Chapter 24-1 Understanding Therapeutic Modalities€¦ · What is the CA’s role when using therapeutic modalities? ... Interferential Therapy ... using four electrodes is practical

2011 Copyright, Chiropractic Educational Network

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Chapter 24-1

Understanding Therapeutic Modalities

Why chiropractors use modalities?

Why are modalities used? To assist in the healing process

1. Analgesia (A deadening or absence of the sense of pain without loss of

consciousness.)

2. Promote tissue healing

3. Reduce swelling & inflammation

4. Promote neuromuscular re-education & muscle strength

5. Reduce pain

Basic Science

First we need to understand each modality is different and there is a specific reason

why the doctor chooses each modality.

What is the Doctor’s role when using therapeutic modalities?

1. Recommend based on need

2. To write an order for it

3. To monitor the affects


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What is the CA’s role when using therapeutic modalities?

1. To follow doctors’ orders

2. To never alter the treatment

3. To perform each procedure professionally and accurately

What is Electrical Muscle Stimulation?

Electric muscle stimulation (EMS) is another therapy that is useful in speeding

up the healing process of injured tissues.

This device sends an impulse into the damaged tissues, causing the muscles in

that region to contract. Ongoing contraction of these muscles will decrease

reflex inhibition and help to restore normal muscle tone, and the sensory input

of this modality will decrease pain and spasm.

Electric muscle stimulation is used for two main reasons; either to decrease

pain, or to cause a muscle to contract. When electric stimulation is used to

decrease pain, the effect of the current is to encourage the body's natural pain-

controlling mechanisms by either blocking a pain nerve's signal or by releasing

opiates (endorphins, similar to those in "runner's high".)

Endorphins reduce the sensation of pain and affect emotions.

When the doctor decides it is appropriate for a patient’s condition, muscle

stimulation is initiated. The muscle contractions caused by the electric muscle

stimulation can range from a mild twitching sensation to a strong contraction.

The treatment patients will be receiving may feel unusual at first, but should

never feel painful or very uncomfortable. Many patients describe the sensation

as tingling, like when your foot falls asleep. As the chiropractic assistant you

will ask if the treatment is tolerable; but YOU need ensure that the level of the

treatment is safe.


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Common questions

Q: What is Electro-Muscle Stimulation?

A: It is a special form of electrical current that is administered at the site of soft tissue

injury, especially muscles, for the blocking of pain.

Q: How does Electro-Muscle Stimulation work?

A: Small amounts of electrical current are induced into the tissue for the purpose of

reducing swelling. This widely used technique safely strengthens muscles and helps

reduce painful symptoms.

Q: What does Electro-Muscle Stimulation feel like?

A: Patients generally feel a slight tingling sensation at first. Since your body may

become accustomed to the initial setting, the intensity may be raised during the

course of your 10-20 minute treatment, for maximum healing effect.

Q: Why is Electro-Muscle Stimulation used?

A: Electro-Muscle Stimulation has been used as an effective form of pain relief. It is

recommended in cases in which pain is accompanied by swelling and inflammation.

Patient Benefits

Reduces pain sensation

Helps decrease swelling

Promotes general muscle tone

Speeds the healing process

Indications for EMS?

Muscle spasm

Muscle tightness

Reduced ROM

Contraindications for EMS?


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Pregnant

Excessive swelling or edema

Pace maker

Any patient suffering from loss of sensation

How do most patients respond to EMS?

Depends on their condition

Depends on their tolerance

Types of EMS

Interferential Therapy

Is delivered with two channels involving four electrodes

o One current is constant and one is variable

You can select a low or high range of frequency

Pre-modulated Therapy

Is often used for treating small areas where using four electrodes is practical

For this therapy two frequencies are mixed

Electric Muscle Stimulation Protocols

Approaching the patient

Be aware of their comfort zone

Introduce yourself

Patient education


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Tell them what the therapy does

Explain what they will experience

Patient preparation

Unveil the involved area

Make sure the area is clean

Be professional

Patient placement

Seated

Face down

Face up

Lateral recumbent

Setting up Machine

Each day run it through the set-up mode

Make sure leads are not bad

Clean all parts that touch the patient

Finding the right intensity

Select an intensity that is clinically correct

Do not turn it up because the patient wants “more”

