Laser: - a dose dependent modality - Monochrome: production of light in 1 specific wavelength - Collimated: directed in direction - Coherent: all photons

are the same Production of laser light: - pumping- energy source causes atoms to move rock to excited state - Photon hits atom and jumps up valency - spontaneous emission- as an atom returns to the norm uninterrupted - this causes emission of one photon in any direction - Any not parallel to direction of emission are attenuated Stimulated Emission - striking of an incident photon into an excited atom - same proton= cloned - 1 in- 2 out Amplification: - Proton bounces back and forth increasing the interaction - some escape semi-reflective mirror and create laser Physiological Effects - interacts with organic molecules of various types - Chromophores are the molecule that are getting interacted with by the - Photobiomodulation- either stimulation or inhibition based on dose mW: units range from 1-300mw Wavelength: do not vary within a uni, but from differing units - longer the wavelength- the greater the penetration and the wider range of the molecules it may influence Tip Size: Not variable within a uni - .25 to .3 mm - difference between single diode and cluster types Time: moves @ a constant rate of 1 sec/ sec Healing Properties/Effects: = ↑ metabolic processes = ↑ mRna synthesis and cell devision = ↑ collagen and connective tissue production = ↑ in fibroblast activity- proliferation and pro-collagen = ↑ lymphatic system removal of bacteria - Immunological: - ↑ phagocytosis - ↑ Bacterial Effect on E.Coli - Stimulation of T and B Lymphocytes activity

TRP .Time= .25 Time=10 seconds or 100 seconds 1.during first trimester of pregnancy .inflammatory) in 10 seconds per cm2 on patient ..antioxidant production of Super Oxide Dimutase. Gladwrap) .005 x . Choose High Setting 3.Directly over unstable DVT Cautions: ..2/.0025 is the watts for the device when set for LOW (DON’T USE) .You’re achieving your J/cm2 (.unless a barrier is used (ie.3 J/cm2 Indications: -Burns -Wounds: non healing.2jcm2..2 -. Draw Squares on/ around the area 4.Cell change in wall permeability .005x.retinal damage HOW TO USE: .25 or 2/.Directly over open wounds.005 is the watts for the device (set) for HIGH . post surgical ulcerations -Connective tissue injury .over or near neoplastic lesions . Push Button .Inflammation: .Oedemas *Overall it IMPROVES RATE AND QUALITY OF TISSUE HEALING Contraindications: . which inhibits prostaglandin formation . Calculate desired amount of energy 2.

metallic implants. Scar tissue Non.becomes greater if the fx is increased Absorption: . plates.less dense a tissue.warms up connective tissue= for chronic problems.everything else.acoustic energy absorbed will cause greatest attenuation .the cell membrane permeability is altered .the greater the absoption.secondary NO 02.kinetic energy is converted to thermal thus increasing the excitement of the chemicals Biological: . Gel . ie. .Where therapeutic effect takes place .sound waves will react differently with different tissues Transmission: .coupling media is used because it transmits the soundwaves well without being greatly affected by them.amount of stuff from inflammation but not removed.all cells around them suffer also. This significantly increase the heating effects on the Periosteum and surrounding the soft tissue . thus the greater the heating effect ultrasound will have on it Reflection: .bone is dense enough to cause significant reflection of the sound waves.Thermal Effects: .Ultrasound: An acoustic modality . often ignored or underplayed Chemical: . pins.intensity in the given tissue is great enough to cause heating .vibrations help to stimulate rates of chemical activity .produced by reversed piezoelectric effect: movement created in a crystal caused by application of an electrical current .only reason to have a heated head: general relaxing.this allows for enhanced cell function and exchanged . cages Thermal Effects: . the more it will transmit the waves Attenuation: .the more dense a tissue.applying an alternating current results in expansions and contractions producing sound waves Effects on Tissues: .

