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Chapter 15: Therapeutic Modalities. Therapeutic Modalities In any rehabilitation program, modalities should be used primarily as adjuncts to therapeutic.

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Presentation on theme: "Chapter 15: Therapeutic Modalities. Therapeutic Modalities In any rehabilitation program, modalities should be used primarily as adjuncts to therapeutic."— Presentation transcript:

1 Chapter 15: Therapeutic Modalities

2 Therapeutic Modalities In any rehabilitation program, modalities should be used primarily as adjuncts to therapeutic exercise and certainly not at the exclusion of range-of-motion or strengthening exercise. In any rehabilitation program, modalities should be used primarily as adjuncts to therapeutic exercise and certainly not at the exclusion of range-of-motion or strengthening exercise.

3 Transmission of Thermal Energy Conduction Heating through direct contact with a hot medium (e.g., hot pack). Conduction Heating through direct contact with a hot medium (e.g., hot pack). ConvectionHeating indirectly through another medium such as air or liquid (e.g., whirlpool) ConvectionHeating indirectly through another medium such as air or liquid (e.g., whirlpool) RadiationTransfer of heat through space from one object to another (e.g., ultraviolet therapy) RadiationTransfer of heat through space from one object to another (e.g., ultraviolet therapy) ConversionHeating through other forms of energy (e.g., ultrasound) ConversionHeating through other forms of energy (e.g., ultrasound)

4 Cryotherapy Application of cold; the major therapeutic value of cold is its ability to produce anesthesia, allowing pain-free exercise. Cold as a therapeutic agent is a type of electromagnetic energy classified as infrared radiation. Wet ice is a more effective coolant because of the extent of internal energy needed to melt the ice. Application of cold; the major therapeutic value of cold is its ability to produce anesthesia, allowing pain-free exercise. Cold as a therapeutic agent is a type of electromagnetic energy classified as infrared radiation. Wet ice is a more effective coolant because of the extent of internal energy needed to melt the ice.

5 Hunting Response Causes a slight temperature increase during cooling. The extent of cooling depends on the thickness of the subcutaneous fat layer. Causes a slight temperature increase during cooling. The extent of cooling depends on the thickness of the subcutaneous fat layer.

6 Skin Response to Cold Stage1 Stage1 Response Response –Cold sensation Estimated Time after Initiation Estimated Time after Initiation –0 to 3 minutes

7 Skin Response to Cold Stage2 Stage2 Response Response –Mild burning, aching Estimated Time after Initiation Estimated Time after Initiation –2 to 7 minutes

8 Skin Response to Cold Stage3 Stage3 Response Response –Relative cutaneous anesthesia Estimated Time after Initiation Estimated Time after Initiation –5 to 12 minutes

9 Physiological Variables of Crotherapy VariableResponse to Therapy Muscle spasmDecreases Muscle spasmDecreases Pain perceptionDecreases Pain perceptionDecreases Blood flowDecreases Blood flowDecreases Metabolic rateDecreases Metabolic rateDecreases Collagen elasticityDecreases Collagen elasticityDecreases Joint stiffnessIncreases Joint stiffnessIncreases Capillary permeabilityDecrease Capillary permeabilityDecrease EdemaControversial EdemaControversial

10 Acute Conditions Acute Inflammation Acute Injury Acute Pain Acute Problems to Gravity Acute Problems to Turbulence Anesthetized Skin Cardiac Involvement Chronic Inflammation Chronic Muscle Spasm Chronic Pain Circulatory Insufficiencies/Impairment Cold Allergy Cold Hypersensitivity Contusions Decreased Range of Morion Distal Body Parts Fever Hematoma Resolution Infection Muscle Strain Peripheral Nerve Injuries Peripheral Vascular Disease Poor Thermal Regulation Post-Surgical Edema Post-Surgical Pain Pressure Contraindications Reduction of Joint Contractures Reduction of Subacute Pain Requiring Postural Support Respiratory Involvement Sensory Loss Skin Conditions/Infections Small Areas Subacute Inflammation Subacute Injury Subacute Muscle Spasm Suspected Fractures Uncovered Open Wounds Ice Massage I C ICCCI I C III CC 15 to 30 minutes Cryotherapeutic Cold or Ice Water Immersion III CC ICCC I II C C 15 to 30 minutes 50°F to 60°F Cryotherapeutic Hydrotherapy Ice Packs (Bags) III CC ICCC II C C 15 to 30 minutes Cryotherapeutic Cold Whirlpool CCCCI CCC I II CC C I C 15 to 30 minutes 50°F to 60°F Cryotherapeutic Hydrotherapy Moist Heat Packs (Hot Packs) IIIC I II CC II I I 15 to 30 minutes Thermotherapeutic Hot WhirlpoolC CC IC C C 15 to 30 minutes 96°F to 104°F Thermotherapeutic Hydrotherapy Paraffin BathC I I C CC I C 15 to 30 minutes 126°F to 130°F Thermotherapeutic

