Therapeutic Modalities

1. Therapeutic Modalities Chapter 6 or 7

2. 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.

3. Electromagnetic Spectrum • Electromagnetic Radiation • Electromagnetic Spectrum • Ionizing Range • Non-Ionizing Range

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

5. Non-Ionizing Range • Ultraviolet- Superficial tissue treatment • Infrared- • Near Infrared- 5-10mm deep • Far Infrared- <2mm deep • Diathermy- Conversion

6. Transfer of Energy • Energy moves from an area of HIGH concentration to an area of LOW concentration. • Radiation • Conduction • Convection • Conversion • Evaporation

7. Radiation • When the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made. • Short-wave Diathermy • Microwave Diathermy

8. 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

9. Convection • Much like conduction, but the medium moves across the body causing variations. • Fluidotherapy • Whirlpools

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

11. 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

12. Factors Affecting Transfer of Energy • Density of Medium • Reflection • Refraction • Absorption • Law of Grotthus-Draper

13. Energy’s Effect on Tissue • Cosine law +/- 10ºF is acceptable • Inverse Square Law E=Es/D² • E= Resulting Energy • Es= Source Energy • D= Distance Squared

14. 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

15. Cryotherapy • Leads to vasoconstriction • Decreases tissue metabolism • Decreases tissue permeability • Decreases capillary permeability • Decreases pain • Decreases spasms • Analgesic relief of pain

16. 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

17. Types of Cryotherapy Applications • Cryokinetics • Ice Massage • Ice Packs • Cryocuffs • Ice Immersion (Whirlpool) • Contrast Bath • Commercial Gel and Chemical Packs

18. Types of Cryotherapy Applications cont. • Controlled Cold-Compression Units • Vapocoolant sprays

19. Cryotherapy • Indications • Acute or chronic pain, or muscle spasm • Acute inflammation • Post surgical pain or edema • Superficial first-degree burns • Facilitate mobilization • Relieve Pain • Decrease Muscle spasiticity

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

21. Thermotherapy • Increases circulation • Increases cellular metabolism • Produces analgesic or sedative effect • Helps resolve pain and muscle spasming • Vasodilatation: • Promotes Healing • Increases Oxygen concentration • Removes debris and waste products

22. Modes of use Conduction Convection Radiation Types of Applications Whirlpools Hot tubs Jacuzzis Moist heat packs Paraffin baths Ultrasound Phonophoresis Diathermy heat Thermotherapy

23. 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

24. Ultrasound • Thermal effects • Non-thermal effects • Application of Ultrasound • 1MHz 3-5cm of penetration • 3MHz superficial tissues and tendons • Continuous- 100% • Pulsed- 10-50%

25. Phonophoresis • Ultrasound with drugs, used to increase absorption and penetration of drugs up to 5 or 6 cms • Anti-inflammatory’s • Cortisol • Dexamethasone • Salicylates • Analgesics • Lidocaine

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

27. Electricity • Flows between two points • DC- Direct-current • Continuous one directional flow • Used for pain modulation or muscular contraction also produce ion movement • AC- Alternating-current • Continuous two directional flow of ions • Used for pain modulation or muscular contraction

28. Amplitude Frequency Pulse duration Pulse charge Electrode set-up Polarity Mode Duty cycle Duration of Treatment Electrotherapy

29. TENS (transcutaneous Electrical Nerve Stimulation) High-Voltage pulsed stimulation Neuromuscular Electrical Stimulation Interferential stimulation Low-Intensity Stimulation Galvanic Stimulation Russian current Faradic current Iontophoresis Electrotherapy

30. Massage • Effleurage • Petrissage • Tapotement • Vibration • Friction

31. 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 Traction

32. Drugs • Anti-inflammatory (NSAIDS) • Anti-pyretic • Analgesics