1. Physical Activity Injuries Lecture 3 Treatment modalities FDSc FISM year 1 Janis Leach

2. Outline Management of acute injury Theory and application of cryotherapy The use of NSAID Theory and application of heat therapies Theory and application of manual therapies Diagnostic imaging

3. Objectives Identify the reasons why we use certain treatments Identify treatment methods and contraindications Determine when to refer on to diagnostic imaging

4. Principles of injury management Minimise extent of damage Reduce pain and inflammation Promote healing Restore strength, flexibility and fitness Rehabilitation

5. Cryotherapy Local application of cold Reduce pain Reduce oedema Decreases blood flow Causes vasoconstriction Pain gate theory Inflammatory process

6. Cryotherapy Different types of application Ice packs Cold sprays Cryocuff Ice bath

7. Cryotherapy - cryocuff

8. Cryotherapy – research? Hubbard and Denegar (2004). Does Cryotherapy Improve Outcomes With Soft Tissue Injury? J. Athletic Training. 39(3): pp 278–279 Access this journal – you can find it on Google. Read through and take notes

9. Cryocuff Some research shows that there was an 80% success rate whereby reduction of pain and swelling was evident after the first and subsequent postoperative visits (Scheffler et al. 1992). Levey et al.(1997) suggested that the cuff application to be effective in relieving pain, temperatures in target tissues need to be cooled to 10°C to 16°C. Manufacturers reports, Cryo/Cuff temp approx 15°C

10. Ice application There is some evidence that cold induced analgesia is short term lasting for approx. 15– 30 minutes after treatment (Bleakley et al. 2006). Enwemeka et al. (2002) found that ice application only reached 1cm into muscle tissue Myra et al. (2001) stated that it can penetrate up to 3cms depending on adipose tissue.

11. Ice application Cold sprays Ice water immersion Ice packs Disposable ice packs Contrast bathing – (heat 4 mins, ice 1-2, finish with ice)

12. Contraindications to Ice Therapy Raynaud’s disease Diabetes Cardiac conditions Open wounds Loss of sensation

13. NSAID Nonsterodal anti-inflammatory drugs (Ibuprofen, naproxen) Inhibit action of prostaglandins by limiting formation of by-products that trigger the inflammatory response Effective if given soon after the injury May cause side effects (gastric)

14. Manual therapies Massage Osteopathy Chiropractors Ultrasound TENS

15. Heat Therapies In pairs read through the journal. Determine a treatment plan for someone with a hamstring tear. Plan your treatment for up to 2 weeks after the injury. Assume that 2/52 they are able to weight bear and have regained about 80% ROM

16. Practical In pairs prepare the cryo cuff and apply appropriately