Therapeutic Modalities in Sports Training: Heat Therapy

1. Athletic Training Modalities 2

2. Modalities: Thermotherapy • Types of Thermotherapy: • Moist Heat: • Whirlpool Bath • A combination of massage and water immersion • A popular thermotherapy used in sportsmedicine.

3. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath • Equipment (Tanks) • Extremity • 15”(wide)x32”(long)x18”-25” (deep) • Legs and arms • Low-Boy • 24”(wide)x62”(long)x18”(deep) • Full body immersion • Lower to the floor • High-Boy • 24”(wide)x32”-48”(long)x28” (deep) • Hip or Leg

4. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (2) • Equipment (2) • Tank with Turbine Motor • Regulates the air and water movement • Amount of movement (agitation) is controlled by the amount of air is emitted (more air/more water movement) • Turbine can be moved up and down, rotated, or locked in place. • Indications • Provides both conduction (Skin contacting the water) and convection (water swirling around skin)

5. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (2) • Indications (2) • Reduce swelling • Reduce muscle spasm • Reduce pain • Active movement of the body part (buoyancy of water)

6. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (3) • Application • Set the Water Temperature • Very Cold Less than 55 • Cold 55-65 • Tepid 80-90 • Neutral 92-96 • Warm 96-98 • Hot 98-104 • Acute Injuries: Very cold-Cold • Chronic Injuries: Tepid-Hot

7. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (4) • Applications (2) • Fill the tank w/water • Have athlete get in a comfortable position • Place the water jet 8”-10” from the injury • Acute injuries: do not to let the water jet hit directly on the injury if it causes pain. • Time: • Acute injuries: no more than 20 minutes • Chronic: 20-30 minutes

8. Modalities: Thermotherapy • Moist Heat: Whirlpool Bath (5) • Special Considerations: • Full body immersion may cause dizziness • Care needs to be taken to prevent the spread of infection • Empty tank after each use • Disinfectant (scrub) • Rinse with clean water • Safety • Ground Fault Circuit Interrupters (GFCI) • Athlete is not to turn whirlpool on or off while in the water • Preferred that the on/off switch be away from the whirlpool

9. Modalities: Thermotherapy • Moist Heat: Paraffin Bath • Equipment • Commercial Paraffin Bath Unit maintains the Paraffin/Mineral Oil mixture at a temperature of 126-130 degrees. The mineral oil lowers the melting point of the paraffin thus allowing the skin to tolerate the higher temperature w/o burning the skin. • Slats in the bottom to protect the athlete from burns & collect settling dirt. • Paper or plastic bags • Towels

10. Modalities: Thermotherapy • Moist Heat: Paraffin Bath (2) • Indications • Appling heat to distal extremities • Good for chronic injuries • Angular body parts (hands, wrist, elbows, ankles and feet) • Application • Thoroughly clean (wash) and dry the body part

11. Modalities: Thermotherapy • Moist Heat: Paraffin Bath (3) • Application (2) • Dip Method • Dip affected part into the paraffin bath and pull it out • Let paraffin harden slightly • Repeat 6-10 times. • After the last dip let the wax harden then place in a plastic bag • Wrap toweling around the plastic bag • After finishing the treatment remove the paraffin and place it back into the Paraffin Bath.

12. Modalities: Thermotherapy • Moist Heat: Paraffin Bath (4) • Application (3) • Soak Method • After dipping the body part into the paraffin bath the athlete leaves it in there for 15-20 minutes w/o moving it. • After finishing the treatment remove from the paraffin and after the paraffin hardens, place it back into the Paraffin Bath.

13. Modalities: Thermotherapy • Deep Heat • Therapeutic Ultrasound • The most commonly used deep heat modality in sports medicine • Uses high frequency sound waves beyond the audible range • Heat is produced by conversion type modality • Sound energy causes molecules in the tissue to vibrate and thus producing heat and mechanical energy • Frequency of sound waves: # of oscillations (movements)/second

14. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (2) • Hertz (Hz): 1Hz = 1 cycle/second • 1kHz = 1000 cycles/second • 1mHz = 1,000,000 cycles/second • The human ear can not detect sounds greater than 20,000 Hz • 1mHz is the frequency most commonly used in ultrasound therapy • The amount of tissue penetration that Ultrasound Therapy will penetrate tissue depends on the type of tissue, tissue density, amount of reflection, scattering and absorption. • The greatest heat is produced between the bone and the adjacent soft tissue

15. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (3) • Equipment: • Therapeutic Ultrasound high frequency generator that produces electricity to the transducer. • The transducer head contains a quartz crystal. Quartz has the property that it can contract and expand. When it contracts and expands it produces the ultrasonic waves. This contraction and expansion is called “piezoeelectrical effect” • The intensity is determined by the amount of energy (electricity) that is delivered to the crystal that is in the sound head. • The intensity is expressed in watts/centimeter squared. • Therapeutic intensities range from 0.1-3.0 w/cm squared.

16. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (4) • Indications • There are 3 types of therapeutic effects from the application of ultrasound: • Thermal Effects • Mechanical Effects • Chemical Effects

17. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (4) • Indications: Thermal • Of skin, muscle and fat the greatest heat is created were the bone/muscle meet (106). • Joint Capsule heated as high as 117.5 • Nerve tissue is 2x as sensitive to ultrasound than muscle. • Increase Collagen Tissue extensibility (main organic part of connective tissue • Alters blood flow • Changes nerve conductivity • Elevates pain threshold • Raises enzymatic activity • Changes muscle contractibility

18. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (5) • Indications: Mechanical • Results from mechanical vibrations (micromassage) • This effect only occurs at very low intensities (.1-.2 w/cm squared) • Indications: Chemical • Accelerates enzymatic activity • Increases capillary permeability • Increases ATP activity in skeletal muscle (ATP=Adenosine Triphosphate: found I all cells& when split energy is produced, energy of muscle is stored in this compound)

19. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (6) • Indications: Other • Joint contracture • Scar tissue • Chronic Tendonitis • Chronic Bursitis • Skeletal muscle spasm • Pain • Undesirable Calcification • Bursitis, tendonitis, myositis ossificans, exostosis • Helps reabsorption of calcium and/or relieves the inflammation • Planter warts

20. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (7) • Application • Ultrasound waves can not travel through air. Since the skin can reflect them there must be some type of coupling medium between the sound head and the skin • The mediums may be lotion, water soluble gels or mineral oil. • Clean the skinprior to any treatment • Direct Skin: Must have a medium • Underwater: water is the medium, No air bubbles

21. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (8) • Combination with other modalities • Hydrocollator Packs • Cryotherapy • Electrotherapy (EGS) • Find trigger points • U.S. increases blood flow while the EGS crates a muscle contraction to help easy the pain/spasm/pain cycle. • Phonophoresis • Method of driving molecules (medication: hyrdocortisone and anesthetic) through the skin by the use of sound waves

22. Modalities: Thermotherapy • Deep Heat: Therapeutic Ultrasound (9) • Special Considerations • Caution must be taken when used over anesthetized areas (pain is the indicator of over treatment) • Caution must be taken when used over areas that have a decrease in circulation • Do not use over high fluid areas • Eyes, ears, testes, spinal cord, brain or heart • Reproductive organs of females • Acute injuries • Epiphyseal plates: very little exposure

23. Modalities: Electrotherapy • Physical Principles • Displays: Magnetic, Chemical, Mechanical and Thermal effects on the body • Electrical current: a string of electrons that pass along a conductor or nerve. • Amperes (amps): measures intensity of the current • Ohms: Measures the resistance of the passage of the electrical current • Voltage: the force that moves the current along • Low Voltage: 0-150 V • High Voltage: above 150 V • Watts (amps x volts): electrical power is measured in

24. Modalities: Electrotherapy • Physical Principles (2) • 2 types of current used in sports medicine • Alternating Current (AC) • Reverses its self 1x/cycle • Used for: • pain modulation • Muscle contraction • Direct Current (DC) {or Galvanic} • Current flows in one direction(+ to -) • Used for: • Pain modulation (Gate control, endogenous opiates) • Muscle contraction • Ion movement (iontophoresis: movement of ions through the skin by the use of electrical current)

25. Modalities: Electrotherapy • Types of Direct Current • Transcutaneous Electrical Nerve Stimulation (TNS or TENS) • Electrogalvanic Muscle Stimulation (EGS) • Electric Muscle Stimulation (EMS)

26. Modalities: Electrotherapy • Transcutaneous Electrical Nerve Stimulation (TNS or TENS) • Used to block the pain signal between the injury and the spinal cord • Stimulates the nerve

27. Modalities: Electrotherapy • Electrogalvanic Muscle Stimulation (EGS) • Stimulates the muscle • 150 V or higher to achieve the best results • Can use for: • Muscle reeducation • Muscle pumping • Muscle strengthening • Atrophy retardation • Iontophoresis

28. Modalities: Electrotherapy • Electric Muscle Stimulation (EMS) • Stimulates the muscle • 0-150 V • Can be use for: • Muscle reeducation • Muscle pumping • Muscle strengthening • Atrophy retardation

29. Modalities • Other Treatment Modalities • Massage • Acupressure • Traction • Intermittent Compression

30. Modalities • Massage: • Definition: Systematic manipulation of the body • Types: • Effleurage: stroking • Petrissage: kneading • Friction: heat producing • Tapotement: percussion • Vibration: rapid shaking

31. Modalities • Massage (2) • Mechanical: • Venous drainage • Lymphatic drainage • Mild stretch of superficial tissue • Stretching and breaking up scar tissue • Physiological: • Relaxation • Stimulation of blood flow • Psychological: • Relaxation

32. Modalities • Massage (3) • Sports Massage • Confined to the specific injury area • Massage Lubricants • Powder, oils, lotions • Confidence • Must be confident in sports massage

33. Modalities • Acupressure • A type of massage that based on acupuncture

34. Modalities • Traction • Drawing tension applied to a body segment • Most commonly used on the cervical and lumbar spine regions • Physiological Effects: • Relief of pressure on nerve roots • Decrease pressure on intervertebral disc • Relief of compression effects of normal posture • Relaxation • Indications: • Relief of spinal nerve impingement • Relief of other nerve impingements

35. Modalities • Intermittent Compression Devices • Pneumatic sleeve applied around the injured extremity with air or water intermittently applied to the area. • Used to control swelling • Used to reduce swelling • Used on acute or chronic injuries • Pitting edema • Creates the movement of lymphatic fluid out of the injured area • Extremity should be elevated during treatment

36. Modalities The End