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The Science of Therapeutic Modalities Legal Considerations Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists ChiropractorsChiropractors.

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Presentation on theme: "The Science of Therapeutic Modalities Legal Considerations Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists ChiropractorsChiropractors."— Presentation transcript:

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3 The Science of Therapeutic Modalities

4 Legal Considerations Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists ChiropractorsChiropractors Athletic Trainers vs. Physical TherapistsAthletic Trainers vs. Physical Therapists ChiropractorsChiropractors

5 When Do You Use Therapeutic Modalities? For First Aid Immediately Following InjuryFor First Aid Immediately Following Injury Throughout The Injury Rehabilitation ProcessThroughout The Injury Rehabilitation Process For First Aid Immediately Following InjuryFor First Aid Immediately Following Injury Throughout The Injury Rehabilitation ProcessThroughout The Injury Rehabilitation Process

6 ChoicesChoices 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 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

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

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

9 RadiationRadiation Process By Which Energy In Various Forms Travels Through SpaceProcess By Which Energy In Various Forms Travels Through Space Sunlight Is A Form Of Radiant EnergySunlight Is A Form Of Radiant Energy Many Modalities Produce Radiant EnergyMany Modalities Produce Radiant Energy Process By Which Energy In Various Forms Travels Through SpaceProcess By Which Energy In Various Forms Travels Through Space Sunlight Is A Form Of Radiant EnergySunlight Is A Form Of Radiant Energy Many Modalities Produce Radiant EnergyMany Modalities Produce Radiant Energy

10 Red Orange Yellow Green Blue Violet

11 Electromagnetic Radiations Other Forms Of Radiation Other Than Visible Light May Be Produced When An Electrical Force Is AppliedOther Forms Of Radiation Other Than Visible Light May Be Produced When An Electrical Force Is Applied

12 RedRed OrangeOrange YellowYellow GreenGreen BlueBlue VioletViolet InfraredInfrared UltravioletUltraviolet

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

14 Collectively The Various Types Of Radiation Form The Electromagnetic Spectrum

15 Electrical Stimulating Currents Commercial Radio and Television Shortwave Diathermy Microwave Diathermy InfraredInfrared LASERLASER Visible Light UltravioletUltraviolet Ionizing Radiation {{ Longest LongestWavelength Wavelength Shortest ShortestWavelength Wavelength Lowest LowestFrequency Frequency Highest HighestFrequency Frequency

16 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 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

17 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 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

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

19 Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… –Reflected When Contacting Biological Tissues May Be… –Reflected

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

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

22 Electromagnetic Radiations Share Similar Physical Characteristics When Contacting Biological Tissues May Be… –Reflected –Transmitted –Refracted –Absorbed When Contacting Biological Tissues May Be… –Reflected –Transmitted –Refracted –Absorbed

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

24 Laws Governing The Effects of Electromagnetic Radiations Law Of Grotthus-DraperLaw 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 Law Of Grotthus-DraperLaw 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

25 Laws Governing The Effects of Electromagnetic Radiations Cosine LawCosine Law –The Smaller The Angle Between The Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Absorption Cosine LawCosine Law –The Smaller The Angle Between The Propagating Radiation And The Right Angle, The Less Radiation Reflected And The Greater The Absorption Source

26 Laws Governing The Effects of Electromagnetic Radiations Inverse Square LawInverse Square Law –The Intensity Of The Radiation Striking A Surface Varies Inversely With The Square Of The Distance From The Source Inverse Square LawInverse 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

27 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

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

29 Electrical Stimulating Currents

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

31 Electrical Stimulating Currents Russian CurrentsRussian Currents Interferential CurrentsInterferential Currents Russian CurrentsRussian Currents Interferential CurrentsInterferential Currents

32 Electrical Stimulating Currents Russian CurrentsRussian Currents Interferential CurrentsInterferential Currents Low-Volt Currents (Iontophoresis)Low-Volt Currents (Iontophoresis) Russian CurrentsRussian Currents Interferential CurrentsInterferential Currents Low-Volt Currents (Iontophoresis)Low-Volt Currents (Iontophoresis)

33 Electrical Stimulating Currents Used Primarily For –Pain Modulation –Muscle Contraction –To Create Ion Movement Used Primarily For –Pain Modulation –Muscle Contraction –To Create Ion Movement

