Modalities Ch. 12

Question 1

what is cryotherapy

Answer 1

use of ice for therapeutic functions

Question 2

cryotherapy beyond immediate care

Answer 2

misconceptions
awesome for immediate care
useful beyond immediate care

Question 3

cryotherapy techniques

-5 major categories

Answer 3

immediate care
post-immediate care
surgical adjunct
cryosurgery
miscellaneous techniques

Question 4

post-immediate care cryotherapy

• primary benefit
• why start therapeutic exercise as early as possible?

Answer 4

primary
-decrease pain
-decrease muscle spasm
why start earlier?
-proper exercise speeds the healing process
-lack of exercise may result in permanent injury

Question 5

post-immediate care precautions

Answer 5

too vigorous exercise may result in permanent disability
optimum healing depends on balance between
-returning to full normal function as quickly as possible
-protect injury from overstress and further injury

Question 6

major cryotherapeutic techniques used during post-immediate care

Answer 6

cryokinetics - exercises
cryostretch
connective tissue stretch
cold compression devices
contrast baths

Question 7

what happens when cold is applied

Answer 7

decreased temperature
tissue destruction
effonts on inflammation
decreased metabolism
decreased and increased pain
decreased muscle spasm

Question 8

temperature change and gradients

Answer 8

immediately after cold application, heat begins moving from the tissue into the cold device
tissue destroyed with severe cooling
–4 to -94 F
tissue is usually cooled to a surface temperature of 33-50F

Question 9

decreased temperature

Answer 9

gradient continues when the cold modality is removed
deep tissue continues to cool after the modality is removed
-as a result of the gradient and heat conduction

Question 10

temperature gradients within the modality

Answer 10

shake cold packs and stir water baths every 5 min. to break up gradient

Question 11

effects on inflammation

Answer 11

many think one benefit of acute injury cryotherapy is to decrease inflammation
probably not true for two reasons
-inflammation is necessary for resolution of the injury
-little research has been done on the acute inflammatory response

Question 12

decreased metablolism

Answer 12

direct relationship between tissue temperature and metabolism

Question 13

effects on pain

Answer 13

cold is the most effective and underused physical modality for pain
clear evidence
by numbing a muscle or joint, active exercise can be used earlier in the rehabilitation process

Question 14

three types of pain

Answer 14

cold pain
residual pain
reinjury pain

Question 15

cold temp

Answer 15

no physiological reason related to increased healing

can be adapted to

Question 16

efforts to minimize cold pain during immersion

Answer 16

development of neoprene toe cap
-eliminates toe pain, which accounts for 50% of pain during immersion
refraining from using cryokinetics
-unfortunate
-pain is both temporary and short lived
using warmer water
-treatment is less effective

Question 17

decreased muscle spasm

Answer 17

muscle spasm is not muscle cramping

Question 18

muscle cramp

Answer 18

seizes

-contracts really strongly

Question 19

muscle spasm

Answer 19

muscle tightness

adhesions in the muscle

Question 20

how muscle spasms are decreased

Answer 20

decreased by cold applications
-specific mechanism unknown
three mechanisms suggested

Question 21

three mechanisms of muscle spasms relief

Answer 21

decreasing nerve conduction
breaking pain-spasm-pain cycle
removing cause of spasm

Question 22

when is using cold to diminish muscle spasm effective?

Answer 22

when combined with stretching

-cryostretch

Question 23

cryostretch technique

Answer 23

cold application until numb
combination of static stretch and isometric contraction
re-numb

Question 24

increased tissue stiffness

Answer 24

cold tissue more stiff so more resistant to movement
some feel this contraindicates exercise after cryotherapy, fearing tissues will tear
-fine motor skills are hindered, but gross motor movement is not

Question 25

decreased arthrogenic muscle inhibition

Answer 25

reverse injury-induced inhibition | may facilitate muscle activity above normal

Question 26

circulatory response

Answer 26

increased and/or decreased blood flow proposed artitrary explanations for an increase in blood flow confusion a result of inappropriate application of CIVD concept ample evidence that cryotherapy decreases blood flow

Question 27

CIVD

Answer 27

Cold-Induced Vasodilation popular thought some claim that CIVD increased blood flow more than heat

Question 28

increased rate of healing

Answer 28

owing to exercise, not cold - exercise increases blood flow far more than either heat or cold - exercise stimulates healing in other ways as well

Question 29

conclusions

Answer 29

no increase in blood flow purpose of cold applications post-immediate care is to facilitate rehab exercise improves healing

Question 30

physiological effects

Answer 30

memorize page 226 - table 12.1

Question 31

recovery cryotherapy

Answer 31

used often to help athletes recover after activity scientists struggle explain why the technique is beneficial -technique is gaining momentum

Question 32

recovery cryotherapy methods

Answer 32

whole body cryotherapy (WBC) cold water immersion (CWI) both techniques were first used for immediate care

Question 33

why use recovery therapy?