Rechecking

After two minutes check the patient to ensure it is still comfortable

The removal process


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Do not allow patients to remove electrodes

Do not pull them off quickly

Electrodes

Small round electrode small square electrode

Non-Disposable electrodes

o

Disposable electrodes

o

o

Electrode Positioning and care

1. The patient must be comfortable

2. They need to be relaxed

3. All negative factors removed

Common problems that CA’s encounter:

Common Problem Result

Bad Patient positioning


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Incorrect electrode placement

Intensity too low

Intensity too high

Electrodes are touching

Using old or damaged electrodes

You forget the patient on therapy

Electrodes do not have good connectivity

You place the electrodes in the wrong area

FYI on muscle stimulator for building muscles:

The amount of money people spend on electric muscle-stimulation devices is

shocking. You've seen them on infomercials. They transmit mild electric shocks to

muscles to make them contract, and they've been touted to help people lose weight

and gain muscle mass. What they really do is zap money from people's wallets.

According to the Federal Trade Commission, it's estimated that 18 million consumers

buy electric muscle-stimulation (EMS) devices to help them shed pounds and build

biceps. On average, Americans spend $178 for these products. That's a $3.2 billion

industry through infomercials alone.

Let’s discuss common concerns chiropractic assistants have

Patient approach

Be careful of their comfort zone for personal space


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Educate

Explain every procedure before you begin it

Place on table

Some patient will have trouble getting onto and off of the table

Position Patient

Ensure the patient is comfortable

Prepare patient area

Expose area of treatment

Be aware that some people may be uncomfortable exposing their skin

Electrode placement

Place the electrodes based on the area of treatment

Machine setup

Always set-up the machine in relation to what is safe for use

Setting the Intensity

Do not turn up the intensity just because the patient think they need more

Stay within the clinically correct settings

Monitor / recheck

Since tissue in the area of involvement may change, be sure to recheck the patient

after several minutes to ensure it does not become too intense

Take down

When removing electrodes be careful not to pull them by the wires

Use caution with elderly people who have thinner skin

Document

The area treated

Settings used

Duration of treatment

How the patient responded to the treatment

Any adverse effects from the treatment

Sensory Receptors

Through our nervous system we have sensors throughout our bodies that detect heat,

pressure, stretch, acceleration, sound, light, smells, tastes and other forms of energy


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Sensory receptors act as transducers, converting many forms of energy into action

potentials that the brain can interpret

Many receptors, such as those in the skin, are simply constructed; others, such as

the eye and ear, are very elaborate

Stimulus

When a stimulus is maintained at a constant level or intensity for a prolonged timeframe

the nerve adapts, thus becoming less sensitive.

Example: Temperature receptors

o Two types: warm & cold receptors

o If one hand is placed in warm water and the other is placed in cold water,

the temperature receptors will adapt and become less sensitive

o After adaptation, if both hands are placed in lukewarm water, the hand

originally in warm water will feel cold, and the hand originally in cold

water will feel warm

There are 2 Basic Types of Pain

There are 2 distinct types of pain, carried by 2 types of nerve fibers

o Slow, C fibers carry pain from deep within the tissues.

The pain is felt as a dull ache which is hard to localize

o Fast, A delta fibers carry sharp, well-localized pain from the surface

Tissue Response

Increase tissue temperature as a result of meeting tissue resistance

Chemical related to ion movement

Endorphin release

Physiologic

Physiologic Effects at Various Functional Levels

Cellular:

Excites nerve cells

changes in membrane permeability

Tissue:

skeletal muscle contraction

smooth muscle contraction

tissue regeneration


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Segmental:

modification of joint mobility

Methods to reduce skin/electrode resistance

use water, saline solution or some type of conducting gel

remove dirt, oil, flaky skin by washing w/alcohol

warm area w/MHP (modulated heat probe)

remove excess hair

Clinical applications

Therapeutic Uses of Electrical Currents

Controlling acute & chronic pain

Reducing Edema

Reducing and/or inhibiting Muscle Spasm

Facilitating Tissue Healing

Facilitating Muscle Reeducation

Strengthening Muscle

General Contraindications to Electrotherapy

Cardiac Disability

Pacemaker

Pregnancy

Menstruation

Cancerous Lesions

Infection Sites


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Exposed Metal Implants

Severe obesity

Levels of Stimulation

Sub sensory Level: between 0 point and point at which patient first notices

sensation

Sensory Level: stimulates only sensory nerves; intensity is increased to point at

which a slight twitch is seen then decreased

Motor Level: produces a visible muscle contraction without causing pain

Pain Control

Parameters:

