superficial heat and cold therapies- PMR

superficial heat and cold therapies

1. CRYOTHERAPY & Superficial Heat Modalities-Updates Dr Rinsha Febin M Post graduate resident

2. Specific heat The amount of energy required to raise the temperature of a given weight of a material by a given number of degrees. Materials with high specific heat require more energy to heat up and hold more energy at a given temperature than materials with low specific heat. Therefore, to transfer the same amount of heat to a patient, thermal agents with high specific heat, such as water, are applied at lower temperatures than air-based thermal agents 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 2

3. Latent heat The energy required for (or released by) a change of state. In the case of water, 1 gram of ice at 0°C requires 336 joules of energy to convert it to 1 g of water at 0°C ( latent heat of fusion ), and 1 gram of water at 100°C requires 2268 joules of energy to convert it to 1 g of steam at 100°C ( latent heat of vaporization ). As matter changes from a state of high kinetic energy to one of lower kinetic energy (e.g. steam to water, liquid to solid), this latent energy is released. Practical applications: ice melting on the skin takes considerable energy (heat) from the skin, thus cooling it, whereas paraffin wax solidifying on the skin gives out considerable heat to the skin, thus warming it. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 3

4. Modes of heat transfer Conduction : Heat transfer by conduction occurs only between materials of different temperatures that are in direct contact with each other. Example: Paraffin bath, Ice pack The greater the temperature difference between a heating or cooling agent and the body part it is applied to, the faster the rate of heat transfer. Materials with high thermal conductivity transfer heat faster than those with low thermal conductivity Heating and cooling agents generally are composed of materials with moderate thermal conductivity to provide a safe and effective rate of heat transfer Place six to eight layers of toweling between a hot pack and the patient to limit the rate of heat transfer and to avoid burns The larger the area of contact between a thermal agent and the patient, the greater the total heat transfer The rate of temperature rise decreases in proportion to tissue thickness. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 4

5. Convection : Heat transfer by convection occurs as the result of direct contact between a circulating medium and another material of a different temperature During heating or cooling by convection, the thermal agent is in motion. more rapid the rate of heat transfer. Circulating blood helps to keep local body temperature at baseline. The risk of thermal injury is increased when circulation is impaired. Conversion : Heat transfer by conversion involves the conversion of a nonthermal form of energy, such as mechanical, electrical, or chemical energy, into heat. For example, ultrasound. Radiation :Heating by radiation involves the direct transfer of energy from a material with a higher temperature to one with a lower temperature without the need for an intervening medium or contact: Infrared lamps. Evapouration : A material must absorb energy to evaporate and thus change form from a liquid to a gas or vapor: Vapocoolant sprays 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 5

6. cryotherapy the therapeutic use of cold, has clinical applications in rehabilitation and in other areas of medicine. HEMODYNAMIC EFFECTS Initial Decrease in Blood Flow  Prolonged cold exposure or or when the tissue temperature reaches less than 10° C (50° F)  cold-induced vasodilation (CIVD): * Lewis temperature cycling with alternating vasoconstriction and vasodilation and called this the hunting response CIVD is most likely to occur in the distal extremities, Cold application should be limited to 15 minutes or less. Is increase in skin redness seen with the application of a sign of CIVD? (oxyhaemoglobin concentration of the blood) 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 6

7. NEUROMUSCULAR EFFECTS Decreased Nerve Conduction Velocity Increased Pain Threshold Altered Muscle Strength Decreased Spasticity Facilitation of Muscle Contraction METABOLIC EFFECTS : Decreased Metabolic Rate 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 7

8. Uses of cryotherapy Apply cryotherapy immediately after injury and during the acute inflammatory phase of healing to help control bleeding, edema, and pain and to accelerate recovery. The prophylactic use of cryotherapy after exercise can reduce the severity of delayed-onset muscle soreness When using cryotherapy to control inflammation on the extremities, apply for no longer than 20 minutes at least 1 hour apart. The combined intervention of rest, ice, compression, and elevation is frequently referred to by the acronym RICE : Cryotherapy, along with compression and elevation, reduces postinjury edema MODIFICATION OF SPASTICITY SYMPTOM MANAGEMENT IN MULTIPLE SCLEROSIS FACILITATION Rapid application of ice as a stimulus to elicit desired motor patterns, known as quick icing 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 8

