KIN 188 – Prevention and KIN 188 – Prevention and Care of Athletic InjuriesCare of Athletic Injuries

Therapeutic Modalities and Therapeutic Modalities and RehabilitationRehabilitation

Therapeutic ModalitiesTherapeutic Modalities

• Modality applications based upon injury site, type of Modality applications based upon injury site, type of injury and severity of injury as well as on MD injury and severity of injury as well as on MD prescription (often implied)prescription (often implied)

• Used to create optimal environment for tissue Used to create optimal environment for tissue healing by limiting inflammatory response and healing by limiting inflammatory response and breaking pain/spasm cycle – focus on breaking pain/spasm cycle – focus on cryotherapy/thermotherapycryotherapy/thermotherapy

• IndicationsIndications– Condition that may benefit from the use of particular Condition that may benefit from the use of particular

modalitymodality

• ContraindicationsContraindications– Condition may be adversely affected by use of particular Condition may be adversely affected by use of particular

modalitymodality

Transfer of EnergyTransfer of Energy

• RadiationRadiation– Transfer of energy without direct contact – diathermy, heat Transfer of energy without direct contact – diathermy, heat

lampslamps• ConductionConduction

– Direct transfer from objects of different temperatures in Direct transfer from objects of different temperatures in contact with one another – ice bags, heat packscontact with one another – ice bags, heat packs

• ConvectionConvection– Occurs when medium (air/water) passes over skin surface Occurs when medium (air/water) passes over skin surface

creating temperature change (affected by rate of movement of creating temperature change (affected by rate of movement of medium) – whirlpools (cold/warm, fans)medium) – whirlpools (cold/warm, fans)

• ConversionConversion– Changes another energy form into heat – in ultrasound, Changes another energy form into heat – in ultrasound,

mechanical energy converted to heat in tissuesmechanical energy converted to heat in tissues• EvaporationEvaporation

– Heat lost as liquid spread over skin surface (liquid becomes Heat lost as liquid spread over skin surface (liquid becomes gas) – vapocoolant sprays, sweatinggas) – vapocoolant sprays, sweating

Cryotherapy PrinciplesCryotherapy Principles

• Typically used in acute situations to Typically used in acute situations to limit inflammatory response and limit inflammatory response and decrease cell metabolismdecrease cell metabolism

• Pain reduced by decreasing nerve Pain reduced by decreasing nerve conduction velocity and decreasing conduction velocity and decreasing muscle spindle activity which muscle spindle activity which decreases muscle spasm and breaks decreases muscle spasm and breaks pain/spasm cyclepain/spasm cycle

• Most treatments last ~15-20 minutesMost treatments last ~15-20 minutes

Cryotherapy PrinciplesCryotherapy Principles

• IndicationsIndications– Acute/chronic painAcute/chronic pain– Acute inflammationAcute inflammation– Muscle spasmMuscle spasm– Post-operative pain Post-operative pain

and swellingand swelling

• ContraindicationsContraindications– Cold allergy/sensitivityCold allergy/sensitivity– Impaired circulationImpaired circulation– Impaired sensationImpaired sensation– Hypertension (severe)Hypertension (severe)– Open wound Open wound

considerationsconsiderations– Cardiac or respiratory Cardiac or respiratory

disorders (body part disorders (body part specific applications)specific applications)

Cryotherapy PrinciplesCryotherapy Principles

• RICE (R) protocol for acute injuryRICE (R) protocol for acute injury

• R – restR – rest

• I – iceI – ice

• C – compressionC – compression

• E – elevationE – elevation

• (R) – referral, if necessary(R) – referral, if necessary

Cryotherapy ApplicationsCryotherapy Applications

• Ice massageIce massage– Ice frozen in cup and massaged onto small area of skinIce frozen in cup and massaged onto small area of skin– Most common application to muscle injuries, spasmsMost common application to muscle injuries, spasms– Fast treatment time (often <5 minutes)Fast treatment time (often <5 minutes)

• Ice packs/bagsIce packs/bags– Easily combined with elevation and compressionEasily combined with elevation and compression– Mold well to body contoursMold well to body contours

• Ice immersion/cold whirlpoolIce immersion/cold whirlpool– ““Slush bucket” vs. whirlpool – temps kept between 50-Slush bucket” vs. whirlpool – temps kept between 50-

6060˚F – use of toe caps˚F – use of toe caps– Care regarding gravity dependent position for acute Care regarding gravity dependent position for acute

injuries – add compressioninjuries – add compression

Cryotherapy ApplicationsCryotherapy Applications

• Commercial gel/chemical packsCommercial gel/chemical packs– Gel packs kept in freezer, chemical packs Gel packs kept in freezer, chemical packs

“activated” by squeezing“activated” by squeezing– Must be careful about leaks and potential for Must be careful about leaks and potential for

frostbitefrostbite

• Intermittent compression unitsIntermittent compression units– Boot/sleeve with cold water circulated through it to Boot/sleeve with cold water circulated through it to

minimize swelling, typically also elevate affected minimize swelling, typically also elevate affected areaarea