Sensory Level

o

Motor Level

o

Edema Reduction:

Sensory-Level Stimulation: attempts to stop formation of edema by preventing

fluid, plasma proteins & solids from escaping into surrounding tissues

Motor-Level Stimulation: assists venous and lymphatic systems in returning

edema substances for filtering and removal


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Section 24-2

Ultra Sound

Ultrasound

Ultrasound is a treatment that can be useful in speeding up the healing process of

injured tissues. Ultrasound travels into the damaged tendons and muscles, causing

the molecules to collide, resulting in a deep heating effect. The thermal effects of

ultrasound decrease pain of the damaged tissues.

Ultrasound also has a mechanical effect on the tissues that possibly causes the

breakdown of scar tissue.

Indications for Ultra Sound

Acute pain

Muscle tightness or spasm

Contraindications for Ultra Sound

Lesions

Swelling

How do most patients respond to Ultra Sound?

Feel relief of symptoms

Feel relaxed

Positioning and care

Use paper towels

Support the feet

Use a gown if possible

Common problems that CA’s encounter:

Common Problem Result

Bad Patient positioning

Incorrect gel usage

Intensity too low

Intensity too high


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Ultra Sound Patient Process:

Patient approach

Educate

Place on table

Position Patient

Prepare patient area

Topical gel application

Machine setup

Setting Intensity

Monitor patient

Document

ULTRASOUND

Deep penetrating modality

Capable of producing changes through both thermal and mechanical

mechanisms

Most frequently used are 1 MHz and 3 MHz


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Terms

Effective Radiating Area (ERA)

Frequency

Intensity

Treatment Duration

Purpose

Transfers of US Through the Tissues

US passes through tissues in the form of longitudinal wave until it hits bone,

when some energy is reflected and the rest is converted into transverse waves

Passage of US through the body causes the tissues to acquire kinetic energy,

resulting in cellular vibration

Transfer of US Through the Tissues

US is reflected or refracted when the energy travels through different density

of tissue

If wave is reflected straight back and meets the incoming wave the intensity of

the wave in that area is increased

Keep sound head moving

US that is reflected off bone can produce periosteal pain

Coupling Agents and Methods

Direct Coupling

Use of US gel

Use enough gel

Body hair can limit US delivery

Try not to have air bubbles

Use slight pressure on sound head

Biophysical Effects

Both thermal and non-thermal effects occur in the body

Non-thermal Effects

May stimulate the healing process

Effects on the Injury Response Cycle

Tissue Healing

US accelerates the inflammatory phase

This may be helpful in the later stages of healing

May also be helpful over superficial wounds in the later stages of healing

Effects on the Injury Response Cycle

Tissue Stretching

Increased extensibility in collagen-rich tissues, including scar tissue

Must be used with passive stretching


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Tissue must be elevated 5°C and then stretched within 3 minutes

May want to place tissue on stretch during the treatment

Pain Control

May have some direct effect to the nerves or as a result of other effects

Direct effects are through eliciting changes within the nerve fiber themselves

Deep penetrating modality

Capable of producing changes through both thermal and mechanical

mechanisms

US waves are capable of:

Reflection

Refraction

Absorption

The area exposed to the sound waves is limited to the size of the sound head

Treatment Duration

Depends on:

The size of the area treated

The output intensity

Therapeutic goals

Coupling Agents and Methods

Direct Coupling

Use of US gel

Use enough gel

Body hair can limit US delivery

Try not to have air bubbles

Use slight pressure on sound head

Combo-therapy

Combo therapy combines ultrasound and electric muscle stimulation as a single

treatment device. Based on some clinical experience, combo therapy is a more

effective treatment than just using ultrasound or muscle stimulation separately.

Ultrasound and electric muscle stimulation are useful treatment modalities for

creating a more favorable environment for the body to heal itself.


