reduces spasticity?
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1. Reflex decrease in gamma-motorneuron activity through stimulation of cutaneous afferents 2. Decrease in afferent spindle discharge by direct cooling of the muscle
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How does cryotherapy reduce inflammation & edema?
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- Fluid filtration is reduced with cold due to vasoconstriction and prevention of increased cap permeability - Inflammation/pain is reduced
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For what time period is cold the best choice for injury?
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24-48 hours
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Why is reduced metabolism an advantage?
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Local metabolism is decreased, leading to a decrease in cellular energy demands (decrease in secondary hypoxic tissue injury, tissues need less oxygen).
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How does cryotherapy influence the vascular system? (3 ways to vasoconstrict)
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Vasoconstriction and reduction in blood flow. 1.Cold has a direct effect on smooth muscle to vasoconstrict 2. There is a reduction in vasodilating neurotransmitters 3. There is a reflex cutaneous vasoconstriction (generalized vasoconstriction)
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How does cryotherapy effect peripheral nerves?
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Decreased NCV in both sensory and motor neurons. Synaptic transmissions may be blocked or impeded. These factors may raise pain tolerance and pain threshold.
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How does cryotherapy effect muscle performance?
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Force generation is decreased after cryotherapy. Performance decreases after therapy.
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How does cryotherapy affect proprioception?
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Somatosensory input is altered for reflex integration. May increase postural sway and decrease balance immediately after therapy, although studies are somewhat inconclusive.
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How does cryotherapy affect the CV system?
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Transient increase in blood pressure Decreased heart rate Decreased respiration rate
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How is cryotherapy & stretching used together?
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Cold in combo with static stretch or hold-relax techniques has been recommended for reducing muscle spasm or decreasing DOMS, increasing ROM. Either during or immediately after cold application, stretch is performed in cycles.
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Cryotherapy indications (7):
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1. Acute injury 2. Acute pain 3. Muscle spasm (acute/chronic) 4. Spasticity with local treatment 5. Facilitation through general treatment (PROM) 6. Reduction of fever 7. Acute burns
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Additional cryotherapy indications (7):
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1. Acute/sub-acute inflammation, pain 2. Trigger points 3. Sprains & strains 4. DOMS 5. Edema 6. Limited motion secondary to pain 7. Nausea (vestibular patient)
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Cryotherapy contraindications (5):
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1. Hx of frostbite 2. Raynaud's disease 3. Hypersensitivity to cold 4. Compromised circulation 5. Angina pectoris (chest pain due to lack of blood flow)
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Cryotherapy precautions (5):
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1. Angina/cardiac dysfunction (no general cold, put away from heart) 2. Regenerating peripheral nerves 3. Open wounds after 48-72 hrs 4. Decreased sensation (CVA, diabetes) 5. Very old, very young
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7 forms of cryotherapy:
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1. Ice massage, towels, cold packs 2. Ice bags 3. Chemical cold packs 4. Vapocoolant spray 5. PRICE 6. Cryopressure 7. Contrast bath
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According to Enwemeka et al article, how does penetration effect the duration of cold?
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Deeper structures (1cm) stay significantly cooler, much longer than superficial tissues.
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According to the Hocut article, how does cryotherapy affect ankle sprains?
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Much faster recovery with the use of cryotherapy when to compared to a group without cryotherapy. Cryotherapy group reduced recovery by 5 days.
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According to Warren et al, which is better- ice or cryo devices?
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Ice has a greater cooling effect than the cryo device, but ice is also significantly more painful than the cryo device.
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According to Yanagisawa et al, how does cryotherapy effect cross sectional area and ROM of rotator cuff after exercise? (ice vs exercise vs ice + exercise)
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ROM was greater in the ice and exercise group. The cross sectional area of the rotator cuff was also less in the ice and exercise group.
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According to Lin, which is better for stretching, heat or cold?
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Static stretching with cold pack significantly increased ROM in the knee.
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According to Sloan/Hain/Powel, is heat or cold better for high grade ankle sprains?
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In both grade 3 and 4 ankle sprains, the cold group returned to activity sooner. In grade 4 sprains, the group returned sooner when compared to grade 3. So, at higher grade ankle sprains, cold has an even greater effect.
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How does muscle, subcutaneous tissue, and skin affect cooling rates?
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The greater the tissue depth, the longer it takes for the cold application to lower the temperature. Changes in skin temp happen very quickly. Subcutaneous muscle & tissue take longer, with muscle taking the longest. *since subcutaneous fat is an insulator, an obese pt for example may take longer to reach desired coldness in muscles
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Procedure for cryotherapy:
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1. Explain Rx to pt (need informed consent) 2. Ask about frostbite/sensitivity, ask about contraindications 3. Expose skin area to be treated 4. Position & drape 5. Inspect area to be treated 6. Determine pt's ability to respond to temperature changes 7. Document
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4 stages of sensitivity to blood flow:
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- Uncomfortable sensation to cold - Burning/stinging - Aching - Numbness * related to nerve endings as they cease to function: decreased blood flow and NCV
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Normal response to cryotherapy (3):
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Skin integrity remains Redness for up to 20 min or longer Numbness for a few minutes
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Abnormal response to cryotherapy (3):
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Frosbite (tingling, burning, pain) Skin mottled with white/red/yellow, bluish skin Blisters
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What method of radiation is used by ice massage?
