Infrared Modalities (Therapeutic Heat and Cold)

2. Infrared Modalities(Therapeutic Heat and Cold)

3. Most of the heat and cold modalities have wavelengths and frequencies that fall in the infrared portion of the electromagnetic spectrum Ice Massage Commercial cold packs Ice packs Cold whirlpool Cold spray Contrast Baths Ice immersion Cryo-cuff Cryokinetics Warm whirlpool Hydrocollator packs Paraffin baths Infrared lamps Fluidotherapy Infrared Modalities

4. Mechanisms of Heat Transfer • Transmission of heat occurs by three mechanisms: • Conduction • Convection • Radiation • Conversion

5. Using Infrared Modalities Appropriately • Thermotherapy- Heating techniques used for therapeutic purposes • Used when a rise in tissue temperature is the goal of treatment • Cryotherapy- The use of cold • Used in the acute stages of the healing process immediately following injury when a loss of tissue temperature is the goal of therapy

6. Clinical Applications • Physiologic effects are rarely the result of direct absorption of infrared energy • No form of infrared energy can have a depth of penetration greater than 1 cm • Effects of infrared modalities are primarily superficial and directly affect cutaneous blood vessels and nerve receptors

7. Clinical Applications • Most effective use of infrared modalities should be to provide analgesia or reduce sensation of pain associated with injury • Gate control theory of pain modulation

8. Effects of Tissue Temperature Change on Circulation • Main physiologic effect is on superficial circulation • Changes due to response of temperature receptors in skin and sympathetic nervous system • When cold is applied the skin vessels progressively constrict to a temperature of about 15° C (59° F) at which point they reach maximum constriction

9. Effects of Tissue Temperature Change on Circulation • At temperatures below 15° C vessels begin to dilate due to paralysis of contractile mechanism in vessel wall or blockage of nerve impulses • General exposure to cold causes sympathetic nerves to elicit cutaneous vasoconstriction, shivering, piloerection, and an increase in epinephrine secretion so vascular contraction occurs

10. Effects of Tissue Temperature Change on Muscle Spasm • Physiologic mechanisms underlying the effectiveness of heat and cold treatments in reducing muscle spasm lie at level of muscle spindle and Golgi tendon organs • Local application of heat relaxes muscles simultaneously lessening stimulus threshold of muscle spindles and by decreasing gamma efferent firing rate • Thus muscle spindles are more easily excited

11. Effects of Tissue Temperature Change on Muscle Spasm • Muscles may be electromyographically silent while at rest during application of heatbut the slightest amount of voluntary or passive movement may cause the Ia efferents to fire • Local applications of cold decrease local neural activity

12. Effects of Tissue Temperature Change on Muscle Spasm • Cold appears to raise the threshold stimulus of muscle spindles, and heat tends to lower it • Local cooling with ice results in a significant reduction of muscle spasm greater than that which occurs with use of heat

13. Effects of Tissue Temperature Change on Performance • Studies on performance do not suggest any clear relationship

14. CryotherapyPhysiologic Effects of Tissue Cooling • General agreement that cold should be initial treatment for musculoskeletal injuries • Primary reason for using cold in acute injury is to lower temperature in injured area thus reducing metabolic rate with a corresponding decrease in production of metabolites and metabolic heat (secondary hypoxic response) • More effective when combined with compression

15. CryotherapyPhysiologic Effects of Tissue Cooling • Used immediately after injury to decrease pain and promote local vasoconstriction • Controls hemorrhage and edema • Hunting Response looks at measured temperature changes rather than circulatory changes • Measurement artifact rather than an actual change in blood flow in response to cold

16. CryotherapyPhysiologic Effects of Tissue Cooling • Used in the acute phase of inflammatory conditions when heat may cause additional pain and swelling Analgesic effects occur due to a decrease in velocity of nerve conduction and through gate control • Effective in treating myofascial pain

17. CryotherapyPhysiologic Effects of Tissue Cooling • Cold is more effective in treating acute muscle pain as opposed to delayed onset muscle soreness (DOMS) which occurs following exercise

18. Cryotherapy techniques include Ice massage Cold packs Ice packs Cold whirlpool Cold spray Contrast baths Ice immersion Cryo-cuff Cryokinetics Cryotherapy Techniques

19. Cryotherapy Techniques • Application of cryotherapy produces a three- to four-stage sensation • Uncomfortable sensation of cold • Stinging • Burning or aching feeling • Numbness • Caution should be exercised when applying intense cold directly to the skin

20. Ice Massage • Remove top 2/3 of paper or styrofoam cupleaving 1” on bottom of cup as handle • Apply using overlapping circular or longitudinal stroke • Once the skin is numb to fine touch treatment ends(7-10 min) • Thermopane develops under ice cup the allows for smooth gliding

21. Commercial Cold Packs • Cold pack should be placed against wet toweling • Mold cold pack around joint • Treatment time required is about 20 minutes on - 20 minutes off • Should be repeated for 2 hours

22. Ice Packs • Similar to the use of commercial cold packs • Flaked or cubed ice in a plastic bag large enough for the area to be treated applied directly to skin and held in place by a moist or dry elastic wrap • Ice pack can be molded to contour of body part

23. Cold Whirlpool • Fill appropriate size whirlpool with cold water and flaked ice with temp. at 50° to 60° F • Use for massaging action • Gravity-dependent positions should be avoided with acute and subacute injuries • A toe cap made of neoprene can be used

