3.1 - heat and cold

• hot/cold packs

• ice massage, contrast bath

• fluidotherapy 

• paraffin 

• infrared lamps 

• whirlpool 

list of thermal agents tfor superficial thermal agents 

• continuous ultrasound

• continuous shortwave diathermy

list of thermal agents for deep heating

1-3cm

skin, subcutaneous tissue/fluids

superficial heating goes about ________ deep and targets….

3-5cm

large muscles, joins

deep heating goes about ________ deep and targets….

• conduction

• convection

• radiation

• conversion

what are the 4 types of heat

conduction

what type of heat involves direct contact to transfer heat

• hot packs

• paraffin

• cold modalities

what are some types of conductive modalities (3)

fast; slow 

with conduction, objects get warm (slow or fast) and get cold (slow or fast)

thermal conductivity 

_____________ is the rate that material transfers heat

((area of contact) x (thermal conductivity) x (temp difference)) / tissue thickness

what is the rate of heat transfer equation

more

does a high water content of more or less conductivity

muscle (this means it transfers heat faster - conductivity)

does muscle or fat have a higher thermal conductivity

• area of contact

  • larger = faster transfer

• temp difference of the 2 materials

  • large gradient = greater change

• conductivity 

  • high is fast, low is slow

• tissue depth 

  • deep = slower to change temp 

what are the four principles for conduction 

true

T/F: In applying paraffin to a patient’s hand, it is important to remove any jewelry due to the high thermal conductivity of metal.

false

T/F: The total amount of heat transferred is the same when comparing a thermal agent applied to the entire quad muscle with the biceps muscle

true

T/F: Placing 6-8 layers of towels between hot pack and skin decreases the heat conduction

convection

what type of heat involves a circulating medium and a material of a different temperature

convection

which is faster process, conduction or convection

• fluidotherapy

• whirlpool

what are two types of convection modalities

motion 

convection is a thermal agent that is in _________

radiation

what type of heat involves energy transfer without contact or intervening material

• radiation intensity

• size and source of radiation

• treatment area

• distance and angle between source and treatment area

radiation depends on what 4 factors

infrared lights 

what is a clinical modality for radiation 

radiation

what type of heat is a thermometer an example of

radiation

what type of heat is this an example of

conversion

what type of heat involves changing nonthermal into heat

ultrasound; diathermy; cold packs activated by striking

an example of conversion heat:

• mechanical: ____________

• electrical: ______________

• chemical: _____________

false 

T/F:  conversion heat involves direct contact 

evaporation

____________ is a process where a liquid changes into a gas

true

T/F: evaporation is cooling ONLY

lower (contact with warm skin causes liquid to change to gas and leaves skin cooler) 

vapocoolant spray evaporates at a (lower or higher) temp than water 

specific heat 

_______________ is the amount of energy required to raise the temperature of a unit of mass of a material by one degree celcius 

more

a high specific heat means (less or more) energy is required to heat up, this also means it can hold (less or more) energy at a given temp

water

what has a higher specific heat, air or water

1. More rapidly

Immersion in a whirlpool will heat a patient’s skin _________ than/as immersion in a bowl of water of the same temperature.

1. More rapidly

2. Less Rapidly

3. The same rate

2. Convection

Blood circulating in the body also transfers heat by ___________ to reduce local changes in tissue temperature.

1. Conduction

2. Convection

3. Conversion

4. Radiation

label all the energy sources/thermal types

• decrease pain

• muscle spasm

• joint stiffness

• increase soft tissue extensibility and ROM

• general relaxation

• MIGHT decrease effects of DMOS

indications for using therapeutic heat (6)

104-113 degrees farenhiet 

the tissue temp must be elevated to __________ to provide a therapeutic effect 

• vascular/hemodynamic effects

• neuromuscular effects

• metabolic effects

• altered tissue extensibility

what are the 4 effects of heat

dilation; smooth

heat causes vaso_________ and it relaxes ___________ muscle

• inc metabolic rate, chemical mediators 

• inc oxygen for repairs

in what ways does heat increase metabolic reactions 

exercise

what is the best way to heat deep muscles

inc; inc; dec

the neuromuscular effects of applying heat

• (inc or dec) nerve conduction velocity

• (inc or dec) thermoreceptors at skin

• (inc or dec) nociceptive afferents at dorsal horn

dec alpha mn → GTOs relax → relax muscle contraction 

how can heat decrease muscle spasms through neuromuscular effects

decreases muscle performance → strength for 30mins after heat → gradually increase up to 2 hours

what is the timeline of muscle performance when applying heat and considering the neuromusclar effects

113-122

past ________ degrees is when tissue is subject to burning

104-113; 5-10 minutes 

to increase tissue extensibility of soft tissue with heat, the tissue temperature must be maintained at ________ degrees for ________ (duration)

no

is there good evidence behind heat increasing flexibility

yes

is there good evidence behind heat reducing pain

kinda… limited but shows positive outcomes by using “heat-wrapped”

is there good evidence behind heat decreasing DOM

• impaired sensation (can burn) 

• vascular disease/insufficiency

• thrombophlebitis 

• over recent or potential hemorrhage (can inc bleeding) 

• over area of known malignancy 

• over infected area 

• over lidocaine patches 

• impaired cognition 

list the contraindications for therapeutic heat (8)

