 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
CRYOTHERAPY
THERMOTHERAPY
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 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
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 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
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 (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
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 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%2Fjwillia
ms%2FHS%2520468%2FSuperficial%2520Thermal%25
20Agents.ppt (akses 19 febuari 2012)