9. CRYOKINETICS AND CRYOSTRETCH Cryokinetics is a technique that combines the use of cold and exercise in the treatment of pathology or disease (athletes). Applying a cooling agent to the point of numbness shortly after any injury to reduce the sensation of pain, thus allowing the patient to exercise and work toward regaining range of motion (ROM) as early as possible in the recovery process cold is applied for up to 20 min(numbing)  performs strengthening and stretching exercises for 3 to 5 minutes until sensation returns.  The cooling agent is reapplied until analgesia is regained. * 5times Cryostretch is the application of a cooling agent before stretching. To reduce muscle spasm, thus allowing greater ROM increases with stretching. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 9

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11. Application techniques Cold or ice packs, ice cups, controlled cold compression units, vapocoolant sprays, frozen towels, ice water, cold whirlpools, and contrast baths. Cool cold packs for at least 2 hours before initial use and for 30 minutes between uses. The typical sequence of sensations in response to cryotherapy is as follows: Intense cold  burning  aching  analgesia  numbness . 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 11

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16. EXAMPLES When applying an ice pack (IP) to the patient’s (pt) left (L) knee to control postoperative (postop) swelling, document the following: S: Pt reports postop L knee pain and swelling that increases with walking. O: Pretreatment: Midpatellar girth 161 ⁄2 in. Gait “step to” when ascending stairs. Intervention: IP L anterior knee for 15 min, L LE elevated. Posttreatment: Midpatellar girth 15 in. Gait “step through” when ascending stairs. A: Decreased midpatellar girth, improved gait. P: Instruct pt in home program of IP to L anterior knee, 15 min, with L LE elevated , 3times each day until next treatment session. When applying ice massage (IM) to the area of the right (R) lateral ( lat ) epicondyle to treat epicondylitis, document the following: S: Pt reports pain in R lat elbow. O: Pretreatment: 8/10 R lat elbow pain. R elbow unable to fully extend. Intervention: IM R lat elbow for 5 min. Posttreatment: Pain 6/10. Full elbow extension. A: Pain decreased and elbow ROM improved. P: Continue IM at end of treatment sessions until pt has pain-free elbow function. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 16

17. Contrast bath 17 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

18. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 18 Why alternating hot and cold?

19. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 19 Conventional CB (10-minute baseline, 4 : 1-minute hot : cold ratio) was applied

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21. SUPERFICIAL HEAT 21 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

22. Hydrocollator pack Made of bentonite, a hydrophilic silicate gel , covered with canvas. Bentonite is used for this application because it can hold a large quantity of water for efficient delivery of heat. Thermostat maintain temperature of 170 °F , removed by tongs or scissors before use Size Lower or middle back – 24 × 24 inch Cervical – 6 × 18 inches Duration 15 to 20 mins Not to lie on packs – (1) risk of burn (2) force silicate gel out Check for burns 22 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

23. Paraffin bath paraffin is mixed with mineral oil in a 6:1 or 7:1 ratio of paraffin to oil to reduce the melting temperature of the paraffin from 54° C (129° F) to between 45° C and 50° C (113° F to 122° F) Paraffin can be safely applied directly to the skin at this temperature because of its low specific heat and thermal conductivity ( less than that of water) Both paraffin and mineral oil has low specific heat which enhances patient ability to tolerate heat from paraffin better than water Paraffin usually is used for heating the distal extremities because it can maintain good contact with these irregularly contoured areas. 23 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

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25. 1 gal(3.78L) of mineral oil to 2 ib (0.9kg) of paraffin ???? Paraffin treatments provide 6 times the amount of heat available in water because mineral oil in paraffin lowers the melting point of paraffin. WHY PLASTIC COVER ? 25 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

26. Hydrotherapy Treat the patient through the medium of water Can be performed in swimming pool, hubbard tank or whirlpool Of this whirlpool is m/c used Patient can move treated part in whirlpool easily to get added benefit of exercise Two types Cold – acute and subacute conditions Warm whirlpool 26 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

27. A Hubbard tank is a large, figure-eight shaped tub filled with warm water that's used for physical rehabilitation. The tank is designed to fully immerse a patient's body so that the warm water can gently massage muscles. How it works The buoyancy of the water reduces strain on muscles and joints. The warm water helps improve circulation and enhance muscle function. The swirled water gently massages affected muscles. 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 27

28. References Physical agents in rehabilitation by Cameron Michelle H, 4 th edition. Clayton's electrotherapy : theory and practice By Edward Bellis Clayton, Angela Forster, Nigel Palastanga , 9 th edition. Braddom's physical medicine and rehabilitation By David X. Cifu, 6 th edition. John Low and Ann Reed, (2008), Electrotherapy Explained, Principles and Practice, Elsvier , India. 28 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M

29. thermometer 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M 29

30. THANK YOU 30 22-02-2025 Cryotherapy & Superficial Heating Modalities Updates - Dr. Rinsha Febin M