Effects of thermal therapy in improving the passive range of knee motion: comparison of cold and superficial heat applications
Y H Lin
Department of Physical Therapy and Graduate Institute of Rehabilitation Science, Chang Gung University, Kweishan, Taoyuan, Taiwan, Republic of China
Objective: To assess the effect of applying a hot pack followed by a cold pack (COLD) on the passive range of knee flexion in subjects with restricted knee motion, specifically comparing this treatment to the application of a hot pack (HEAT) alone.
Design: Seventy-one subjects were randomized into two groups to conduct a clinical randomized before–after trial.
Interventions: Each subject received either (1) cold pack or (2) hot pack during passive knee joint stretching.
Main outcome measure: Goniometry was used to measure the passive knee flexion at the baseline (KROM1), before (KROM2) and after (KROM3) applications of a hot pack with/without a cold pack.
Results: Repeated ANOVA measurements revealed a marked increase in the passive range of knee flexion in the two study groups (p < 0.001). Moreover, the paired t-test displayed statistical increments of knee flexion across the different measurement phases, except for the treatment phase without the cold pack. The range of knee flexion following the treatment with the application of a cold pack significantly exceeded that after treatment without a cold pack.
Conclusion: Cold pack application had a limited but significant effect during mechanical stretching for restricted knee motion.
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Lehman and associates (1970) studied the effects of heat and stretching on rat tail tendons.6 The results indicated that heating alone produced no significant elongation and that stretching alone produced no residual elongation. Significant elongation occurred if heat and stretch were combined. A greater increase in length was maintained if the stretch was held during the period of cooling since “reorganization of the tissues is thought to occur during the cooling period.”6 Overall, the most effective method of producing a plastic deformation of connective tissue was to apply a sustained stretch during the application of heat and to maintain the stretch during the period of cooling.
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Lehmann JF, DeLateur BJ. Therapeutic heat. In: Lehmann JF, editor. Therapeutic heat and cold. 4th rev. ed. Baltimore: Williams and Wilkons, 1990: 417-59.
Lehmann JF, Masock AJ, Warren CG, Koblanski JN. Effect of therapeutic temperatures on tendon extensibility. Archives of Physical Medicine & Rehabilitation 1970 Aug; 51(8): 481-7.