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TENS Units

Help between visits

Good for chronic conditions

Increases functional capacity

Massage Therapy

Massage therapy is a hands-on manipulation of the soft tissue and joints of the

body.

The soft tissues include muscle, skin, tendons and associated fascia, ligaments

and joint capsules.

Massage has many diverse physiological effects, which are primarily due to the

therapist's hands moving over the body.

The different movements can physically stretch muscles, ligaments, tendons

and fascia, encourage the circulation through the tissue, inhibit muscular spasms

and be either sedating or stimulating to the nervous system.

Massage Therapy

The therapeutic use of massage by a registered massage therapist affects all the

systems of the body- in particular, the muscular, circulatory, lymphatic

(immune) and nervous systems.

Many of today's health problems can benefit from massage therapy because

the manipulation of soft tissues affects so many of our bodily systems.

The benefits of massage are extensive. Massage therapy treatments will have a

therapeutic affect and improve health by acting directly on the muscular,

nervous, circulatory and lymphatic (immune) systems.

Massage treatments aim to:

Develop, maintain, rehabilitate or augment physical function.

Relieve or prevent physical dysfunction and pain.

Relax tight and tense muscles.


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Improve circulation, recovery time and immune system function.

Reduce overall stress

Massage therapy is also effective in the control of pain chronic or acute, in

stress reduction, and in creating a sense of relaxation and well-being.

With a therapeutic massage, stress can be significantly reduced. This, in turn,

will increase energy, improve your outlook on life, and in the process boost

your immune system function.

Active Release Techniques

ART provides a way to diagnose and treat the underlying causes of cumulative

trauma disorders that result in symptoms of numbness, tingling, burning and

aching.

ART is a type of manual hands-on therapy that corrects muscular and soft

tissue problems caused by adhesion formation as a result of injury, overuse or

cumulative trauma.

The ART provider uses their hands to evaluate the texture, tightness, and

movement of muscles, fascia, tendons, ligaments, and nerves. Abnormal tissues

are treated by combining precisely directed tension with very specific patient

movements.

Acupressure

A non-intrusive precursor of acupuncture, acupressure stimulates the flow of

vital energy - known as "chi" - that circulates along the body's meridians and

influences the functioning of certain internal organs.

By applying thumb and fingertip pressure, specific symptoms are relieved and

balance is restored to the entire body.

Cranio-Sacral Therapy

CST is a gentle, hands-on method of evaluating and enhancing the functioning

of a physiological body system called the Cranio-sacral system, comprised of

the membranes and cerebrospinal fluid that surround and protect the

brain and spinal cord.


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Using a soft touch generally no greater than 5 grams - or about the weight of a

nickel - practitioners release restrictions in the Cranio-sacral system to improve

the functioning of the central nervous system.

By complementing the body's natural healing processes, CST is increasingly

used as a preventive health measure for its ability to bolster resistance to

disease, and is effective for a wide range of medical problems associated with

pain and dysfunction.

Deep Connective Tissue Massage

This deep form of bodywork helps to release myofascial restrictions in the

body. It relieves chronic tension, increases range of motion, improves

posture and enhances self-awareness.

Connective tissue massage restores length and flexibility to the fascia,

normalizing the tissue and bringing greater health through the fascial system.

This deep form of bodywork helps to release myofascial restrictions in the

body. It relieves chronic tension, increases range of motion, improves posture

and enhances self-awareness.

Connective tissue massage restores length and flexibility to the fascia,

normalizing the tissue and bringing greater health through the fascial system.

Kinesiology

A "muscle testing" form of chiropractic introduced in 1964, practitioners also

examine structural factors such as posture and gait and make recommendations

about lifestyle changes.

Kinesiology is also a non-invasive therapy, in which applied kinesiologists

apply light finger-tip massage to pressure points on the body or head in order

to stimulate or relax key muscles.

Neuromuscular therapy also includes muscle test for diagnosis, then emphasizes

the role of the brain, spine, and nerves to assess and restore balance of the

body's skeletal structure.

Kinesiology is used to improve digestion, energy, and sports performance and

to ease back and joint pain, allergies, asthma, depression and headaches.


