cold review (2).docx

**Effects of Heat and Cold Application** **[Effects of Cold Application ]** 1. Decrease local tissue temperature 2. **Decrease cell metabolism** 3. Vasoconstriction of arterioles and capillaries (at first) 4. Decrease blood flow (at first) 5. **[Decrease nerve conduction velocity]** 6....

**Effects of Heat and Cold Application** **[Effects of Cold Application ]** 1. Decrease local tissue temperature 2. **Decrease cell metabolism** 3. Vasoconstriction of arterioles and capillaries (at first) 4. Decrease blood flow (at first) 5. **[Decrease nerve conduction velocity]** 6. Decrease delivery of leukocytes and phagocytes 7. Decrease lymphatic and venous drainage 8. **Decrease muscle excitability** 9. Decrease muscle spindle depolarization 10. Decrease formation of accumulation of edema 11. **[Decrease anesthetic effects ]** **[Effects of Heat Application]** 1. Increase local temperature superficially 2. **Increase local metabolism** 3. **Vasodilation of arterioles and capillaries** 4. **[Increase blood flow to part heated]** 5. Increase leukocytes and phagocytes 6. Increase capillary permeability 7. Increase lymphatic and venous drainage 8. Increase metabolic wastes 9. Increase axon reflex activity 10. Increase elasticity of muscles, ligaments and capsule fibers 11. **Analgesia** 12. **Increase formation of edema** 13. **Decrease muscle tone** 14. **Decrease muscle spams** **Indication and Contraindication of Cryotherapy** **(pay more attention to contraindications for cold and hot)** **[Indications ]** 1. During acute and subacute inflammation 2. Acute pain 3. Chronic pain 4. Acute swelling (controlled hemorrhage and edema) 5. Myofascial trigger points 6. Muscle guarding 7. Muscle spasm 8. Acute ligament sprain 9. Acute contusion 10. Bursitis 11. Tenosynovitis 12. Tendonitis 13. Delayed onset muscle soreness **[Contraindications]** 1. **Impaired circulation** 2. **Peripheral vascular disease** 3. **Hypersensitivity to cold** 4. **Skin anesthesia** 5. **Open wounds or skin conditions (cold whirlpools and contrast baths)** 6. **Infection** 7. **Raynaud's** 8. **Cold allergy** **Indications and Contraindications for Thermotherapy** **[Indications ]** 1. Subacute and chronic inflammatory conditions 2. Subacute and chronic pain 3. Subacute edema removal 4. Decrease ROM 5. Resolution of swelling 6. Myofascial trigger points 7. Muscle guarding 8. Muscle spasm 9. Subacute muscle strain 10. Subacute ligament sprain 11. Subacute contusion 12. Infection **[Contraindications]** 1. **Acute musculoskeletal conditions** 2. **Impaired circulations** 3. **Peripheral vascular disease** 4. **Skin anesthesia** 5. **Open wounds or skin conditions (cold whirlpools and contrast baths)** 6. **Fever** \*\*\***Possibly during pregnancy, genitals, metal implants, cancer\*\*\*\*\*** **Deciding Whether to Use Heat vs. Cold** **Evaluate the patient to determine the answer to each question.** 1. **Does the body feel warm to touch?** 2. **Is the injured area still sensitive to light to moderate touch?** 3. **Does the amount of swelling continue to increase over time?** 4. **Does swelling increase during activity?** 5. **Does pain limit the joint's range of motion?** 6. **Would you consider the acute inflammation process still to be active?** 7. **Does the patient continue to display improvement with the use of cold modalities?** **If all of the patients answers to these questions are "no," then heat can be safely used. As the number of "yes" answers increases, so does the indication to use** cold. **Developing a Rehabilitation Program.