Cold Therapy
As old as medicine itself is the practice of
applying cold to injured tissues. These days, the evaporation of volatile
fluids from the skin or the application of various types of ice or frozen gel
packs can both lower the local temperature of the tissues. The skin temperature
drops to 10°C rather frequently.
Ice therapy has the potential to alleviate the following symptoms:
(a) pain;
(b)
spasticity;
(c) muscle spasms;
(d) edema.
(f) offer an excitatory stimulation when muscles are inhibited;
(e) encourage healing.
Since ice therapy is by far the most popular way to apply cold to the body, it
will be covered in more detail than the other approaches.
Mathematical principles:
Heat is transferred from the skin to the ice when it is put to the skin, melting it. The ice needs a significant amount of energy (latent heat of fusion) to change its state; for example, 1 g of ice at 0°C needs 491 J to warm up to 1 g of water at 37°C, yet 1 g of water at 0°C only needs 155 J. Therefore, it's crucial to employ ice during treatment rather than merely cold water while attempting to cool tissues.PHYSIOLOGICAL EFFECTS AND USES
Response of the circulatory system
The skin's first reaction to cold is a
localized vasoconstriction in an attempt to maintain body temperature. The
result of this homeostatic reaction is that the component can get extremely
chilly. There is a brief vasodilatation followed by alternating intervals of
constriction and dilatation, depending on the area affected. Lewis's hunting
reaction is the term used to describe this apparent "hunting" for a
mean point of circulation. According to some experts, the arteriovenous
anastomosis closes during vasodilatation episodes, increasing blood flow via
the capillaries. This helps reduce swelling and repair damaged tissue. Physiotherapeutic
uses of circulatory effect
Optimizing Healing Through Ice Therapy
The initial vasoconstriction is frequently employed to restrict the amount of blood that extravasates into the tissues. After ice therapy, compression bandages of some kind are typically applied. Tissue fluid and metabolic exchanges occur via the capillary membrane, which is affected by the alternating phases of vasoconstriction and dilatation. As a result, a relatively localized impact is created that can lessen swelling by allowing extra tissue fluid to be drawn out of the affected location and reintroduced into the bloodstream. More nutrients and materials for repair might reach damaged areas thanks to increased circulation. Ice is therefore highly helpful in reducing edema and promoting healing. For example, massaging with ice cubes can hasten the healing process of bed sores.
Enhanced Muscle Performance with Cooling:
Cooled muscle can contract many more times
before tiredness sets in because of Hoffman's law, which states that cooled
tissues have a lower metabolic rate. Perhaps in cases of local tissue damage or
metabolite accumulation, the enhanced circulation is removing chemicals that
are activating nociceptors and causing pain.
Brain reaction
The principal thermal receptors are found in the skin. The number of cold than warm receptors is several times more. The prolonged discharge of impulses by the cold receptors in response to chilling rises in frequency as cooling continues.It has been demonstrated that cooling lowers the rate at which nerve fibers in a mixed peripheral nerve conduction. The A fibers, or the myelinated group, are the first to be impacted by a slow cooling. Eventually, the non-myelinated B and subsequently C fibers are impacted at extremely low temperatures. In theory, the action on the fibers should cause motor paralysis before affecting the fibers linked to deep pain (C) or spasticity.
But
in actuality, cold never causes motor paralysis, thus a different mechanism
than decreased conduction must be useful in easing pain and stiffness.
lessening of discomfort
Ice has long been used as a pain reliever, and this is one of its main benefits. Stimulation of cold receptors that return impulses that have entered the spinal cord through the posterior root is most likely the mechanism at work. The 'pain-gate' is closed when these impulses, which enter the cord by relatively large-diameter nerves, effectively block out any other (pain) impulses trying to enter. It is possible to characterize the cold stimulus as unpleasant, which activates regions in the midbrain that may release endorphins or enkephalin—the body's opiate-like substances—into the posterior horn, thereby decreasing pain.This momentarily lessens discomfort. However, during this phase of temporary pain relief, some good physiotherapy in the form of strengthening exercises or mobilization needs to be provided if some permanent pain reduction is to be attained.
