Title: Chapter 15: Therapeutic Modalities
1Chapter 15Therapeutic Modalities
2Therapeutic Modalities
- In any rehabilitation program, modalities should
be used primarily as adjuncts to therapeutic
exercise and certainly not at the exclusion of
range-of-motion or strengthening exercise.
3Transmission of Thermal Energy
- Conduction Heating through direct contact
with a hot medium (e.g., hot pack). - Convection Heating indirectly through another
medium such as air or liquid (e.g., whirlpool) - Radiation Transfer of heat through space from
one object to another (e.g., ultraviolet
therapy) - Conversion Heating through other forms of
energy (e.g., ultrasound)
4Cryotherapy
- Application of cold the major therapeutic value
of cold is its ability to produce anesthesia,
allowing pain-free exercise. Cold as a
therapeutic agent is a type of electromagnetic
energy classified as infrared radiation. Wet ice
is a more effective coolant because of the extent
of internal energy needed to melt the ice.
5Hunting Response
- Causes a slight temperature increase during
cooling. The extent of cooling depends on the
thickness of the subcutaneous fat layer.
6Skin Response to Cold
- Stage 1
-
- Response
- Cold sensation
- Estimated Time after Initiation
- 0 to 3 minutes
7Skin Response to Cold
- Stage 2
-
- Response
- Mild burning, aching
- Estimated Time after Initiation
- 2 to 7 minutes
8Skin Response to Cold
- Stage 3
-
- Response
- Relative cutaneous anesthesia
- Estimated Time after Initiation
- 5 to 12 minutes
9Physiological Variables of Crotherapy
- Variable Response to Therapy
- Muscle spasm Decreases
- Pain perception Decreases
- Blood flow Decreases
- Metabolic rate Decreases
- Collagen elasticity Decreases
- Joint stiffness Increases
- Capillary permeability Decrease
- Edema Controversial
10Cryotherapeutic Methods
- Ice Massage
- Duration 10 to 15 minutes
- Indications
- small muscle areas
- subacute injury
- subacute inflammation
- muscle strain
- Contusions
- acute pain
- chronic pain
- Contraindications
- pressure contraindications
- suspected fractures
- uncovered open wounds
- circulatory insufficiency
- cold allergy
- cold hypersensitivity
- anesthstized skin
11Cryotherapeutic Methods
- Cold or Ice Water Immersion
- Duration 10 to 20 minutes
- Temp 50F to 60ºF
- Indications
- Distal body parts
- Acute injury
- Acute inflammation
- Acute pain
- Chronic pain post-surgical pain
- Post-surgical edema
- Contraindications
- Cardiac involvement,
- Respiratory involvement
- Uncovered open wounds
- Circulatory insufficiency
- Cold allergy
- Cold hypersensitivity
- Anesthetized skin
12Cryotherapeutic Methods
- Ice Packs (Bags)
- Duration 15 to 30 minutes
- Indications
- Acute injury
- Acute inflammation
- Acute pain
- Chronic pain
- Post-surgical pain
- Post-surgical edema
- Contraindications
- Cardiac involvement
- Respiratory involvement
- Uncovered open wounds
- Circulatory insufficiency
- Cold allergy
- Cold hypersensitivity
- Anesthetized skin
13Cryotherapeutic Methods
- Contraindications
- Acute problems to turbulence
- Acute problems to gravity
- Requiring postural support
- Skin conditions
- Cardiac involvement
- Respiratory involvement
- Uncovered open wounds
- Circulatory insufficiency
- Cold allergy
- Cold hypersensitivity
- Anesthetized skin
- Cold Whirlpool
- Duration 5 to 30 minutes
- Temp 50F to 60F
- Indications
- Subacute inflammation
- Chronic inflammation
- Peripheral vascular disease
- Peripheral nerve injuries
- Distal body parts
14Cryotherapeutic Methods
- Cryokinetics
- Combines cryotherapy with exercise
15Thermotherapy
- Application of heat Heat has the capacity to
increase the extensibility of collagen tissue.
