Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an...
Transcript of Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an...
![Page 1: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/1.jpg)
Evidence Based Practice
Cold and Heat Therapy
Michael G. Dolan, MA, ATCProfessor/Athletic TrainerDirector, Sports Medicine Research LaboratoryCanisius CollegeBuffalo, NY
2008 EATA Meeting at Valley Forge
![Page 2: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/2.jpg)
Show Me the Evidence!
![Page 3: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/3.jpg)
What is Evidence-Based Practice?
2008 EATA Meeting at Valley Forge
Best Research
Patient ValuesClinical Experience
![Page 4: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/4.jpg)
Cold, Heat, and Some Electricity
2008 EATA Meeting at Valley Forge
![Page 5: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/5.jpg)
Evidence-Based Practice
Large Scale Randomized Clinical Trials that examine our treatments and determine our clinical practice
Get Involved!
Lots of theories
Testimonials
Education & manufacturer driven
Uninjured human subjects
Animal Models
Some RCT’s
Where are we today? Where do we want to go?
![Page 6: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/6.jpg)
1. Put some ice on it
Top Ten Things an Athletic Trainer Says
![Page 7: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/7.jpg)
Does it?
![Page 8: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/8.jpg)
If so, which treatments are most effective?
![Page 9: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/9.jpg)
How can we optimize our treatments?
![Page 10: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/10.jpg)
The most common clinical practice in sports medicine
“Put some ice on it”Does ice reduce swelling after an ankle sprain?Does it hasten recovery?
![Page 11: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/11.jpg)
Systematic Review of Cryotherapy on Return to Play
83 relevant clinical trials79 were excluded because they did not include return to play as an outcome4 reviewed studies
Hubbard et al JAT 39(1) 88-94
2 had a positive RX effect
1 had a positive effect but attributed it to compression
1 showed no difference
All had PEDro Scores of 3 or 4 (1-10)
![Page 12: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/12.jpg)
PEDro Scale
![Page 13: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/13.jpg)
Physiotherapy Evidence Database (PEDro)
PEDro Score0
Weak
10
Strong
3 - 4 5 6-80-2 9-10
Most Cold and Heat Studies
Goal of future Studies
![Page 14: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/14.jpg)
The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials
There was marginal evidence that ice plus exercise is most effective, after ankle sprain and postsurgery There was little evidence to suggest that the addition of ice to compression had any significant effect, but this was restricted to treatment of hospital inpatients Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment.
Bleakley et al., Am J Sports Med 2004 32 (1), 251-61.
![Page 15: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/15.jpg)
Compared 20 minutes ice pack to intermittent (10 minutes 10 minutes off) ice packs
The intermittent protocol reduced pain on activity one week after injury
No other statistical difference in terms function, swelling and pain at rest
Statistical significance vs. clinical significance
![Page 16: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/16.jpg)
Compared Heat and cold on acute ankle sprains
Concluded that cold worked better than heat
No Controls
Did cold make it better or did heat make it worse?????
Hocutt et al. AJSM 1982:10(5)316-9
![Page 17: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/17.jpg)
Comparison of cold, heat and contrast therapy on ankle swelling
Measurement error was greater than treatment effect
No Control Group
Subacute Ankle Sprains
1 Treatment per day
All Three Interventions Increased Limb Volume!
Cold had the smallest increase and was deemed most effective
Cote et al. Phys Ther 1988, 68(7) 1072-6
PEDro Score0
Weak
10
Strong
5
![Page 18: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/18.jpg)
High Voltage Pulsed Current (HVPC)
Long touted by clinicians as an effective tool in managing pain and edema and thereby hastening recoveryNo evidence that it hastens recovery!!