11 Cryotherapeutic Methods Ice Massage Duration: 10 to 15 minutes Duration: 10 to 15 minutesIndications: small muscle areas small muscle areas subacute injury subacute injury subacute inflammation subacute inflammation muscle strain muscle strain Contusions Contusions acute pain acute pain chronic pain chronic pain Contraindications pressure contraindications pressure contraindications suspected fractures suspected fractures uncovered open wounds uncovered open wounds circulatory insufficiency circulatory insufficiency cold allergy cold allergy cold hypersensitivity cold hypersensitivity anesthstized skin anesthstized skin

12 Cryotherapeutic Methods Cold or Ice Water Immersion Duration: 10 to 20 minutes Duration: 10 to 20 minutes Temp: 50°F to 60ºF Temp: 50°F to 60ºFIndications: Distal body parts Distal body parts Acute injury Acute injury Acute inflammation Acute inflammation Acute pain Acute pain Chronic pain post-surgical pain Chronic pain post-surgical pain Post-surgical edema Post-surgical edema Contraindications Cardiac involvement Cardiac involvement Respiratory involvement Respiratory involvement Uncovered open wounds Uncovered open wounds Circulatory insufficiency Circulatory insufficiency Cold allergy Cold allergy Cold hypersensitivity Cold hypersensitivity Anesthetized skin Anesthetized skin

13 Cryotherapeutic Methods Ice Packs (Bags) Duration: 15 to 30 minutes Duration: 15 to 30 minutesIndications: Acute injury Acute injury Acute inflammation Acute inflammation Acute pain Acute pain Chronic pain Chronic pain Post-surgical pain Post-surgical pain Post-surgical edema Post-surgical edema Contraindications Cardiac involvement Cardiac involvement Respiratory involvement Respiratory involvement Uncovered open wounds Uncovered open wounds Circulatory insufficiency Circulatory insufficiency Cold allergy Cold allergy Cold hypersensitivity Cold hypersensitivity Anesthetized skin Anesthetized skin

14 Cryotherapeutic Methods Cold Whirlpool Duration: 5 to 30 minutes Duration: 5 to 30 minutes Temp: 50°F to 60°F Temp: 50°F to 60°FIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Peripheral vascular disease Peripheral vascular disease Peripheral nerve injuries Peripheral nerve injuries Distal body parts Distal body parts Contraindications Acute problems to turbulence Acute problems to turbulence Acute problems to gravity Acute problems to gravity Requiring postural support Requiring postural support Skin conditions Skin conditions Cardiac involvement Cardiac involvement Respiratory involvement Respiratory involvement Uncovered open wounds Uncovered open wounds Circulatory insufficiency Circulatory insufficiency Cold allergy Cold allergy Cold hypersensitivity Cold hypersensitivity Anesthetized skin Anesthetized skin

15 Cryotherapeutic Methods Cryokinetics Combines cryotherapy with exercise Combines cryotherapy with exercise

16 Thermotherapy Application of heat; Heat has the capacity to increase the extensibility of collagen tissue. Application of heat; Heat has the capacity to increase the extensibility of collagen tissue.

17 Physiological Variables of Thermotherapy VariableResponse to Therapy Muscle spasmDecreases Muscle spasmDecreases Pain perceptionDecreases Pain perceptionDecreases Blood flowIncrease Blood flowIncrease Metabolic rateIncrease Metabolic rateIncrease Collagen elasticityIncrease Collagen elasticityIncrease Joint stiffnessDecrease Joint stiffnessDecrease Capillary permeabilityIncrease Capillary permeabilityIncrease EdemaIncrease EdemaIncrease

18 Comparing the Physiological Variables of Crotherapy and Thermotherapy Response toResponse to Variable CryotherapyThermotherapy Muscle spasmDecreases Decreases Muscle spasmDecreases Decreases Pain perceptionDecreases Decreases Pain perceptionDecreases Decreases Blood flowDecreases Increases Blood flowDecreases Increases Metabolic rateDecreases Increases Metabolic rateDecreases Increases Collagen elasticityDecreases Increases Collagen elasticityDecreases Increases Joint stiffnessIncreases Decreased Joint stiffnessIncreases Decreased Capillary permeabilityDecreased Increases Capillary permeabilityDecreased Increases EdemaControversial Increases EdemaControversial Increases

19 Thermotherapy Special Considerations in the Use of Superficial Heat Never apply heat when there is a loss of sensation Never apply heat when there is a loss of sensation Never apply heat immediately after an injury Never apply heat immediately after an injury Never apply heat when there is decreased arterial circulation Never apply heat when there is decreased arterial circulation Never apply heat directly to the eyes or genitals Never apply heat directly to the eyes or genitals Never heat the abdomen during pregnancy Never heat the abdomen during pregnancy Never apply heat to a body part that exhibits signs of acute inflammation Never apply heat to a body part that exhibits signs of acute inflammation

20 Thermotherapy Superficial tissue is a poor thermal conductor Superficial tissue is a poor thermal conductor temperature rises quickly on the skin surface as compared with the underlying tissues temperature rises quickly on the skin surface as compared with the underlying tissues There are limitations of superficial tissue There are limitations of superficial tissue The deeper tissues, including the musculature, are not significantly heated because the heat transfer from the skin surface into deeper tissues is inhibited by the subcutaneous fat, which acts as a thermal insulator, and by the increased skin flow, which cools and carries away the heat externally applied. The deeper tissues, including the musculature, are not significantly heated because the heat transfer from the skin surface into deeper tissues is inhibited by the subcutaneous fat, which acts as a thermal insulator, and by the increased skin flow, which cools and carries away the heat externally applied.

