Indications of cryotherapy?
- active acute inflammatory response
- before ROM exercises, after physical activity
Indications of thermotherapy?
- control inflammatory reaction in subacute or chronic stages
- encourage tissue healing
- promote venous drainage
- reduce edema and ecchymosis
- improve ROM before physical activity
What is radiation?
heat transferred from one object to another
ex. shortwave diathermy, UV therapy
What is conversion?
heat generated from another energy source (ex. sound, electricity, chemical agents)
ex. ultrasound
What is evaporation?
heat transferred from a surface when liquid becomes a gas
ex. sweat, vapocoolant spray
What is convection?
heat transferred through movement of fluid or gas
- factors that may influence the heating are temperature, speed of movement, and conductivity
ex. whirlpool
What is conduction?
heat transferred from direct contact between two objects
ex. moist heat pack, paraffin, ice pack
What should the temperature range of cold modalities be?
0-18 degrees C
What are the physiological effects of cryotherapy?
- vasoconstriction of arterioles and venules
- increases blood viscosity = reduces blood flow
- lowers metabolic rate = decreases ischemic injury, waste products, muscle fatigue, and increases muscular contraction
- reduction of new swelling
- decreases collagen elasticity
- decreases free nerve ending excitability = decreased pain perception
Explain the Hunting Response.
phenomenon causing slight temperature increase during cooling
Contraindications of cryotherapy?
- cold allergy
- Raynaud’s
- circulatory or sensory impairment
- advanced diabetes
- arthritis
- hypertension
- deep vein thrombosis
- hypo or hyper cold sensitivity
- uncovered open wounds
- nerve palsy
- cardio/respiratory disorders
- hemoglobinemia
- lupus
What does CBAN stand for and how long is each portion?
C- Cold (0-3 mins) B - Burning (2-7 mins) A - Aching (2-7 mins) N - Numbness (5-12 mins) \+ Analgesia (18-21 mins)
What is the cryokinetic cycle?
- numb the area (12-20 min, following CBAN)
- exercises within pain limits - must be PF, should be active, should focus on flexibility and strength, should progress as quickly as possible)
- when numbness wears off, reapply for 3-5 mins
- Repeat cycle 5 times
What pain theory is used in thermotherapy?
Gate control theory
What is the Piezoelectric effect?
expansion and contraction of crystals in an ultrasound head produces an oscillation voltage
Explain what the frequency parameter of an ultrasound is.
1MHz - energy is absorbed by deeper tissues - 3-5cm
3MHz - energy is absorbed by superficial tissues - 1-2cm
What does BNR stand for and what does it mean?
Beam Nonuniformity Ratio - the amount of variability of intensity in the beam
- lower BNR = more uniform
What is ultrasound intensity?
amount of energy delivered to sound head in w/cm2
Which sensory nerve fibres are large, slightly myelinated, fat, produce instant pain, withdrawal, and acute pain?
A-delta fibres
Which sensory nerve fibers are slow, unmyelinated, produce throbbing, pressure, chronic pain?
C-Fibers
Which sensory nerve fibers are large, myelinated, fast, and produce a nonpainful stimuli?
A-alpha and A-beta fibers
Explain the Gate Control theory.
- only allows one sensation to pass through the brain at a time, acute
- stimulation of a-beta blocks the impulses at the spinal cord level of pain messages carried by a-delta and c-fibers
ex. TENS, massage, cryotherapy
Explain the Endorphin Release theory.
operates at supraspinal and spinal levels
- prolonged stimulation of a-delta and c-fibers trigger release of beta endorphins by the ant. pituitary
- beta endorphins bind to opiate binding sites in the nervous system and have long half-life (multiple hour analgesic effect)
- chronic pain
What are the 3 types of currents?
- Direct - uninterrupted, monophasic or galvantic
- Alternating - uninterrupted, bidirectional, biphasic, ex. premod, IFC, TENS
- Pulsed - interrupted by discrete periods of no electron flow, 3+ pulses grouped together, uni or bidirectional, ex. NMES, Russian, High Volt