34 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 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

35 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) Producing Muscle Contraction, Relaxation, And Tetany –Depends On Type Of Current Alternating (AC) Direct (DC) Polyphasic (Interferential) –Depends On Frequency (Russian Currents)

36 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 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

37 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 Muscle Re-education Muscle Pumping Contractions To Reduce Edema Retardation Of Atrophy Muscle Strengthening Increasing Range Of Motion

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

39 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)

40 Shortwave And Microwave Diathermy

41 DiathermyDiathermy 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 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

42 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 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

43 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 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

44 Infrared Infrared Modalities Cold = Cryotherapy Heat = Thermotherapy Cold = Cryotherapy Heat = Thermotherapy

45 Cryotherapy

46 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 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

47 Cryotherapy Techniques Ice Bags or Ice PacksIce Bags or Ice Packs

48 Cryotherapy Techniques Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage

49 Cryotherapy Techniques Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage Fluori-methane (Spray and Stretch)Fluori-methane (Spray and Stretch) Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage Fluori-methane (Spray and Stretch)Fluori-methane (Spray and Stretch)

50 Cryotherapy Techniques Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage Fluori-methane (Spray and Stretch)Fluori-methane (Spray and Stretch) Contrast BathContrast Bath Ice Bags or Ice PacksIce Bags or Ice Packs Ice MassageIce Massage Fluori-methane (Spray and Stretch)Fluori-methane (Spray and Stretch) Contrast BathContrast Bath

51 Thermotherapy

52 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 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

53 Thermotherapy Techniques Hydrocollator PacksHydrocollator Packs

54 Thermotherapy Techniques Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools

55 Thermotherapy Techniques Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools Paraffin BathsParaffin Baths Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools Paraffin BathsParaffin Baths

56 Thermotherapy Techniques Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools Paraffin BathsParaffin Baths FluidotherapyFluidotherapy Hydrocollator PacksHydrocollator Packs WhirlpoolsWhirlpools Paraffin BathsParaffin Baths FluidotherapyFluidotherapy

57 Ultraviolet Light Therapy

58 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 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

59 LASER Therapy

60 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 Helium-Neon (HeNe) & Gallium-Arsenide (GaAs) Produces No Thermal Effects Soft-tissue And Fracture Healing Pain Management Not Approved By FDA For Therapeutic Use

61 Magnet Therapy

62 Despite Popularity No One Really Knows How They Work!! Generally Thought To Be Safe Despite Popularity No One Really Knows How They Work!! Generally Thought To Be Safe

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

64 Therapeutic Ultrasound

65 Unlike Other Modalities Ultrasound Is Acoustic Energy

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

67 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 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

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

69 Mechanical Modalities

70 Intermittent Compression

71 Mechanical Units That Create External Pressure Facilitates Venous And Lymphatic Reabsorbtion Of Edema Helps Decrease Pain & Increase ROM Mechanical Units That Create External Pressure Facilitates Venous And Lymphatic Reabsorbtion Of Edema Helps Decrease Pain & Increase ROM

72 Traction

73 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 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

74 Traction Techniques Manual TractionManual Traction

75 Traction Techniques Manual TractionManual Traction Traction MachinesTraction Machines Manual TractionManual Traction Traction MachinesTraction Machines

76 Traction Techniques Manual TractionManual Traction Traction MachinesTraction Machines Wall-Mounted TractionWall-Mounted Traction Manual TractionManual Traction Traction MachinesTraction Machines Wall-Mounted TractionWall-Mounted Traction

77 Traction Techniques Manual TractionManual Traction Traction MachinesTraction Machines Wall-Mounted TractionWall-Mounted Traction Inversion TractionInversion Traction Manual TractionManual Traction Traction MachinesTraction Machines Wall-Mounted TractionWall-Mounted Traction Inversion TractionInversion Traction

78 Massage Techniques

79 Massage Many Massage Techniques –Hoffa Massage –Acupressure/Shiatsu –Connective Tissue –Myofascial Release –Rolfing –Trager Many Massage Techniques –Hoffa Massage –Acupressure/Shiatsu –Connective Tissue –Myofascial Release –Rolfing –Trager

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

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