The Role ofThe Role ofTherapeutic ModalitiesTherapeutic Modalities

Clinical applications of Clinical applications of Cold & Heat ModalitiesCold & Heat Modalities

What Modalities Do!What Modalities Do!

Create Optimal environment for injury Create Optimal environment for injury repair by limiting the inflammatory repair by limiting the inflammatory processesprocesses

Breaking the pain-spasm cycleBreaking the pain-spasm cycle Aids in healing cycleAids in healing cycle

Increases localized circulation and transfer Increases localized circulation and transfer nutrientsnutrients

What is a Modality?What is a Modality?

Application of some form of stress to the body Application of some form of stress to the body for the purpose of eliciting and adaptive for the purpose of eliciting and adaptive response.response.

To be deemed “Therapeutic”To be deemed “Therapeutic” Stress applied must be conducive to the healing Stress applied must be conducive to the healing

process of the injury in its current state.process of the injury in its current state.• Requires a BALANCE:Requires a BALANCE:

Protecting the areaProtecting the area Returning the body to normal functionReturning the body to normal function Improper use of the modality will hinder the healing processImproper use of the modality will hinder the healing process

Indication vs. ContraindicationIndication vs. Contraindication Heat vs. Cold / US: 100% vs. 50%Heat vs. Cold / US: 100% vs. 50%

Thermal AgentsThermal Agents

Cold Modalities (CryotherapyCold Modalities (Cryotherapy)) Heat is removed from the body and absorbed by the Heat is removed from the body and absorbed by the

cold modalitycold modality The more the skin is cooled, the greater the cooling of The more the skin is cooled, the greater the cooling of

underlying tissuesunderlying tissues• Application for 15-20 minutes or lessApplication for 15-20 minutes or less

Most rapid and significant temperature changes occur Most rapid and significant temperature changes occur in the skin and synoviumin the skin and synovium

Cold application leads to vasoconstriction at the Cold application leads to vasoconstriction at the cellular level decreasing the need for oxygen.cellular level decreasing the need for oxygen.

• Decreases # of cells destroyed.Decreases # of cells destroyed.

Types of CryotherapyTypes of Cryotherapy Ice MassageIce Massage

Produces significant cooling of the skinProduces significant cooling of the skin Increase of blood flow once treatment has endedIncrease of blood flow once treatment has ended Useful prior to ROM exercises/activityUseful prior to ROM exercises/activity Rubbed over skin in small circular motions for 7-10 min.Rubbed over skin in small circular motions for 7-10 min.

Ice Packs / Contoured Cryo CuffsIce Packs / Contoured Cryo Cuffs Can be molded to body’s contoursCan be molded to body’s contours Applied for 15-20 minutes (Ice will reverse its effect and start heating)Applied for 15-20 minutes (Ice will reverse its effect and start heating) Cryo Cuffs combine ice and compressionCryo Cuffs combine ice and compression

Ice Immersion / Cold WhirlpoolsIce Immersion / Cold Whirlpools Quickly reduce over entire surface of Quickly reduce over entire surface of DISTALDISTAL extremity extremity During inflammatory phase of rehab: OK to combine with ROM During inflammatory phase of rehab: OK to combine with ROM

exercisesexercises Temperatures range from 13-18’ C (55-65’ F)Temperatures range from 13-18’ C (55-65’ F)

Commercial Gel / Chemical PacksCommercial Gel / Chemical Packs Chemical reaction is at an alkaline pH – may cause skin burnsChemical reaction is at an alkaline pH – may cause skin burns

Vapocoolant SpraysVapocoolant Sprays Fluori-Methane spray uses rapid evaporation of chemicals on the skin Fluori-Methane spray uses rapid evaporation of chemicals on the skin

area to freeze the skin prior to stretching musclearea to freeze the skin prior to stretching muscle

ThermotherapyThermotherapy

Heat Application Heat Application USUALLY used in phase two to increase USUALLY used in phase two to increase

blood flow and promote healing.blood flow and promote healing. Increases circulationIncreases circulation Cellular metabolismCellular metabolism Decreases muscle spasm and painDecreases muscle spasm and pain

Contraindicated if swelling/pain has not Contraindicated if swelling/pain has not subsidedsubsided

Types of ThermotherapyTypes of Thermotherapy Whirlpool and Immersion BathWhirlpool and Immersion Bath

Combine hot/warm water with a hydromassaging effectCombine hot/warm water with a hydromassaging effect• Increases superficial skin temperatureIncreases superficial skin temperature

Used for relaxation; muscle spasm/painUsed for relaxation; muscle spasm/pain Facilitates ROM after prolonged immobilizationFacilitates ROM after prolonged immobilization 20-30 minutes with temperatures @ 98-110’F20-30 minutes with temperatures @ 98-110’F NEVERNEVER put injured body part directly on jets put injured body part directly on jets

Hydrocollator PacksHydrocollator Packs Provides superficial moist heat to slightly deeper tissueProvides superficial moist heat to slightly deeper tissue Packs consist of silicone gel compartments encased in a canvas Packs consist of silicone gel compartments encased in a canvas

fabricfabric Stored in hot water (160’F)Stored in hot water (160’F) Wrapped in layers of toweling for approx. 20 min.Wrapped in layers of toweling for approx. 20 min.