16Physiological Variables of Thermotherapy
- Variable Response to Therapy
- Muscle spasm Decreases
- Pain perception Decreases
- Blood flow Increase
- Metabolic rate Increase
- Collagen elasticity Increase
- Joint stiffness Decrease
- Capillary permeability Increase
- Edema Increase
17Comparing the Physiological Variables of
Crotherapy and Thermotherapy
- Response to Response to Variable
Cryotherapy Thermotherapy - Muscle spasm Decreases Decreases
- Pain perception Decreases Decreases
- Blood flow Decreases Increases
- Metabolic rate Decreases Increases
- Collagen elasticity Decreases Increases
- Joint stiffness Increases Decreased
- Capillary permeability Decreased Increases
- Edema Controversial Increases
18Thermotherapy
- Special Considerations in the Use of Superficial
Heat - Never apply heat when there is a loss of
sensation - Never apply heat immediately after an injury
- Never apply heat when there is decreased arterial
circulation - Never apply heat directly to the eyes or genitals
- Never heat the abdomen during pregnancy
- Never apply heat to a body part that exhibits
signs of acute inflammation
19Thermotherapy
- Superficial tissue is a poor thermal conductor
- temperature rises quickly on the skin surface as
compared with the underlying tissues - There are limitations of superficial tissue
- The deeper tissues, including the musculature,
are not significantly heated because the heat
transfer from the skin surface into deeper
tissues is inhibited by the subcutaneous fat,
which acts as a thermal insulator, and by the
increased skin flow, which cools and carries away
the heat externally applied.
20Thermotherapeutic Methods
- Moist Heat Packs (Hot Packs)
- Duration 20 to 30 minutes
- Indications
- Subacute inflammation
- Chronic inflammation
- Reduction of subacute pain
- Reduction of chronic pain
- Subacute muscle spasm
- Chronic spasm
- Decreased range of motion
- Hematoma resolution
- Reduction of joint contractures
- Infection
- Contraindications
- Acute conditions
- Peripheral vascular disease
- Impaired circulation
- Poor thermal regulation
21Thermotherapeutic Methods
- Hot Whirlpool
- Duration 5 to 30 minutes
- Temp 96F to 104F
- Indications
- Subacute inflammation
- Chronic inflammation
- Peripheral vascular disease
- Peripheral nerve injuries
- Distal body parts
- Contraindications
- Acute problems to turbulence
- Acute problems to gravity
- Fever
- Requiring postural support
- skin conditions
22Thermotherapeutic Methods
- Paraffin Bath
- Duration 15 to 30 minutes
- Temp 126F to 130F
- Indications
- Subacute inflammation
- Chronic inflammation
- Limited range of motion after immobilization
- Contraindications
- Open wounds
- Skin infection
- Sensory loss
- Peripheral vascular disease
23Hydrotherapy Methods
- Contrast Bath
- Duration 20 to 30 minutes
- Temp 50F to 60F96F to 104F
- Indications
- Ecchymosis removal
- Edema removal
- Subacute inflammation
- Chronic inflammation
- Impaired circulation
- Contraindications
- Acute injuries
- Cold hypersensitivity
- Whirlpool contraindications
- Cold application contrindications
- Hot application contrindications
24Hydrotherapy Methods
- Contraindications
- Acute problems to turbulence
- Acute problems to gravity
- Requiring postural support
- Skin conditions
- Cardiac involvement
- Respiratory involvement
- Uncovered open wounds
- Circulatory insufficiency
- Cold allergy
- Cold hypersensitivity
- Anesthetized skin
- Cold Whirlpool
- Duration 5 to 30 minutes
- Temp 50F to 60F
- Indications
- Subacute inflammation
- Chronic inflammation
- Peripheral vascular disease
- Peripheral nerve injuries
- Distal body parts
25Hydrotherapy Methods
- Hot Whirlpool
- Duration 5 to 30 minutes
- Temp 96F to 104F
- Indications
- Subacute inflammation
- Chronic inflammation
- Peripheral vascular disease
- Peripheral nerve injuries
- Distal body parts
- Contraindications
- Acute problems to turbulence
- Acute problems to gravity
- Fever
- Requiring postural support
- skin conditions
26Acoustic TherapyUltrasound
- Relies on molecular collision for transmission.