Decrease in spasticity
Damage to the upper motor neuron causes a pathological state of elevated muscular tone known as spasticity. Frequently, the extrapyramidal system's superior control over the small anterior horn cell is relinquished, causing it to fire more frequently and spontaneously. When a hypertonic spastic state manifests, the overall effect of this is to raise the tone of the extrafusal muscle fibers.Alleviating Spasm with Cold Therapy:
A typical reaction to pain or injury, a spasm is characterized by an increase in muscle tone in a particular area, seemingly intended to prevent additional damage and movement. But the quantity of spasm generated is frequently significantly more than what is required to provide protection, and prolonged muscle contraction itself begins to cause pain, which frequently leads to further spasm.Most likely, the same mechanisms explain how cold alleviates stiffness and spasm. Numerous theories have been put forth. Numerous sources attribute this to decreased nerve conduction velocity or decreased sensitivity of receptors, including the muscle spindle. While these certainly do occur, these structures are fairly deep, and it would take several minutes to produce a low enough temperature to affect them (assuming that a low enough temperature could be reached at all). In contrast, a clinically significant reduction in spasticity or spasm can be shown within 30 seconds of applying ice. At this point, just the skin can be impacted by an injury.
Managing Spasm and Spasticity Effectively:
More long-term treatment is necessary to maintain this state once spasm and spasticity have been minimized. When it comes to spasms, this usually just means taking proactive steps to end the cycle of pain, spasm, more agony, and more spasm. The physiotherapist's preferences determine the approaches utilized for treating spasticity. In an effort to physiologically inhibit the dominant groups, some people try to contract the antagonists of the dominant spastic muscles. Some individuals utilize their decreased spasticity to attain more typical postural responses, ultimately striving to reinstate typical movement patterns.
Agitated cold
Ice can be used as a cutaneous stimulation to boost excitatory bias surrounding anterior horn cells when delivered cold in the right way. When coupled with additional stimulation methods and the patient's free will, this can frequently cause an inhibited muscle to contract (as long as the peripheral nerve is still present). When muscles are inhibited after surgery or in the later phases of a mixed peripheral nerve's regeneration, this effect can be applied.Methods of Implementation
The method used to apply ice will change depending on the desired outcome. It can be utilized in the subsequent manners:(a) ice packs;
(b) ice towels;
(c) immersion;
(d) massaging ice cubes;
(e) excitatory cold (rapid ice).
Each application method will be thoroughly explained, along with any approach
adjustments needed for certain circumstances. Towels with ice
This application method is often used due to its low risk of causing an ice
burn.
Preparation
1 Make the bed ready by taking off the covers and blankets and covering it with a waterproof covering.2. Properly expose the area that has to be treated while shielding the patient's necessary garments.
3. To make the ice solution, put two large
bowls or buckets filled with
one part water to several parts crushed or flaking ice. After mixing, you
should have a mixture that you can submerge two terry towels in.
Utilization
1 As much ice as possible clings to one towel once the excess water is wrung out of it. After that, it is applied to the area being healed.2. After 30 seconds, but no more than two minutes, the towels are replaced. place for a minimum of
3. Ten towels at a time may be applied in
succession; more may be used if the physiotherapist believes they will be
beneficial for around fifteen to twenty minutes. helpful, that is, the entire
course of treatment
Adaptation of method
If there is swelling, you can raise the affected limb and cover the entire joint with ice cloths.With the towels in place, the patient can work out. The physiotherapist may also use manual resistance techniques while the towels are in place.
In order to treat spastic muscles, the physiotherapist applies towels throughout the muscle's length, from its origin to its insertion, and uses the proper relaxation and facilitation techniques.
Packs of ice
An ice towel folded into the proper form or a specifically designed terry-towel
bag can be filled with crushed or flaked ice.
