Hydrotherapy is an important therapeutic modalities and while giving therapy we need to know the science of Hydrotherapy. This PPT describes the sciences of Hydrotherapy.
5. WATER
• Water is an oxide of hydrogen.
• It is tasteless odorless colorless liquid.
• Used as the standard of specific gravity, specific heat
ect..
• Presented in all organic tissue so known as basis of
life.
• Also known as universal solvent.
6. HEAVY WATER (D2O)
• A compound analogues to water, but containing
deuterium or heavy hydrogen.
• It is in capable of supporting life.
SN Properties H2O D2O
1 Freezing point 0°C / 32° F 3.8°C
2 Boiling point 100°C / 212° F 101.4°C
3 Common density at 20°C 0.996 1.1059
4 Heat of maximum density 4 11.6
5 Latent heat of steam 536cal/ gm 537cal/ gm
6 Latent heat of melting point 80cal/ gm 75.5cal/ gm
7. Temperature:
• Temperature is a measure of the average amount
kinetic energy possessed by an individual
molecule of a body (kinetic theory of heat).
– Temperature is a measure of sensible heat of cold in
a body.
– Temperature is expressed as Fahrenheit or
Centigrade.
8. Basics of Heat
• Heat: a term used to describe the energy that
matter can store in the form of electronic,
atomic, or molecular motion.
– The great the molecular motion, the greater the heat
production
9. Basics of Cold
• Cold: in a physical sense is a negative condition,
depending on the decrease in the amount of
molecular vibration that constitutes heat. The
less the molecular motion, the less heat
production. Thus, a sensation of cold results.
11. THERMOMETRY
• Definition :
The property of system that determines
whether or not the system is on thermal
equilibrium with other system.
• Human asses this level through special
temperature receptor in skin.
• CNS tend to recognize the contrast and
judgment made by it is not absolute.
12. MERCURY THERMOMETER
• these are the devices to measure the
temperature using mercury as ideal.
• Principle:
• Mercury can expand faster than glass
while heated equally.
• Mercury is packed in is packed in a small
diameter glass tube.
• Small changes in temperature also will
cause large movement of mercury column
along the tube.
13. CELSIUS SCALE
• The technique is founded by
French scientist CELSIUS.
• To measure the temperature the
melting point and boiling point
of water are found.
• Reading between them are
divided into 100 parts , called
degrees.
14. FAHRENHITE SCALE
• Discovered by German physicist
“DANIAL FAHRENHITE.
• Lower temperature is attended by
freezing the mixture of ice and salt.
• Fresh water freezes at 32° F and boils
at 212° F under normal atmospheric
presser.
• Normal human body temperature is 96.3°
F.
15. KELVIN SCALE
• There is no upper limits of
movement of atom and heat
production but there is definitely
lover limit where mo motion occurs
at all.
• The point is called absolute zero-
273.2°C
• Kelvin meter absolute 0=0° k
• Freezing point if water = 273° K boiling
point=373°K
16. THERMOGRAPHY
• The process of sensing the
temperature of quite large area of
body by photographing the
surface by infra red sensitive film.
The film is made to give a color
response to different temperature.
• It gives colorful map for different
temperature.
• Used to identify inflammation
and hot spot etc..
17.
18. ELECTRIC THERMOMETER
• It is an electric
device used to
measure
temperature.
• Reading is not
always accurate.
19. ALCOHOL THERMOMETER
• Color alcohol is put
in a glass capillary
tube for easy
reading.
• Generally used for
room or water bath
temperature.
20.
21. HEAT AND COLD
• GENERAL PRINCIPLES:-
1. Solid atoms are closely packed--- they can not move
from its positions--- atoms vibrates on its own
position---- the kinetic energy of atom is known as
heat. When extra energy is added to a solid atom it
vibrates more and becomes more hotter.
2. Liquid molecules have greater amplitude of
vibration ---- they can over come from inter atomic
force of their neighborhood..
22. HEAT AND COLD
3. Atoms are widely spaced on gas---- they can
move randomly
When extra energy is added to gas it vibrates
more space between molecule increases due to
more motion so it expanse
4. This principles are used to change the heat
energy to the mechanical energy
eg…. Steam engine of train
thermometer.
