MODALITAS FISIOTERAPI PANAS & DINGIN

Jelaskan kenapa modalitas panas & dingin merupakan modalitas suhu terbaik? Bedakan efek fisiologi modalitas panas & dingin Bagaimana tehnik penggunaan modalitas panas & dingin Kategorikan indikasi & kontraindikasi modalitas panas & dingin Jelaskan energi yang daya konduktivitasnya baik terhadap kasus

DECREASING TISSUE TEMPERATUR INCREASING TISSUE TEMPERATUR THERMAL ENERGY HOT THERMOTHERAPY COLD CRYOTHERAPY KONDUKSI DECREASING TISSUE TEMPERATUR INCREASING TISSUE TEMPERATUR THERAPEUTIC EFFECT

HEAT TRANSFER MECHANISM CONDUCTION (DIRECT) CONVECTION (MOVEMENT) RADIATION (WAVE) CONVERSION THERMO & CRYO THERAPY US

Clinical Use Of The Conductive Energy Modalities Secara fisiologis konduktivitas terjadi hanya sampai SUPERFICIAL dan CUTANEOUS BLOOD & Nerve (1 cm) dengan menggunakan modalitas panas dan dingin ini. Penggunaan kedua modalitas ini tergantung dari tujuan pengobatan Panas  suhu meningkat meningkatkan sirkulasi darah di bawah kutaneus  metabolisme meningkat Dingin  suhu menurun  menurunkan sirkulasi darah  menurunkan sensasi  acute inflamation & reconditioning state of injury management

CRYOTHERAPY

Hemodynamic effect initial decrease blood flow

Hemodynamic effect later increase blood flow Ketika suhu < 10oC  dilatasi Krn efek lokal Cold Therapy ini akan menimbulkan paralysis (rasa baal) pada jaringan kontraktil dan memblockade (inhibit) impuls saraf (axon) yg menuju ke pembuluh darah. Ketika suhu sudah mencapai 0oC. Pembuluh darah akan berdilatasi maximum Ketika di berikan ice akan kulit terlihat me-merah konsentrasi oxyhemoglobin meningkat

Hunting Response 1930’s ; Lewis performed skin studies with temperature change during cold treatments. When the fingers were immersed in cold water, alternating periods of cooling & warming were seen in the skin. Thoughts were that intermittent cold-induced vasodilation (CIVD) lasting 4-6 min. after approximately 30 min. of cryotherapy application (p. 109) Stated that it prevented local tissue injury Today’s researchers state that CIVD does not occur during standard cryotherapy sessions.

Neuromuscular effect decrease nerve conduction Serabut saraf yg berdiameter kecil dan bermyelin akan lebih cepat berkonduksi terhadap DINGIN Serabut A-delta merupakan serabut saraf yg cepat berkonduksi Neuromuscular effect decrease spasticity Terjadi krn penurunan aktivitas gamma motor neuron, afferent spindle & golgi tendon organ

Neuromuscular effect increase pain threshold Counter-irritation via meknisme gate control & penurunan muscle spasm, penurunan kecepatan saraf atau postinjury edema Cold akan menurunkan aktivasi kerja saraf afferent , dgn meningkatkan TENSION pada otot (muscle spindle) lihat pain-spasm-cycle Cold akan menurunkan rasa nyeri pada cedera akut via mengurangi aliran darah dan menurunkan inflamasi

Neuromuscular effect altered muscle strength Kekuatan otot isometrik akan meningkat setelah diberikan Ice Massage selama 5 menit atau kurang. Krn adanya fasilitasi saraf motorik dan mempersiapkan performa otot via psychological motivation

Neuromuscular effect Facilitation Muscle Contraction Pemberian Cryotherapy ini untuk menstimulus/memfasilitasi dari aktivitas Alpha Motor Neuron untuk merangsang timbulnya kontraksi otot yg mengalami flaccid akibat Upper Motor Neuron Dysfunction Efek ini hanya dapat diamati dalam beberapa detik setelah pendinginan dan berlangsung sangat singkat Namun jika diberikan pendinginan lebih lama akan menurunkan aktivitas gamma motor neuron, dimana tidak akan terjadi kontraksi otot Dan ini masih perlu penelitian lebih lanjut lagi!!!