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Conduction
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What is the duration of treatment for ice massage?
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5-15 minutes (Anesthetize skin, redness will appear.Decrease pain/spasm, increase ROM)
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Ice massage procedure:
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Follow general superficial cold guidelines: - Position towels under and around area - Rub ice using moderate speed and rhythmic motion - Keep rest of body warm - Continue until anesthesia is reached - Dry, inspect skin - Perform other interventions - Document
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What needs to be documented for an ice massage?
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- Method used (type of cold agent) - Use of compression or elevation - Area treated - Patient position - Duration of Rx - Patient response during & after treatment - Change in skin apperance or adverse responses
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What method of radiation does ice towels use?
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Conduction
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How long is the duration for an ice towel treatment?
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5-10 minutes
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What is the procedure for ice towel treatment?
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Put ice shavings in a wet towel, repeated every 2-3 minutes. very time consuming.... usually will increase ROM
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What method of radiation does an ice pack use?
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Conduction (plastic bags filled with ice)
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How long is the duration for ice packs?
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10-20 min
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What is the procedure for ice packs?
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Put moist towels between ice pack and skin (prevent frostbite) May decrease ROM if stifness of intra-articular tisues are cooled.
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How can a pt make a home ice pack?
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Use doubled freezer ziplok bags; add 2 parts water, 2 part rubbing alcohol (usually more water than alcohol). Freeze overnight before using. Make several if needed.
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What is the duration of treatment for commerical cold packs?
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10-20 minutes indications: edema, pain, bleeding
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Benefits of commerical ice packs
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Less intense form of cold, works well on large areas Reusable (hydrated gel) Different sizes, forms to body part
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Procedure for a cold pack:
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Follow general superfical cold guidelines: -Cover involved area with a moist towel - Place pack over towel - Cover with a dry towel - Dry & inspect skin after - Additional interventions - Document
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What form of radiation does vapocoolant spray use?
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Conduction/sensory effect Evaporation
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Procedure for vapocoolant:
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- Spray from origin to insertion (Ethyl chloride or flouri methane) - 2 to 4 spray applications - Precautions: eyes, US head
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Benefits of vapocoolant:
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May increase ROM when stretch is applied
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How does vapocoolant work?
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Stimulates A fibers involved in the gate control theory. Reduces the pain-spasm-pain cycle which would otherwise inhibit stretch of the muscle . Cold inhibits the mm spindle activation.
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Indications for vapocoolant:
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LBP Torticollis (maybe?) Acute mm spasm Myofascial trigger points
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Procedure for vapocoolant:
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Follow general superficial cold guidelines: - Remove all sources in ignition area - Hold container 2 feet from surface, spray should hit skin at an agle - Spray from origin to insertion 2-4 times - Maintain slight stretch on the muscle - Avoid skin frosting - Perform additional interventions - Document
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PRICE
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Protect Rest Ice Compression Elevation
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How does a cryocuff work?
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Combination of cold conduction and compression Used both acute & post surgically. May increase ROM due to decreased edema
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What is the duration of a cryocuff treatment?
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20 minutes drain cuff to rechill
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Procedure for cryocuff:
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Follow general superficial cold guidelines: - Place cuff around joint - Fill reservoir with water & ice - Elevate reservoir until cuff is full - Dry & inspect skin - Perform additional inteventions - Document
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How does a contrast bath work?
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Used as a vascular exercise causing alternate constriction & dilation of local blood vessels
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Indications for a contrast bath:
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Subacute swelling, DOMS Stimulates blood flow & healing
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Temperatures for a contrast bath:
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Warm bath 104-106 F Cold Bath 50-60
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Contrast bath procedure:
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Follow general superficial cold guidelines: - Immerse in warm bath / cold bath for a 3:1 or 4:1 ratio - Encourage ROM - End with warm or cold depending upon injury status - After treatment, dry & inspect skin - Perform additional interventions - Document
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Duration of treatment for a contrast bath:
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Repeat for 20-30 minutes
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According to Moeller et al, what additional precautions are necessary?
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Must use caution in individuals with low body fat, especially when cold treatment is over a nerve.
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What are some outcome measures to use to assess the effectiveness of cold?
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Edema (girth, volume) Pain (pain scale) ROM (goni) Functional movements (gait or AROM) Muscle guarding (flexibility & ROM)
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Advantages & disadvantages of heat:
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Advantages: decrease pain, increase tissue extensibility, decrease stiffness Disadvantages: may cause increase swelling
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Advantages & disadvantages of cold:
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Advantage: prevent swelling, decrease pain Disadvantage: increase stiffness, decrease tissue extensibility