24. Cold Spray and Stretch • Flourimethane is used • Cooling is superficial • Useful in treating trigger points • Spraying Technique • Same direction • Proximal to distal • Gate Control pain modulation • Stretching Technique

25. Contrast Baths • Used to treat subacute swelling • Uses alternating hot (104-106o) and cold (50-60o) immersions • Does not reduce edema through “pumping” action as suggested • 3:1 or 4:1 heat:cold ratios have been recommended • Best used as a transition from cold to heat

26. Ice Immersion • Ice buckets allow ease of application (50-60o) • Container should be large enough to allow for movement of body segment • Body segment is subject to gravity-dependent positions • Neoprene toe cap may be used

27. Cryo-cuff • Used both acutely following injury and post-surgically • Applies both cold and compression simultaneously • Ice chills water which flows into sleeve from cooler • As cooler is raised pressure in cuff is increased

28. Cryokinetics • Combines cryotherapy with exercise • Idea is to numb injured part (1--12 min) the work toward achieving normal ROM through progressive active exercise • Numbness usually last for 3-5 min. at which point ice is reapplied for 3-5 minutes until numbness returns- Repeated five times • Exercises should be pain free and progressive in intensity concentrating on both flexibility and strength

29. ThermotherapyPhysiologic Effects of Tissue Heating • Local superficial heating (infrared heat) is recommended in subacute conditions for reducing pain and inflammation through analgesic effects • During later stages of healing a deeper heating effect is desirable and should be achieved using the diathermies or ultrasound

30. ThermotherapyPhysiologic Effects of Tissue Heating • Increase in temperature increases metabolism • 13% increase in metabolism for each 1° C • Superficial heat vasodilates vessels which increases capillary blood flow thus increasing tendency toward formation of edema • In mild or moderate inflammation increased capillary blood flow causes an increase in supply of oxygen, antibodies, leukocytes, and other nutrients and enzymes, along with clearing of metabolites

31. ThermotherapyPhysiologic Effects of Tissue Heating • Used to produce an analgesic effect through gate control • Most frequent indication for the use • Heat is applied in musculoskeletal and neuromuscular disorders • Increases the elasticity and decreases the viscosity of connective tissue

32. ThermotherapyPhysiologic Effects of Tissue Heating • Produces a relaxation effect and a reduction in muscle guarding by: • Relieving pain • Lessening hypertonicity of muscles • Producing sedation • Decreaseing spasticity, tenderness, and spasm • Decreasing tightness in muscles and related structures

33. ThermotherapyPhysiologic Effects of Tissue Heating • Primary goals of thermotherapy include • Increased blood flow • Increased muscle temperature to stimulate analgesia • Increased nutrition to the damaged cells • Reduction of edema • Removal of metabolites and other products of inflammatory process

34. Thermotherapy Techniques • Warm Whirlpool • Hydrocollator Packs • Paraffin Bath • Infrared Lamps • Fluidotherapy

35. Warm Whirlpool • Temperature Range • Upper Extremity 98° -110° F • Lower Extremity 98- 104° F • Full body 98° - 102° F • Time of application should be 15 to 20 minutes • Caution is indicated in gravity-dependent position in subacute injuries • Whirlpool maintainance

36. Hydrocollator Packs • Canvas pouches of petroleum distillate • Water temperature 170o • 6 layers (1”) of toweling recommended • Don’t lie on top of hot pack • Time of application should be 15 to 20 minutes

37. Paraffin Baths • Mixture ratio of paraffin to mineral oil 2 pounds:1 gallon • Mineral oil reduces temp of the paraffin to 126° F • Extremity dipped into paraffin for a couple of seconds then removed to allow paraffin to harden • Repeat until 6 layers have accumulated • Wrap in a plastic bag with several layers of toweling

38. Infrared Lamps • Infrared generators • Non-luminous- metal coil wrapped around core of non-conducting material • No longer used • Luminous-Tungsten filament and quartz red lamps

39. Infrared Lamps • Superficial tissue temperature can be increased even though unit does not touch patient • Seldom used because of limited depth of skin penetration < 1 mm • Moist towels should cover the area to be treated • Distance from treatment area to lamp should be adjusted according to treatment time • 20 inches = 20 minutes

40. Fluidotherapy • Dry heat modality that uses a suspended air stream of corn husks • Recommended temperatures vary by body part & tolerance in a range of 110° to 125°F • Active and passive exercise is encouraged during treatment • Treatments are approximately 20 minutes

41. Acute or subacute inflammation Acute pain Chronic pain Acute swelling Myofascial trigger points Muscle guarding Muscle spasm Acute muscle strain Acute Ligament sprain Acute Contustion Bursitis Tenosynovitis Tendinitis Delayed onset muscle soreness SummaryIndications for Cryotherapy

42. Impaired circulation Peripheral vascular disease Hypersensitivity to cold Skin anesthesia Open wounds or skin conditions (cold whirlpools and contrast baths) Infection SummaryContraindications for Cryotherapy

43. Subacute and chronic inflammatory conditions Subacute or Chronic pain Subacute edema removal Decreased ROM Resolution of swelling Muscle guarding Muscle spasm Subacute Muscle strain Subacute Ligament sprain Subacute Contustion Infection Myofascial trigger points SummaryIndications for Thermotherapy

44. SummaryContraindications for Thermotherapy • Acute musculoskeletal conditions • Impaired circulation • Peripheral vascular disease • Skin anesthesia • Open wounds or skin conditions (cold whirlpools and contrast baths)