• Vapo-coolant spraysVapo-coolant sprays– Flourimethane is most common, spray and stretch Flourimethane is most common, spray and stretch

application for spasms/trigger pointsapplication for spasms/trigger points

Thermotherapy PrinciplesThermotherapy Principles

• Typically used after inflammatory process Typically used after inflammatory process has subsided to increase blood flow and has subsided to increase blood flow and promote healingpromote healing– If used on acute injury, will worsen swellingIf used on acute injury, will worsen swelling– Vasodilation response brings oxygen and Vasodilation response brings oxygen and

nutrients and rids waste products and debrisnutrients and rids waste products and debris

• Increases extensibility of connective tissue Increases extensibility of connective tissue – pre-stretching/rehab applications– pre-stretching/rehab applications

• Most treatments last ~15-20 minutesMost treatments last ~15-20 minutes

Thermotherapy PrinciplesThermotherapy Principles

• IndicationsIndications– Subacute or chronic Subacute or chronic

inflammationinflammation– Muscle spasmMuscle spasm– Decreased ROMDecreased ROM– Joint contractureJoint contracture

• ContraindicationsContraindications– Acute inflammationAcute inflammation– Impaired circulationImpaired circulation– Impaired sensationImpaired sensation– Impaired thermal Impaired thermal

regulationregulation– MalignancyMalignancy– Open wound Open wound

considerationsconsiderations

Thermotherapy ApplicationsThermotherapy Applications

• Warm whirlpoolWarm whirlpool– Must use GFCI for safety, use of “jets” adds massage effectMust use GFCI for safety, use of “jets” adds massage effect– Temps kept between 102-110Temps kept between 102-110˚F, care with full body ˚F, care with full body

immersionimmersion

• Moist heat packMoist heat pack– Hydrocollator (silicate/sand filled) packs kept at 158-170Hydrocollator (silicate/sand filled) packs kept at 158-170˚F˚F– Wrapped in covers/toweling and applied to bodyWrapped in covers/toweling and applied to body– Effects are superficialEffects are superficial

• Paraffin bathParaffin bath– Best for providing heat to contoured areas (hands, feet)Best for providing heat to contoured areas (hands, feet)– Wax and oil heated to liquid state (118-126Wax and oil heated to liquid state (118-126˚F)˚F)– Immersion method vs. wrap/pack/glove methodImmersion method vs. wrap/pack/glove method

RehabilitationRehabilitation

• When developing a therapeutic exercise program, often helpful to When developing a therapeutic exercise program, often helpful to follow sequential steps in program designfollow sequential steps in program design

• Patient assessmentPatient assessment– ROM, muscle strength, neurological integrity, joint stability, level of ROM, muscle strength, neurological integrity, joint stability, level of

functional activitiesfunctional activities• Interpretation of assessmentInterpretation of assessment

– Allows for identification of primary and secondary structural and Allows for identification of primary and secondary structural and functional deficitsfunctional deficits

• Establishment of goalsEstablishment of goals– Short-term and long-term goals for return to functional activitiesShort-term and long-term goals for return to functional activities

• Develop and supervise planDevelop and supervise plan– Establishment of techniques and applications to address each deficit Establishment of techniques and applications to address each deficit

and meet established goalsand meet established goals• Reassess progressReassess progress

– Goals and/or treatment applications may change based upon progress Goals and/or treatment applications may change based upon progress or the lack thereofor the lack thereof

Phases of RehabilitationPhases of Rehabilitation

• Significant variability in language and Significant variability in language and terminology amongst different referencesterminology amongst different references

• Each phase has specific therapeutic Each phase has specific therapeutic objectives and criteria for progression to next objectives and criteria for progression to next phasephase– Often overlap between phasesOften overlap between phases– For all phases, techniques and applications should For all phases, techniques and applications should

be as functional as they can be given the be as functional as they can be given the circumstancescircumstances

Phases of RehabilitationPhases of Rehabilitation

• Phase I – Immobilization PhasePhase I – Immobilization Phase– Characterized by desire to limit inflammatory Characterized by desire to limit inflammatory

response and minimize effects of immobilizationresponse and minimize effects of immobilization• Phase II – Introduction of Vigorous Phase II – Introduction of Vigorous

Therapeutic ExerciseTherapeutic Exercise– ROM, strength/power/endurance, proprioceptionROM, strength/power/endurance, proprioception

• Phase III – Return to Functional ActivitiesPhase III – Return to Functional Activities– Sport-specific activities followed by return to playSport-specific activities followed by return to play

• Phase IV – MaintenancePhase IV – Maintenance– Continued efforts to maintain physiological Continued efforts to maintain physiological

response to rehab efforts to minimize risk of re-response to rehab efforts to minimize risk of re-injuryinjury