Therapeutic Modalities

Chapter 6 or 7

Therapeutic Modalities

Indication: A condition that could benefit from a specific modality.

Contraindication: A condition that could be adversely affected if a particular modality is used.

Electromagnetic Spectrum

Electromagnetic Radiation Electromagnetic Spectrum

Ionizing RangeNon-Ionizing Range

Ionizing Range

Energy readily alters the components of atoms. Used for X-rays and Treating Cancer. Not used by Athletic Trainers

Non-Ionizing Range

Ultraviolet- Superficial tissue treatment Infrared-

Near Infrared- 5-10mm deepFar Infrared- <2mm deep

Diathermy- Conversion

Transfer of Energy

Energy moves from an area of HIGH concentration to an area of LOW concentration.

Radiation Conduction Convection Conversion Evaporation

Radiation

When the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made.

Short-wave Diathermy Microwave Diathermy

Conduction

Direct transfer of energy between two objects in physical contact with each other. Energy is transferred from the area of high temp. to the area of low temp.

Ice packs Moist heat packs Paraffin

Convection

Much like conduction, but the medium moves across the body causing variations.

Fluidotherapy Whirlpools

Conversion

Changes other energy forms into Heat. Ultrasound Microwave Liniments or Balms

Evaporation

Heat is absorbed by the liquid on the skins surface and cools the skin as it turns into a gaseous state.

Vapocoolant sprays Alcohol

Factors Affecting Transfer of Energy

Density of Medium Reflection Refraction Absorption Law of Grotthus-Draper

Energy’s Effect on Tissue

Cosine law+/- 10ºF is acceptable Inverse Square Law E=Es/D²

E= Resulting EnergyEs= Source EnergyD= Distance Squared

Cryotherapy Heat Abstraction Depth of 5cm can be

cooled Change in Temperature

depends on: Type of Agent Temp. difference between

agent and tissue Amount of insulation

Thermal Conductivity Limb circumference Duration of application

Cryotherapy

Leads to vasoconstriction Decreases tissue metabolism Decreases tissue permeability Decreases capillary permeability Decreases pain Decreases spasms Analgesic relief of pain

Cryotherapy

Ideal Temperature 32-65°F 20-30 mins. (10-15 mins.) of treatment 30+ mins. If a towel is used 90 mins. Is the bodies rewarming period Four progressive sensations

Cold Burning Aching Analgesia

Types of Cryotherapy Applications

Cryokinetics Ice Massage Ice Packs Cryocuffs Ice Immersion (Whirlpool) Contrast Bath Commercial Gel and Chemical Packs

Types of Cryotherapy Applications cont.

Controlled Cold-Compression Units Vapocoolant sprays

Cryotherapy Indications

Acute or chronic pain, or muscle spasmAcute inflammationPost surgical pain or edemaSuperficial first-degree burnsFacilitate mobilizationRelieve PainDecrease Muscle spasiticity

Cryotherapy Contraindications

Hypersensitivity Cold Allergy Circulatory or sensory impairment Reynaud’s disease Hypertension Open wounds Cardiac or respiratory disorders Nerve palsy Arthritis

Thermotherapy Increases circulation Increases cellular metabolism Produces analgesic or sedative effect Helps resolve pain and muscle spasming Vasodilatation:

Promotes Healing Increases Oxygen concentrationRemoves debris and waste products

Thermotherapy Modes of use

Conduction Convection Radiation

Types of Applications Whirlpools Hot tubs Jacuzzis Moist heat packs

Paraffin baths Ultrasound Phonophoresis Diathermy heat

Ultrasound Indications

Increase deep tissue heat Decrease inflammation Decrease muscle spasms Decrease pain Increase extensibility of

collagen tissue Decrease pain of neuromas Decrease joint adhesions Treat myositis ossificans

Contraindications Hemorrhage Infection Thrombophlebitis Suspected malignancy Impaired circulation or sensation Stress fracture sites Epiphyseal growth plates Over the Eyes, Heart, Spine, or

genitals

Ultrasound

Thermal effects Non-thermal effects Application of Ultrasound

1MHz 3-5cm of penetration3MHz superficial tissues and tendons

Continuous- 100% Pulsed- 10-50%

Phonophoresis Ultrasound with drugs, used to increase absorption

and penetration of drugs up to 5 or 6 cms Anti-inflammatory’s

CortisolDexamethasoneSalicylates

AnalgesicsLidocaine

Electrotherapy

Decrease pain Increase blood flow Increase Range of Motion Increase muscle strength Muscle re-education Facilitate absorption of medicines

Electricity Flows between two points DC- Direct-current

Continuous one directional flowUsed for pain modulation or muscular contraction also

produce ion movement AC- Alternating-current

Continuous two directional flow of ionsUsed for pain modulation or muscular contraction

Electrotherapy

Amplitude Frequency Pulse duration Pulse charge Electrode set-up Polarity Mode

Duty cycle Duration of Treatment

Electrotherapy TENS (transcutaneous

Electrical Nerve Stimulation)

High-Voltage pulsed stimulation

Neuromuscular Electrical Stimulation

Interferential stimulation

Low-Intensity Stimulation Galvanic Stimulation Russian current Faradic current Iontophoresis

Massage

Effleurage Petrissage Tapotement Vibration Friction

Traction Indications

Herniated disc Spinal nerve impingement Spinal nerve inflammation Joint hypo-mobility Narrowing of intervertebral

foramen Degenerative joint disease Spondylolisthesis Muscle spasm and guarding Joint pain

Contraindications Unstable vertebrae Acute lumbage Gross emphysema S4 nerve root signs Temperomandibular joint

dysfunction Patient discomfort

Drugs

Anti-inflammatory (NSAIDS) Anti-pyretic Analgesics