plates and cages .5 .healing Fractures .Use over heating mechanical Calcific Deposits: tendinosus.sound wave through tissue moves molecules e.cause a little inflammation .Trp.don’t like pain . pins.oscillation of particles in fluid .may help in cell metabolism . capsulitis) .both these are managed by the use of Low Intensity Pulsed Ultrasound Contraindications: .Duty Cycle.the movement of molecules will have a variety or effects.Healing soft tissue injuries .be aware of metallic implants.decrease in viscosity .inviting new blood ..Intensity .deep vein thrombosis .Vascular Disorders.Infection.w/cm2. some of which are: .g. topical agents may be driven deeper into tissue .worried about stiffness want to break down deposits .deep heat Phonophorisis: .Time.Causes movement.loosening cell and molecule structure Acoustic Streaming: .duty cycle: 50% or 100% . think flour and sieve .patient position is very important -Gel Ultrasound head before you touch machine . most marked at the edge of cells .Using ultrasound.Patients on blood thinning medication . bursitis.Gel Patient or put extremity into bucket of water .trigger point.due to the unidirectional movement that ultrasound produces .Mechanical: .topical agents. Difflam.later stages .put meringue on ultrasound head .Acute and Chronic inflammatory conditions (tendonitis. voltarin Non-thermal: pushing inflammation out .acoustic streaming causing modulating effect Indications: .

blastic activity-↑maturation .DC 50%).Arnica and Traumeal .5wpcm2prevents heat .starting to get swollen.Difflam and Voltaren .Heat.Clastic Phase heat CHRONIC: . tissue damage.Anti Inflammatory.Topical Pharmaceutical.5 wcm2 @ 100% Duty Cycle – trying to get some heat.↑ quality and rate of tissue healing .Comfrey. tape (b.1 wcm2 (pulsed.Heat packs: to increase extensibility and flexibility. Maybe do some effleurage .c it decreases proprioception) .Compressive Bandage.TIME: How long .Ultrasound. Elastic Bandage .5-1.Small Area: supraspinatus.Soft Tissue= cross Friction= cold ice pack after .Cold Pack. iliolumbar ligament.Prescribe Excercises that lay down bone/tissue in relation to stress .(10-20 mins) for 24-48 hours (10 on.break up tissue to lay it down again properly .pain modulating and wound healing properties. .rolled ankle . 10 off) .5w per cm2 DC= 50% SUBACUTE: .Large Area: moreso continuous.not ankle brace. erector spinae.Natural.ultrasound= .Continuous SCENARIO: Pt comes in to see you with a Sprained Ankle ..Laser @ 2J .1 hour before. ITB ACUTE: .5wcm2. not healing yet Controlling and Managing Condition: ACUTE: . ankle and wrist or insertion 50% @ .↑ blastic activity.5.Passive ROM PERSON WHO HAD NOT DONE THIS….

blocks impulses from other sensory receptors .Nociceptor Sensory: activation of large diameter sensory fibres .the effects are longer lasting.effects are immediate but not long lasting . Noxious. Motor.low intensity causing small contractions may work in a similar manner to sensory .stronger contractions may supress the CNS .Electrical Pain Modulation: .natural release Motion: Stimulating neuro-muscular junction .Higher intensities causing larger.very local pain killing. Noxious: strongly effecting fibres leads to analgesia . .may also help in decreasing inflammation which will have a role in pain perception.Pain relief may be afforded several different ways using electrical stimulation Sensory.

may interefere with breathing and swallowing .Muscle Re education .TENS: . motor nn.Pain Relief .Oedema Reduction . modulated Contraindications: . nociceptive Pulse Width: (30 (motor rehabilitation) -250 microseconds (sensory and motor)) Intensity: Channel 1 or 2.Ant Neck.sensory.Therapeutic Effect: .Target Tissues: .Cardiac Pace Makers.Carotid Sinus Area.Pregnancy (relative) . normal.may have an effect on cardial rhythm .Motor function through local effects on nn.decrease pain through gaiting or endorphins .Trans.Dementia .Obstetric .Thoracic/ Cerebral .Lack of Sensation Indications: . app safe for fixed rate pacemakers. .then increase until pain is gone Mode: burst.wait for sense of tingling.Rehab .but not demand .