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Myofascial Release

This slow and subtle technique can be used to release fascia and muscle

throughout the body. The therapist uses light to moderate traction and a

twisting approach to achieve biomechanical and reflex change through an

appropriate tension on the soft tissue.


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Section 24-3

Understanding the Healing Process

Phases of the Healing Process

Inflammatory Response Phase

Fibroblastic Repair Phase

Maturation/Remodeling Phase

Understanding the Healing Process

Inflammatory Response Phase

A series of events occurring in vascular tissues in response to injury or antigen,

pathogen or allergen which causes infection, illness or allergic reaction

Characteristics of Inflammation

Swelling:

Redness:

Heat:

Pain:

Loss of Function:

What is the purpose of the inflammatory phase?

Control effects of injury

Return tissue to normal state by localizing & disposing of injury by-products to

set stage for repair


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Factors Which Impede Healing

Extent of Injury

Edema

Poor Vascular Supply

Tissue Separation

Muscle Spasm

Atrophy

Health

Age

Nutrition

Infection

Climate

Healing Process of Various Body Tissues


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Section 24-4

Understanding Pain

What is pain?

There is no universally accepted definition of pain, or agreement on its causes. However,

for those experiencing pain, there is no confusion at all as they say “It hurts!”

Many patients have heard horror stories about pain and that a previously treating doctor

told them nothing could be done to relieve their pain. In recent years, the techniques

and treatments chiropractors use for pain management have come a long way. Today

patients can have their pain well-managed or removed thus greatly improving their

quality of life. Each patient experiences pain differently and their emotional responses

will vary.

Thought:

The side effects from pain medication are worse than the pain.

Fact:

Side effects from pain medication can be severe; this is why more patients

was chiropractic care that is drug-free

Thought: Many patients entering your office may have used or still be using

prescription drugs

from their previous treating doctor.

Facts:

Your health care team needs to understand the pain related to their

condition and realize they do need relief of their specific pain. As a health

care professional, your doctor will most likely recommend they discontinue

the use of any pain relievers or muscles relaxers. However, as the

chiropractic assistant you are not allowed to give this advice.

When a patient comes in pain their perception of that pain is conveyed to the brain

or central nervous system by the sensory nerves. Pain can be described as either

sensory or motor pain in relation to which branch of the autonomic nervous system is

conveying the nerve impulses. Specifically musculoskeletal pain tends to be constant

at a certain level of sensation. It can be present all the time or only on movement

and no matter what kind of pain is present in the body both sensory and motor

nerves are involved. You must acknowledge their pain as that is normally their

presenting complaint upon entering your office for care.

Mechanism of Pain Control


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Pain: “unpleasant sensory & emotional experience associated with actual or potential

tissue damage” (International Association for Study of Pain)

Types of Pain

Acute:

o Injury just occurred

o usually sharp

Chronic:

o more than a 6 month duration

o may be a disease in itself

Referred:

o acute or chronic pain perceived to be in an area with little relation to

existing condition

Radiating:

o pain that starts at one point and spreads out from there

Two types of pain scales:

1. Numerical Scale

o rate pain on a scale of 1-10

2. VAS scales

o which utilizes photos

Visual Analogue Scales:

Used to ask a patient to mark on a diagram where pain lies

Or


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Numerical Scale

On a scale of 0-10 rate your pain with “0” reflecting no pain and “10” the worst pain

possible

0 1 2 3 4 5 6 7 8 9 10

Since pain is the one of the most frequent complaints of a patient and an extremely

difficult symptom to measure, you need to ask specific questions to get the answers you

need. These include:

1. How intense has the pain been for you?

no pain

mild

discomforting

distressing

horrible

excruciating

2. Can you sit in a chair without discomfort?

Common responses:

Pain prevents me from sitting

I avoid sitting because it increases the pain

3. What makes it better?

Need to know what they have tried

o did it work

o how long it helped

4. What makes it worse?

You must know what aggravates a condition

Sensory Receptors:

Thermoreceptors: temperature & temperature change (cold & hot)

Mechanoreceptors: pressure, touch, skin stretch

Proprioceptors: changes in muscle length and tension, changes in joint position

Nociceptors: pain


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Response to Stimulus:

