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PHYSICAL MODALITIES

PHYSICAL MODALITIES. Be familiar with the characteristics of physical modalities that are applied for therapeutic purposes Identify physiological and therapeutic effects of physical modalities Be familiar with contraindications and precautions in using physical modalities

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PHYSICAL MODALITIES

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  1. PHYSICAL MODALITIES

  2. Be familiar with the characteristics of physical modalities that are applied for therapeutic purposes Identify physiological and therapeutic effects of physical modalities Be familiar with contraindications and precautions in using physical modalities Identify adverse effects for each modality Learning objectivies

  3. Learning Objectives Cont’d . . . • When given a clinical scenario, be able to: • Define goals of treatment with a specific physical modality • Choose the appropriate device • Select the appropriate parameters • Apply the treatment safely and competently • Modify treatment if needed

  4. Traction

  5. To treat a variety of cervical and lumbar spine problems • Creates separation of vertebrae • Alters proprioceptive discharge of spine • Stretches connective tissue • Stretches muscle • Improves blood and lymphatic flow • Decreases pressure on disk Indications for Traction

  6. Vertebral joint distraction • Elongation of the cervical spine of 2–20 mm, can be achieved with 25 pounds or more of tractive force • Reduction of compression and nerve root and disc irritation • Reduction of pain, muscle spasm, and inflammation • Loosening of adhesions in the dural sleeves Physiological Effects

  7. Effcets of traction

  8. Intradiscal pressures

  9. Friction is the counterforce that opposes motion or attempted motion Friction is always parallel to the surface in contact and opposite in direction. friction

  10. Friction must be considered when applying traction. You must overcome friction in order to achieve separation of joints. When using a split table for lumbar traction friction is eliminated. Friction

  11. Traction Techniques • Manual Traction

  12. Traction Techniques • Manual Traction • Traction Machines

  13. Traction Techniques • Manual Traction • Traction Machines • Wall-Mounted Traction

  14. Traction Techniques • Manual Traction • Traction Machines • Wall-Mounted Traction • Inversion Traction

  15. General: • Malignancy in the region of the spine • Osteopenia • Infectious process • Congenital spinal deformity contraindications

  16. Cervical ligamentous instability • RA, Down's Syndrome, Marfan Syndrome, Achon-droplastic dwarfism • Infectious process of the spine • Atlantoaxialsubluxation with spinal cord compromise • Vertebrobasilar insufficiency Cervical Contraindications

  17. Pregnancy Caudaequina compression Aortic aneurysms Restrictive lung disease Active peptic ulcer disease Hiatal hernia Lumbar contraindications

  18. Cervical: • sitting or supine position is ordered. Depends on patient's comfort in different positions. To relieve symptoms of nerve root compression, 20°–30° of flexion optimally opens the intervertebral foramina. • Lumbar: • Supine with 90° of hip and knee flexion is the most common position used. Reduces lumbar lordosis and the spine is relatively flexed, opening the intervertebral foramina. Positioning

  19. Intermittent vs. continuous: • Intermittent forces provide a greater pull. These are used for distraction, when neural foramina opening or retraction of herniated disc material is desired • Continuous traction is used for prolonged muscle stretch, such as in muscle relaxation Positioning continued

  20. Cervical spine: • Distraction requires >25 pounds; amounts greater than 50 pounds do not provide additional advantage. For cervical radiculopathy may use 25 pounds with neck flexion described earlier • Lumbar spine: • For posterior vertebral separation requires forces> 50 pounds; for anterior separation forces > 100 pounds are needed Amount of pull

  21. Increased pain due to “rebound effect”: • Patient will initially feel relief after the treatment but start to experience increased pain thereafter potential worse than initially • Science behind it not well understood • Likely due to large forces on the spine • Avoid by gradually progressing forces and constant re-evaluation of patient response Adverse Effects

  22. Continuous passive motion

  23. A technique in which a joint is moved constantly in a mechanical splint to prevent stiffness and to increase the range of motion Usually used post-operatively Thought to prevent scar tissue from developing and decrease the problem of stiffness Continuous passive motion (CPM)

  24. Stiffness following surgery or injury to a joint develops as a progression of four stages : bleeding, edema, granulation tissue, and fibrosis CPM properly applied during the first two stages of stiffness acts to pump blood and edema fluid away from the joint and periarticular tissues This allows maintenance of normal periarticular soft tissue compliance Physiological effects

  25. Obtaining early functional range of motion post operatively Reduction in pain and discomfort Therapeutic effects

  26. Joint replacement Synovectomy Contracture release Excision of heterotopic ossification Fixation of intra-articular fractures Indications

  27. The use of CPM in conjunction with anticoagulation therapy may produce an intra-compartmental haematoma • Skin irritation from the straps or carriage cover may develop precautions