Paraffin BathParaffin Bath Hot wax and mineral oilHot wax and mineral oil Temperatures are approx. 125-130’FTemperatures are approx. 125-130’F Great for contoured bony areas of the body (feet, hands, wrists)Great for contoured bony areas of the body (feet, hands, wrists)

Contrast BathContrast Bath Cryo and Thermo Therapy combinedCryo and Thermo Therapy combined Works well for Subacute and Chronic injuriesWorks well for Subacute and Chronic injuries Two whirlpools or containers placed side by sideTwo whirlpools or containers placed side by side

• One filled with cold water (50-65’F)One filled with cold water (50-65’F)• Once filled with hot water (98.6-111’F)Once filled with hot water (98.6-111’F)

Injured extremity is alternated between tubs at a 3:1 Injured extremity is alternated between tubs at a 3:1 ratio or 4:1ratio or 4:1

Treatments begins and ends with ice unless injury is Treatments begins and ends with ice unless injury is chronic chronic

DiathermyDiathermy Uses electromagnetic energy to elicit deep Uses electromagnetic energy to elicit deep

penetrating thermal effectspenetrating thermal effects FluidotherapyFluidotherapy

Uses heat and shaved corkUses heat and shaved cork Hot air blows into a box creating a massaging effectHot air blows into a box creating a massaging effect

UltrasoundUltrasound Uses high frequency sound waves to elicit deep Uses high frequency sound waves to elicit deep

thermal and Non-thermal effects in deep tissuethermal and Non-thermal effects in deep tissue Alternating current flowing through a “piezoelectric Alternating current flowing through a “piezoelectric

crystal” (produce + and – charge)crystal” (produce + and – charge) Two effects from ultrasoundTwo effects from ultrasound

• ThermalThermal Elevate tissue temperatureElevate tissue temperature Increase blood flowIncrease blood flow Reduce muscle spasm and painReduce muscle spasm and pain

• PulsedPulsed Lower intensityLower intensity Non thermalNon thermal Facilitate repair and healingFacilitate repair and healing Reduce edema Reduce edema

PhonophoresisPhonophoresis• Used to drive anti-inflammatory drugs through the skinUsed to drive anti-inflammatory drugs through the skin

Hydrocortisone, anestheticsHydrocortisone, anesthetics

Thermotherapy AgentsThermotherapy Agents

Neuromuscular Electrical Neuromuscular Electrical Stimulation (NMES)Stimulation (NMES)

Applied to injured or immobilized muscles Applied to injured or immobilized muscles in early stages of exercise when muscle is in early stages of exercise when muscle is at its weakest.at its weakest.

Used to:Used to: Reduce swellingReduce swelling Muscle spasm and atrophyMuscle spasm and atrophy Increase blood flow/ ROM (range of motion) Increase blood flow/ ROM (range of motion)

and muscle strengthand muscle strength Enhance wound healingEnhance wound healing ReEducate musclesReEducate muscles

Electrical energy flows between two pointsElectrical energy flows between two points

Types of Electric Stim.Types of Electric Stim. Interferential CurrentInterferential Current

Utilizes two separate channelsUtilizes two separate channels Quadripolar electrode to produce 2 simultaneous electrical currents Quadripolar electrode to produce 2 simultaneous electrical currents

acting on the tissue (4 electrodes)acting on the tissue (4 electrodes) Treatment time is 20 min.Treatment time is 20 min.

• Covers a larger areaCovers a larger area PreMod CurrentPreMod Current

Utilizes one1 channel & 2 electrodesUtilizes one1 channel & 2 electrodes• Covers a smaller areaCovers a smaller area

Treatment time is 20 min.Treatment time is 20 min. BiphasicBiphasic

Utilizes 1 or 2 channelsUtilizes 1 or 2 channels Less intense contractionLess intense contraction Great for muscle re-educationGreat for muscle re-education

• Intermittent contractionsIntermittent contractions• Co-contractionsCo-contractions

RussianRussian Identical to Biphasic Identical to Biphasic

• but more massaging with muscle contractionbut more massaging with muscle contraction

High Volt (Old School)High Volt (Old School) Utilizes 1 channel 2 electrodesUtilizes 1 channel 2 electrodes Reduces edema, pain, and muscle spasm during Reduces edema, pain, and muscle spasm during

acute phase.acute phase. Maintains muscle size during immobilizationMaintains muscle size during immobilization Muscle re-educationMuscle re-education Increases blood flow to tissuesIncreases blood flow to tissues

Transcutaneous Electrical Nerve Stimulation Transcutaneous Electrical Nerve Stimulation (TENS)(TENS) Produces analgesia Produces analgesia Decreases acute and chronic pain Decreases acute and chronic pain Used continuously after surgery (30-60 min. sessions)Used continuously after surgery (30-60 min. sessions) Works to override the body’s internal signals of pain Works to override the body’s internal signals of pain

(Gait control theory)(Gait control theory)

AnnouncementsAnnouncements

Game coverage reportsGame coverage reports Due 3 weeks after gameDue 3 weeks after game Last home event April 25Last home event April 25thth May 14May 14thth ALL work must be turned in. ALL work must be turned in.

Taping FinalTaping Final Written/Short AnswerWritten/Short Answer Ankle Tape (ONLY)Ankle Tape (ONLY)

No Class on April 21stNo Class on April 21st