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

THERMAL
ENERGY

HOT

COLD

THERMOTHERAP
THERMOTHERAP
Y
Y

CRYOTHERAPY

KONDUKSI
DECREASING TISSUE
TEMPERATUR

INCREASING TISSUE
TEMPERATUR

THERAPEUTI
C EFFECT

HEAT TRANSFER
MECHANISM
CONDUCTION
(DIRECT)

CONVECTION

THERMO & CRYO THERAPY

(MOVEMENT)

RADIATION
(WAVE)

CONVERSION

US

Clinical Use Of The

Conductive
Energy
Secara fisiologis konduktivitas terjadi hanya sampai
SUPERFICIAL dan CUTANEOUS BLOOD & Nerve (1 cm)
Modalities
dengan menggunakan modalitas panas dan dingin
ini.
Penggunaan kedua modalitas ini tergantung dari
tujuan pengobatan
1.Panas suhu meningkat meningkatkan sirkulasi
darah di bawah kutaneus metabolisme meningkat
2.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 memerah konsentrasi oxyhemoglobin
meningkat

Hunting Response
1930s ; 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

Todays 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, 30 o 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

D. WHIRPOOL ICE

B. COLD PACK

E. EVAPORATING

C. ICE PACK

F. CONTRAS BATH

G. CRYO +
COMPRESSION

THERMOTHERAPY-HEAT

Hemodynamic effect
Vasodilatation

Cellular
temperature cell metabolism O2; cell

waste excreted
temperature blood hemoglobin releases O2
(106F = twice as much O2 released)
temperature (104-113F) 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

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

c. Infrared
Lamp

b. Parafin

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 joints 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 hasnt been

determined
Commonly used 3:1 or 4:1 ratio to equal 20
mins.
4:1

C:H

3:2
C:H

2:3
C:H

1:4
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 (2 nd
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)