cryo therapy lecture
TRANSCRIPT
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Thermal Agents: Cryotherapy
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Basics of Heat
Heat: a term used to describe the energy
that matter can store in the form of
electronic, atomic, or molecular motion.The great the molecular motion, the greater the
heat production
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Basics of Cold
Cold: in a physical sense is a negative
condition, depending on the decrease in the
amount of molecular vibration thatconstitutes heat. The less the molecular
motion, the less heat production. Thus, a
sensation of cold results.
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Temperature:
Temperature is a measure of the average
amount kinetic energy possessed by an
individual molecule of a body (kinetictheory of heat).
Temperature is a measure of sensible heat of
cold in a body.Temperature is expressed as Fahrenheit or
Centigrade.
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Classification of temperatures:
for treatment purposes, are
classified as follows:
Very Cold 32 to 55 F
Cold 55 to 65 F
Cool 65 to 80 F
Neutral 80 to 92 F
Warm 92
to 98
FHot 98 to 104 F
Very Hot 104Hot
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Transfer of energy: heat, or the
loss of hear, occurs in any of the
following ways: Conduction: Contact
Convection: movement
Evaporation: through liquid-gas transfer
Radiation: electromagnetic waves
Conversion: transfer from one energy typeto another
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Factors in heat transfer Cont
Conductivity: the power of transmitting
heat, electricity or sound. A tissues
conductivity is usually dependent on thewater content; the higher the water content
the better the conductivity
Muscle - 72-75% water and conducts well Bone and skin are 5-16% water and poor
conductors
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Factors in heat transfer Cont
Resistance: the tissues opposition to the
passage of energy
Expressed in Ohms.
Bone and fat have high resistance
Muscle and Skin low
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Cryotherapy
Used to describe the application of cold
modalities that have a temperature range
between 32 and 65 F
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Cryotherapeutic Benefits
To obtain therapeutic benefits
skin temp. must be reduced to 57 F for optimal
decrease in local blood flow
skin temp must be reduce to 58F for analgesia
Skin tempertaure must be reduced to 36F to
produce intra-articular temp. changes in theknee
The temp of the skin over a joint decreased the temp
in a joint proportionally 10 F skin 6.5 F joint
Also remember that temperature is relative!
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Effects of Cold on
Application Site Vasoconstriction
Decreased Rate of Cell metabolism
resulting in a decreased need for oxygen
Decreased production of cellular wastes
Reduction of inflammation
Decreased Pain
Decreased Muscle Spasm
S i Eff f C ld
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Systemic Effects of Cold
Exposure
General vasoconstriction in response tocooling of the posterior hypothalamus (this
happens with a .2F of circulating blood
Heart rate is decreased Respiration Decreases
Shivering and increased muscle tone
If core temperature continues to drop this is the
bodys response to increase heat
IN GENERSAL THIS DOES NOT OCCUR
WITH ICE APPLICATION!
Th Eff f I I j
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The Effects of Ice on Injury
Response
Indications
Acute injury or Inflam
Acute or chronic pain
Small 1st degree burns
Postsurgical pain and
edema
In conjunction with rehab
ex.Neuralgia
Acute or chronic muscle
spasm
Spastically accompanyingCNS disorders
Contraindications
Cardiac or Resp.
involvement
Uncovered open
wounds
Circ. Insufficiency
Cold Allergy
Anesthetic Skin Advanced Diabetes
Raynauds
Phenomenon
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Raynauds Phenomenon
A vascular reaction to cold application or
stress that results in a white, red, or blue
discoloration of the extremities. The fingersand toes are the first to be affected. This is
a sympathetic nervous system reflex
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Physiological Effects of Cold:
MetabolicDecreased secondary cell deaths by hypoxia
(swelling prevents oxygen from reaching cells).
The decrease in metabolism allows them to livewithout as much oxygen.
Normal body temperature is 37 C.
Increase above 45 C (113 F) proteins
denature
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Physiological Effects of Cold:
MetabolicReduction of edema through decreased
capillary hydrostatic pressure and decreased
permeability and osmotic pressureIncrease blood viscosity (make it thicker so it
wont flood the area as quickly)
Decrease in chemical mediator effectiveness
(they cause vasodilatation)
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Physiological Effects of Cold:
MetabolicDecreases below 15 C (58 F) a hunting
response (Lewis 1932) incurs
Histamine like release yields an increasevasodilatation as a self defense response
Arterio-venal anastomoses (artery directly to
veins) allow pooling of blood in feet, hands,
ears, and lips. May be place of huntingresponse
Dont go below 58 F and keep time shorter
than 30 minutes to be on the safe side
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Physiological Effects of Cold:
Pain Local decrease in free nerve ending
sensitivity
Increases the threshold for nerve firing
Slows synaptic activity
Allows disruption of pain-spasm-pain cycle
via analgesia
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Physiological effects of cold:
Hemodynamic
Vasoconstriction from smooth muscle in
arterioles
reflex vasoconstriction from A-delta (spinal
reflex to preserve body heat)
Cold blood hits hypothalamus and may start
shivering response if cold enough
A small amount of vasoconstriction gives a 4fold decrease in blood flow
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Muscle Activity
Decreased muscle spasm by decreasingmuscle spindle activity.
