Temperature Therapy
Properties of Heat Therapy: Warming the tissues initiates vasodilation, which is the process by which veins and arteries become larger and allow the movement of more blood. Trauma to body tissues often leads to restrictions in natural fluid movement, or ischemia. When the muscle tissue feels "lumpy" or "crunchy" it is a sign that ischemia is beginning. This can occur following an acute injury or from chronic stress to the body such as poor postural alignment or unhealthy body movement patterns. By increasing blood flow to a specific area, you will also increase the movement of oxygen and nutrients to that area - a crucial piece of the healing process. Another important aspect of heat therapy is its ability to create more pliability in the tissues. If a muscle is stiff and has limited movement, heat activates thermal receptors which alter brain perception and send a signal to the tissue to decrease muscle spindle cell sensitivity. These muscle spindle cells are responsible for muscle contraction and release. Warming the tissues resets the cells allowing movement patterns to be less restricted and return to normal.
Conditions for Heat Therapy: Because heat therapy has such a large affect on the circulatory system, it will have the most impact on tissues that have direct blood flow i.e. muscles and their tendinous attachments. Injuries to these tissues are commonly known as strains, and in severe cases, tears. Strains and tears occur under two conditions: First is overuse, when the tissues are asked to performing beyond their intended movement. This can occur from an acute, excessive load on the tissue, or it can occur as a chronic condition where the load placed on the tissue compounds over time. Second is underuse, when tissues are not used enough to induce muscular metabolism. During muscular metabolism old tissue cells that are no longer needed are broken down and elminated from the body and new cells are created to keep the tissue strong.
Indications for Heat Therapy: Some conditions that commonly require heat therapy include strained muscles or tendons. A strain occurs when the fibers of a muscle or tendon have been stretched beyond a healthy point. This can lead to tearing of the tissues and heat encourages the return of nutrient rich blood to begin and sustain healing. Other conditions that respond well to heat therapy include: Autoimmune conditions such as arthritis, Visceral pain such as stomach and uterine cramping, and joints with decreased range of motion.
Application of Heat Therapy: Heat therapy can be applied in a variety of ways - electric heating pads, microwable heat packs, heated towels. These forms of heat can be applied in a consistent manner until the heat has dissapated. A note of caution in regards to electric heating pads: most heating pads have an automatic cut off setting, but if the area being treated begins to feel to hot, remove the temperature stimulant and allow the tissues to cool naturally.
Properties of Cold Therapy: Cooling tissues initiates vasoconstriction, which is the process by which veins and arteries become smaller. When tissues are damaged, the body's response is to send additonal fluids to the area to cushion, or protect, the injured area and to flood that area with additonal nutrients needed for cell restoration. This causes the areas to appear swollen and commonly presents with redness or a warm feeling to the skin. While this response is beneficial in the early stages of healing, if it persists too long it can be a hinderance when it comes time to begin restoring natual movement patterns. Cooling the tissues inhibits the receptors that signal the body to send increased fluids to the injured area.
Conditions for Cold Therapy: The body's inflammatory response is higher in areas where the tissues DO NOT have direct blood flow, I.e. ligament attachments. In this case, the fluid sent to cushion and protect injured areas is intersitial fluid. Interstitial fluids exist in the space under the dermal (skin) layers and outside the muscle or organ tissues. This fluid contains metabolic waste as the cells renew themselves. It helps to lubricate the tissues as they move against one another. Cold therapy is most effective in preventing this body repsonse.
Indications for Cold Therapy: As previously discussed, cold therapy works well for areas that have no direct blood flow. This includes sprained ligaments where fluid can build up and, in the late stages of healing, prohibit the restoration of typical movement patterns. Cold therapy is also beneficial in areas where trigger points are present. Trigger points are areas of tissue receiving an over load of contraction signals from the nervous system. Cold therapy will decrease nerve activity and encourage relaxation do the stressed tissues.
Application of Cold Therapy: Cold therapy must be applied more carefully than heat therapy due to the body’s response when the tissues become too cold. When cold therapy is applied for too long, the body stops the production of various enzymes that can cause tissue degradation. While this is a positive effect in a preservation situation like frost bite, it is a huge hinderance in the healing process for sprained or torn ligament tissues. In order to avoid this physiologocal process from taking place, cold therapy should be applied in cycles. The cycles are as follows: 10-15 minutes of exposure to the cold stimulant, 10 minutes without any temperature changing stimulant, then another 10-15 minutes of exposure to the cold stimulant.
Properties of Contrast Therapy: As an alternative to singular temperature therapy, contrast therapy can also be very beneficial for the health of various body tissues. Contrast therapy is the application of heat and cold stimulants in alternating progression. By alternating the temperature stimulus, the blood vessels dilate then constrict in a quick succession. This allows a large influx of nutrient rich blood while also preventing the vessels from releasing excess fluids that cause tissues to become inflamed.
Conditions and Indications for Contrast Therapy: While singular temperature is most helpful for injured tissues, contrast therapy is most helpful in healthy tissues that may be fatigued or stressed. Post massage or post workouts are ideal times for contrast temperature therapy.
Application of Contrast Therapy: The goal of thermotherapy is to change the cutaneous, intra-articular and core temperature of soft tissue, the application pattern is even more important. The proper application of contrast therapy involves 20 minutes of exposure to the heat stimulant, 10 minutes without any temperature changing stimulant, 20 minutes of exposure to the cold stimulant, 10 minutes without any temperature changing stimulant, then reintroduction of each stimulus with another 10 minute break between. The break between each stimulus is especially important in contrast therapy. If you were to apply a cold stimulant immediately after the heat stimulant, you would only be bringing the tissue temperature to normal rather than bringing it down below normal. These temperature adjustments to the tissue help achieve the desired physiological effect in the body.
