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 Electrical Stimulating Currents
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

51. What Should Thermotherapy Be Used For?
To Increase Local Temperature
To Increase Local Metabolism
To Increase Blood Flow (Vasodilation)
To Increase Venous And Lymphatic Drainage
To Increase Elasticity of Muscles & Ligaments
To Increase Nerve Conduction Velocity
To Increase Muscle Excitability
Analgesia

52. Thermotherapy Techniques
Hydrocollator Packs

53. Thermotherapy Techniques
Hydrocollator Packs
Whirlpools

54. Thermotherapy Techniques
Hydrocollator Packs
Whirlpools
Paraffin Baths

55. Thermotherapy Techniques
Hydrocollator Packs
Whirlpools
Paraffin Baths
Fluidotherapy

56. Ultraviolet Light Therapy

57. What Can Ultraviolet Therapy Be Used For?
Causes Chemical Changes In Skin That Have A Bactericidal Effect
Effects Are Primarily Superficial In Nature (<2mm)
To Treat A Variety Of Skin Lesions Including Acne, Folliculitis, Pityriasis, Tinea, Septic Wounds
Seldom Used In Treatment Because Of Availability Of Topical Agents

58. LASER Therapy

59. What Are Low-Power Lasers Used For?
Helium-Neon (HeNe) & Gallium-Arsenide (GaAs)
Produces No Thermal Effects
Soft-tissue And Fracture Healing
Pain Management
Not Approved By FDA For Therapeutic Use

60. Magnet Therapy

61. Magnet Therapy Despite Popularity No One Really Knows How They Work!!
Generally Thought To Be Safe

62. What Are Magnets Used For?
Pain Modulation
Facilitate Strength
Explanations
Increased Circulation
Increased Temperature
Changes In pH
Reestablishing Normal Polarity Within The Injured Cell

63. Therapeutic Ultrasound

64. Unlike Other Modalities Ultrasound Is Acoustic Energy

65. Ultrasound
Frequently Classified With Diathermy As A “Deep Heating” Modality
Mechanical Vibration
Sound Wave Trans-formed From High Frequency Electrical Energy

66. Acoustic Energy Cannot Travel Through Space
Relies On Molecular Collision For Transmission
More Dense Medium = Higher Velocity Of Travel
Depth Of Penetration Greater Than Any Form Of Electromagnetic Energy

67. What Should Ultrasound Be Used For?
Thermal Effects Particularly In Deeper Tissues
Non-Thermal Effects
To Enhance Healing At Cellular Level

68. Mechanical Modalities

69. Intermittent Compression

70. Intermittent Compression
Mechanical Units That Create External Pressure
Facilitates Venous And Lymphatic Reabsorbtion Of Edema
Helps Decrease Pain & Increase ROM

71. Traction

72. What Should Traction Be Used For?
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

73. Traction Techniques
Manual Traction

74. Traction Techniques
Manual Traction
Traction Machines

75. Traction Techniques Manual Traction Traction Machines
Wall-Mounted Traction

76. Traction Techniques Manual Traction Traction Machines
Wall-Mounted Traction
Inversion Traction

77. Massage Techniques

78. Massage Many Massage Techniques Hoffa Massage Acupressure/Shiatsu
Connective Tissue
Myofascial Release
Rolfing
Trager

79. What Should Massage Be Used For?
Massage Has Effects On:
Circulation And Lymphatic Flow
Nervous System
Muscles
Myofascia
Skin
Scar Tissue
Psychological Responses
Relaxation
Pain