23. QUALITY OF HEAT
• Calorie:- the amount of heat needed to
raise the temperature of 1 gram of water
by 1°C.
• 1 calorie = 4.18 KJL/ Kg / °C for water.
• Specific heat:- this is equivalent to the amount
of heat required to raise the temperature of 1
gm of substance by 1 degree. Corresponding
value for water is 1.
24. SN SUBSTANCES SPECIFIC HEAT (KJ/ KG1°C/ )
1 Water 4.18
2 Air 1.01
3 Mercury 0.14
4 Paraffin wax 2.7
5 Rubber 2.01
6 Whole human body 3.56
7 Skin 3.77
8 Fat 2.3
9 Muscle 3.75
10 Bone 1.59
11 Whole blood 3.64
12 Aluminum. 0.904
13 Copper 0.402
14 Gas 0.77
25. LATENT HEAT
• The specific amount of energy required for or released
by to change the state of matter.
• When the matter is changed from a state of higher
kinetic energy to lower kinetic energy (steam to water ,
liquid to solid) the latent heat is released.
• When the matter is changed from a state of lower
kinetic energy to higher kinetic energy ( water to steam ,
solid to liquid ) the latent heat is absorbed.
26. LATENT HEAT
• When 1 gm of Ice is
converted into 1 gm
of water it takes
336KJ at 0° C
• When 1 gm of water
is converted into 1
gm of vapor it takes
2226 KJ at 100 ° C
29. CONDUCTION
• The conduction is take place as
transformation neighboring
atom or molecules.
• Particle is not moving but
vibrates its own place and
passing the heat to nearer
particle.
• Mainly in solid
30.
31. CONVECTION
• The heat is transformed by
the bulk movement of
molecules.
• The heated molecules takes
heat and goes away or heated
particles becomes less dense
so come up.
• Happens in liquids
32. RADIATION
• Heat can be transform
by radiation
• First heat energy is
converted in to electro
magnetic radiation.
• Heat is transformed with
out any intervening
matters.
• eg. Solar radiation.
33. WHEN HEAT IS ADDED
• The matter expanses.
• Heat cause separation of molecules.
• Production of electromagnetic radiation.
• Thermionic emission.
• Development of potential different between two
dissimilar objects.
• Viscosity of natters reduces.
• Change in state of matter.
• Release or taken of latent heat.
34.
35. causes of heat gain
• Basal metabolism.
• Metabolism of muscle
contraction.
• Metabolism of other
tissue other than basal
metabolism eg. Digestion.
• Absorption of radiation
from environment.
• Conduction from hotter
objects.
Causes of heat loss.
• Radiation to the
environment.
• Conduction to the colder
objects.
• Conduction to the air.
• Insensible perspiration.
• Pulmonary evaporation.
• Excretion of urine feces
and other fluid.
36. MAINTENANCE OF HOMEOTHERMY
• Rising environmental temperature---- heat gain sweating---
evaporation of sweat--- heat loss. 1 gm of sweat takes 2.5 KJ
heat.
• When outer temperature is less ---- blood takes heat from
core organ and disseminates to surface called force
convection--- heat loss.
• Exposing cold ---- vasoconstriction---- reduce blood flow to
surface--- decrease heat loss.
• Exposing hot ---- vasodilatation---- increase blood flow to
the skin---- increase heat loss– no more different between
surface and core temperature.
• Thicker layer of sub cutaneous fat also serve as thermo
insulater.
37. COUNTER CURRENT HEAT
EXCHANGE
• Heat can be exchange
between the warm arteriole
blood moving from the
body core to the periphery
an cooler venous blood
returning from extremities.
• Heat can be pass from
warm artery to cooler vein.
• Again vain takes heat toward
the center --- the exchange
continuous.
38. CUTANEOUS THERMO RECEPTOR
• Hot :cold receptors= 1:8.
• Many of those are identical to
pain nerve ending.
• They serve as:-
• Indicator of temperature.
