Heat and Cold Lab

Question 1

Contraindications for cold

Answer 1

Circulatory compromise or peripheral vascular disease

Cold hypersensitivity and intolerance

Over-regenerating peripheral nerves

Cryoglobulinemia

Paroxysmal cold hemoglubinuria

Raynaud’s disease or phenomenon

Question 2

Circulatory compromise or peripheral vascular disease

ask the patient:

Answer 2

Do you have poor circulation?

Question 3

Cold hypersensitivity and intolerance

ask the patient:

Answer 3

Do you develop a skin reaction when exposed to the cold?

Question 4

Over-regenerating peripheral nerves

ask the patient:

Answer 4

Do you have nerve damage in this area?

Do you have any numbness
or tingling in this limb? If so, where?

Question 5

Cryoglobulinemia

ask the patient:

Answer 5

Has your doctor told you you have a condition in which cold
temperatures can impair your circulation?

Question 6

Paroxysmal cold hemoglubinuria

ask the patient:

Answer 6

Do you experience symptoms of fatigue, exercise intolerance,
pallor, or jaundice after being exposed to the cold?

Question 7

Paroxysmal cold hemoglubinuria

ask the patient:

Answer 7

Do you have any unusual responses to cold?

Do you develop a rash
when cold?

Do you have severe pain, numbness, and color changes
in your fingers when exposed to cold?

Question 8

Precautions for cold

Answer 8

Superficial main branch of a nerve

Over an open wound

Hypertension

Poor sensation or mentation

Very young and very old patients

Question 9

Superficial main branch of a nerve

ask the patient:

Answer 9

Monitor for signs and symptoms of changes in nerve conduction
such as numbness and tingling

Question 10

Over an open wound

ask the patient:

Answer 10

Inspect the skin closely for deep wounds, cuts, or abrasions

Question 11

Hypertension

ask the patient:

Answer 11

Do you have high blood pressure?

Question 12

Poor sensation or mentation

ask the patient:

Answer 12

Check the patient for adverse responses to cold such as wheals
or abnormal changes in color or strength

Question 13

Very young and very old patients

ask the patient:

Answer 13

How old are you?

Question 14

Cold Set Up

Answer 14

Always assess sensation in the area to be treated

Position the patient in a way that they are comfortable while the cold therapy can be effectively administered

Prepare the cooling agent (cold pack, ice bag, ice massage, cold compression unit, vapocoolant spray, ice water bath, contrast bath)

Apply towels as appropriate for patient comfort

Apply the modality to the area to be treated

Set a timer for the duration of the treatment

Provide a way for the patient to reach the clinician during treatment as needed

Assess outcomes after treatment

Question 15

Dosage To Reduce Swelling

Answer 15

4-20 min

Combine with compression and elevation to help prevent unwanted swelling that can occur from
extreme cold

Tissue temperature should not drop
below 15°C (59°F)

Question 16

Dosage To Block Pain

Answer 16

4.5-15 min

Tissue temperature should be below 13.6°C (56.5°F)

Question 17

Dosage To Cool Muscles or Joints

Answer 17

15-30 min

ice massage or ice pack

Question 18

Dosage To Decrease Spasticity

Answer 18

20-45 min

Question 19

Contraindications for heat

Answer 19

Circulatory compromise or peripheral vascular disease

Decreased sensation

Application over areas of acute inflammation, or over infected areas where infection may spread or cross-contamination may occur

Application over areas of recent hemorrhage or potential hemorrhage

Application over areas of known malignancy (heat may increase activation and movement of malignant cells)

Application in any situation deemed unreliable by the practitioner

Question 20

Circulatory compromise or peripheral vascular disease

ask the patient:

Answer 20

Do you have poor circulation?

Question 21

Decreased sensation

ask the patient:

Answer 21

Do you have any areas of numbness/decreased sensation
(clear with objective examination)

Question 22

Application over areas of acute inflammation, or over infected areas where infection may spread or cross-contamination may occur

ask the patient:

Answer 22

History of infection?

Question 23

Application over areas of recent hemorrhage or potential hemorrhage

ask the patient:

Answer 23

History of recent trauma?

Question 24

Application over areas of known malignancy (heat may increase activation and movement of malignant cells)

ask the patient:

Answer 24

Recent, untreated cancer diagnosis

Question 25

Application in any situation deemed unreliable by the practitioner ask the patient:

Answer 25

Assess ability of patient to communicate

Question 26

heat advantages:

Answer 26

decrease pain increase tissue extensibility decrease stiffness

Question 27

heat disadvantages:

Answer 27

may cause increase swelling

Question 28

cold advantages:

Answer 28

may prevent further swelling decrease pain

Question 29

cold disadvantages:

Answer 29

increase stiffness decrease tissue extensibility

Question 30

moist heat pack advantages:

Answer 30

ease of preparation and application variety of shapes and sizes available moist, comfortable heat relatively inexpensive to purchase and replace (assuming a tank is already owned)

