Therapeutic Modalities

Chapter 6 or 7

Therapeutic Modalities
Indication:

A condition that could benefit from a specific modality. A condition that could be adversely affected if a particular modality is used.

Contraindication:

Electromagnetic Spectrum
Electromagnetic

Radiation Electromagnetic Spectrum

Ionizing

Range Non-Ionizing Range

Ionizing Range
Energy

readily alters the components of atoms. Used for X-rays and Treating Cancer. Not used by Athletic Trainers

Non-Ionizing Range
Ultraviolet Infrared Near

Superficial tissue treatment

Infrared- 5-10mm deep Far Infrared- <2mm deep

Diathermy-

Conversion

Transfer of Energy
Energy

moves from an area of HIGH concentration to an area of LOW concentration. Radiation Conduction Convection Conversion Evaporation

Radiation
When

the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made. Short-wave Diathermy Microwave Diathermy

Conduction
Direct

transfer of energy between two objects in physical contact with each other. Energy is transferred from the area of high temp. to the area of low temp. Ice packs Moist heat packs Paraffin

Convection
Much

like conduction, but the medium moves across the body causing variations. Fluidotherapy Whirlpools

Conversion
Changes

other energy forms into Heat. Ultrasound Microwave Liniments or Balms

Evaporation
Heat

is absorbed by the liquid on the skins surface and cools the skin as it turns into a gaseous state. Vapocoolant sprays Alcohol

Factors Affecting Transfer of Energy

Density

of Medium Reflection Refraction Absorption Law of Grotthus-Draper

Energys Effect on Tissue

Cosine

law +/- 10F is acceptable Inverse Square Law E=Es/D

E=

Resulting Energy Es= Source Energy D= Distance Squared

Cryotherapy
Heat Abstraction Depth of 5cm can be cooled Change in Temperature depends on:

Thermal Conductivity Limb circumference Duration of application

Type of Agent Temp. difference between agent and tissue Amount of insulation

Cryotherapy
Leads

to vasoconstriction Decreases tissue metabolism Decreases tissue permeability Decreases capillary permeability Decreases pain Decreases spasms Analgesic relief of pain

Cryotherapy
Temperature 32-65F 20-30 mins. (10-15 mins.) of treatment 30+ mins. If a towel is used 90 mins. Is the bodies rewarming period Four progressive sensations
Ideal
Cold

Burning

Aching

Analgesia

Types of Cryotherapy Applications

Cryokinetics Ice

Massage Ice Packs Cryocuffs Ice Immersion (Whirlpool) Contrast Bath Commercial Gel and Chemical Packs

Types of Cryotherapy Applications cont.

Controlled

Cold-Compression Units Vapocoolant sprays

Cryotherapy
Indications
Acute

or chronic pain, or muscle spasm Acute inflammation Post surgical pain or edema Superficial first-degree burns Facilitate mobilization Relieve Pain Decrease Muscle spasiticity

Cryotherapy

Contraindications
Hypersensitivity Cold Allergy Circulatory or sensory impairment Reynauds disease Hypertension Open wounds Cardiac or respiratory disorders Nerve palsy Arthritis

Thermotherapy
Increases

circulation Increases cellular metabolism Produces analgesic or sedative effect Helps resolve pain and muscle spasming Vasodilatation:
Promotes

Healing Increases Oxygen concentration Removes debris and waste products

Thermotherapy

Modes of use
Conduction Convection Radiation

Paraffin baths Ultrasound Phonophoresis Diathermy heat

Types of Applications
Whirlpools Hot tubs Jacuzzis Moist heat packs

Ultrasound

Indications
Increase deep tissue heat Decrease inflammation Decrease muscle spasms Decrease pain Increase extensibility of collagen tissue Decrease pain of neuromas Decrease joint adhesions Treat myositis ossificans

Contraindications

Hemorrhage Infection Thrombophlebitis Suspected malignancy Impaired circulation or sensation Stress fracture sites Epiphyseal growth plates Over the Eyes, Heart, Spine, or genitals

Ultrasound
Thermal

effects Non-thermal effects Application of Ultrasound

1MHz

3-5cm of penetration 3MHz superficial tissues and tendons

Continuous-

100% Pulsed- 10-50%

Phonophoresis
Ultrasound

with drugs, used to increase absorption and penetration of drugs up to 5 or 6 cms Anti-inflammatorys
Cortisol Dexamethasone Salicylates

Analgesics
Lidocaine

Electrotherapy
Decrease

pain Increase blood flow Increase Range of Motion Increase muscle strength Muscle re-education Facilitate absorption of medicines

Electricity
Flows

between two points DC- Direct-current

Continuous

one directional flow Used for pain modulation or muscular contraction also produce ion movement
AC-

Alternating-current

Continuous

two directional flow of ions Used for pain modulation or muscular contraction

Electrotherapy
Amplitude Frequency Pulse duration Pulse charge Electrode set-up Polarity Mode

Duty cycle Duration of Treatment

Electrotherapy
TENS (transcutaneous Electrical Nerve Stimulation) High-Voltage pulsed stimulation Neuromuscular Electrical Stimulation Interferential stimulation

Low-Intensity Stimulation Galvanic Stimulation Russian current Faradic current Iontophoresis

Massage
Effleurage Petrissage Tapotement

Vibration
Friction

Traction

Indications

Contraindications
Unstable vertebrae Acute lumbage Gross emphysema S4 nerve root signs Temperomandibular joint dysfunction Patient discomfort

Herniated disc Spinal nerve impingement Spinal nerve inflammation Joint hypo-mobility Narrowing of intervertebral foramen Degenerative joint disease Spondylolisthesis Muscle spasm and guarding Joint pain

Drugs
Anti-inflammatory Anti-pyretic Analgesics

(NSAIDS)