• Contributes to control the body
temp
• Above 45º C and below 15º C
temperature sensation merges
with pain.
• Different neurons has there
pick discharge.
• Hot at 40 ºc
• Cold at 15 ºc
39. TEMPERATURE PERCEPTION
• When skin is heated --- decrease cold receptor activity
and corresponding increase frequency of warm
receptor activity.
• Then both frequency returns to frequency appropriate
for new absolute skin temperature.
• Optimal perception of temperature change at :- 30ºc
(even 1ºC can be sense)
• At cooler and hotter temperature marked
change of 5ºC to 10ºC can sense, minute
can not be sensed.
42. METABOLIC CONTROL
• When heat is lost from body, restoration can be made by increasing
the metabolic activity.( HARDY 1982)
• Cold expose---- stimulates sympathetic nervous system– shivering --
- increase muscular activity--- heat gain.
• Short shivering produce quite good heating whereas prolong
shivering doubles the basal metabolism.
• Brown adipose tissues are activated.
• Resting condition 70% heat is produced by viscera and brain and 30
% by skin and muscle.
• During activity and shivering muscle and skin produces 90% heat.
• Increase blood and increase nutrition and O2 supply to working
muscle facilitates the muscular contraction as well as dissipates heat
from working muscle. .( HARDY 1982
43. VASOMOTOR CONTROL
• Cold exposure ---
sympathetic
stimulation ---
vasoconstriction---
cause venous blood
almost nothing but
nutritive blood flow
is mediated through
papillae.
44. VASOMOTOR CONTROL
• Heat exposure ----
vasodilatation– dilatation of
venous plexus rise skin
temperature.
• The capillary loops are
connected to the deep venous
plexuses--- blood moving
from it either transfer heat to
overlying skin or dissipates
heat from skin to other part.
45. HYDRATIC CONTROL
• Cause of sweating.
• Center of sweating.
• Innervations.
• Anatomy of gland.
• Mechanism of sweating.
• How sweating regulates body
temperature.
46. BEHAVIORAL CONTROL
• Clothing
• Artificial thermal
insulator.
• Reflect sleeping bag.
• Voluntary exercise.
• Shade.
• Using fans, AC and
cooler etc.
• Bathing
47. PHYSIOLOGICAL EFFECTS
1. Temperature dependent physical and chemical
changes.
• Metabolic changes
• Viscosity
• Collagen tissue extensibility.
2. Temperature dependent physiological changes.
• Nerve stimulation and
• vascular adaptation.
48. METABOLIC ACTIVITIES
• VANT HOFF’S LAW:- any chemical changes capable of
being accelerated by heat is accelerated by raise in
temperature.
• Metabolism being a series of chemical reaction will increase
in the raise and decrease with in fall in temperature.
• 1°C ↑ in temp------ ↑ metabolic rate by 13%.
• 4 1°C ↑ in temp------ ↑ metabolic rate by 60%.
• At low temperature reaction slows significantly
• Tissue destruction occur if ICF and ECF frozen.
• Appropriate raise in temperature --- all cell activities ↑
• CONCEPT OF OPTIMAL TEMPERATURE.
49. VISCOSITY AND COLLAGEN TISSUE
CHANGE
• VISCOSITY
• Rising temperature
of liquids lowers the
viscosity.
• Falling temperature
increase viscosity.
• This changes effects
the tissue fluid
viscosity.
• COLLAGEN TISSUE
CHANGE
• With in therapeutic applicable
range (40°C -45°C) the
collagen tissue length
increases. …. (LEHMANN et
all 1970.)
• Above 50°C– the collagen
melts… (MASON and
RIGBY 1963.)
• While cooling collagen tissues
shortens----- cause of joint
stiffness in cold . …(
WRIGHT and JOHNS )
50. NERVE STIMULATION
• Heat and cold stimulates the sensory receptor of the skin.
• Afferent nerve stimulated by heat have analgesic effects ----
gate control mechanism (GAMMON and STARR 1941).
• Therapeutic heating stimulates the heat receptor and inhibits
the nociceptive impulse so local heating are analgesic.