  28. Soft tissue constraints (ligaments) are insufficient: • If the joint is unstable • If rigid fixation of fractures have not been attained contraindications

  29. General principles: Often applied in the recovery room immediately after surgery even when the patient is wearing brace or surgical bandages The arc of motion is often a low arc of 20 to 30 degrees is used initially and progressed to 10 to 15 degrees per day application

  30. The rate of motion is usually 1 cycle per 45 seconds or per 2 minutes The amount of time on the CPM machine ranges from 1 hour, three time a day to continuous for 24 hours. After surgery use is for 6 to 8 hours a day Duration minimum for CPM is usually less than one week when a satisfactory range of motion is reached Application continued

  31. Increased bleeding • Return to the operating room for evacuation of hematoma • Nerve compression palsies • DVT • Wound complications: • CPM must not be used through the full range of motion until the swelling has been reduced. This is accomplished by "working" the end-ranges of motion Adverse effects

  32. Mobilization

  33. A manual therapy technique comprising a continuum of skilled passive movements to the joint complex that are applied at varying speeds and amplitudes, with the intent to restore optimal motion, function, and/or to reduce pain Uses a grading system for progression of force Mobilization therapy

  34. Grade 1: • Passive movement in a small range, approximately 15-25% of the available joint play range • Grade 2: • Bone is passively moved in a moderate range to 50% or half of the available joint play range • Grade 3: • Passive force causes one bone to move to the end of the available joint play range • Grade 4: • Bone is passively moved to the end-range, and a fast thrust is performed. This is manipulation Grading system

  35. A passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit • Active and passive motion occurs within the range of motion of the joint complex and not beyond the joint’s anatomic limit) • Requires extensive training and supervision • NOT performed at the PT tech level Manipulation

  36. Improve tissue extensibility Restore range of motion of a joint complex Optimize muscle function Reduce soft tissue swelling, inflammation or movement restriction Physiological effects

  37. Modulate pain Induce relaxation Increased mobility Improved function Therapeutic effects

  38. Loss of joint range of motion Pain Muscle guarding Indications

  39. Severe osteoarthritis or osteoporosis Tumor or malignancy in the area The cervical region if there is dysfunction with the flow of blood within the vertebral artery Joint bleeding Loose body in a joint Joints near a growth plate Precautions and contraindications

  40. Detailed knowledge of anatomy and biomechanics is required to perform this skill Clinical practice and experience is essential in understanding joint play and the desired motion of each joint Mobilization is not a skill to be preformed at the PT tech level unless advanced training has be taken application

  41. Fracture Dislocation Joint capsule tearing Ligamentous tearing Muscle or tendon injury Nerve damage Adverse effects

  42. Questions?

  43. How much distraction of the cervical spine is achieved with 25 pounds of traction? What position causes the most intradiscal pressure? Which causes the least? What are the general contraindications of traction? When should intermittent vs. continuous traction be applied? What amount of pull in needed in the lumbar spine? Comprehension Check

  44. What is the goal of the CPM? What are the contraindications of CPM? Describe the grading system of mobilization What is manipulation? Are PTTs allowed to manipulate? What are the adverse effects of mobilization and manipulation? Comprehension check

  45. 2-20mm of distraction of the cervical spine is achieved with 25 pounds of traction Seated, bent forward with weights in the hands causes the most intradiscal pressure. Lying supine causes the least Comprehension Check

  46. The general contraindications of traction are: • Malignancy in the region of the spine • Osteopenia • Infectious process • Congenital spinal deformity Answers

  47. Intermittent traction is for a greater pull. It is used for distraction when neural foramina opening or retraction of herniated disc material is desired. Continuous traction is used for prolonged muscle stretch, such as in muscle relaxation For posterior distraction, forces> 50 pounds are needed. For anterior separation, forces > 100 pounds are needed Answers

  48. The goal of the CPM is to prevent scar tissue from developing and decrease the problem of stiffness • The contraindications of CPM are: • Soft tissue constraints (ligaments) are insufficient: • If the joint is unstable • If rigid fixation of fractures have not been attained answers

  49. The grading system of mobilization: • Grade 1: • Passive movement in a small range, approximately 15-25% of the available joint play range • Grade 2: • Bone is passively moved in a moderate range to 50% or half of the available joint play range • Grade 3: • Passive force causes one bone to move to the end of the available joint play range • Grade 4: • Bone is passively moved to the end-range, and a fast thrust is performed. This is manipulation answers

  50. Manipulation is a passive, high velocity, low amplitude thrust applied to a joint complex within its anatomical limit. PTTs are NOT allowed to perform manipulation • The adverse effects of mobilization and manipulation are: • Fracture • Dislocation • Joint capsule tearing • Ligamentous tearing • Muscle or tendon injury • Nerve damage answers

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