** **Understanding the healing process** - **[SAID principle]** - *[Specific adaptations for imposed demands]* - When an injured structure is subjected to stresses and overloads of varying intensities, it will gradually adapt over time to whatever demands are placed upon it. - Too little stress no progress - Too much stress increased chance of injury - May result in inflammation, pain, loss of ROM, increase in laxity of ligaments. - Early rehab involves submaximal exercise performed in short bouts several times a day. - Exercise intensity will increase as the healing process progresses. - Exercises will then be performed less often - Conditioning mode will follow which may include high intensity exercises 3-4 times per week. **Goals of a rehabilitation program -- Identified and Adjusted daily based on progress or regress** I. **To control [swelling]** A. Through immediate first aid management B. When swelling occurs 1. It is caused by several factors a. Bleeding b. Production of synovial fluid c. Accumulation of inflammatory by-products d. Edema 2. Causes an increased pressure in the area e. This pressure results in an increase in pain 3. Causes neuromuscular inhibition f. Results in weak muscle contractions 4. Swelling occurs most likely 72 hours post injury 5. It will inhibit the healing process 6. By controlling the acute injury stage the rehabilitation may be 7. **PRICE** helps to control swelling g. **Protection** 1. Splints 2. Pads 3. Immobilization devices 4. Crutches h. **Restricted activity (rest)** 5. Will vary depending on severity of injury a. Most minor injuries 24-48 hours before rehab begins 6. If not rested the injured area will be subjected to 7. It does not mean no mobility or that the athlete does nothing. 8. Controlled mobility is superior to immobilization in b. Scar formation c. Revascularization d. Muscle regeneration e. Reorientation of muscle fibers and tensile properties i. **Ice** 9. Used for controlling metabolism f. Secondary cell hypoxia 10. Used to decrease pain 11. Used for vasoconstriction g. Controls hemorrhaging 12. Reduces muscle guarding and spasms 13. It will decrease nerve conduction velocity h. This helps with pain control 14. Pain sensations include i. Uncomfortable sensation of cold -- pain j. Burning k. Aching l. Numbness j. **Compression** 15. Single most important technique for controlling initial 16. Purpose to mechanically reduce the amount of space for 17. Best application is with an Ace wrap m. Apply firm but evenly 18. Pressure can build causing pain 19. Wrap should be kept in place despite the pain to control the swelling n. Make sure there is no circulatory problems and 20. In cases of tendonitis, bursitis, tenosynovitis, the k. **Elevation** 21. Eliminates the effects of blood pooling due to gravity 22. Assists in venous and lymphatic drainage 23. Greater the degree of elevation the greater the effect in II. **Control [Pain]** C. Is determined by 8. Extent of injury 9. Athlete's response and perception of pain 10. Circumstances in which injury occurred l. Why and how should 2&3 affect injury D. Can modulate pain by using PRICE immediately after injury E. Medications F. Pain will inhibit strengthening and flexibility exercises G. Pain will dictate rate of progress H. Pain, swelling or other symptoms after exercise or activity will indicate that III. **Restore [ROM]** I. May be caused from: 11. Muscle, tendon, fascia inability to stretch 12. Connective tissue contractures (joint capsule, lig) 13. Combination of both J. Need to incorporate stretching exercises K. Possible joint mobilization or traction may be necessary IV. **Restore [muscle strength, endurance & power]** L. **Isometric** 14. Early phases of rehab 15. Muscle contracts but neither shortens nor lengthens M. **Isotonic or Progressive Resistive Exercise (PRE's)** 16. Most commonly used strengthening tech 17. Free weight, theraband, exercise machines 18. Fixed resistance with accomadating speed 19. May be either eccentric or concentric m. Concentric the muscle contracts and shortens n. Eccentric the muscle contract while it lengthens. N. **Isokinetic** 20. Used during later phases of rehab 21. Fixed speed with accomodating resistance 22. May use either eccentric or concentric 23. Used commonly for return to play criteria V. **Reestablish [neuromuscular control]** O. Should be a prime concern P. Position of joint space is mediated by mechanoreceptors found in muscles and Q. Neuromuscular control relies on CNS 24. To interpret and integrate