(KANUI 1985)
• Local heating alters the contentious sensation
• At heated region hyperalgesia occurs. (CERVERO 1993)
• heating reduces muscle spasm may be due to the secondary
afferent muscle spindle nerve ending and GTO nerve
ending. (LHEHAMANN and LATURE 1982)
• At lower temperature conduction rate is decreased
• Very cold abolish nerve conduction --- so numbness.
51. BLOOD VESSELS CHANGES
• While heating the skin vasoconstriction occur
evident by production of erythema.
• While heating the skin vasodilatation occur evident
by production of paleness and cyanosis.
• Vasodilatation and vasoconstriction is a
compensatory mechanism for regulating heat loss
and heat gain.
• Heat application causes
• Capillary dilatation.
• Opens arteriovenous anastomeses.
52. CAUSES OF VASODILATATION
• Direct effect of heat capillary arterioles and venules’s
tunica media causing relaxation to them (LEHMANN
and LATURE1982)
• An axon reflex triggered by stimulation of poly modal
receptor.
• Co2 and lactic acid dilates the vessels which are the by
products of ↑ metabolism.
• Very hot --- damages proteins --- initiates an
inflammatory reaction ---- release of vasodilators eg.
Bradykinins and Histamine like substances.
53. BLOOD AND TISSUE FLUID
• Viscosity decreases.
• Arterioles and capillary dilatation.
• Increase capillary blood pressure and flow.
• Acidity of blood rises.
• Both CO2 and O2 tension increases.
• Increase lymph formation.
• Higher blood leucocytes.
• Decrease beta Endorphin levels.
• decrease in FSH and LH haematic concentrations.
• decrease of ACTH, prolactin and norepinephrine.
54. THERAPEUTIC EFFECTS OF LOCAL
TISSUE HEATING
1. Encouragement of healing.
2. Control of infection.
3. Relief of pain.
4. Reduction of muscle spasm.
5. Sedative effects.
6. Increase range of motion.
7. Oedema of extremities.
8. Skin infection.
9. Antimicrobial effects.
10. Promotion of elimination.
55. ENCOURAGEMENT OF HEALING
• it is due to
– Increase metabolic rate.
– Increase cellular activity.
– Increase local blood flow.
• Heating is not beneficial in
early inflammation.
• Very mild heating (2 °C to 5
°C ) is beneficial.
• All shorts of therapeutic
heating are indicated in
chronic inflammation and
post traumatic conditions eg.
RA OA
56. CONTROL OF INFECTIONS
• Mechanism are not well known.
• May be defense mechanism is enhanced.
• Dry surface heating is anti macrobiotic.
• Heating induces hyperkinetic circulation.
– helps in migration of phagocytosis,.
– Migration of fibroblast.
– Altered temperature inhibits the bacterial growth.
57. RELIEF OF PAIN
• Activation of sensory heat receptors may activates the pain
gate mechanism.
• The development of hyperalgesia as a consequence of mild
heating suggest that skin mechanoreceptor pathways are
influenced, which may contributes on modulation of pain.
(CERVERO et al 1983)
• Heating cause the secretion of neuroanalgesic like Endorphin.
• Increased blood flow wash out the pain provoking metabolites
eg. Prostaglandin and bradykinin. (CHANMUGHAN 1980)
• Pain may be relieved by.
– reduction of muscle spasm –
– Decrease sympathetic nervous system activity following theraputic
heating. (MICHLOVITZ)
58. REDUCTION OF MUSCLE
SPASM
• heating reduces muscle
spasm may be due to
the secondary afferent
muscle spindle nerve
ending and GTO
nerve ending.
(LHEHAMANN and
LATURE 1982)
59. SEDATIVE EFFECTS
• LEHMANN and LATEUR
1982.
• They suggested that
before normal sleep
there will be slight rise
in skin temperature so
therapeutic heating
induces sleep. It is just a
consequences but may
be a reflex
phenomenon.
• Warm is associated with
comfort and relaxation.
