The Science of Therapeutic Modalities

2. The Science of Therapeutic Modalities

3. Legal Considerations • Athletic Trainers vs. Physical Therapists • Chiropractors

4. When Do You Use Therapeutic Modalities? • For First Aid Immediately Following Injury • Throughout The Injury Rehabilitation Process

5. Choices • Athletic Trainers Have A Choice Of A Variety of Therapeutic Techniques • Most All Athletic Trainers Eventually Choose To Use Therapeutic Modalities • How You Choose To Use A Therapeutic Modality Is An Individual Decision • The Choice Must Be Based On Theoretical Knowledge And Practical Experience

6. Regardless of Choice Remember….. • When Using a Therapeutic Modality In Rehabilitation It Should Be Used ONLY As An Adjunct To Other Forms Of Therapeutic Exercise

7. How Do We Classify Modalities? • Therapeutic Modalities Used By Athletic Trainers Can Be Classified As Being…. • Electromagnetic • Acoustic • Mechanical

8. Radiation • Process By Which Energy In Various Forms Travels Through Space • Sunlight Is A Form Of Radiant Energy • Many Modalities Produce Radiant Energy

9. Spectrum Red Orange Yellow Green Blue Violet Prism

10. Electromagnetic Radiations • Other Forms Of Radiation Other Than Visible Light May Be Produced When An Electrical Force Is Applied

11. Infrared Spectrum Red Orange Yellow Green Blue Violet Ultraviolet

12. Electromagnetic Radiations • In Addition, Other Forms Of Radiation Beyond Infrared And Ultraviolet Regions May Be Produced When An Electrical Force Is Applied • These Radiations Have Different Wavelengths And Frequencies Than Those In The Visible Light Spectrum

13. Collectively The Various Types Of Radiation Form The Electromagnetic Spectrum

14. Electromagnetic Spectrum Longest Wavelength Lowest Frequency Electrical Stimulating Currents Commercial Radio and Television Shortwave Diathermy Microwave Diathermy Infrared { LASER Visible Light Ultraviolet Shortest Wavelength Highest Frequency Ionizing Radiation

15. Wavelength And Frequency • Wavelength-Distance Between Peak Of One Wave and Peak of the Next Wave • Frequency-Number Of Wave Oscillations Or Vibrations Per Second (Hz, CPS, PPS) • Velocity=Wavelngth X Frequency

16. Electromagnetic Radiations Share Similar Physical Characteristics • Produced When Sufficient Electrical Or Chemical Forces Are Applied To Any Material • Travel Readily Through Space At An Equal Velocity (300,000,000 meters/sec) • Direction Of Travel Is Always In A Straight Line

17. Electromagnetic Radiations Share Similar Physical Characteristics • When Contacting Biological Tissues May Be…

18. Electromagnetic Radiations Share Similar Physical Characteristics • When Contacting Biological Tissues May Be… • Reflected

19. Electromagnetic Radiations Share Similar Physical Characteristics • When Contacting Biological Tissues May Be… • Reflected • Transmitted

20. Electromagnetic Radiations Share Similar Physical Characteristics • When Contacting Biological Tissues May Be… • Reflected • Transmitted • Refracted

21. Electromagnetic Radiations Share Similar Physical Characteristics • When Contacting Biological Tissues May Be… • Reflected • Transmitted • Refracted • Absorbed

22. Laws Governing The Effects of Electromagnetic Radiations • Arndt-Schultz Principle • No Changes Or Reactions Can Occur In The Tissues Unless The Amount Of Energy Absorbed Is Sufficient To Stimulate The Absorbing Tissues

23. Laws Governing The Effects of Electromagnetic Radiations • Law Of Grotthus-Draper • If The Energy Is Not Absorbed It Must Be Transmitted To The Deeper Tissues • The Greater The Amount Absorbed The Less Transmitted and Thus The Less Penetration

24. Laws Governing The Effects of Electromagnetic Radiations • Cosine Law • The Smaller The Angle Between The Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Absorption Source Source

25. Laws Governing The Effects of Electromagnetic Radiations • Inverse Square Law • The Intensity Of The Radiation Striking A Surface Varies Inversely With The Square Of The Distance From The Source Source 1 Inch 2 Inch

26. Electromagnetic Modalities • The Majority of Therapeutic Modalities Used By Athletic Trainers Emit A Type Of Energy With Wavelengths And Frequencies That Can Be Classified As Electromagnetic Radiations