Ant Neck.Pain.but not demand .Capacitive: ability to pass a current .b/c carrier fx= more comfortable penetrates deeper .Pregnancy (relative) .Oedema Management Contraindications: .Not an inhouse..but you don’t get the noxious stimuli of the sensory .Thoracic/ Cerebral .mi in machine .Skin Impedance: .Channel 2: 4085 *peak of both at same time.Lack of Sensation Cautions: .Just fx we set.Interferential: Using 2 currents of medium frequencies (approx. amount of hair. hydration level (low effects) .Bi-Polar .Cardiac Pace Makers. skin condition.Dementia.bonus with interferential.Trans.claimed to be the great advantage of interferential Effect: the primary physiological effect is depolarisation of peripheral sensory or motor nerves Indications: .Symptomatic Approach .is inversely related to frequency .may have an effect on cardial rhythm .may interefere with breathing and swallowing .Ohmic: Electrode size.Two Types: . app safe for fixed rate pacemakers.person has to carry it around (therefore TENS better) .Skin acts as a capacitor.Channel 1: carrier . increase pain Electrode Placement: . storing holding and resisting current flow .Carotid Sinus Area.fainting.which doesn’t do anything .increase fx= easier to pass through body .summate causing depolarisation .Some ptt may have an adverse reaction including. 400-500 hz) Quad Polar.Has a single carrier frequency. rash.Patients may become dependent because they like the feel .get the burst of the TENS machine.muscle re-education -motor .via sensory and motor innervation .QuadPolar .

less skin resistant .Premodulation .4000 or 5000 hz . Then Increase Beat fx.turn up until muscle begins to tingle Sensory pain: .fx.treatment area is placed at the crossing point Pros: The fx’s are modulated in patient.Thus patient receives the thereapeutic frequency only Pros: .Set Ampl.20-40 mins .muscle rehab .interferential.the fx of the skin receives is lower and thus is stimulated more Quad Polar: . 1 Area: Quad Polar . * BALANCE: change it to whichever end is still hurting more than other. Modulation: .without the sensory stimuli Therefore more comfortable for the patient.2 sets of electrodes crossed .no need to balance amplitude Cons: .tell them to notify you when it begins to tingle.the two.w-scan: useful for large areas or vague pain Cons: only one treatment area may be addressed * constant and premod.Each channel enters the patient at the carrier frequency ..can use each channel in a different treatment area .the current of one or both channels is modulated in the unit .always reset to 0.0.muscle rehabilitation .you get the benefits of muscle per second Pre-Mod/ Bipolar: .more comfort for the patient .30 mins .due to being modulated in the machine.Quadpolar . thus allowing for better penetration.1-10hz: . on crossing interact and form the therapeutic beats .makes a TENS machine Muscle Rehab: .fx current passes with current .relations between fx and resistance= ↑ fx= passes through body easier.carries fx.80-150hz . to 0.

Mobilization of fluid -Oedema with ice (10-12 mins) .Oedema .Hypertonic or Hypotonic mm -mechanism is unknown . MFR.Hand Held Massagers: .General Relaxation .Hemorrhage .Infection. muscles and tendons .Postural drainage (5-15 mins) .General Relaxation: 3-5 mins .with other STT (PNF.Vibration intolerant ptt .TrP .Postural Drainage .Gaiting of Pain.Thrombophlebitis .Post.fascia.includes skin lesions .Congestion Contraindications: .General Relaxation .3-5 mins .STT 10 seconds.Assisting in breaking up adhesions .Varicose vv Treatment Times: .Vascular Pathology .6 seconds .Post.Gaiting of pain .Altering muscle tension . tendons less then 10 mins Altering muscle Tension: . OI) Indications: .Malignancy .2minutes Ultrasound: .Exercise .Mobilization of fluid .Assist in breaking up adhesions . muscles.Trp.Acute Inflammation .Adhesions .fascia.Exercise (5-15 mins) .

.2J.2J.5 wpcm2= 50% Duty Cycle = 20% err on the side of caution ..inflammation..increase speed of activity .blastic activity.Centre the squares over area of pathological structures .5wpcm2= 100% Laser: .Healing Tissue .↑ phagocytosis.Handheld/ transportable pain modulating device .Inflammation .Heating .. change in cell wall permeation Tens: .