60. INCREASE OF RANGE OF MOTION
1. Analgesic effects of heat allows greater
tolerance of stretching. (MICHLOVITZ 1986)
2. The heat reduces the viscosity of the tissue so
joint stiffness reduces (WRIGHT and JOHN
1961)
3. Increase collagen extensibility in higher
temperature. (LAHMANN et al 1970)
4. Heat allows synovialfluid to move causes better
nourishment of a vascular cartilages ald
lubricates the articular surface.
61. OEDEMA OF EXTREMITIES
• Heat helps to relive the chronic Oedema of
extremities (WADSWORTH and
CHANMUGAN 1980).
• This must be given elevating the part above the
level of heart.
• It causes vessel dilatation which induces increase
rate of fluid exchange and re absorption of
exudates.
• Heating is contraindicated in acute edema.
62. SKIN INFECTION
• Through drying of the skin
surfaces coupled with local
vasodilatation seem to be
effective factor.
• Skin hyperthermia can affect
cell replication ---- benefits
the hyperproliferative disease
like psoriasis.
• Dry heating interferes with
fungal growth in skin.
•
63. ANTIMICROBIAL EFFECTS
• Heat interferes the
bacterial growth.
• Heat modulates
phagocytosis.
• Heat facilitates the
antibody production.
64. PROMOTION OF ELIMINATION
• Heat promotes the
elimination from skin.
• Heat cleans the parts.
• Heat induces sweating so
causes wash out of
metabolic end products.
65.
66. INTRODUCTION
• cooling the body surface is simply the transfer
of energy away from the tissue.
• it lowers the local temperature and provokes the
thermoregulatory mechanism.
• Cooling depends on:-
• Cooling agent and tissue and tissue temperature.
• Thermal conductivity of the tissue.
• Local vascularity.
• Duration of cooling.
• Size of the area cooled.
67. EFFECT OF COLD
• When cold is applied skin temperature drops very fast
and markedly.
• Subcutaneous temperature reduces moderately.
• Deep tissue temperature very slowly.
• PALASTANGA et al. (1988)
– Cold application ---- 4 cm depth muscle --- temp reduced by
3.5°C in 30 min.
– Cold application ---- 2 cm depth muscle --- temp reduced by
5°C in 20 min.
– Skin temperature dropped by 18°C with in 10 minute.
68. PHYSIOLOGICAL CHANGES
• LOCAL EFFECT
– On cutanious blood flow.
– On muscle blood flow.
– On metabolic rate.
– On peripheral nervous system.
– On muscle.
• GENERAL EFFECTS.
69. RAYNAUD'S PHENOMENON
• A vascular reaction to cold application or stress that
results in a white,red, or blue discoloration of the
extremities. The fingers and toes are the first to be
affected
– Raynaud's phenomenon is a condition resulting from
poor circulation in the extremities (i.e., fingers and
toes). In a person with Raynaud's phenomenon, when
his or her skin is exposed to cold or the person
becomes emotionally upset, the blood vessels under the
skin tighten and the blood flow slows
– This happens because the blood vessels under the skin
tighten. When blood does not reach parts of the body,
these areas may turn blue and feel cold.
70. LOCAL EFFECT
• Vasoconstriction
• Decreased Rate of Cell metabolism resulting in
a decreased need for oxygen
• Decreased production of cellular wastes
• Reduction of inflammation
• Decreased Pain
• Decreased Muscle Spasm
71. ON CUTENIOUS BLOOD FLOW
• Immediate vasoconstriction of the cutenious vessels ---
Blanching occurs.
• Restriction of blood flow to the skin---- minimizes the
heat loss.
• Vasoconstriction is due to.
– Reflex action in ANS triggered by cutenious thermal
receptor,
– Direct effect of cold on smooth muscle of artery.
– Influence of local hormone SEROTONON and
BRADYKININ secreted in response of cold.
72. LEWIS HUNTER REACTION
• cold application --- vasoconstriction --- followed
by marked vasodilatation ---- last for 15 min till
another episodes of vasoconstriction occur.
• It is the protective mechanism against Ischemia.
• LEWIS suggested that this reaction is due to:-
• Initial vasoconstriction due to cold.