Intramuscular fibers (muscle spindle) runs
parallel to fibers of the muscle. Ia and II runto dorsal horn of spinal cord and respond to
stretch. As the muscle contracts the spindle
contracts so it remains sensitive. Colddirectly decreases the activity in the Ia and
II fibers. The lower the temperature, the
lower the activity.
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Effects of Immediate Treatment
RICE - Rest, Ice, Compression, Elevation
Serves to counteract the bodys initial response
to injury
Rest limits scope of original injury by
preventing further trauma
Ice - function is to decrease cells metabolism,
decrease the need or oxygen and reduce the
amount of secondary hypoxic injury by
enabling tissues to live on limited oxygen and
secondarily reduce pain
Crushed ice is the ideal form of cold application
during initial injury because it produces the mostrapid temp. decrease.
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Effects of Ice on Immediate Tx
Compression -
decreases the pressure gradient between blood
vessels and tissue and discourages furtherleakage from capillaries.
Also Encourages Lymphatic drainage
Compression Types Circumferential - provides even pressure
Collateral - Pressure on 2 sides (aircast)
Focal Compression - U-shaped horseshoe pads
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Effects of Ice on Immediate Tx
Elevation
Decreases the hydrostatic pressure within the
capillary beds to encourage absorption ofedema by lymphatic system
This has the greatest effect at 90 perpendicular
to the ground
at 45 the effect of gravity is 71% comparatively
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Cryokinetics
The use of cold in conjunction with
movement
Used to decrease pain and allow for free motion
through the normal ROM
Results in more pronounced macrophagereaction, quicker hematoma resolution,
increased vascular growth, faster regeneration
of muscle and scar tissue
Initiated when the underlying soft tissue and
bone are intact and the pain is limiting the
amount of function
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Penetration depends on many
factors: Cold has a longer wavelength than heat
Local temperature gradient
Treatment surface area covered
thickness and characteristics of tissue
treated (fat is an insulator, tissues with high
water content have better heat transfer)
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Clinical Application
Cold Pack
Ice Massage
Ice Immersion
Cryostretch
Whirlpools
Slides in Packet for specific review of each
Clinical Application
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Cold Packs
Ice Bags,
Reusable Cold Pack
Instant Cold Back
Tx time for all are 15-30 minutes
Because of lasting effects application should be
no less than 2 hours apart
For controlled Cold Therapy Units - may be
applied continuously for 24 to 48 hours post
acute injury or surgery
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Cold Packs
Indications Acute injury (may use
with wet wrap)
Acute or Chronic Pain
Postsurgical Pain andEdema
Shape of Body part
Precautions
AC joint and other areas
may not be suitable for wet
wrap
Tension of elastic wrap
should be enough to
provide adequate
compression without
unwarranted pressure
Ensure Circulation w/wrap
Frostbite - if had before
chance for reoccurrence
over large or superficial
nerves
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Ice Massage
Appropriate for
delivering cold tx to
small evenly shapedareas.
Most effective for
muscle spasm,
contusion and otherminor well-localized
areas
Duration of tx
5-15 minutes or until
ice runs out
if the purpose is
analgesic, then stop
when numb
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Ice Massage Indications
Subacute inflam or inj
Muscle strain
Contusion Acute or chronic pain
Contraindications
All other ice contraind.
When pressure is not
warranted
Suspected Fx
Precautions
Injuries where pressure
massage may be
contraindicated
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Ice Immersion
Temp. 50 - 60 F
Time 10-20 min.
Indications Acute Injury or Inflam.
Acute or Chronic Pain
Post surgical pain
Contraindications
Same as general
Contraindications
Acute injury where
gravity is
contraindicated
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Cryostretch
Spray and Stretch vapocoolant
Traditionally preformed with ethyl chloride
due to its ability to quickly evaporate andcool superficial tissue
This technique is limited to a counterirritant
simply masks the symptoms to allow for astretch
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Cryostretch
Precautions
Can cause frostbite
Ethyl Chloride is
extremely flammable
Ethyl Chloride is a
local anesthetic but if
inhaled can become
general
Its use is based on
tradition rather than
fact
Contraindications Allergy
Open wounds
Post/surgical
Eyes
All other cold
contraind & contraind
to passive stretch
Indications
Trigger points
Muscle spasms
Decreased ROM
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Cold Whirlpools
Duration of Tx
15-20 minutes
Temp 50 - 60 F Indications
Decreased ROM
Cryokinetics
Subacute to chronic
inflammation
Peripheral nerve
injuries (avoid
extremes)
Contraindications
Acute conditions
where water turbulence
would further irritate
area
Gravity
Postsutural
Skin Conditions
All other
contraindications