- Ultrasound is a mechanical wave in which energy
is transmitted by the vibrations of the molecules
of the biological medium through which the wave
is traveling.
27Acoustic TherapyUltrasound
- Ultrasound has both thermal and non-thermal
effects.
28Acoustic TherapyUltrasound
- When used for thermal changes, non-thermal
changes also occur. - For the majority of thermal effects to occur, the
tissue temperature must be raised to a level of
104F to 113F for a minimum of five minutes. - Temperatures below this range will be
ineffective.
29Acoustic TherapyUltrasound
- Non-thermal effects of ultrasound are cavitation
and acoutsic microstreaming.
30Acoustic TherapyUltrasound
- Cavitation is the formation of gas-filled bubbles
that expand and compress because of
ultrasonically induced pressure changes in tissue
fluids. - Cavitation results in an increased flow in the
fluid around these vibrating bubbles.
31Acoustic TherapyUltrasound
- Microstreaming is the unidirectional movement of
fluids along the boundaries of cell membranes
resulting from the mechanical pressure wave in an
ultrasonic field. - Microstreaming can alter cell membrane structure
and function because of changes in cell membrane
permeability to sodium and calcium ions important
in the healing process. - As long as the cell membrane is not damaged,
microstreaming can be of therapeutic value in
accelerating the healing process.
32Acoustic TherapyUltrasound
- The non-thermal effects of therapeutic ultrasound
in the treatment of injured tissues may be as
important as the thermal effects and perhaps are
even more important. - The non-thermal effects of cavitation and
microstreaming can be maximized while the thermal
effects are minimized by using an intensity of
0.1 to 0.2 W/cm² with continuous ultrasound or
1.0 W/cm² at a duty cycle of 20 percent (pulsed).
33Acoustic TherapyUltrasound
- Ultrasound energy generated at a frequency of 1
MHz is transmitted through more superficial
tissues and absorbed primarily in the deeper
tissues at depths of 3 to 5 cm. - A 1 MHz frequency is most useful in individuals
with high percent body fat and whenever the
desired effects are in the deeper structures. - At a frequency of 3 MHz the energy is absorbed in
the more superficial tissues with the depth of
penetration between 1 and 2 cm.
34Acoustic TherapyUltrasound
- 3 MHz
- Superficial Tissues
35Acoustic TherapyUltrasound
- Frequency of Treatment
- Acute injuries require more frequent treatments
over a shorter period of time (pulsed duty
cycle). - Chronic conditions require fewer treatments over
a longer period of time (continuous duty cycle). - Should begin as soon as possible after the injury
(at least within 48 hours). - Treatments should be limited to no more than 14
treatments then avoid ultra sound for two weeks.
36Acoustic TherapyUltrasound
- Phonophoresis
- Uses ultrasound to drive ions
37Acoustic TherapyUltrasound Indications
- Acute and post acute conditions (non-thermal)
- Soft tissue healing and repair
- Scar tissue
- Joint contracture
- Chronic inflammation
- Increased extensibility of collagen
- Reduction of muscle spasm
- Pain modulation
- Increase blood flow
- Soft tissue repair
- Increase in protein synthesis
- Tissue regeneration
- Bone healing
- Repair of non-union fractures
- Inflammation of myositis ossificans
- Plantar warts
- Myofascial trigger points
38Acoustic TherapyUltrasound Contraindications
- Acute and post acute conditions (thermal)
- Areas of decreased temperature sensation
- Areas of decreased circulation
- Vascular insufficiency
- Thrombophlebitis
- Eyes
- Reproductive organs
- Pelvis immediately following menses
- Pregnancy
- Pacemaker
- Malignancy
- Epiphyseal areas in young children
- Total joint replacement
- Infection
39ElectrotherapyElectrical Stimulation
- Electricity is a form of energy that displays
magnetic, chemical, mechanical, and thermal
effects on tissue. - It implies a flow of electrons between two
points.