27. Electromagnetic Modalities Include... • Electrical Stimulating Currents • Shortwave And Microwave Diathermy • Infrared Modalities • Thermotherapy • Cryotherapy • Ultraviolet Radiation Therapy • Low-Power Lasers • Magnet Therapy

28. Electrical Stimulating Currents

29. Electrical Stimulating Currents • All Can Be Classified As Transcutaneous Electrical Stimulating Currents • Electrical Muscle Stimulators (EMS) • Transcutaneous Electrical Nerve Stimulators (TENS) • Low Intensity Stimulators (LIS / MENS)

30. Electrical Stimulating Currents • Russian Currents • Interferential Currents

31. Electrical Stimulating Currents • Russian Currents • Interferential Currents • Low-Volt Currents (Iontophoresis)

32. Electrical Stimulating Currents • Used Primarily For • Pain Modulation • Muscle Contraction • To Create Ion Movement

33. What Can Electrical Stimulating Currents Be Used For? • Pain Modulation • Stimulation of sensory cutaneous nerves (Gate Control) at high frequency i.e. TENS • Production of B-endorphins at lower frequency i.e. Electroacutherapy

34. What Can Electrical Stimulating Currents Be Used For? • Producing Muscle Contraction, Relaxation, And Tetany • Depends On Type Of Current • Alternating (AC) • Direct (DC) • Polyphasic (Interferential) • Depends On Frequency (Russian Currents)

35. Therapeutic Uses Of Electrically Induced Muscle Contraction • Muscle Re-education • Biofeedback • Uses Surface EMG To Measure, Process, And Feedback Reinforcing Information Via Auditory Or Visual Signals • Helps Athlete Develop Greater Voluntary Control In Terms Of Either Neuromuscular Relaxation Or Muscle Re-education

36. Therapeutic Uses Of Electrically Induced Muscle Contraction • Muscle Re-education • Muscle Pumping Contractions To Reduce Edema • Retardation Of Atrophy • Muscle Strengthening • Increasing Range Of Motion

37. What Can Electrical Stimulating Currents Be Used For? • Facilitating Soft Tissue And Bone Healing Through Biostimulative Effects • Subsensory Microamperage Currents (LIS)

38. What Can Electrical Stimulating Currents Be Used For? • Producing a Net Movement Of Ions Through The Use Of Continuous Low-voltage Currents That Elicit A Chemical Change In The Tissues (Iontophoresis)

39. Shortwave And Microwave Diathermy

40. Diathermy • High Frequency Electromagnetic Energy • Cannot Depolarize Nerve or Muscle • Both SWD and MWD Used Primarily To Generate Heat In The Tissues • SWD Also Used For Nonthermal Effects

41. Shortwave Diathermy • Generators Induce Magnetic And/Or Electrical Fields • May Be Either Continuous Or Pulsed • Continuous SWD Produces High Frequency Vibration Of Molecules In Tissues Generating Heat • Pulsed SWD Causes Repolarization In Damaged Cells Correcting Dysfunction

42. When Should Diathermy Be Used? • If The Skin Or Some Underlying Soft Tissue Is Tender And Will Not Tolerate Pressure • In Areas Where Subcutaneous Fat Is Thick And Deep Heating Is Required • Pulsed SWD Produces The Same Magnitude And Depth Of Muscle Heating as 1MHz Ultrasound (Draper, JAT 1997) • When The Treatment Goal Is To Increase Tissue Temperatures In A Large Area

43. Infrared Modalities • Cold = Cryotherapy • Heat = Thermotherapy

44. Cryotherapy

45. What Should Cryotherapy Be Used For? • To Decrease Local Temperature • To Decrease Local Metabolism • To Decrease Blood Flow (Vasoconstriction) • To Decrease Venous And Lymphatic Flow • To Decrease Nerve Conduction Velocity • To Decrease Muscle Excitability • Analgesia

46. Cryotherapy Techniques • Ice Bags or Ice Packs

47. Cryotherapy Techniques • Ice Bags or Ice Packs • Ice Massage

48. Cryotherapy Techniques • Ice Bags or Ice Packs • Ice Massage • Fluori-methane (Spray and Stretch)

49. Cryotherapy Techniques • Ice Bags or Ice Packs • Ice Massage • Fluori-methane (Spray and Stretch) • Contrast Bath

50. Thermotherapy