Question 31

moist heat pack disadvantages:

Answer 31

no method of temperature control once applied to the patient does not readily conform to all body parts sometimes awkward to secure in place on a patient does not retain heat for longer than about 20 minutes a passive intervention - patient exercise cannot be performed simultaneously may leak and then be discarded (hydrophilic or gel packs)

Question 32

Paraffin wax

Answer 32

Efficient source of heat low melting point of about 129°F (54°C) paraffin has a low specific heat- does not feel as hot as water of the same temperature; therefore less risk of a burn

Question 33

paraffin wax conducts heat slower than water at the same temperature =

Answer 33

allowing tissues to heat up more slowly, decreasing the risk of a burn important when treating patients with sensitive skin or diminished skin sensation

Question 34

Paraffin most commonly used for:

Answer 34

the distal extremities, including the fingers, hand, wrist, and perhaps elbow in the upper limb and the toes, foot, and ankle in the lower limb

Question 35

2 types of Paraffin treatment

Answer 35

1) Dip and wrap- most common 2) Dip and re-immerse

Question 36

Dip and Wrap (Most Common):

Answer 36

patient dips their hand or foot into the paraffin wax (which is typically heated to around 125-130°F or 52-54°C) for a few seconds and then removes it The hand or foot is then wrapped in a plastic bag or sheet and covered with a towel or blanket to retain the heat for 10-15 minutes This method provides uniform heat and is commonly used for improving joint mobility and reducing pain and stiffness

Question 37

Dip and Re-immerse:

Answer 37

patient dips their hand or foot into the paraffin wax, removes it, and then dips it again (re-immerses) for several layers of wax process is repeated to create thicker layers of wax for deeper heat penetration, which can be especially helpful for deeper tissues or more chronic conditions patient can keep the wax on for a similar duration, usually 10-15 minutes

Question 38

Paraffin treatment =

Answer 38

For both methods, the extremity to be treated should be washed, dried and all jewelry should be removed If a ring(s) cannot be removed, cover with adhesive or surgical tape to prevent the wax from getting trapped in its crevices When treating the hand and wrist the fingers should be slightly spread apart, the wrist relaxed, and the hand and wrist dipped into the wax to a few centimeters above the wrist joint The hand is then removed from the wax and held above the bath until the wax has stopped dripping and the wax becomes opaque; then the hand is dipped again Repeat ~ 8 to 10 times until a solid wax glove has formed around the fingers, hand, and wrist

Question 39

patient reminders during paraffin:

Answer 39

The patient should be reminded not to move the hand and fingers / not to break the seal of the glove being formed Remove after ~15-30 minutes

Question 40

Relative to other heat modalities, ___ may not be significantly better at decreasing pain or increasing joint ROM

Answer 40

paraffin wax

Question 41

Hoyrup and Kjorvel compared whirlpool and wax interventions for hand therapy, measuring hand volume, ROM, and pain levels before and after 3 weeks of intervention:

Answer 41

All subjects showed significant improvements in ROM as well as decreased pain, but no significant differences were found between the modalities

Question 42

Paraffin should not be applied:

Answer 42

over open wounds, or in patients with infected skin lesions due to fear of exacerbating the lesion Cover contagious skin conditions or warts with a bandage or tegaderm prior to immersion in the wax bath to avoid contaminating the paraffin bath

Question 43

Whirlpool

Answer 43

form of hydrotherapy where the patient immerses part of their body in a whirlpool bath, typically with circulating warm or cold water

Question 44

Convection with Water:

Answer 44

The whirlpool provides heat or cold through convection, where the water circulates around the body part, allowing the heat or cold to penetrate effectively.

Question 45

Warm Whirlpool:

Answer 45

Can be used to promote relaxation, facilitate motion, and increase blood flow to tissues Helps to soften muscles and improve flexibility by providing continuous, uniform heat Often used for facilitating exercise and mobility in patients who have stiffness or limited range of motion

Question 46

Cold Whirlpool:

Answer 46

Used primarily for controlling pain and swelling by reducing blood flow and inflammation in acute injuries or after surgery Can be an effective method for managing edema and inflammation

Question 47

warm vs cold whirlpool

Answer 47

warm = Facilitate motion and exercise cold = Control pain and swelling

Question 48

Whirlpool Considerations

Answer 48

Inspections, proper cleaning procedures, temperature controls Infection control Dependent positioning of limb **rarely used any more- using whirlpool for wound care

Question 49

Inspections and Proper Cleaning:

Answer 49

needs regular inspections and proper cleaning procedures to prevent bacteria growth, as stagnant water can harbor pathogens Temperature controls should be monitored closely to ensure safety, as excessively hot or cold water can cause burns or discomfort

Question 50

Infection Control:

Answer 50

whirlpools are frequently used in wound care, infection control measures are essential to prevent cross-contamination and spread of infections

Question 51

Dependent Positioning:

