Cold Therapy

Question 1

Increased physiological responses to cryotherapy application

1. Joint stiffness:
2. Pain threshold:
3. Increased Blood Viscosity:
4. Muscle Strength:

Answer 1

1. Joint stiffness: decreased extensibility of collagen tissue and increased tissue viscosity
2. Pain threshold: inhibition of A delta and C fibers (gate theory), interruption of pain-spasm cycle, decreased sensory and motor conduction, synaptic transmission slowed or blocked
3. Increased Blood Viscosity: decreased blood flow in small vessels facilitates red blood cells adhering to one another and vessel wall, impeding blood flow
4. Muscle Strength: facilitation of alpha motor neuron (short duration: 1-5 min)

Question 2

Decreased Physiological responses of body sytems with cryotherapy application

1. Blood flow
2. capillary permeability
3. elasticity of nonelastic tissues
4. metabolism
5. muscle spasm
6. muscle strength
7. spasticity
8. vasoactive agents

Answer 2

1. Blood flow = sympathetic adrenergic activity produces vasoconstriction of arteries etc.
2. capillary permeability = decreased fluids into interstitial tissue
3. elasticity of nonelastic tissues: decreased
4. metabolism: dec rate of cellular oxidation
5. muscle spasm: decreased firing of II afferents of ms spindle, increased firing of Ib GTO fibers reduces alpha MN activity and thus decreases tonic extrafusal activity
6. muscle strength: decreased blood flow, increased viscous properties of ms, (long > 5-10 min)
7. spasticity: decreased muscle spindle discharge (afferents: primary, secondary) decreased gamma motor neuron activity
8. Vasoactive agents: decreased blood flow

Question 3

Thermal Agents: Cryotherapy - Local Effects

Answer 3

• Decreased:
  
  • Blood flow,
  • capillary permeability,
  • elasticity of nonelastic tissues,
  • metabolism,
  • muscle spasm,
  • muscle strength (after 5-10 mins),
  • spasticity,
  • vasoactive agents
• Increased:
  
  • Joint stiffness,
  • pain threshold,
  • blood viscosity,
  • muscle strength (in first 5 mins)
  • Vasoconstriction causes skin blanching at center with hyperemia due to histamine reaction around edge of the contact area.

Question 4

Thermal Agents: Cryotherapy - General Effects

Answer 4

• Decreased:
  
  • Metabolic rate,
  • HR,
  • RR,
  • venous BP
• Increased:
  
  • Blood flow to internal organs,
  • CO,
  • SV,
  • arterial BP,
  • shivering (when core temp drops)

Question 5

Thermal Agents: Cryotherapy - General Indications

Answer 5

• Modulate pain
• Reduce or eliminate soft tissue inflammation or swelling
• Reduce ms spasm
• Reduce hypersensitivity
• Cryokinetics
• Management of symptoms in multiple sclerosis

Question 6

Thermal Agents: Cryotherapy - General Contraindications

Answer 6

• Cold hypersensitivity (urticaria)
• Cold intolerance
• Cryoglobulinemia
• Peripheral vascular disease
• Impaired temperature sensation
• Raynauds Paroxysmal
• cold hemoglobinuria
• Over regenerating peripheral nerves.

Question 7

Thermal Agents: Cryotherapy - General Precautions

Answer 7

• Hypertension
• Impaired temp sensation
• Open wound
• Over superficial nerve
• Very old or young
• Cognitive changes

Question 8

Thermal Agents: Cryotherapy - Application (types)

Answer 8

• Cold pack:
  
  • Dampen towel w/ warm water
  • Treatment temp: 0-10 deg F
  • Treatment Time: 10-20 min
• Ice pack:
  
  • Treatment temp: 0-10 deg F
  • Treatment Time: 10-20 min

Question 9

Thermal Agents: Cryotherapy - Application: Ice Massage

Answer 9

• Stages: cold, burning, ache, numb
• Area no greater than 4x6 inches
• Not over superficial nerve
• Time: 5-10 min or analgesia

Question 10

Thermal Agents: Cryotherapy - Application: Vapocoolant Spray

Answer 10

• (evaporation)
• Hold 18-24 inches away @ 30 deg
• Spray 4 inches/sec
• Allow complete evaporation,

repeat

• Ms PROM stretch before during
• Time: 10-15 minutes *trigger points