• Vasodilatation due to release of histamine like substances.
• Secondary vasoconstriction due to wash out of
vasodilators. Again effect of cold.
73. ON MUSCLE BLOOD FLOW
• WOLF 1971 epsilateral
cooling of fore arm
muscle for 15 min
reached maximum
cooling of reference arm
after 18 min and
maximum cooling of
contralateral arm after 42
minute.
74. ON METABOLIC RATE
• Metabolic rate is
diminished markedly.
• VANT HOFFS
PRINCIPLE
• ↓02 up take.
• Development of
blanching and cold
induce erythema due to
LEWISHUNTING
REACTION.
75. ON PERIPHERAL NERVOUS
SYSTEM
• Clod stimulates the skin receptors.
• Intense cold reduces the conduction velocity of
nerve impulse.
• It delay synaptic transmission.
• ABRASSION et al 1966
– Cooling forearm --- fall in motor conductivity of
MEDIAN and ULNAR nerve.
76. ON MOTOR SYSTEM
• Muscle strength is diminished by cooling the
limb in water on 10- 15 °C.
• Motor skilled are diminished.
• KAURAMEN & VANHARARANTA 1997
– Ice application over the fore arm for 15 min ---
decreases the velocity of the movement and finger
tapping speed.
77. GENERAL EFFECT
• Immediate simulation of cold receptor.
• Marked activation of cold receptor.
• Reflex vasoconstriction occurs.
• Cold blood reaches hypothalamus --- initiates
vasoconstriction by stimulating vasomotor
center.
• Shivering will occurs.
• ↑brown adipose tissue activity.
78. EFFECTS ON HEMODYNAMIC
– Vasoconstriction from smooth muscle in
arterioles
– reflex vasoconstriction from A-delta (spinal
reflex to preserve body heat)
– Cold blood hits hypothalamus and may start
shivering response if cold enough
– A small amount of vasoconstriction gives a 4
fold decrease in blood flow
79. METABOLIC EFFECTS
– Decreased secondary cell deaths by hypoxia (swelling
prevents oxygen from reaching cells). The decrease
in metabolism allows them to live without as much
oxygen.
– Normal body temperature is 37 ° C.
– Increase above 45° C (113° F) proteins denature
80. METABOLIC EFFECTS
– Reduction of edema through decreased capillary
hydrostatic pressure and decreased permeability and
osmotic pressure
– Increase blood viscosity (make it thicker so it won’t
flood the area as quickly)
– Decrease in chemical mediator effectiveness (they
cause vasodilatation)
81. METABOLIC EFFECTS
– Decreases below 15 ° C (58 Þ F) a “hunting”
response (Lewis 1932) occurs
• Histamine like release yields an increase vasodilatation as a
self defense response
– Arterio-venal anastomoses (artery directly to veins)
allow pooling of blood in feet, hands, ears, and lips.
May be place of hunting response
– Don’t go below 58 ° F and keep time shorter than 30
minutes to be on the safe side
84. RECENT INJURIES
• bleeding wounds--- cold cause vasoconstriction and
increase the viscosity if the blood so helps in haemostasis .
• Prolonged application stops internal bleeding.
• Cold is applied immediately cutenious burn –--- stops so
many heat induces reaction.
• Soft tissue injury --- cold is applied as a componint of
PRICE.
• MC LEAN (1989)
– Cooling the tissue in early stage of injury will minimize the
secondary cell damage (nacrosis) by reducing the metabolic rate.
– Cooling reduces the inflametory reaction
85. EFFECT ON PAIN
• It is due to:
– Local decrease in free nerve ending sensitivity
– Increases the threshold for nerve firing
– Slows synaptic activity
– Reduction of oedema.
– ↓ release of pain provoking irritant.
– Sensory stimulation of pain gate mechanism.
– Allows disruption of pain-spasm-pain cycle via
analgesia
86. MUSCLE SPASM
• May be due to
suppression of motor
conductivity.
• Tissue injury ---- muscle
spasm as protective
mechanism----- further
pain--- cold relives
injuries so relives spasm.
