1. Using Therapeutic Modalities- Part 1 COLD AND HOT THERAPIES

2. Transmission of Thermal Energy  Conduction  Heat is transferred from a warmer object to a cooler one  Paraffin, electric heating pads, ice/cold packs  Convection  Transference of heat through the movement of fluids or gasses  Whirlpool bath  Conversion  Generation of heat from another energy form  Sound, electricity, chemical agents  Ultrasound: Mechanical energy from sound waves  Diathermy: heat produced by applying electrical currents of specific wave lengths  Liniments/Balms: heating sensation through counter irritation of sensory nerve endings

3. Cryotherapy  Infrared Radiation  Cold objects abstracts heat from a warmer object  Muscle is a good conductor  Fat is a poor conductor  ½” of subcutaneous fat – significant muscle cooling after 10 minutes  4/5” of subcutaneous fat – muscles temperature barely drops  Ice/cold packs, immersion in cool/cold water

4. Cryotherapy  Physiological effects  Vascoconstriction  Increased blood VISCOSITY  Decreased chemical mediator release  Decreased capillary permeability  Reduced swelling  Decreased muscle spasm  Hunting Response: slight increase in temperature during cooling

5. Cryotherapy Contraindications  Reynaud’s Phenomenon: cold exposure causes vasospasm of digital arteries (lasts for minutes to hours)  Cold allergies or hypersensitivity  Over superficial nerves  Uncovered open wounds  Poor circulation or decreased sensation  Post surgery, diabetes, neuropathy

6. Cryotherapy Techniques  Ice Massage (32ºF)  Ice is rubbed in overlapping circles over a 10-15 cm area 5-10 minutes  Cold/ice water immersion (50º-60ºF)  10-15 minutes  Ice bag (34º-36º)  Wet ice packs 15-20 minutes  Vapocoolant sprays  Flouri-menthane (reduce spasm, treat trigger points)  Cryokinetics  Combines cryotherapy and exercise  Ice until numb (12-20 minutes) exercise 3-5 minutes, ice until numb (3-5 minutes) repeat 3-5 times

7. Ice Massage

8. Cold Water Immersion

9. Ice Bag

10. Vapocoolant Sprays

11. Cold and Compression

12. Thermotherapy  Infrared modality  Increase in subcutaneous temperature and spreads indirectly through deeper tissues  Muscle temperatures increase with circulation and conduction  Moist heat causes greater increase than dry  Dry heat can be tolerated at higher temperatures

13. Thermotherapy  Physiological effects  Heat must be absorbed into tissue which increases cellular activity  Increased EXTENSIBILITY of collagen tissue  Decreased joint stiffness  Reduced pain (GATE CONTROL THEORY)  Reduced Muscle Spasm  Increased nerve conduction  Increased blood flow and LYMPHATIC drainage  Assist inflammation

14. Thermotherapy Contraindications  Acute inflammation  Impaired circulation  Poor thermal regulation  Infections  Cancer  Pregnancy (over the low back or abdomen)

15. Thermotherapy Techniques  Moist Heat packs (160º-170ºF)  Contains a silica gel in a cotton pad that retains water and a constant heat level for 20-30 minutes  Layers of towels should be used between the packs and skin  Whirlpool (100º-110ºF)  Convection and conduction  Paraffin (126º-130ºF)  Glove method: 6-12 Dips  Immersion: submerged for 20-30 minutes  Contrast Bath (100º-110ºF)/(50º-60ºF)  Increased blood flow without accumulation of additional edema  3:1 or 4:1 Warm: Cold 20 minutes

16. Moist Heat Packs

17. Paraffin

18. Contrast Bath