![Page 19: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/19.jpg)
e
Michlovitz et al, JOSPT 1988;9,301-304
Ice and high voltage pulsed stimulation in treatment of acute lateral ankle sprains
30 subjects who sustained a grade l or ll Ankle Spain
ICE + HVPS
for 30 minutes
ICE for 30 minutes
ICE followed by HVPS
No treatment effect but a tendency toward decreased pain, edema, and an increase in ankle dorsiflexion
ATC treat within minutes of the injury
Most swelling has already occurred
One 30 Minute Treatment per day
Did not measure function
![Page 20: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/20.jpg)
e
Michlovitz et al, JOSPT 1988;9,301-304
Ice and high voltage pulsed stimulation in treatment of acute lateral ankle sprains
No treatment effect but a tendency toward decreased pain, edema, and an increase in ankle
dorsiflexion
PEDro Score0
Weak
10
Strong
4
![Page 21: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/21.jpg)
Does cryotherapy and e-stim have an added effect?
If not, which is more effective
Does either modality provide a “clinical effect”
Funded by a Grant from NYSATA
![Page 22: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/22.jpg)
Cryotherapy
CHVPC
Decreases MetabolicActivity
Decrease in Capillary Permeability
+ =Greater RX Effect?
Acute Trauma Management
What effect does initial treatment have on acute edema formation?
![Page 23: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/23.jpg)
Results
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
1.1
Pre-Trauma
0 30 60 90 120 150 180 210 240
Time (min)
Cha
nge in Lim
b Vo
lume (m
L/kg
)
Treated Limb
Untreated Limb
![Page 24: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/24.jpg)
Cryotherapy + HVPC had no added treatment effect
Comparison of Treatment
-0.2
0
0.2
0.4
0.6
0.8
1
1.2
Pre-Trauma
0 30 60 90 120 150 180 210 240
Time (min)
Cha
nge in
Vol
ume (m
l/kg)
CWI
CHVPC
CWI+CHVPC
![Page 25: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/25.jpg)
Limb
Volumes
Time
Trauma 0 30 60 90
RXRE
ST
RX REST
“Staircase Effect”
120
Control Limbs
Continuous RX
![Page 26: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/26.jpg)
Supported by a NYSATA Grant
How can we improve the treatment effect?
Is more better?
JAT 2003, 38(4) 225-229
![Page 27: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/27.jpg)
Effects of Continuous Treatment on Edema Formation
0
0.2
0.4
0.6
0.8
1
1.2
Pre-T 0 30 60 90 120 150 180 210 240
Minutes
Cha
nge
in L
imb
Volu
me(
mL/
Kg)
UntreatedTreated
JAT 2003, 38(4) 225-229
“Golden Minute” for Acute Management
![Page 28: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/28.jpg)
How can we optimize our treatments?
Pain &
Edema
Injury
Max
Return to Play
Exercise
Untreated
Intermittent
Continuous
Acute Trauma Management
Min
![Page 29: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/29.jpg)
Is Amount of Time Treated Related to RX Effect?
Inflammation 100%
0 25 50 75 100
Minutes per day expressed as %
Cont. HVPC 85%
Cryotherapy 6%Compression 96%
Elevation 17%
HVPC 1%
![Page 30: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/30.jpg)
Effects of electrical stimulation on pain, edema and return to play following
ankle sprains in college and professional athletes
A Multi-Center Clinical Trial
Frank C. Mendel PhDMichael G. Dolan, MA, ATC
John Marzo, MDDale Fish, PhD, PT
Gregory Wilding, PhD
Funded by a grant from The National Football League
![Page 31: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/31.jpg)
50 Acute Lateral Ankle Sprains
Standard RICE Intervention
Treatment Control
Pain Swelling Functional testing RETURN TO PLAY
HVPC Inhibited recovery in Grade I lateral Ankle Sprains
HVPC had no effect on recovery of Grade II lateral Ankle Sprains
Effects of HVPC on acute lateral ankle sprains in collegiate and professional football players. Mendel et al. In Review.
![Page 32: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/32.jpg)
Effects of HVPC on Return to Play Following Ankle Sprains
PEDro Score
10
Strong
0
Weak
9-10
Clinical trials often give unexpected results
Time of Intervention
Does stim retard inhibit healing?