• Cold decrease
metabolism --- removes
lactic accumulation --- so
87. SPASTICITY
• Cold stimulates the cutenious receptors --- reflex
stimulation of CNS ---- enhanced motor unit activity--
-- so decrease spasticity. (CLINDININ & SZUMSKI
1971)
• Cutenious stimulation ---- reflex effect diminishing
gamma motor neuron activity ---- diminishing muscle
spindle discharge.
• Sympathetic stimulation due to cold.
• Cooling on the small myelinated fusimotor efferent
and secondary afferent and large thickly myelinated
extrafusal fiber (cold blocks the temperature)
88. MUSCLE STRENGTH
• RAJADHYAKSHYA el al 1982 found there is
increase of strength of Quadriceps by 17% after 30
min of cooling for 24 hours.
• May be due to facilitatory effect on ALPHA MOTOR
NEURON POOL.
• Cold stimulates the sympathetic nervous system ----
release of catacolamine which enhances muscular
performances.
• But prolonged applications affects muscle metabolism
---- so muscle weakness.
89. MUSCLE ACTIVITY
• Decreased muscle spasm by decreasing muscle
spindle activity.
• Intramuscular fibers (muscle spindle) runs parallel
to fibers of the muscle. Ia and II run to dorsal
horn of spinal cord and respond to stretch. As
the muscle contracts the spindle contracts so it
remains sensitive. The lower the temperature, the
lower the activity.
90. CHRONIC INFLAMMATION
• Relives pain.
• May helps to control such minor acute and sub
acute inflammatory changes.
• More than absolute cold revalsive and and
constract applications are effective
(WARDSWORTH and CHANMUGAN 1980)
91. CHRONIC OEDEMA AND JOINT
EFFUSION
MOON and GANGNANI 1989.
– 9 hemiplegics patients with swollen limb were
treated with ice for 30 min fro some days---
reduction of hand volume in all patient
Contraindicated in obstructive oedema
Cold helps in case of acute joint effusion.
–Cold helps in case of acute joint effusion.
92. SYSTEMIC EFFECTS OF COLD
EXPOSURE
• General vasoconstriction in response to cooling
of the posterior hypothalamus (this happens
with a .2°F of circulating blood
• Heart rate is decreased
• Respiration Decreases
• Shivering and increased muscle tone
– If core temperature continues to drop this is the
body’s response to increase heat
– IN GENERAL THIS DOES NOT OCCUR WITH
ICE APPLICATION!
93. CRYOKINETICS
• The use of cold in conjunction with movement
– Used to decrease pain and allow for free motion
through the normal ROM
– Results in more pronounced macrophage reaction,
quicker hematoma resolution, increased vascular
growth, faster regeneration of muscle and scar tissue
– Initiated when the underlying soft tissue and
bone are intact and the pain is limiting the
amount of function
94. PENETRATION OF COLD
• Cold has a longer wavelength than heat
• Local temperature gradient
• Treatment surface area covered
• thickness and characteristics of tissue treated (fat
is an insulator, tissues with high water content have better
heat transfer)
95. THERAPEUTIC EFFECT OF COLD
• To obtain therapeutic benefits
– skin temp. must be reduced to 57 °F for optimal
decrease in local blood flow
– skin temp must be reduce to 58°F for analgesia
– Skin temperature must be reduced to 36°F to produce
intra-articular temp. changes in the knee
• The temp of the skin over a joint decreased the temp in a
joint proportionally 10° F skin 6.5° F joint
– Also remember that temperature is relative.
96. THERAPEUTIC EFFECT OF COLD
• RICE - Rest, Ice, Compression, Elevation
– Serves to counteract the body’s initial response to injury
– Rest limits scope of original injury by preventing
further trauma
– Ice - function is to decrease cell’s metabolism, decrease
the need or oxygen and reduce the amount of
secondary hypoxic injury by enabling tissues to live on
limited oxygen and secondarily reduce pain
• Crushed ice is the ideal form of cold application during
initial injury because it produces the most rapid temp.
decrease.
