Use of Supports Heat an Cold

SUPPORTS

Braces are used for several reasons: to immobilize a part, to correct misalignment, to relieve strain on weak muscles, to facilitate function, and to limit movement in a certain direction. Correcting misalignments associated with weakness often requires supportive measures. However, such measures may not be effective if there is tension in the muscles opposing the weak ones. Applying a support in a bad position will not relieve tension; the contracted muscle needs to be stretched. The question often arises whether people with Weak abdominal muscles should be advised to use support. Would the support be so reliable that the muscles will weaken? By employing postural and muscle testing procedures, trial and error can be minimized when determining when to use supportive measures. The degree of weakness and the extent of the failure alignment aid to determine if support is needed. Extreme weakness caused by stress or fatigue can require temporary bed rest or a restriction of movement of the affected part through the application of a support. Moderate weakness may or may not require support, largely depending on the individual's occupation. Mild muscle weakness generally responds to localized exercise without support or reduced functional activity. When it comes to abdominal muscle strength, adults who have a fair or lower rating need support. It is often difficult to convince a person that wearing a bandage will help increase the strength of weak muscles. This claim appears to be contrary to the general knowledge that exercise and activity increase muscle strength. It should be explained to the patient that instead of a particular muscle weakness caused by lack of exercise, it is caused by continuous tension. The support will relieve postural tension and allow the muscles to function in a position closer to normal. Each time a support has been applied, another question arises: how long will the support be needed? Support should be permanent only if the supported portion has been irretrievably weakened (eg, by paralysis or injury). However, most conditions of muscle weakness associated with postural failure can be corrected and supports should only be temporary until muscle strength is restored. If no treatment other than support is used, the individual may become addicted to the support and reluctant to withdraw it. However, if the therapeutic exercises are intended to complement the wearing of the brace so that it can be abandoned later, the appliances become only a corrective aid rather than a permanent part of the treatment.

HEAT

Therapeutic effects of heat include relief from pain and muscle spasms, decreased joint stiffness, increased collagen tissue extensibility, increased blood flow, and some assistance in resolving inflammatory infiltrates. The relaxing properties of surface heat make it an effective modality in the treatment of tension or contractures muscles, relieving pain and spasm and facilitating stretching. However, heat should not be applied to muscles that are weak due to stretching, as further relaxation of these muscles is not indicated. Heat should not be used in the most acute conditions or in areas where sensitivity and circulation are impaired. Hydromassage is not recommended for patients with swelling, as it requires a dependent position of the arm or leg during treatment. If the heat causes increased pain or feels "uncomfortable," this generally means that the type of heat used is wrong or excessive in duration or intensity. When used carefully, deep heat, such as ultrasound, can be effective in increasing the extensibility of tight connective tissue, increasing blood flow.

COLD

The vasoconstriction effect of tissue cooling makes surface cold application an effective way to reduce pain and swelling / edema after trauma. Additionally, the therapeutic cold can be used to inhibit spasticity, facilitate muscle contraction for various forms of neurogenic weakness, and for muscle re-education. Heat and cold are similar in that they both cause analgesia, reduce muscle spasm secondary to musculoskeletal disease or nerve root irritation, and reduce spasticity resulting from upper motor neuron etiology. However, the cold is more helpful in reducing spasticity because the effects last longer. Cooling the muscle tissue increases the muscle's ability to maintain voluntary contraction. There are a number of conditions for which therapeutic colds should not be used. Cold should not be applied to muscles when the following conditions are present: hypertension (due to secondary vasoconstriction), Raynaud's disease, rheumatoid arthritis, local ischaemia of the extremities, vascular damage (eg, frostbite or arteriosclerosis), allergic cold (cold urticaria), paroxysmal cryhemoglobinuria, cryoglobulinemia or any disease which produces a marked cold blood pressure response. The most common methods of applying cold include cold packs, cold soaking, and ice massage. Spray and stretch is a cryotherapy application with a spray of coolant, followed by stretching the muscles involved.

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