PAM Thermal Modalities 2 — Questions and Answers
Question 1: What is the primary physiological effect of cryotherapy that makes it useful immediately after acute musculoskeletal injury?
- Increases local metabolic rate
- Reduces vascular permeability and edema formation (Correct answer)
- Increases nerve conduction velocity
- Promotes collagen synthesis
Correct answer: Reduces vascular permeability and edema formation
Cryotherapy reduces vascular permeability and limits edema by causing vasoconstriction and slowing local metabolic activity after acute injury.
Question 2: During ice massage, the therapist should apply the ice in a slow, overlapping circular motion for approximately how long before analgesia is achieved?
- 1–2 minutes
- 5–10 minutes (Correct answer)
- 15–20 minutes
- 25–30 minutes
Correct answer: 5–10 minutes
Ice massage typically achieves analgesia within 5–10 minutes as evidenced by the patient reporting the four stages: cold, burning, aching, then numbness.
Question 3: Which of the following best describes the 'hunting response' associated with prolonged cold application?
- Sustained vasoconstriction leading to ischemia
- Alternating cycles of vasoconstriction and vasodilation (Correct answer)
- Immediate vasodilation followed by edema
- Increased sympathetic nervous system activity
Correct answer: Alternating cycles of vasoconstriction and vasodilation
The hunting response (Lewis reaction) involves alternating cycles of vasoconstriction and vasodilation to protect tissue from cold-induced injury during prolonged application.
Question 4: A patient with Raynaud's phenomenon is referred for ankle rehabilitation. Which thermal modality should the therapist AVOID?
- Hot pack to the ankle
- Paraffin bath to the foot
- Ice pack to the ankle (Correct answer)
- Warm whirlpool to the foot
Correct answer: Ice pack to the ankle
Cryotherapy is contraindicated in Raynaud's phenomenon because cold triggers pathological vasospasm that can lead to tissue ischemia.
Question 5: When using a vapocoolant spray (e.g., fluoromethane) for spray-and-stretch technique, the spray should be directed at what angle relative to the skin surface?
- 90 degrees (perpendicular)
- 45–60 degrees
- 15–30 degrees (Correct answer)
- 0 degrees (parallel)
Correct answer: 15–30 degrees
Vapocoolant spray is applied at a 15–30 degree angle to the skin surface to maximize coverage and allow even cooling along the muscle's length.
Question 6: Cold water immersion at 10–15°C is MOST commonly used for which clinical scenario in sports rehabilitation?
- Chronic low back pain management
- Post-exercise recovery to reduce delayed onset muscle soreness (Correct answer)
- Pre-exercise warm-up before competition
- Treatment of peripheral neuropathy
Correct answer: Post-exercise recovery to reduce delayed onset muscle soreness
Cold water immersion at 10–15°C is widely used as post-exercise recovery to reduce DOMS and accelerate return to training readiness.
Question 7: Which tissue characteristic makes skin and subcutaneous fat more susceptible to temperature change from superficial cold modalities than deeper muscle tissue?
- Higher water content in superficial tissues
- Lower thermal conductivity and reduced blood flow in superficial fat (Correct answer)
- Greater density of thermoreceptors in the skin
- Higher metabolic rate in subcutaneous tissue
Correct answer: Lower thermal conductivity and reduced blood flow in superficial fat
Subcutaneous fat has low thermal conductivity and sparse vascularity, so it changes temperature more readily and insulates deeper muscle from cold modalities.
PAM Thermal Modalities 2
What is the primary physiological effect of cryotherapy that makes it useful immediately after acute musculoskeletal injury?