Treatments - Hot + Cold Flashcards
(15 cards)
Physical Effects of Heat
> Rise in temperature > Expansion (molecules = further apart) > Changes in physical state (latent heat of fusion = energy released during state change) > Acceleration in chemical reactions > Reduction in viscosity of fluids
*Heat = transferred by conduction/convection/radiation
Physiological Effects of heat
> Increased metabolic activity (more O2 + nutrients = more waste products)
Increased blood flow (surface vasodilation -more blood cells arrive - can create greater oedema)
Increased collagen extensibility
Reduce joint stiffness
Reduce muscle spasm
Reduced pain (via pain gate theory)
- Effects depend on size/depth/duration/intensity
- Bone will absorb more than soft tissue (have to be careful not to damage bone)
Heat - Indications for use
> Extensibility of scar tissue > Reduce joint stiffness > Reduce muscle spasm > pain relief > Increase rate of healing * Only whilst heated but may then allow therapies which create longer term change * Can soothe high tone - relaxing
Heat - Dangers
> Burns/Scalds - Optimal therapy = 40-45 degrees - @ 45 degrees - burns after an hour - @ 50 degrees - burns after a minute - @ 65 degrees - burns after a second > Can exacerbate a problem - gangrene/acute inflammation *HAVE TO WARN PATIENT OF RISKS + DOCUMENT THIS
Heat - Contraindications
> Lack of thermal sensation - ALWAYS TEST 1ST (hot/cold test tubes)
Impaired circulation - inability to disperse heat
Haemorrhage risk - increased circulation
Devitalised skin or skin conditions - can be made worse
Heat - Paraffin wax bath
> melts @ 42-50 degrees when mixed with mineral oil (as it solidifies it releases latent heat - gets hotter)
Procedure
- Check wax temp
- check contraindications
- INFORMED CONSENT (explain/warn/document)
- Skin test
- wash
- dip 4/5 times
- wrap in a towel to insulate for ~20 mins
- Remove wax - can be therapy to tool to get hand moving/grip tool
*Patient needs a way of contacting physio or knows how to take off themselves
- Check skin after
- Document
Heat - Hydrocollators
> 75-80 degrees silicate gel in water bath
towelling prevents exceeding 40-42 degrees
Procedure
- Check temp
- check contraindications
- INFORMED CONSENT (explain/warn/document)
- skin test
- apply for ~20mins
- check skin after
- document
*way of patient contacting physio or knows how to remove
Heat - Wheat/Lavender bags
> Heated to temperature in microwave > towelling prevents temp exceeding > Procedure - check temp - check contraindications - INFORMED CONSENT (explain/warn/document) - skin test - apply for ~20 mins - check skin after - document *way of patient contacting physio or knows when + how to remove
Cold Therapy - Physiological effects
> Decreased metabolic rate
Lewis Hunting reaction
- Initial vasoconstriction
- after 5-15mins = vasodilation as neurotransmitter levels are reduced by cold
- alternating from then onwards
Increase blood viscosity
may reduce swelling
pain relief (inhibits mostly a delta fibres)
Reduce high tone (potential to reduce signals + actions on muscle spindles - however can cause psychological tension)
*Subcutaneous fat shields deeper tissues
Cold - Indications for use
> Decrease Oedema - reduce blood flow
Minimise acute inflammation - post injury/surgery/flare-up
Reduce muscle spasm/spasticity - reduces signals but ‘high awareness state’ may actually make worse
Reduce chronic oedema/effusion
Cold - Contraindications
> Decreased sensation - TEST 1ST
Circulatory disorders
- peripheral vascular disease/raynauds - cold can’t be dispersed so burns/necrosis risk = higher
- cryoglobulinemia -abnormal proteins which become insoluble in cold
- Cold Urticaria - rash develops after cold exposure
Cold - Precautions
> Cardiac disease - not near heart
Altered blood pressure - cold causes rapid bp change
skin hypersensitivity
psychosocial factors - patient dependent
Cold - Dangers
> Ice burns - below 5 degrees
Frostbite
Fatty Necrosis - damage to underlying skin (bruising)
Cold - Methods
> Cryocuff
Ice pack
> Method
- Check temp
- Check contraindications
- INFORMED CONSENT (explain/warn/document)
- Skin test
- apply for 20 mins (oil on skin if direct application)
- check skin
- document
Heat vs. Cold therapy
> HEAT
- promote healing
- relax: extensibility/tone/spasm/stiffness
- pain relief
- Never heat if area = already hot (sign of acute inflammation)
> COLD
- reduce inflammation/swelling (especially if acute)
- Pain relief