proprioceptive and kinesthetic info o. This helps to control individual muscles and joints p. Coordinates movements R. Nervous system tends to forget how to put info together S. Regaining NM control means reestablishing previous sensory patterns T. It is the minds attempt to teach the body conscious control of a specific U. Repetition makes progression less difficult, less concentration more V. Is a step by step process W. Closed kinetic chain exercises are essential for NMC X. Is critical throughout rehab but is most critical during early stages VI. **Reestablish [balance]** Y. Involves complex integration of muscular forces, neurological senses, Z. Proprioceptive training is key to prevent further injuries **VII [Cardiorespiratory fitness]** A. Single most neglected component B. Will decrease rapidly 25. ½ hearbeat per day of immobilization C. Difficult to balance rehab and conditioning due to 26. Pain 27. Psychological issues (depression, ect) 28. Boring 29. Difficult to see immediate benefits D. Pool activities are excellent for maintaining CRF E. Cycling is also beneficial **VIII Functional progression** A. Includes gradual progressive activities 1. Broken down into component parts 2. Monitored carfully a. Pain and swelling are guidelines 3. Helps to achieve normal ROM, strength, neuromuscular control **IX Functional testing** B. Used to determine how close an athlete is to returning to competition C. Figure eights, shuttle run, vertical jump Remember - Stable to Unstable / Static to Dynamic \*\*\* when trying to make an exercise easier or harder. **Criteria for increasing physical demands (from weightbearing to full participation)** 1. - 2. - 3. - 4. - 5. - 6. - 7. - 8. - 9. - 10. - 11. - 12. - 13. - 14. - TENDONITIS Causes - Increasing too fast, too much, too hard, too many reps - Rule of thumb -- 10-15% increments per week is safe - Tennis player hitting a backhand late -- lateral epicondylitis - Improper weight-lifting - Pronation while running - Weak rotator cuff -- leads to humerus instability and possible impingement - Tendons prone to reduced circulation - Achilles tendon - Supraspinatus - Areas where tendon is compressed against the bone or retinacular tendons - Biceps tendon -- transverse lig holds the tendon in bicipital - Groove Basic Treatment for tendonitis A. Identify the causative factor\ B. Correct the causative factor\ C. Reduce inflammatory process with modalities, medications, therapeutic exercise, activity modification +-----------------+-----------------+-----------------+-----------------+ | Intensities | Level | Pain Occurrence | Activity | | | | | Restriction | +-----------------+-----------------+-----------------+-----------------+ | Mild | 1 | No pain | No Restriction | | | | | | | | 2 | Pain with | No Restriction | | | | extreme | | | | | exertion that | | | | | stops when | | | | | activity stops | | +-----------------+-----------------+-----------------+-----------------+ | Moderate | 3 | Pain with | Limit extreme | | | | extreme | exertion but | | | 4 | exertion that | has little | | | | lasts 1-2 hours | effect on | | | | post exercise | normal workouts | | | | | | | | | Pain with | Inability to | | | | moderate | perform at | | | | exertion that | normal level or | | | | lasts 4-6 h | to perform some | | | | after exercise | activities | +-----------------+-----------------+-----------------+-----------------+ | Severe | 5 | Pain with any | Inability to | | | | exertion that | perform any | | | 6 | rapidly | sport activity | | | | increases in | | | | | intensity and | Inability to | | | | lasts 3-24h | perform any | | | | | sport activity | | | | Pain during | and possible | | | | even daily | difficulty with | | | | activity | some daily | | | | | activities | +-----------------+-----------------+-----------------+-----------------+ Fractures Know locations How they heal What inhibits the healing process Diagnostics for a fracture -- X-ray Diagnostics for a stress fracture -- bone scan Signs/Symptoms What are internal and external fixators used for?