Answer 51

patient’s limb may be in a dependent position, which could pose a risk for swelling or discomfort if not monitored carefully

Question 52

Decreased Use:

Answer 52

Rarely used today, especially for wound care, as more effective, targeted treatments like hydrocolloid dressings, vacuum-assisted closure (VAC) therapy, or other modern wound care approaches have largely replaced the use of whirlpools used occasionally for soft tissue mobilization or joint rehabilitation, especially if exercise in water is beneficial to the patient's therapy plan

Question 53

Contrast Bath Therapy:

Answer 53

repeated immersion of an extremity into alternating hot and cold water, typically in a tub or tank promote circulation, manage pain, and aid in desensitization

Question 54

Contrast Bath Therapy Procedure:

Answer 54

Repeated Immersion: The patient’s extremity is immersed first in hot water and then in cold water, alternating between the two. Hot Water: Usually set around 100-110°F (38-43°C). Cold Water: Typically set around 50-60°F (10-15°C). 3:1 Ratio of Time

Question 55

3:1 Ratio of Time

Answer 55

common protocol is to alternate 3 minutes in hot water with 1 minute in cold water for a total of 4-5 cycles creates a pumping effect on the blood vessels

Question 56

Vascular Pumping Action:

Answer 56

rapid alternation between hot and cold causes vasodilation (when the blood vessels widen with heat) followed by vasoconstriction (when the blood vessels constrict with cold) alternating action is thought to help with circulation by promoting blood flow through the extremity *Hypothetically should increase circulation but little evidence to support that conclusion

Question 57

Contrast Bath Recommended Use:

Answer 57

pain relief and desensitization * more evidence for this than improving circulation

Question 58

Heat vs Cold depends on several factors:

Answer 58

1. Stage of Injury or Disease 2. Area of Body Treated 3. Medical Status 4. Patient Preference 5. Use in Home Program

Question 59

1. Stage of Injury or Disease:

Answer 59

Acute Phase (Inflammation): Cold therapy is generally preferred during the acute phase of injury (typically within the first 48 hours) to reduce pain, inflammation, and swelling. Cold has a vasoconstrictive effect, reducing blood flow to the area and limiting inflammation. Subacute or Chronic Phase: Heat therapy may be more effective once the acute inflammation subsides. Heat helps to increase blood flow, relax muscles, and improve soft tissue elasticity, aiding in recovery and mobility.

Question 60

2. Area of Body Treated:

Answer 60

Joints: Cold is often preferred for (localized areas) reducing joint pain and swelling, especially around areas like the knee or elbow. Muscle Tension: Heat is often preferred for (larger muscle groups) muscle spasms or stiffness as it promotes muscle relaxation.

Question 61

3. Medical Status:

Answer 61

Circulatory Issues: For patients with poor circulation (e.g., diabetes, peripheral vascular disease), cold therapy may be contraindicated, as it can further decrease circulation and potentially worsen symptoms. Neurological Conditions: Patients with reduced sensation (e.g., neuropathy) should be cautious with both modalities to avoid burns or frostbite. Heat may be more tolerable in these cases, but temperature monitoring is essential.

Question 62

4. Patient Preference:

Answer 62

Sensitivity to Cold or Heat: Some patients may have a preference based on personal comfort or tolerance. For example, some may find cold more effective for pain relief, while others may prefer the soothing nature of heat. If a patient is particularly sensitive to cold, heat may be a better option and vice versa. For instance, if heat is more soothing, a patient may be more likely to stick with a home program.

Question 63

5. Use in Home Program:

Answer 63

Ease of Application: Cold therapy is often easier for patients to apply at home, especially with ice packs or cold compresses, which can be wrapped and used during daily activities. Heat may require more attention to application (e.g., hot packs or heating pads), but some patients may find it easier to use due to comfort. Duration and Frequency: For home use, it’s important to consider the patient’s ability to maintain the therapy for the recommended amount of time. Cold therapy is typically applied for shorter durations (e.g., 15-20 minutes), while heat can often be applied for longer periods.

Question 64

When to Use Cold:

Answer 64

During the acute inflammatory phase (e.g., after sprains, strains, or surgery) to reduce swelling and pain. For pain management around joints before range of motion exercises. In cases of muscle spasm (if tolerated), cold can help reduce spasm and provide temporary relief.

Question 65

When to Use Heat:

Answer 65

For chronic muscle tension, stiffness, or post-acute recovery. When pain relief is needed, especially for conditions like arthritis or muscle spasms. Psychologically, heat may provide more comfort, encouraging better patient adherence to the treatment plan.

Question 66

Cold is best for __ injuries with ___ and ___, especially if the goal is to reduce ___ and ___.

Answer 66

acute inflammation pain swelling muscle spasm

Question 67

Heat is more beneficial for ___ and increased ___, especially after the acute phase or for ___ conditions.

Answer 67

muscle relaxation blood flow chronic