Therapeutic Modalities

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Therapeutic Modalities
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Introduction

• Therapeutic modalities create an optimal
  environment for injury repair (DO NOT CAUSE
  HEALING)
• Most common types of modalities
• Cryotherapy (cold)
• Thermotherapy (heat)
• Massage
• Electrical stimulation
• Therapeutic ultrasound

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Physiology Basics

• Vasodilation
• Increased size of vascular structures
• Means more oxygen to the tissue
• Vasoconstriction
• Decreased size of vascular structures
• Useful for preserving compromised/injured
  cells/tissue

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Physiology Basics

• Analgesia
• Diminished/reduced sensation
• Metabolic rate
• Activity level of cells
• Reducing MR can preserve cells damaged by injury
• Inflammation
• Series of events that hinder optimal function

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Cryotherapy (Ice)

• Physiological effects
• Decreased local metabolic rate
• Important in preventing secondary hypoxic injury
• Decreased local blood flow
• Vasoconstriction
• Decreased presence of inflammation the
  processes of inflammation

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Cryotherapy (Ice)

• Physiological effects
• Reduced swelling
• Decreased nerve conduction velocity
• Analgesia- pain decreased

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Cryotherapy (Ice)

• Indications
• Acute injuries
• After activity
• Swelling
• Spasm
• Pain
• Mild burns

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Cryotherapy (Ice)

• Contraindications
• Hunting response
• Prolonged exposure to cold may lead to
  superficial vasodilation to protect cold bodypart
• Raynauds phenomenon
• Cold allergy

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Cryotherapy (Ice)

• Application
• Ice massage
• 7-10 minutes
• Excellent for muscle spasm and deep soreness

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Cryotherapy (Ice)

• Application
• Ice bags, ice towels, or cold packs
• 15-20 minutes (no longer than 30)
• If using packs, be sure to avoid direct contact
  to protect skin!
• Cold whirlpool / ice immersion
• 5-15 minutes, 55-65 degrees
• Duration and temperature depends on surface area
  immersed

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Thermotherapy (Heat)

• Physiological effects
• Increased local circulation
• Vasodilation
• Increased local metabolic rate
• Increased collagen extensibility
• Increased nerve conduction velocity
• Analgesia

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Thermotherapy (Heat)

• Indications
• Sub-acute injury
• Prior to activity
• Reduce spasm/guarding
• Contraindications
• Acute injury
• Impaired sensation

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Thermotherapy (Heat)

• Application
• Warm whirlpool
• Treat 15-20 minutes (no longer than 30)
• 98-110 degrees
• Contrast baths
• Switch back and forth between hot and cold 31 or
  41 to induce vascular pumping action from
  repeated vasodilation/vasoconstriction
• Particularly useful for troublesome swelling or
  edema

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Thermotherapy (Heat)

• Hydrocollator packs
• Treat 20 minutes
• 150-160 degrees
• Will burn! Must pad with layered towels or
  covers!

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Thermotherapy (Heat)

• Paraffin bath
• Great for angular extremities (hands feet)
• 125-127 degrees
• Wash body part
• Dip body part 4-5 times, then wrap in ice bag and
  towel
• Treat 20-30 minutes
• Dispose of wax or return to bath for re-use
• Do not use with open wounds

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Massage

• Physiological effects
• Increased local blood flow (if done properly)
• Increased venous/lymph return
• Analgesia sedative neurological effect
• Indications
• Sub-acute injury
• Soreness
• Persistent swelling

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Massage

• Contraindications
• Acute injury (may disturb clotting mechanism)
• Fracture sites
• Open wounds

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Types of Therapeutic Massage

• Effluerage
• Petrissage
• Tapotement
• Vibration
• Cross-friction

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Effluerage

• Slow, rhythmic, soothing strokes toward the heart
• One hand always in contact w/ patient
• Use massage lotion or cream, gloves optional
• Helps calm/soothe athlete
• Encourages venous lymph return

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Petrissage

• Deeper kneading of large muscle masses
• Stimulates local circulation
• Eliminates muscle trigger points

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Tapotement

• Percussion, cupping, or hacking of the large
  muscle groups
• Typical health-spa massage
• Invigorates- increases neural response
• Increases local circulation

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Vibration

• Rhythmic oscillations of larger muscle groups
• Most often quads and hams
• Physiologically speaking, we are not really
  certain of its effects
• Perhaps largest benefit is psychological

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Cross-friction

• Best empirically-supported technique
• Increases local blood flow
• Reduces sensation of pain
• Accommodation
• Useful in restoring full function ROM
• Typical treatment lasts 5 minutes

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Electrical Stimulation

• Many types available
• Transcutaneous Electical Nerve Stimulation (TENS)
• Useful for pain relief
• Portable units are very affordable
• Typically treat for 20 minutes

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Electrical Stimulation

• Many types available
• Interferential quad polar (IFQP)
• Uses four pads
• Good for pain control
• Premodulated Bipolar (PMBP)
• Uses two pads
• Good for pain control when IFQP not ideal (small
  body parts, etc)

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Electrical Stimulation

• Other types also available
• Settings
• Higher frequencies tend to produce fast acting,
  comfortable treatment for acute injuries, while
  lower frequencies tend to elicit longer lasting
  relief for chronic injuries
• Typical treatment lasts 15 minutes at intensity
  of comfort for patient

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Therapeutic Ultrasound

• Sound energy which results in deep heating to
  tissue
• May penetrate up to 3-5 cm when administered a 1
  MHz, up to 1-2 cm at 3 MHz.
• Must keep ultrasound head moving to prevent burns
• Typical treatment lasts 5-6 minutes at intensity
  of 1-1.5 w/cm2

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