Phasic: produce an impulse when stimulus is increased or decreased but not

sustained/adapt to constant stimulus

Tonic: produce impulse as long as stimulus is present

Neural Transmission

Afferent Nerve Fibers: transmit signals from sensory receptors to brain

First Order Afferents: transmit impulses from receptor to dorsal horn of spinal

cord

Second Order Afferents: synapse w/first order afferents in dorsal horn and

carry message to brain

Third Order Afferents: carry impulse to various brain centers to be interpreted

and acted on

Fourth Order Afferents: between various centers in brain

Types of Pain:

Fast: brief, well localized, well-matched to stimulus; originates in skin & carried

on A(d) fibers

Slow: aching, throbbing, poorly localized, less related to stimulus; carried on

C fibers

Neurophysiologic Methods of Pain Control

3 Models of Analgesic Mechanisms:

1. Ascending Input: stimulation of ascending A (b) afferents block impulses on A and

C Fibers

2. Descending Control: stimulation of descending (efferent) pathways at dorsal horn

of spinal cord blocks impulses of A & C fibers

3. B-Endorphin Release: long-term

Descending Pain Control Mechanisms: Pain is gated by higher levels of CNS

Pain stimulus reaches midbrain

Impulses are sent down efferent tract which inhibit pain transmission at dorsal

horn of spinal cord through release of enkephalins


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Cognitive Influences:

way pain is perceived and responded to may facilitate or inhibit pain

perception

Chronic Pain:

Pain Management:

Identify the source of pain: may come from serious underlying disorder

Recognize pain is real to patient even if its psychosomatic

Match therapeutic agent to each specific situation

No one best way “trial & error”

Never apply a modality without having a rationale for its use

Therapist must approach with confidence/believe in what doing


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Section 24-5

Spinal Traction

Spinal Traction

Definition: separation of spinal elements through the process of pulling. Therapeutic

spinal traction uses manually or mechanically created forces to stretch and mobilize the

spine. Traction may alleviate back pain by stretching tight spinal muscles that result from

spasm and widen intervertebral foramen to relieve nerve root impingement.

Effects:

Muscles:

Joints:

Ligaments:

Nerves:

Disk:

Mechanical-Cervical:

Most mechanical traction devices used to treat the cervical spine are

comprised of a head halter with over-the-door pulley system.

Manual Cervical:

Is a minimal impact, hands-on approach where the patient lies in a

relaxed and comfortable position as the doctor or therapist applies

gentle and controlled pressure.

Position:

supine with head very near edge of table

Patient must remain totally relaxed, dead weight

Support head and neck at mastoid process

Tx Time: 3-10 minutes

Mechanical-Lumbar:

Position:

o supine with legs extended

o Patient should remain totally relaxed

o Grasp patient just superior to ankles

o Pull gently-using body weight-lean back

o Requires a lot of strength, more effective mechanically


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Manual Lumbar

Manual Lumbar traction involves distracting the body's weight by

pulling at the ankles with again using controlled force.

Indication for lumbar traction:

Impingement of a Nerve Root

Disk Hernia ion

Spondylolisthesis

Narrowing within intervertebral foramen

Degenerative Joint diseases

Sub-acute Pain

Joint Hypo mobility

Disco genic Pain

Muscle Spasm or guarding

Muscle Strain

Spinal ligament or connective tissue contractures

Contraindications:

Acute sprains/strains

Acute inflammation

Vertebral Joint instability

Any condition in which movement exacerbates the problem

Tumors

Bone Diseases

Infection

Pregnant Females

General Considerations:

Reassess after treatment

Will know after first several treatments whether it will be effective or not

Minimize compressive forces post treatment

Lumbar: no sitting, standing

Cervical: soft collar


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Section 25-6

Heat and Cold Therapy

Cryotherapy

Effects of Cold

Local Tissue Temperature Decrease

Baseline Muscle Temp: 97.5 F

Analgesia @ 58 F

Therapeutic Benefits @ 57 F

Analgesia

Decreased nerve conduction velocity

Decreased excitability of nerve endings

Gate Control Theory

Indications

Acute inflammation or injury

Acute or chronic pain

Post-surgical pain/edema

Acute or chronic muscle spasm

In conjunction w/rehabilitation

Contraindications

Cardiac or respiratory involvement

Uncovered open wounds

Circulatory insufficiency

Anesthetic Skin

Advanced Diabetes

4 Stages of Cold

Uncomfortable Cold

Burning

Aching

Numbness


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Cold Spray

Fluoro-Methane or Ethyl chloride

Used to decrease spasm

Heat Applications

Most heat used in a chiropractic office is from using a heated pad

**Pictured above is standard cervical hot pack that is placed in a hydroculator (shown

below)

