Modali'es Update Part 3
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1 Modali'es Update Part 3 Laurie Edge- Hughes, BScPT, MAnimSt (Animal Physio), CAFCI, CCRT The Canine Fitness Centre Ltd., Calgary, AB, Canada Four Leg Rehab Inc, Cochrane, AB, Canada 1
2 Mechanisms of Heat Exchange ConducKon (direct contact) ie hot packs ConvecKon (direckng air or liquid) ie dryers RadiaKon (from warm to cool) ie lamps Conversion (altering energy) ie Ultrasound EvaporaKon (fluid changes to vapor) ie perspirakon INDICATIONS Pain Relief To increase circulakon Muscle spasm Facilitate Kssue healing Prepare a skff joint or muscle for exercise Chronic swelling Tissue scarring 2
3 CONTRAINDICATIONS Large area or high enough temps as to raise core body temps in pregnant pakents, or pakents with cardiac issues PaKents with DVT / thrombosis / thrombophlebiks PaKents infected with TB Areas of impaired sensakon AcKvely bleeding Kssues Over reproduckve organs (testes) Recently irradiated Kssues In pakents unable to give accurate / Kmely feedback Areas of impaired circulakon Inflamed Kssues (d/t recent injury or chronic flare- up) Over heat sensikve skin Over areas of skin break- down Areas of edema Thermal Therapies (HOT) CAUTIONS Areas near or over eyes Anterior neck & carokd sinus Pregnant women People with cardiac failure 3
4 Thermal Therapies (HOT) SAFE Over implants containing metal, plaskc, or cement Over electronic devices Near chronic wounds Over superficial or regenerakng nerves Near the head, chest, or heart Over ackve epiphysis To pakents with hypertension PHYSIOLOGICAL EFFECTS Increased local circulakon Decreased pain Increased Kssue extensibility Decreased muscle spasm Muscle relaxakon Via dilakon of blood vessels and skmulakon of local circulakon, heat helps to mobilize Kssue & metabolites, increase Kssue oxygenakon and increase metabolic rate of cells and enzyme systems. 4
5 THERMOTHERAPY Proposed sequences of physiological & cellular funckons... (Belanger 2004) APPLICATION Best AFTER the acute inflammakon stage Superficial heat directly penetrates only 1cm Most profound physiological effects are when Kssue temps are raised to degrees F. Skin & subq fat will rise to these temps aber 5 mins of superficial heat Deeper Kssues need mins to achieve the same (with superficial heat) Water as hot as the hand can tolerate is F. Heat in one locakon may cause reflex vasodilakon at a distal site. 5
6 INDICATIONS Pain relief InflammaKon Reduce swelling Hemorrhage Fever Muscle guarding spasm Control bleeding ContraindicaKons Impaired circulakon Over chronic wounds Over regenerakng nerves PaKents with cold sensikvikes To pakents with DVT / thrombosis / thrombophlepiks To anterior neck & carokd sinus To Kssues affected with tuberculosis 6
7 PRECAUTIONS (may treat this condikon with lower intensikes and/or more monitoring) To areas of impaired sensakon Tissues near / over eyes Damaged or at risk skin To pakents with cardiac failure (reduce intensity or size of applicakon) To pakents with hypertension (reduce intensity or size of applicakon) SAFE Over ackve epiphysis Over metal, plaskc, or cement implants Over electronic devices Over areas of known malignancy Over low back or abdomen of pregnant pakents Over recently irradiated Kssues Over reproduckve organs Skin diseased areas Over the chest, heart, head Any inflamed Kssues 7
8 EFFECTS Decrease in local circulakon Decrease in pain Decrease in Kssue extensibility MECHANISMS OF ACTION ConstricKon of blood vessels Decreased Kssue metabolism» (inhibits inflamm. mediators) Affects small myelinated nerve fibres» (reduce nerved conduckon) can directly affect 1 4 cm depths CRYOTHERAPY Physiologic effects... (Sluka 2009; Belanger 2004) 8
9 APPLICATION Apply in the first 48 hrs following acute musculoskeletal injuries or any Kme there is heat and swelling Repeat every 2 4 hrs for minutes Current trends are using cold for hours at a Kme (cryocuff, game- ready ) Effects occur when Kssue temp gets between degrees F. Do not allow for an airspace between the skin and cold medium (air gets colder and can damage the skin) 9
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