Metabolic effect Decrease Metabolic Effect Pendinginan akan mengurangi dari aktivitas metabolisme lokal pada area yg di terapi Hal ini berkaitan dgn adanya inflamasi dan pemulihan Oleh karena itu, cold therapy cocok dalam menangani inflamasi akut Dan tidak cocok untuk menangani proses penyembuhan yg terlambat, krn dapat menggangu proses pemulihannya Aktivitas enzim perusak cartilage, termasuk kolagen, elastase, hyaluronidase, dan protease, dapat dihambat dengan menurunkan suhu sendi, 30o C atau kurang Oleh krn hal tersebut di atas, cold therapy bisa digunakan untuk prevention atau mengurangi kerusakan kolagen pada kasus radang sendi seperti Ostheoarthritis & Reumathoid desease

Tehnik Cryotherapy A. ICE MASSAGE B. COLD PACK C. ICE PACK D. WHIRPOOL ICE E. EVAPORATING SPRAY F. CONTRAS BATH

G. CRYO + COMPRESSION

THERMOTHERAPY-HEAT

Hemodynamic effect Vasodilatation Cellular –  temperature   cell metabolism   O2; cell waste  excreted  temperature  blood hemoglobin releases O2 (106°F = twice as much O2 released)  temperature  (104°-113°F) plastic deformation of collagen-rich tissues occurs more easily Blood & Fluid Dynamics –  b. flow   edema, but  b. flow removes wastes, etc. Triggers release of bradykinin

Pain Control – Analgesic effect Neuromuscular effect Changes in nerve conduction velocity and firing rate  chemical reactions & cell metabolism  nerve conduction Pain Control –  circulation   congestion in area Mechanical pain  by reducing pressure on nerves (swelling is removed) Analgesic effect

Metabolic effect Increased metabolic rate  aktivitas enzim pada suhu 39o-40o C   reaksi biokimia sell, oksigen, & pemulihan (healing) namun pemanasan ini dapat merusak jaringan kolagen pada sendi penderita rheumathoid arthritis ? Inflamasi akut

Altered tissue extensibility effect Increased colagen extensibility Kenaikan suhu akan meningkatkan extensibilitas pada jaringan. Ketika jaringan di beri pemanasan sebelum dilakukan stretching, akan terjadi peningkatan yg lebih ketika stretching dan akan mencegah kesobekan jaringan

Tehnik aplikasi a. Hot Pack b. Parafin c. Infrared Lamp d. fluidotherapy

Which One Should be Used? You must know the healing phases Answer the following questions Does the body area feel warm to the touch? Is the injured area still sensitive to light to moderate touch? Does the amount of swelling continue to  over time? Does swelling  during activity (joint motion)? Does pain limit the joint’s ROM? Would you consider the acute inflammation process to still be active? Does the patient continue to display improvement with the use of cold modalities? If all of the answers are “no”, then heat can be safely used. If “yes” is the answer to several of the questions then cold should be used.

Contrast Therapy Alternating cryotherapy and thermotherapy agents Results in vasoconstriction & vasodilation of blood vessels in the area Thought to be a “Pumping” action – stimulates venous & lymphatic return Effective transition from cold to hot therapy Use during subacute or chronic phases to remove edema & ecchymosis

Contrast Therapy Most effective treatment time hasn’t been determined Commonly used 3:1 or 4:1 ratio to equal 20 mins. 4:1 3:2 2:3 1:4 C:H C:H C:H C:H Treatment may end in either hot or cold – depends on the stage of the injury End in warm – increases tissue temperature for increased stretch and increased activity

Contrast Therapy This therapy does not significantly influence subcutaneous tissues greater than 1 cm. Has been shown to increase circulation in both extremities Unclogs vasculature therefore decreases pain and increases ROM Contrast herbs & cold whirlpool (CWP) have been shown to be more effective than WWP for DOMS

HOT OR COLD

PUSTAKA E.Prentice, William. 2009. Therapeutic Modalities for Sport Medicine and Athletic Training. New York. McGrawHill H. Cameron, Michelle. 2003. Physical Agents In Rehabilitation From Research And Practice (2nd edition). United States. Elselvier J. Williams. Superficial Thermal Agents (persentation).http://www.educ.uidaho.edu%2Fjwilliams%2FHS%2520468%2FSuperficial%2520Thermal%2520Agents.ppt (akses 19 febuari 2012)