Indications for using Hot Packs

Muscle spasms

Muscle tightness

Pain

Tenderness

Reduced range of motion

Contraindications

Swelling or edema in involved area

Lesions

Infection

Safety Precautions for Hydroculator

Clean once per month

o Turn off tank

o Unplug from electrical outlet

o Drain entire tank

o Clean with non-abrasive solution

o Clean actual hot packs with a soft toothbrush


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Keep children away from the hydroculator

Place on a sturdy table to avoid spillage

Use tongs or potholder to remove pads from the tank

Safety Precautions using hot packs

Cover pack before placing on the patient

o Make sure the open end is not towards the patients head if using in

the cervical spine

Recheck the patient as all patients have a different tolerance to heat

Comparison of Hot & Cold Modalities

Deciding Between Heat & Cold?

Is the area warm to touch?

Is the area sensitive to light/mod touch?

Is the amount of swelling increasing?

Does swelling increase w/activity?

Does pain limit ROM?

Is the inflammatory process still active?

Is the patient improving w/ the use of cold?


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Section 25-7

Therapeutic Terminology

Acupressure- applied finger pressure on muscle or tissue.

Acupuncture- needle piercing of the connective tissues to release blockages and pain.

Alexander Technique- Aligns the spine and improves biomechanics

Applied Kinesiology- Test muscles for weakness and strengths

Chakra- Even centers of energy in the body.

Connective Tissue Massage- massages layers of tissue between the skin and the

muscles.

Craniosacral Therapy- Gentle noninvasive pressure on the skull and the tailbone to

release restrictions and balance spinal fluid flow.

Deep Tissue massages Myofasical connective tissue release through deep

manipulations.

Energy Balancing- Balancing energy auras with crystals, herbs, oils or by visualizations.

Homeopathy- Administration of minute doses of natural substances to rid the body of

toxins or diseases.

Hydrotherapy- uses heat or water to stimulate healing.

Lymp Drainage Massage- this is light slow repetitive strokes to remove toxins and

bacteria from the body.

Myofascial Release- A connective tissue release using gliding stokes to stretch and

move the fascia.

Myotherapy- trigger Point therapy

Neuromuscular Therapy- trigger point therapy-

Reflexology- is a massage type technique on the feet. Relexology is based on the

areas of the foot which all body parts and organs are associated to certain points in

the feet. These areas are worked by rubbing pressure to release tension or pain and

increase circulation or flow of energy.


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Reiki- Is a form of energy work in which the therapist taps into the life forces of

healing to assist others in pain. Rolfing- is a deep manipulation of the myofascial

muscle system.

Shiatsu- Finger pressure massage.


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26-1

Rehabilitation

There are many types of Rehabilitation. Let’s start with the feet

1. Statistics

a. By the age of 20, nearly 80% of us have some kind of foot problem, and by

age forty almost all of us do.

2. Your Body

a. Your body is an interconnected system of specialized parts, and the

support structure which holds everything together is made up of bones,

muscles, tendons, and ligaments.

b. Even if your feet don’t hurt, they may be contributing to your overall

postural balance. If you’re having pain or discomfort in a specific area of

your body.

c. This can occur anywhere from your feet to your neck

3. What Causes Foot Problems?

a. From the time you learn to walk, your feet assume three crucial functions

as they support your body whenever you;

1. Stand

2. Walk

3. Run

4. Your feet assist you in achieving movement from one place to another

a. They protect your bones and soft tissues from damaging shock stress

as you move.

b. Being overweight, having minor structural defects in the feet, or

injuries can contribute to additional foot and body stress.

Pronation

Is considered the most common foot problem.

In pronation, some of the bones of the foot drop to a less stable position

because the foot arches are too weak to keep them in proper alignment.

The arches themselves may be unnaturally stretched ("flat feet"), and

stress on the entire foot increases.


