Heat and Cold Modalities

What are the application methods for superficial heat?

• Heat packs (Hydrocollator or wheat packs)

• Wax baths

• Chemical heat wraps

• Wheat bag

What indicates the use of heat?

• Relief of pain, muscle spasm by neural reflexes

• Increase tissue extensibility

• Tissue healing (Chronic injuries)

• Detrimental in early stages. Can increase bleeding, oedema or chemical activity

What are the physiological effects of heat?

• Vasodilation

• Increases metabolism, removing metabolites

• Decreases muscle spasm and pain

• Increase collagen extensibility, decreases viscocity→ increases ROM

What are the contraindications or precautions to heat?

• Pregnancy or severe cardiac disease

• Impaired sesnation or local circulation

• Bleeding or inflammation of recent acute injury

• DVT

• Skin conditions or trauma

• Malignant or infected tissue

• Previous radiotherapy

• Acute febrile illness (within last 24 hours)

• Reduced consiousness

• Extreme obesity

What is the dosage for heat modalities?

• Therapeutic effects: Heat for ~20 mins, tissue temperature between 40-45 degrees

• Heating of tissue will be slower where subcutaneous fat is present

What are the methods of cold application?

• Crushes ice

• Gel Cold packs

• Cryocuff

• Ice massage

• Can be performed with compression

What is the clincial indication for cold modalities?

• Relief of pain and oedema

• Can improve outcomes in acute injuries

What are the physiological effects of cold modalities?

• VAsoconstriction

• Increases fluid viscocity

• Decreases inflammation

• Decreases metabolism→ Reduce secondary hypoxia

• Decrease nerve conduction→ decrease pain

• After first 48 hours, usefulness of superficial cooling on healing is minimal

What are the contraindications to cold modality?

• Vasospasm

• Cold urticaria (cold allergy/hypersensivity)

• Crycoglobulinaemia, haemoglobulinaemia

• Impaired circulation or severe CVD

• DVT

• Chronic wounds

• Haemorrhaging tissue

• Reduced consiousness

• Anterior neck

• Regenerating nerve

What is the dosage of cold modalities?

• Up to 20 minutes. Rewarming period should be twice as long.

• 10 minutes over areas of minimal subcutaneous fat or superficial nerves

• Avoid cooling prior to electrical device use or before activity