decreases vascular permeability through decrease in vasoactive mediators
utilize PRICE principle
*decrease in blood flow does NOT decrease blood O2 concentration
describe the 4 clinical applications of cryotherapy for pain control (direct and indirect mechanisms):
gate control theory
NCV of A Deltas
lowered pain for 1-2 hours probably due to residual temp. decrease
pain spasm pain cycle
describe the 3 clinical applications of cryotherapy for spasticity:
decrease afferent, spindle and GTO activity
raises activation threshold of the muscle spindle rendering it less excitable
10-30 minute application lasts up to 1 hour
list 7 contraindications for cryotherapy:
cold hypersensitivity (cold induced urticaria)
cold intolerance
sensory deficits : inability to feel
cryoglobulenemia or hemoglobinuria: collection of proteins that turn to gel like substance impairing circulation. RBC released to urine (renal failure)
raynaud's
PVD (peripheral vascular disease) or circulatory dysfxn (advanced diabetes)
the allergic rxn to cold tx in the form of hives is called:
cold induced urticaria
the rxn to cold tx that results in the fingers becoming white due to lack of blood flow, then blue as the vessels dilate to keep blood in tissues, then finally red as blood flow returns is called:
Raynaud's phenomenon
the disease happens in the same extremity that is tx'd
the phenomenon happens in the extremity opposite of the tx'd extremity
list 4 precautions to using cryotherapy:
superficial main branch of a nerve: ulnar nerve, peroneal nerve (can produce dropfoot for 48 hrs)
over open or infected wound: impedes metabolism, so slows wound healing
poor sensation or mentation: not able to tell if its too cold
using cold in conjunction with movement is called:
cryokinetics
used in ROM exercises to limit pain associated with them
be cautions that there isn't too much masking of pain and you are causing further damage to the tissue
cold spray used to decrease skin temp. and pain prior to passive stretch is called:
cryostretch
passive stretch helps break the pain-spasm-pain cycle (work trigger points)
causes a quick temp drop in skin by quickly evaporating
what are the indications for cryostretch:
muscle spasm
trigger points
decrease ROM
which is a more dangerous form of cryostretrch vapo coolant:
fluoromethane or ethyl chloride:
ethyl chloride
what are the precautions for cryostretch:
allergy to spray
open wounds
protection of eyes
a cooler of ice water, a nylon sleeve for body part, a hose connected to the cooler, and the cooler raised about the sleeve allowing water to flow into the sleeve and provide compression is called:
cryo-cuff
how much pressure does the cryo- cuff apply:
30-40 mmHg
a useful cryo-compressive modalitiy that uses a sleeve to cover the extremity and fills with cold fluid and air that is pumped in by the machine is called:
game ready
very useful for inflammation control and reducing edema
the depth of penetration of cryotherapy is:
5 cm
advantage over heat: penetration gets deeper
how long is the duration of the effects of cryotherapy:
hours
slow metabolism, prevents 2ndary hypoxic death
blood flow for cryotherapy is:
increased /decreased
decreased
rate of cell metabolism for cryotherapy is:
increased /decreased
decreased
oxygen consumption for cryotherapy is:
increased /decreased
decreased
cell wastes for cryotherapy is:
increased /decreased
decreased
fluid viscosity for cryotherapy is:
increased /decreased
decreased
what are the 4 therapeutic goals of thermotherapy (superficial heat):
increase tissue extensibility
increase circulation
accelerate cell metabolism
reduce pain similar to ice pack, gate theory of pain control
list the modes of heat transfer for the following thermotherapy modalities:
hot pack:
WP:
fluidotherapy:
paraffin:
infrared:
hot pack: conduction
WP: conduction + convection
fluidotherapy: convection
paraffin: conduction
infrared: heat source, light bulb
the hemodynamic effects of thermotherapy physiology is:
vasodilation
increased blood flow at the level of tissue heating
-appropriate modality for targeted tissue
whole body heating can cause systemic vasodilation
list the 3 mechanisms for hemodynamic effects of thermotherapy physiology:
direct reflex (vessels vasodialate): through the release of nitrous oxideindirect reflex (via spinal cord)
chemical mediators
list the 2 chemical mediators of inflammation that vasodilate for thermotherapy physiology:
local release of histamine and prostaglandins
increases permability
