Chapter 12

2. Chapter 12 Therapeutic Physical Modalities

3. Objectives • Upon completion of this chapter, you should be able to: • Explain the use and effectiveness of physical modalities • Describe the various thermal modalities and their applications

4. Objectives (cont’d.) • Upon completion of this chapter, you should be able to (cont’d.): • Explain and describe the use of therapeutic ultrasound • Explain and describe the use of electrical modalities

5. Therapeutic Physical Modalities • Therapeutic physical modalities • Heating, cooling, and mechanical/electrical methods of treatment used on the human body • Physical modalities • Hot and cold treatments, therapeutic ultrasound, and various electrical modalities

6. Therapeutic Physical Modalities (cont’d.) • Used along with other forms of treatment • To relieve pain, reduce or retard swelling, decrease spasm, and promote healing • Can minimize time lost from participation • Used improperly, condition may worsen

7. Thermal Modalities • Cryotherapy • Use of cooling agents (e.g., cold packs, cold bucket baths, and ice massage) • Most widely used therapy • Responses include: reduction of tissue metabolism, decreased nerve conduction velocity, reduced muscle spasm, secondary vasodilatation, and increased in muscle strength • If left on too long, counter effects may occur

8. Thermal Modalities (cont’d.) • Ice packs • Effective for local areas of concern • Quick and economical • Plastic bags with ice cubes • Gel packs • Chemical-activated cold pack

9. Thermal Modalities (cont’d.) • Ice massage • Used for localized problems (e.g., tennis elbow) • Only takes about five minutes

10. Thermal Modalities (cont’d.) • Cold water compression • Cold and compression applied simultaneously

11. Thermal Modalities (cont’d.) • Ice baths • Immersion in a bucket of ice water • Allows complete, uniform coverage • Some exercise movements may be performed

12. Thermal Modalities (cont’d.) • Contraindications/precautions • Cryotherapy should be used with caution on persons who have: • Thermoregulatory problems • Sensory deficits • Hypersensitivity to cold • Impaired circulation • Heart disease • Malignant tissue

13. Thermal Modalities (cont’d.) • Heating agents • Heat is applied superficially (skin deep), or with a modality capable of heating tissues up to a few inches beneath the skin • Beneficial effects: • Reduced pain • Promotion of healing • Increased range of motion • Muscle relaxation

14. Thermal Modalities (cont’d.) • Heating agents (cont’d.) • Localized vigorous heating effects: • Substantially increased vasodilatation • Increased metabolic rate and capillary pressure and flow • Clearance of metabolites • Oxygenation of tissue

15. Thermal Modalities (cont’d.) • Hydrocollator packs • Moist hot packs used for superficial heating • Kept warm in a heated stainless-steel container filled with hot water in the range of 60°C to 90°C • Left in place for 10 to 20 minutes contradictions [Insert Figure 12-6]

16. Thermal Modalities (cont’d.) • Contraindications/precautions • ATC must assess the condition and injury status • Heat is not used until 48 to 72 hours after injury • Heat dilates the vessels and could cause additional bleeding if healing is not adequate

17. Thermal Modalities (cont’d.) • Contraindications/precautions (cont’d.) • Heat should not be used: • In acute states, with athletes who have impaired circulation, in areas of diminished sensation, or with athletes who may be heat intolerant

18. Thermal Modalities (cont’d.) • Hydrotherapy • Superficial heating • Agitated, heated water in a whirlpool • Larger area on an extremity can be treated • Athlete can perform range-of-motion exercises

19. Thermal Modalities (cont’d.) • Contrast therapy • Alternating hot and cold water baths for specified time periods • May be used in the subacute injury stage (48 to 72 hours after the injury incurs)

20. Thermal Modalities (cont’d.) • Ultrasound • Deep-heating modality • Not recommended during acute injury stage

21. Therapeutic Electrical Modalities • Pass electrical currents through skin into the body causing nerve tissue stimulation • Use may be limited by law • Two main categories: • Electrical stimulation • Transcutaneous electrical nerve stimulation

22. Therapeutic Electrical Modalities (cont’d.) • Electrical stimulation therapy • Effects include increasing range of motion and muscle strength, reeducating muscles, improving muscle tone, controlling pain, etc. • Neuromuscular electrical stimulation is most common

23. Therapeutic Electrical Modalities (cont’d.) • Transcutaneous electrical nerve stimulation • Commonly applied with a portable unit for pain control • Electric current is applied through a surface electrode pad that is in contact with the external skin surface

24. Therapeutic Electrical Modalities (cont’d.) • Contraindications • Electrical stimulation should not be used: • Over the carotid sinus • During pregnancy • In individuals with pacemakers • On people who are sensitive to electricity • Any time active motion is contraindicated

25. Conclusion • Appropriate selection and use of physical therapeutic modalities can have a dramatic beneficial effect • The wrong selection can have an adverse effect • Careful consideration of the nature and stage of the injury is mandatory