Healing Phases and Treatment Goals

Healing Phases

• Initial injury/inflammation (up to 48 hours): Characterized by vasoconstriction followed by vasodilation and clot formation, culminating in phagocytosis.
• Proliferative (1-2 weeks): Focuses on fibroblast arrival, epithelialization, collagen production, closure/retraction, and revascularization.
• Maturation (up to 1 year): The final stage involves collagen remodeling, where the balance of production and lysis occurs.

Treatment Goals

• Initial injury phase: Passive care focused on preventing further injury, minimizing inflammation, pain, and functional deficits.
• Proliferative phase: Active care to increase circulation, cellular metabolism, range of motion (ROM), and ease of movement.
• Maturation phase: Active care with increased load and intensity to further enhance circulation, cellular metabolism, ROM, and ease of movement.

Thermal Biophysical Agents

Heat Transfer Methods

• Conduction: Heat transfer through direct contact.
• Convection: Heat transfer through a circulating medium.
• Radiation: Transfer of heat energy without conduction or convection.
• Conversion: Non-thermal energy transformed into heat.
• Evaporation: Heat absorbed through evaporation.

Cryotherapy Examples

• Conduction: Cold packs, ice massage, cold immersion, vapocoolant sprays, controlled cold units.
• Convection: Cold immersion.
• Evaporation: Vapocoolant spray.

Cryotherapy Indications & Timing

• Primarily indicated for the first 24-48 hours post-injury to reduce fluid filtration, inflammation, pain, and local metabolism. Prolonged intense cold might cause edema.
• Pain reduction, decreased edema, muscle relaxation, limited secondary hypoxic tissue injury, suitable for post-operative conditions. Ice massage can reduce pain thresholds around myofascial trigger points.

Cryotherapy Contraindications & Precautions

• Contraindications: Urticaria (cold hypersensitivity), cold intolerance, cryoglobulinemia, paroxysmal cold hemoglobinuria, Raynaud's phenomenon, areas of nerve regeneration or vascular compromise.
• Precautions: Hypertension, thermoregulatory disorders (like MS), open wounds, poor circulation, cognitive impairment, age extremes (65+), cold aversion.

Cryotherapy Perception Progression

• Cold, burning, aching, analgesia (numbness).

Cryotherapy Dosage

• General use: 10-30 minutes.
• Specific use like ice massage: 5-10 minutes.
• Cold bath: 15-20 minutes.

Cryotherapy Assessment

• Edema (girth measurement), pain (Numerical Pain Rating Scale), ROM (goniometry/measuring movement), function (observation), muscle guarding (ROM assessments).

Documentation Considerations

• Use the FITT principle (Frequency, Intensity, Time, Type).
• Record objective parameters and assessment of treatment effect.

Thermotherapy Contraindications & Precautions

• Contraindications: Recent or potential hemorrhage, DVT, impaired sensation, vascular insufficiency, impaired cognition, malignancy, untreated infection.
• Precautions: Acute injury/inflammation, pregnancy, impaired circulation/thermal regulation, edema, open wounds, cardiac conditions/insufficiency, topical counter irritant creams, demyelinated nerves.

Thermotherapy Effects

• Deep heat therapy can decrease isometric strength initially in the first 30 minutes, followed by an increase for 2 hours. Similar findings exist with whirlpool immersion.
• Heat therapy (compared to cold pack and control) reduces eccentric DOMS within 30 minutes after muscle heat therapy.
• A higher adipose tissue presence increases sensitivity to heat.

Paraffin Bath Details

• Low melting point (129°F).
• 8-10 dips.
• Treatment time: 15-20 minutes.
• Safer than moist heat.

Tissue Damage Temperature (Heat)

• Tissue damage begins at 113°F.

PEACE & LOVE Mnemonic

• A helpful acronym to remember considerations for rehabilitation and healing.