list 3 neuromuscular effects of thermotherapy physiology:
increase nerve conduction velocity: propagate signal faster
increased pain threshold: raise threshold, able to withstand more pain, more relaxed
changes in muscle strength
list things of neuromuscular effects of thermotherapy physiology that increases NCV:
increased nerve conduction and decreased latency in both sensory and motor nerves
shortens duration of sodium channels opening
-demyelinated nerves vulnerable
nerve conduction velocity is also shown to decrease firing rate yielding relaxation in muscle spasm, list the 3 neuromuscular effects:
decrease firing rate in Type II muscle spindle and gamma efferants
increase firing rate to Type I fibers from GTO
thus reducing muscle contraction
list 2 things of neuromuscular effects that increase pain threshold:
direct reduction in pain through gate theory
indirect pain relief from vasodilation leading to decreased tissue ischemia and muscle spasm reduction
GTO's more relaxed
list 2 things of neuromuscular effects that effects muscle strength:
initial reduction in strength and endurance secondary to decreased alpha motor neuron activity
subsequent increase in strength secondary to reduction in pain
at what temperature does metabolic activity increase:
102-109 F or 39-43 C
at what temperature does metabolic activity decrease:
50 C or 122 F
what are the metabolic effects of thermotherapy physiology:
increased metabolic and enzymatic rxn
increases O2 uptake and potential healing
potential negative event through increase collagenase in RA (rheumatoid arthritis)
list 4 things of thermotherapy physiology that increases collagen extensibility:
facilitates plastic deformation (cross bridging)
greater increase in length with less force
decreased risk of tissue tearing
maximum increase in length at 104-113 F for 5-10 minutes
the clinical applications of thermotherapy for accelerated healing are: (2)
increased circulation
increased metabolic rate: increased enzymatic activity, increased availability of O2
the clinical applications of thermotherapy for increased joint mobility, ROM, and decreased joint stiffness are: (3)
increased soft tissue extensibility
maximum increase in length at 104-113 F
stretch during, immediately after : effects of heat only lasts a few minutes
therapeutic goals and TTR (tissue temperature rise)
the modality that has low specific heat so the higher temp. can be tolerated better that if it were the same water temp. is called:
how long is the tx time:
paraffin bath
tx time: 15-20
which of the following has modalities has the greatest risk of frostbite:
C. resuable cold pack
which of the following is a contraindication of the use of a paraffin bath:
A. skin conditions
which of the following modalities uses convection as the method of heat transfer:
A. whirlpool
which of the following is not a local effect of cold application:
C. decreased viscosity of fluids in the area
which of the following modalities has the greatest depth of penetration into the tissues:
D. ice bag
heat application by itself (i.e. without stretching exercise) is sufficient to enlongate collagen rich tissues:
a. true
b. false
b. false
which of the following is not a local effect of heat application:
B. increased muscle tone
a ____ degree F drop in skin temp is needed to reduce the sensitivity of muscle spindles:
D. 9
as the size (area) of the body exposed to cold immersion increases, the temperature of the immersion should:
a. increase
b. decrease
a. increase
the primary reason for the use of cold during the immediate tx of an injury is:
D. decrease cell metabolims
the "hunting response" has been demostrated to occur in all body parts during cold application:
a. true
b. false
b. false
mosit heat packs are stored in water having a temperature range b/w ___ and ___ F:
B. 160/170
the thermal effects obtained from a moist heat pack occur up to up ___ cm beneath the skin:
C. 3
2 cm: superficical
2-5 cm: deep heating
raynaud's phenomenon is a common contraindication to the use of cold and is characterized by:
B. altering bouts of pallor and cyanosis
following a 20 minute ice immersion and a short rewarming period, there __ a decreased joint porprioceptive ability:
a. is
b. is not
b. is not
which of the following is not a systemic effect to cold exposure:
A. increased HR
if the goal of your tx is to produce long-lasting cold within the quad. muscle prior to exercise (in the subacute or chronic stage of injury), which one of the following modalities would be most appropriate: