Sports Medicine: Just the Facts

• Poor thermal regulation (systemic applications)


• Malignancy
  •Edema

SUPERFICIAL HEAT APPLICATION
METHODS

HOT PACKS (HYDROCOLLATOR)

•Transfer of heat energy by conduction

• Application:Silicate gel in a canvas cover


• When not in use these packs are kept in thermostati-
  cally controlled water baths at 70 to 80°C.


• Used in terry cloth insulating covers or used with
  towels placed between the pack and the patient for
  periods of 20 to 30 min.


• Advantages: Low cost, easy use, long life, and
  patient acceptance


• Disadvantages:Difficult to apply to curved surfaces


• Safety:One should never lie on top on the pack, as it
  is more likely to cause burns. Towels should be
  applied between the skin and hydrocollator pack.

HEAT LAMPS

• Heat primarily by the conversion of radiant energy to
  heat, i.e., the direct application of photons to living
  tissue leading to heat production.


• Application:Simple to use but require some attention
  to avoid injuries or burn.


• In practice, therapeutic temperatures are usually
  obtained when the heat sources are about 50 cm from
  the skin.


• The intensity of heating of point heat sources, such as
  incandescent bulbs, drops off in accordance with the
  inverse squared (1/r^2 ) law, the heating effectiveness of
  linear sources, such as some quartz lamps, may follow
  a more slowly decreasing 1/r relationship.


• Safety:These agents produce erythema (known as
  erythema ab igneand erythema calor).


• Chronic use may produce a permanent brownish dis-
  coloration.

HYDROTHERAPY

• Heat transfer is primarily by convection
  
  
  • Uses a fluid medium (usually H 2 O) to apply heat
    and cold.
    •Immersion of large portion of the body in water at
    neutral temperatures between 36.5 and 40°C for
    20 min.
  
  
  
  

•Water temperatures are limited to about 39°C if a

significant fraction of the body is immersed.

• Hydrotherapy medium may be stationary or in
  motion.

SPECIFICMODES

• Whirlpool baths and hubbard tanks
  •Tanks range in size/construction from small
  portable units to treat a portion of a limb to fixed
  Hubbard tanks for the entire body.
  
  
  • Hydrotherapy is expensive in terms of labor and
    resources.
  
  
  
  

ADVANTAGES/SPECIFICUSES

• Wounds and burns:Hydrotherapy may lessen pain
  and speed healing of open wounds (Burke et al, 1998;
  Juve Meeker, 1998).


• Used for wounds and treatments when gentle mechan-
  ical debridement, heat, and solvent actions are desired.
  •For larger wounds, a 0.9% NaCl solution, improves
  comfort and lessens the risks of hemolysis and elec-
  trolyte imbalance.


• Musculoskeletal/pain applications: Hydrotherapy is
  often used as an adjunct to joint mobilization after
  cast removal or prolonged mobilization.


• Sitz baths (small warm water bath) for perineal and
  anal pain


• Used to treat musculoskeletal pain, spasms, and ten-
  sion myalgia.


• In clinical institutions where disinfecting procedures
  are followed and areas of stagnant water are avoided,
  infection appears to be rare.

DISADVANTAGES

• Should not be used with edematous limbs.
  •Treatment systems and infection control are time con-
  suming.

CONTRAST BATHS

APPLICATION

• Contrast baths consist of two baths: a warm bath at
  38–44°C and a cool reservoir at about 10–18°C.
  •Treatment begins by soaking the involved limb in the
  warm reservoir for about 10 min and then progressing
  to about four cycles of 1- to 4-min cold and 4- to 6-min
  warm soaks (Woodmansey, Collins, and Ernst, 1938).

ADVANTAGES/DISADVANTAGES

• Most commonly used to produce reflex hyperemia
  and desensitization in patients with complex regional
  pain syndrome I.


• Athletes may find the cold baths uncomfortable.

406 SECTION 5 • PRINCIPLES OF REHABILITATION