40ElectrotherapyElectrical Stimulation
- All therapeutic electrical generators are
transcutaneous electrical stimulators. - The majority of these generators are used to
stimulate peripheral nerves and are correctly
called transcutaneous electrical nerve
stimulators (TENS). - Occassionally the terms neuromuscular electrical
stimulator (NMES) or electrical muscle stimulator
(EMS) are used however, these terms are only
appropriate when the electrical current is being
used to stimulate muscle directly, as would be
the case with denervated muscle in which
peripheral nerves are not functioning.
41ElectrotherapyElectrical Stimulation
- Direct Current (DC current)
- Flows in one direction only from the positive
pole to the negative pole. - Direct current may be used for pain modulation or
muscle contraction or to produce ion movement.
42ElectrotherapyElectrical Stimulation
- Alternating Current (AC current)
- The direction of current flow reverses itself
once during each cycle. - Alternating current may be used for pain
modulation or muscle contraction.
43ElectrotherapyElectrical Stimulation
- Pulsed Current
- Pulsed currents usually contain three or more
pulses grouped together. - These groups of pulses are interrupted for short
periods of time and repeat themselves at regular
interval. - Pulsed currents are used in interferential and
so-called Russian currents (currents interfere
with each other).
44ElectrotherapyElectrical Stimulation
- Duration
- Duration 10 to 30 minutes
- Can be used with ice or heat
45ElectrotherapyElectrical Stimulation
- High Voltage or Pulsed Indications
- Peripheral nerve injuries,
- Delaying denervation
- delaying disuse atrophy
- Post-traumatic edema reduction
- Increase local blood circulation
- Joint contracture prevention
- Maintenance of range of motion
- Muscle strengthening
- Muscle spasm reduction
- Inhibitation of spasticity
- Muscle re-education
- Assist voluntary muscle function
- Interferential Indications
- Acute pain
- Chronic pain
- Muscle spasm
46ElectrotherapyElectrical Stimulation
- Contraindications
- Demand-type pacemakers
- Over pelvic or lumbar areas
- During pregnancy
- Pain of central or unknown origin
- Areas of particular sensitivity
- carotid sinus
- laryngeal muscles
- pharyngeal muscles
- upper thorax
- temproal region
- cancerous lesions
- sites of infection
47Electrotherapy Electrical Stimulation
- Iontophoresis
- Uses electrical current to drive ions
48Massage Therapy
- Sports massage causes mechanical, physiological,
and psychological responses.
49Massage Therapy
- Mechanical Response
- Encourages venous and lymphatic drainage, mildly
stretch superficial and scar tissue
50Massage Therapy
- Physiological Response
- Reflex effects, relaxation, stimulation, and
increased circulation
51Massage Therapy
- Psychological Response
- The tactile system is one of the most sensitive
systems in the human organism. Humans respond
psychologically to being touched and is an
important means for creating a bond of confidence
between the athletic trainer and the athlete.
52Massage Therapy
- Massage Strokes
- Effleurage
- Petrissage
- Tapotement
- Vibration
- Deep Friction
53Massage Therapy
- Effleurage
- Stroking divided into light and deep methods.
- Light stroking is designed primarily to be
sedative. - It is also used in the early stages of injury
treatment. - Deep stroking is therapeutic compression of soft
tissue, which encourages venous and lymphatic
drainage.
54Massage Therapy
- Petrissage
- Kneading a technique adaptable primarily to
loosen heavy tissue areas such as the trapezius,
latissimus dorsi, or the triceps. - Friction heat producing
- Often used around joints and other areas where
tissue is thin and is used on tissues that are
especially unyielding such as scars, adhesions,
muscle spasms, and fascia.
55Massage Therapy
- Tapotement
- Percussion produces an invigorating and
stimulating sensation.
56Massage Therapy
- Vibration
- Rapid shaking rapid movement that produces a
quivering or trembling effect. - It is used because of its ability to relax and
soothe. - Although vibration can be done manually, the
machine vibrator is usually the preferred
modality.
57Massage Therapy
- Deep Friction
- Often precedes activity, restoring mobility to a
muscle.
58Massage Therapy
- Massage in sports is usually confined to a
specific area and is seldom given to the full
body. - The time required for giving an adequate and
complete body massage is excessive in athletics. - It is not usually feasible to devote this much
time to one athlete. - Five minutes is usually all that is required for
massaging a given area.