Making the bed
A polythene sheet gutter is folded and set on top of the bed. To direct the water created by the melting ice into a container at the side of the bed, a folded towel is positioned beneath its sides. The area that has to be treated will be below the gutter. getting the patient ready. The section that needs to be treated is removed and placed comfortably over the gutter that has been ready.Before applying the ice pack, a vegetable or nut oil is applied to the skin. Attempting to avert an ice burn is this. Ice burns are caused by the skin being extremely cold. This could happen if the pack's water seeps through to the skin, absorbing salts from it and making the area extremely cold. Super-cooling is prevented because of the oil layer, which makes the water created by the melting ice flow off skin and into gutters more quickly and easily. Oil keeps the pack from freezing to the patient's skin because of its extremely low freezing point. As the water created transfers heat from the skin to the ice inside the pack, melting the ice is a crucial step in the healing process.
Utilization
The area that has to be treated is covered with the wet ice pack. Never put a pack over a limb as this will inevitably exert pressure on a particular part of the limb and may cause localized circulation reduction. Reduced circulation could lead to an ice burn and interfere with the body's natural response to cooling.You can leave the pack in place for ten to twenty minutes.
Submersion
The component that is to be treated is submerged in an ice solution using the immersion technique. Regretfully, only specific areas like the hands, feet, and elbows can be submerged.Prepration:
50% ice and 50% water combined in an appropriate container make up the solution.Utilization
The patient submerges the part in the solution and holds it there for a total of ten minutes, which can be done in one ten-minute session or several shorter ones. The patient frequently feels excruciating agony in the submerged area, which can occasionally be so bad that it makes him pass out. It is imperative that he receives appropriate support and supervision during his treatment.
Massage using ice cubes
Because it doesn't require an ice maker, ice cube massage is a practical
application technique. A household refrigerator's freezer section is adequate.
This makes this method helpful in wards, tiny departments, and above all at
home. Preparation
One end of a big block of ice, such as water frozen in a yogurt pot, is wrapped in a towel, while the other end is left unwrapped. Both exposure and assistance for the patient are sufficient.Utilization
Using only light pressure, the exposed end of the ice block is massaged in a circular motion over the area being treated. The application can be used for a maximum of ten minutes. It's possible that the intended outcome will occur earlier. When treating bed sores, this method is quite helpful. The sore is gently massaged with ice for around two minutes. Next, the skin is softly dried (either with a dab or a hair dryer's warm airflow). Three or four repetitions of the ice treatment are made. Almost instantly, there is a noticeable increase in circulation, which should hasten the healing process. When pressure zones are on the verge of collapsing, a similar method can be applied since the increased circulation might stop this from happening.Agitated cold
It is possible to use the distinct sensory stimulation of ice on the skin to help inhibited muscles contract. The inhibited muscle's spinal root level supply (myotome) must be determined first, followed by the location of the skin's corresponding root supply (dermatome).After that, the skin is dried and the dermatoine is swiftly stroked three times with ice. The posterior horn allows this sensory stimulus to enter the cord and travel back via the peripheral nerve. Numerous connections between the anterior horn cells and these sensory fibers are assumed to raise the degree of excitement surrounding the anterior horn cell.
If the patient is willing to exert additional
effort to make the muscle contract, the increased excitement can be sufficient.
When inhibition is present or during the later phases of nerve lesion recovery,
the "quick ice" method can be an effective stimulus to promote
voluntary muscle activation.
CONTRAINDICATIONS TO ICE TREATMENT
Psychological
Many patients are terrified of the prospect of using ice, especially the elderly. In fact, a lot of people say that the cold exacerbates their illness. It can be best to avoid using ice if the therapist is unable to convince or show the patient that it will help.Cardiac ailments
After a myocardial infarction, cold treatment should be avoided for six months. The first shock of the ice treatment may result in a significant reduction in blood pressure, which could make the heart less able to satisfy this demand.Heart rate is weak
Since the heart and the left shoulder share a
sympathetic nerve supply, it has been demonstrated that applying ice to the
left shoulder can cause an excess of excitatory impulses to go down these
sympathetic nerves and into the heart. Thus, in patients suffering from any
kind of heart condition, ice applied to the left shoulder should be avoided.
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