Prospective
Double Blind
Credible Placebo
![Page 33: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/33.jpg)
Application of Continuous HVPC in Athletes
Acute Trauma Management
![Page 34: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/34.jpg)
Extended Treatment using HVPC
![Page 35: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/35.jpg)
BEST PRACTICES: THE TAKE HOME MESSAGE
Limited evidence that RICE and E-Stim hasten recoveryApply RICE+ other interventions ASAPConsider Extended Treatment Times and reapply at frequent time intervals (more is sometimes BETTER)Supervised Rehab supplemented by home therapy
![Page 36: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/36.jpg)
Thermotherapy
Application of superficial and deep heat to improve treatment outcomes
![Page 37: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/37.jpg)
Cochrane Review of Superficial Heat and Cold
Acute and subacute low back painHeat wrap therapy reduced pain after 5 daysOne trial of 90 participants with acute low back pain found that a heated blanket significantly decreased pain One trial of 100 participants with a mix of acute and subacute low back pain examined the additional effects of adding exercise to heat wrap and found that it reduced pain after 7 days
French et al Spine 2006, 31 (9), pp. 998-1006
![Page 38: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/38.jpg)
Philadelphia Panel
Evidence-Based Clinical Practice Guidelines
Low Back Knee Shoulder Neck
US for calcific Tendon lesions
ExerciseTENS +
Exercise
ADL’s + Exercise
Thermotherapy is ineffective or no studies to evaluate
![Page 39: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/39.jpg)
Effects of heat wraps on skin and muscle temperatures
ThermaCare J& J Back Plaster ABC Warme-Pflaster
↑ temp at 2 cm depth with less sensation of heat
↑ temp at skin and greater sensation of heat
Trowbridge JOSPT, 2004,34(9) 549-558
You Decide
![Page 40: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/40.jpg)
Heat Wraps in the prevention and early treatment of low back DOMS
Mayer et al. Arch. of Phys. Med 2006 87(10) 1310-1317
2 RCT’s
Prevention Treatment
Heat Wrap Control Heat Wrap Cold
Pain Intensity ↓47% at 24 hours for heat wrap group
Pain relief was ↑ 138% at 24 hours for Heat Wraps
No differences in self-reported function or disability
Self Reported disability and function decreased 53% & 45% for
heat wrap group
![Page 41: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/41.jpg)
Nadler et al. Overnight use of continuous low-level heatwrap therapy for relief of low back pain. Arch of Phys. Med 2003:84(3) 335-342
Subjects with non-specific low back pain
Do heat wraps worn overnight affect pain, stiffness and ROM?
Heat Wrap worn overnight
Overnight use of heatwrap therapy provided effective pain reliefthroughout the next day, reduced muscle stiffness and disability,
and improved trunk flexibility. Positive effects were sustained more than 48 hours after treatments were completed.
Control
![Page 42: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/42.jpg)
Robertson and Baker: A review of therapeutic ultrasound: effectiveness studies. Phys. Ther. 2001 81(7)1339-1350
35 randomized clinical trials that examined US in soft tissue injuries
10 had acceptable methods and included treatment and control groups
2 reported positive outcomes (carpal tunnel syndrome &
calcific tendonitis of the shoulder)
little evidence that active therapeutic ultrasound is more effective than placebo in promoting soft tissue healing.
8 reported no treatment effect
![Page 43: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/43.jpg)
BEST PRACTICES: THE TAKE HOME MESSAGE
Limited evidence that thermotherapy hastens recoveryModerate evidence that continuous heat therapy decreases pain and improves function in non-specific back pathologyAre these results transferable to other conditions that athletictrainers manage?
![Page 44: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/44.jpg)
Thanks for the Invitation
2008 EATA Meeting at Valley Forge
![Page 45: Evidence Based Practice Cold and Heat Therapy - goeata.org · decreased pain, edema, and an increase in ankle dorsiflexion PEDro Score 0 Weak 10 Strong 4 Does cryotherapy and e-stim](https://reader031.fdocuments.us/reader031/viewer/2022011808/5c9bd11909d3f21a138bdb6d/html5/thumbnails/45.jpg)
Evidence Based Practice
Cold and Heat Therapy
Michael G. Dolan, MA, ATCProfessor/Athletic TrainerDirector, Sports Medicine Research LaboratoryCanisius CollegeBuffalo, NY
2008 EATA Meeting at Valley Forge