• over area of acute injury or inflammation

• over abdomen or low back during pregnancy

• impaired circulation

• metal in area (only superficial

• area of edema

• over area where liniments or heat rubs were recently applied

• cardiac insufficiency

• over an open wound (nerve with paraffin, closely monitor)

• demyelinated nerves

precautions of therapeutic heat (9)

burns 

_________ is the second most common suit for malpractice in PT 

158-167

hot packs are stored at ____________ degrees

6-8; 2-3

must use _______ layers of toweling with therapeutic heat; note that a hot pack cover equals _________ layers of toweling

5 minutes 

you must check in with the patient after ________ when using therapeutic heat 

125-134 fahrenheit

what is the appropriate temperature for paraffin

• dip-wrap

• painting

what are the 2 techniques for paraffin

6-10 times 

when you do the dip-wrap method with paraffin, how many times do you dip, lift and allow wax to dry 

6-10 layers

how many layers do you use for the painting paraffin technique

100-118 fahrenheit

what is the appropriate temp for fluidotherapy

20 minutes 

how. many times is fluidotherapy applies for 

• explain purpose, procedure, expectations to patient

• clear contraindications

• check sensation

• apply agent

• perform a 5 min check

• after treatment: inspect skin and document results

what is the 6 step process of therapeutic heat application

5 min

when does a patient reach “peak heat” when getting therapeutic heat

heat (doesn’t add cold) 

cryotherapy removes (cold or heat) 

• inflammation

• pain

• edema

• reduce spasticity

• facilitation of movement

• increase pain threshold

clinical indications for using cryotherapy

• temp difference between objects

• time of exposure

• conductivity of tissue

• type of agent

• total body surface being cooled

cooling depends on what 5 factors

• hemodynamic 

• neuromuscular effects 

• metabolic effects 

what are the 3 effects of cold therapy 

constriction

hemodynamic effects of cold causes immediate vaso___________

• smooth muscle of blood vessel walls contract

• decreased production of vasodilator mediators

• increased blod viscosity

• reflexes causing vasoconstriction

what are the 4 effects of vasoconstriction from the hemodynamic effects of cold

5-10 minutes 

after __________(duration) of cold application, the possibility of cold induced vasodilation can occur 

10-15 minutes

limit cold therapy applications to _________ to limit vasodilation

dec; inc; force; dec; proprioception

neuromuscular effects of cold:

• (dec or inc) nerve conduction velocity

• (dec or inc) pain threshold

• alters muscle _________ generation

• (dec or inc) spasticity

• alters _______________

A delta

neuromuscular effects of cold is especially effective for ________ nerve fibers

true 

T/F:  cold therapy can treat myofascial pain and trigger points 

inc; dec; isometric

the temporarily altered muscle strength from the neuromuscular effects of cold:

• < 5 minutes = (dec or inc)

• > 5 minutes = (dec or inc)

• cooling 10-20 → decreased _________ muscle strength initially

10-30 minutes

cooling for _________(duration) decreases spasticity, clonus, resistance to PROM, and some reflexes

false 

T/F:  cold therapy is recommended when healing is delayed 

true

T/F: cold therapy can treat inflammatory joint disease: osteoarthritis and rheumatoid arthritis

20 minutes; 1 hour

when using cold therapy, never apply longer than _______ and at least _________ apart

1+ hours

cold therapy applied for 10-15+ minutes can control pain for _________

true

T/F: cold therapy can reduce spasticity

upper

cold therapy can treat spasticity with (lower or upper) motor neuron dysfunction

false (MS sx are aggravated in the heat) 

T/F:  it is better to treat MS with heat rather than cold 

cooled; takes longer when vessels are vasoconstricted, it’s faster when they are vasodilated

it takes longer for a (cooled or warmed) area to return to normal temperature; why

PRICE(s) = protection, rest, ice, compression, elevation, stabilization

POLICE = protection, optimal loading, ice, compression elevation

what does PRICE(s) and POLICE stand for

PEACE = protection, elevation, avoid anti-inflammatories, compression, education 

LOVE = load, optimism, vascularization, exercise 

what does PEACE and LOVE stand for 

acute (remember the A stands for avoid anti-inflammatories)

what stage of healing would you use the acronym PEACE

• cold urticaria

• cold intolerance

• cryoglobulinemia

• raynaud’s disease/phenomenon

• paroxysmal cold hemoglobinuria

• over regenerating peripheral nerve

• over area of circulatory compromise

• over area of PVD (esp. PAD)

contraindications for cold therapy (8)

• HTN - monitor 

• thermoregulatory disorders 

• over a superficial peripheral nerve 

• over an open wound 

• poor sensation 

• poor cognition 

• the very young and very old 

• persons with aversion to cold 

precautions for cold therapy 

• tissue death

• frostbite

• nerve damage

what are the three adverse effects to using cold therapy

59 fahrenheit (skin should be between 59 and 113)

always keep tissue temperature above __________ degrees

2 cm 

cold packs reduce temperature of skin/tissues up to _______ deep 

with

what is more effective: ice bag with or without water

water/alcohol bag

what is more effective:

• ice bag with water

• water/alcohol bag

1 

you should be using _______ towel layers if the agent is < 30 degrees fahrenheit 

10-15 min

general treatment time for cold packs

• intense cold

• burning

• aching

• numbness

• anesthesia

what are the normal reactions/sensations to cryotherapy

small 

ice massage application is typically done over a (small or large) area