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Feet can become "tired and achy" or experience a burning pain, and

walking can begin to feel "clumsy" as you try to move your foot in a way

that avoids further pain.

Supination

This is when a patient has excessively high arches

This makes the patient have problems with knees, ankle and low back as

their feet turn outward.

Children

A child is a unique individual, of course, so the specifics of his or her care can

only be determined by a health care professional like a chiropractor.

In general terms, a chiropractor may recommend a postural evaluation,

examination of the feet, testing of any painful areas, X-rays (to rule out more

serious conditions), adjustments or manipulation where needed, spinal/pelvic

stabilizers (foot orthotics), and rehabilitative exercise.

Child Evaluation

Your family chiropractor is best qualified to evaluate your child's postural

health.

Given all the natural growth developments and potentially serious conditions

which can affect a child, it is not surprising that a recent study indicated

children need chiropractic care for low back pain nearly twice as much as

their parents

Just like the adult the child should have periodic postural evaluations; every

six months to one year is usually sufficient.

Heel Spurs

Heel spurs are small deposits of bone-like calcium on the heel bone

(calcaneus

Usually there are located on or near the bottom of the foot.

What causes heel spurs?

Some experts believe that a spur is the body's attempt to strengthen its

foundation.


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Being overweight, having abnormal foot biomechanics, or running regularly

on hard surfaces can cause excessive stress on the foot, which may lead to the

production of a spur.

Other authorities contend that spurs are a normal part of the aging process:

some studies have shown that calcaneal spurs are more frequently found in

people after age 50.

The best data currently available projects that between 11% and 16% of the

population have heel spurs. It is also interesting to note that spurs occur

almost twice as often in adult females as they do in adult males.

Treatment of Heel Spurs

The treatment you receive will probably focus in general on reducing

swelling, relieving pain, restoring functional movement and position through

joint mobilization, protecting your foot from additional stress, and

strengthening your foundation.

Depending on your specific condition, your healthcare professional may

instruct you to do some or all of the following items after you leave the clinic:

Rest: a decrease or stoppage of running and jumping exercises is often

indicated.

Ice the heel, to help bring down any swelling.

Exercise, to help build muscle strength and joint stability.

A therapeutic Exercise System is often recommended by healthcare

professionals for heel spur conditions.

Wearing foot orthotics to protect the heel and to help the adjustments hold

better.

Stabilizers for this condition can be designed to provide a protective "cushion"

around the heel area, and also change your foot's posture to help take

pressure off the spurs and make you more comfortable.


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How would spinal/pelvic stabilizers help my back? My feet don't hurt!

Your feet are the foundation of your body, and if your feet are not properly

supported, you can have problems anywhere from your ankles on up through

your neck.

Orthotic therapy is essential in restoring structural and functional balance

and developing the strength and flexibility to keep your body stable as you

stand, walk, or run.

Depending on a variety of factors (lifestyle, health, age, weight, sex), your

healthcare professional will select the stabilizers best suited for you.

Because it is very important to wear your stabilizers all day long, and

because most people wear at least two styles of shoes each day, your

healthcare professional may decide that a stabilizer Combo (two pairs) would

be best for your low back condition.

Orthopedic supports-Understanding Your Feet?

Did you Know?

Leg Length Inequality

1. ANATOMICAL

o

o

o

o

o

2. FUNCTIONAL

o

o

o

o

o


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The 3 arches of the foot

1.

2.

3.

Common Conditions Associated with Pronation and LLI

1.

2.

3.

4.

5.

6.

Orthotics - Goal #1

Create a symmetrical foundation by blocking excessive pronation or

supporting Supination within the established normal angulation

ranges.

Orthotics - Goal #2

Provide heel strike shock protection

o The natural heel strike shock absorption mechanisms are

compromised with faulty pedal biomechanics making the

individual more susceptible to bone marrow edema and stress

fractures.

Orthotic - Goal #3

Enhance sensory - motor reflexes

o The sensory information from the feet affects muscular efficiency, balance, gait,

and posture.

Documents

Chapter 24-1 Understanding Therapeutic Modalities€¦ · What is the CA’s role when using therapeutic modalities? ... Interferential Therapy ... using four electrodes is practical