SOUTHWEST MISSOURI STATE UNIVERSITY
SPORTS MEDICINE/ATHLETIC TRAINING CURRICULUM
COLD THERAPY
Cold therapy: Ice should be utilized throughout the duration of an injury, especially for the first 24-48 hours after an injury, it is the only thing used. Ice is usually used after activity. The physiological effects of ice include a decrease in: circulation, metabolism, nerve conduction velocity, heart rate, respiration, and extensibility of tissues; and an increase in the viscosity of fluids. Ice also reduces muscle spasm, produces shivering (which maintains muscle tone), and provides pain relief. In addition to its use in relieving pain and muscle spasm, ice is used to decrease bleeding, swelling, and inflammation. Ice should not be used over open wounds, areas of undiagnosed skin rash, moles or warts, areas lacking in sensation, areas previously frostbitten, or on individuals allergic or hypersensitive to cold. As a body part is cooled it will undergo many different sensations including chilling, burning, aching, and numbness. This sequence occurs within 5-10 minutes. Application of ice ranges from 10-20 minutes. It should be noted that ice should not be left on for more than 20 minutes at a time and that at least an hour should elapse between applications of ice. Remember, WHEN IN DOUBT ALWAYS USE ICE
Perform_____ times daily or as indicated ( )before activity ( )after school ( )after activity ( )lunch time ( )after work ( )in the morning ( )before bed ( )supper time ( )when painful ( )in the late afternoon
( )increased swelling ( )after strengthening or range-of-motion exercises
Different methods of applying cold therapy include:
1. Ice massage-fill an 8 ounce Dixie cup 2/3's full of water and freeze. When ready to use it peel back half the cup and rub the ice over your hand to remove any rough spots. Place the ice on the injured area and begin rubbing in a circular or back and forth pattern for 10 minutes. The skin may become red with possible white patches. These should return to normal within a few hours. If a rash develops or any increase in swelling is noted discontinue use of ice massage and try another form of cold therapy.
2. Ice pack-fill a plastic bag 2/3's full of crushed ice and tie the bag without any air in it. Conform it to the body part on which it is to used for 20 minutes.
3. Slush packs-conform to areas better, so they are used on areas that are hard to keep an ice pack on. A slush pack consists of a plastic bag 2/3's full of water with 1-2 tablespoons of salt added. Tie the bag without any air in it and freeze it for 10-12 hours. Place it on the body part to be iced for 20 minutes.
4. Ice soak-take any type of container(bucket, waste basket,...)-that is the appropriate size for the body part to be soaked and fill it half full of water and approximately another fourth full of ice (more ice may be needed). Place the body part to be soaked in the container for 10-20 minutes.
5. Cold Whirlpool(if available)-place the body part to be iced in the whirlpool and have someone outside the whirlpool turn on the turbine. Temperature should be between 45-60 degrees F. The treatment time is 10 minutes.
Any forms of cold therapy can be interchanged if one is not available.
SOUTHWEST MISSOURI STATE UNIVERSITY
SPORTS MEDICINE/ATHLETIC TRAINING CURRICULUM
HEAT THERAPY
Heating: Heat is generally used after all bleeding has stopped at the injury site, usually 48-72 hours after injury. The local effects of heat are increased circulation, increased metabolic rate, increased sweating, increased extensibility of tissues, and a local temperature rise. Due to these effects, heat is used to decrease muscle spasm, relieve pain, speed the removal of the waste products of trauma, promote the healing process, and facilitate the warm- up process so that a better stretch of muscles may be achieved. Discontinue the use of heat if there is increased swelling in the area after its application. Caution must be used when applying heat over areas of impaired circulation and areas lacking sensation. Some of the common methods of heat application are discussed below.
Perform_____ times daily or as indicated ( )before activity ( )after school ( )after activity ( )lunch time ( ) after work ( )in the morning ( )before bed ( )supper time ( )when painful ( )when muscles stiffen ( )increased swelling ( )before/during strengthening or range-of-motion exercises
1. Hot packs: place pack in cover or towels and apply to area to be heated for 20 minutes. Add more towels around pack if it becomes too warm. Never lay on packs. Follow with stretching exercises.
2. Heating pad-turn to desired heat setting, then apply to area to be heated for 15-20 minutes. To prevent burns, never sleep with the heating pad on. Follow with stretching exercises. Heating pads can be used in place of hot packs.
3. Warm Whirlpool (if available) --place the desired body part to be heated in a whirlpool. The turbine should be turned on by someone not in contact with the water. Whirlpool treatments should last from 15-20 minutes. Perform any exercises (such as range of motion) that are prescribed while you are in the whirlpool and finish with stretching after the treatment. The temperature of extremity whirlpools should range from 102-106 degrees F and total body whirlpools should be approximately 98 degrees F.
4. Hot baths/Warm Soaks/Showers-these can be used in place of whirlpools. Regulate temperature to a comfortable level then immerse body part to be heated or place it under the spray of the shower. Do this for 20-30 minutes. Stretch during treatment and afterward.
Counterirritants (BenGay, Icey Hot, Deep Heet, Atomic Balm, etc.)--these products only irritate the skin nerves producing a sensation of heat without actually heating the underlying tissues. They have none of the specific effects of heat and therefore none of its benefits. So their use is not recommended. These products have also been known to cause skin rashes due to their irritating effect on the skin.
Contrast Baths
Contrast Baths: Contrast baths are used to decrease swelling in an injured area. These baths use both heat and cold in combination. The change from cold to hot and back is thought to cause a switch in physiological properties which create a pumping action that helps speed the removal of swelling. The blood flow through the injured area decreases from constriction of blood vessels and then increases with dilation of blood vessels. To do contrast baths you need a container with hot water between 105-110 degrees F and a container of cold water approximately 60 degrees F. Then place the containers in a position so that the injured part can be readily switched between the two. This treatment takes approximately 30-40 minutes. Place the injured part in the hot water for 5 minutes. Then place it in the cold for 2 minutes then
the hot for 4 minutes. Repeat the cycle of cold 2 minutes, hot 4 minutes 4 more times with the last soak in the hot water being 5 minutes. The 4 to 2 ratio may be decreased to a 3 to 1 ratio. During the treatment the patient should perform active range of motion in both baths.
Perform_____ times daily or as indicated ( )before activity ( )after activity ( )after work ( )in the morning
( )before bed ( )when painful ( )when muscles stiffen ( )increased swelling.