Answer 33

anecdotal psychological benefit looking for every advantage to improve performance

Question 34

problems, precautions, and contraindications

Answer 34

``` frostbite chilblains nerve palsy cold hypersensitivity/allergies vasospastic disorders cold-induced pain ```

Question 35

frostbite

Answer 35

cell damage, blood vessel damage cold modality left on >1 hour or combined with pressure gel packs

Question 36

chilblains

Answer 36

inflammatory condition caused by mild frostbite - reddish purple skin that is swollen and may burn or itch - resolves in a fwe days or weeks - no permanent damage

Question 37

nerve palsy

Answer 37

most common during treatment of the later fibular head controversy over actual cause: cold, compression or combination recommendation: be careful when applying cold and compression to areas where large nerves are superficially located peroneal, ulnar nerves

Question 38

cold hypersensitivity/allergies

Answer 38

many forms most common is cold urticaria - allergic anaphylactic reaction causes wheals to form soon after the treatment which subside in 10-30 minutes treatment -antihistamine -avoid precipitation conditions -use alternate method severity of reaction lessens with further cold therapy

Question 39

vasospastic disorders

Answer 39

improper dilation ischemic necrosis Raynaud's Phenomenon: local functional changes in peripheral circulation as a result of Raynaud's disease or other condition skin turns pale or cyanotic, then red - may go back and forth

Question 40

cold-induced pain

Answer 40

some athletes simply cannot tolerate pain of cold therapy, especially immersion do not force therapy; try alternate methods

Question 41

contraindications

Answer 41

``` specific diseases -Raynaud's -cold hypersensitivity -cold urticaria cardiac and respiratory disorders compromised or impaired local circulation or innervation (anesthetic skin) uncovered open wounds infection advanced diabetes lupus - immune system disorder ```

Question 42

precautions

Answer 42

no application >1 hour major superficial nerves be careful when applying a commercial ice pack more than 5-10 minutes do not apply a gel ice pack under an elastic bandage be careful when athlete is performing exercises that cause pain following cold applications be careful when using cryotherapy when treating a person who -is hypertensive -is paralyzed -has coronary artery disease -has a rheumatoid condition

Question 43

progression of cold sensation

Answer 43

cold, pain, tingling, numbness or cold, burning, aching, analgesia potentially due to... -differing conduction velocities of different nerve types or -nerve endings as they temporarily cease to function resulting from decreased blood flow cold therapy causes analgesia - not anesthesia (loss of sensation) better word is hypalgesia (decrease in pain)

Question 44

cryokinetics

Answer 44

cold + movement commonly used for acute sprains to greatly reduce rehab time systematic combination of cold-induced hypalgesia and progressive, graded exercise

Question 45

application of cryokinetics

Answer 45

``` numb the body part -immersion preferred and most common -may also use ice massage, ice packs use pain as a guide exercise the body part -only while area is numb activity should be progressive -begin with simple ROM ```

Question 46

cryokinetics and numbness

Answer 46

numbness usuallylasts 2-5 minutes re-numb area, repeat exercise repeat about 5 times

Question 47

contrast bath

Answer 47

alternating immersion in hot and cold water baths supposedly causes alternating vasodilation and vasoconstriction sort of creates a pump

Question 48

contrast bath flaws

Answer 48

edema reduction -picked up by lymphatic system which does not have vasoconstriction/vasodilation tissue temperature change -not very significant capillaries and lymph vessels do not vasodilate cryokinetics more effective

Question 49

lymphedema pumps

Answer 49

pump forces air or chilled water into sleeve, applying pressure to the joint sleeve intermittently inflates and deflates changes in pressure force lymphatic and venous drainage from extremity and reduce edema cryokinetics is preferred for edema reduction -"pump rate" is greater with cryokinetics cryokinetics offers additional benefits of active exercise

Question 50

application types

Answer 50

``` ice bags cold gel packs chemical cold packs ice immersion cold whirlpool ice massage Cryo Cuff GameReady ```