97. THERAPEUTIC EFFECT OF COLD
• Compression -
– decreases the pressure gradient between blood
vessels and tissue and discourages further leakage
from capillaries.
– Also Encourages Lymphatic drainage
– Compression Types
• Circumferential - provides even pressure
• Collateral - Pressure on 2 sides (aircast)
• Focal Compression - U-shaped horseshoe pads
98. THERAPEUTIC EFFECT OF COLD
• Elevation
– Decreases the hydrostatic pressure within the
capillary beds to encourage absorption of edema by
lymphatic system
– This has the greatest effect at 90° perpendicular to
the ground
• at 45 ° the effect of gravity is 71% comparatively
99. CRYOTHERAPY
• Used to describe the application of cold
modalities that have a temperature range
between 32° and 65° F
100. The Effects of Ice on Injury
Response
• Indications
– Acute injury or Inflam
– Acute or chronic pain
– Small 1st degree burns
– Post-surgical pain and edema
– In conjunction with rehab ex.
– Neuralgia
– Acute or chronic muscle
spasm
– Spasticity accompanying
CNS disorders
• Contraindications
– Cardiac or Resp.
involvement
– Uncovered open
wounds
– Circ. Insufficiency
– Cold Allergy
– Anesthetic Skin
– Advanced Diabetes
– Raynaud’s Phenomenon
102. Cold Packs
• Ice Bags,
• Reusable Cold Pack
• Instant Cold Back
• Tx time for all are 15-30 minutes
– Because of lasting effects application should be no
less than 2 hours apart
– For controlled Cold Therapy Units - may be applied
continuously for 24 to 48 hours post acute injury or
surgery
103. Cold Packs
• Indications
– Acute injury (may use
with wet wrap)
– Acute or Chronic Pain
– Postsurgical Pain and
Edema
– Shape of Body part
• Precautions
– AC joint and other areas may
not be suitable for wet wrap
– Tension of elastic wrap
should be enough to provide
adequate compression
without unwarranted pressure
– Ensure Circulation w/wrap
– Frostbite - if had before
chance for reoccurrence
– over large or superficial
nerves
104. Ice Massage
• Appropriate for
delivering cold tx to
small evenly shaped
areas.
• Most effective for muscle
spasm, contusion and
other minor well-
localized areas
• Duration of tx
– 5-15 minutes or until ice
runs out
– if the purpose is
analgesic, then stop when
numb
105. Ice Massage
• Indications
– Subacute inflam or
injury
– Muscle strain
– Contusion
– Acute or chronic pain
• Contraindications
– All other ice
contraindicated
– When pressure is not
warranted
– Suspected Fx
• Precuations
– Injuries where pressure
massage may be
contraindicated
106. Ice Immersion
• Temp. 50° - 60 ° F
• Time 10-20 min.
• Indications
– Acute Injury or Inflam.
– Acute or Chronic Pain
– Post surgical pain
• Contraindications
– Same as general
Contraindications
– Acute injury where
gravity is contraindicated
107. Cryostretch
• “Spray and Stretch” vapocoolant
• Traditionally preformed with ethyl chloride due
to its ability to quickly evaporate and cool
superficial tissue
• This technique is limited to a counterirritant
– simply masks the symptoms to allow for a stretch
108. Cryostretch
• Precautions
– Can Cause frostbite
– Ethyl Chloride is
extremely flammable
– Ethyl Chloride is a local
anesthetics but if
inhaled can become
general
– It’s use is based on
tradition rather than
fact
• Contraindications
– Allergy
– Open wounds
– Post/surgical
– Eyes
– All other cold contraind
& contraind to passive
stretch
• Indications
– Trigger points
– Muscle spasms
– Decreased ROM
109. Cold Whirlpools
• Duration of Tx
– 15-20 minutes
– Temp 50° - 60 ° F
• Indications
– Decrased ROM
– Cryokinetics
– Subacute to chronic
inflammation
– Peripheral nerve injuries
(avoid extremes)
• Contraindications
– Acute conditions where
water turbulence would
further irritate area
– Gravity
– Postsutural
– Skin Conditions
– All other
contraindications