21 Thermotherapeutic Methods Moist Heat Packs (Hot Packs) Duration: 20 to 30 minutes Duration: 20 to 30 minutesIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Reduction of subacute pain Reduction of subacute pain Reduction of chronic pain Reduction of chronic pain Subacute muscle spasm Subacute muscle spasm Chronic spasm Chronic spasm Decreased range of motion Decreased range of motion Hematoma resolution Hematoma resolution Reduction of joint contractures Reduction of joint contractures Infection Infection Contraindications Acute conditions Acute conditions Peripheral vascular disease Peripheral vascular disease Impaired circulation Impaired circulation Poor thermal regulation Poor thermal regulation

22 Thermotherapeutic Methods Hot Whirlpool Duration: 5 to 30 minutes Duration: 5 to 30 minutes Temp: 96°F to 104°F Temp: 96°F to 104°FIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Peripheral vascular disease Peripheral vascular disease Peripheral nerve injuries Peripheral nerve injuries Distal body parts Distal body partsContraindications Acute problems to turbulence Acute problems to turbulence Acute problems to gravity Acute problems to gravity Fever Fever Requiring postural support Requiring postural support skin conditions skin conditions

23 Thermotherapeutic Methods Paraffin Bath Duration: 15 to 30 minutes Duration: 15 to 30 minutes Temp: 126°F to 130°F Temp: 126°F to 130°FIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Limited range of motion after immobilization Limited range of motion after immobilizationContraindications Open wounds Open wounds Skin infection Skin infection Sensory loss Sensory loss Peripheral vascular disease Peripheral vascular disease

24 Hydrotherapy Methods Contrast Bath Duration: 20 to 30 minutes Duration: 20 to 30 minutes Temp: 50°F to 60°F:96°F to 104°F Temp: 50°F to 60°F:96°F to 104°FIndications: Ecchymosis removal Ecchymosis removal Edema removal Edema removal Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Impaired circulation Impaired circulationContraindications Acute injuries Acute injuries Cold hypersensitivity Cold hypersensitivity Whirlpool contraindications Whirlpool contraindications Cold application contrindications Cold application contrindications Hot application contrindications Hot application contrindications

25 Hydrotherapy Methods Cold Whirlpool Duration: 5 to 30 minutes Duration: 5 to 30 minutes Temp: 50°F to 60°F Temp: 50°F to 60°FIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Peripheral vascular disease Peripheral vascular disease Peripheral nerve injuries Peripheral nerve injuries Distal body parts Distal body parts Contraindications Acute problems to turbulence Acute problems to turbulence Acute problems to gravity Acute problems to gravity Requiring postural support Requiring postural support Skin conditions Skin conditions Cardiac involvement Cardiac involvement Respiratory involvement Respiratory involvement Uncovered open wounds Uncovered open wounds Circulatory insufficiency Circulatory insufficiency Cold allergy Cold allergy Cold hypersensitivity Cold hypersensitivity Anesthetized skin Anesthetized skin

26 Hydrotherapy Methods Hot Whirlpool Duration: 5 to 30 minutes Duration: 5 to 30 minutes Temp: 96°F to 104°F Temp: 96°F to 104°FIndications: Subacute inflammation Subacute inflammation Chronic inflammation Chronic inflammation Peripheral vascular disease Peripheral vascular disease Peripheral nerve injuries Peripheral nerve injuries Distal body parts Distal body partsContraindications Acute problems to turbulence Acute problems to turbulence Acute problems to gravity Acute problems to gravity Fever Fever Requiring postural support Requiring postural support skin conditions skin conditions

27 Relies on molecular collision for transmission. Relies on molecular collision for transmission. Ultrasound is a mechanical wave in which energy is transmitted by the vibrations of the molecules of the biological medium through which the wave is traveling. Ultrasound is a mechanical wave in which energy is transmitted by the vibrations of the molecules of the biological medium through which the wave is traveling. Acoustic Therapy: Ultrasound

28 Ultrasound has both thermal and non- thermal effects. Ultrasound has both thermal and non- thermal effects.

29 Acoustic Therapy: Ultrasound When used for thermal changes, non- thermal changes also occur. When used for thermal changes, non- thermal changes also occur. For the majority of thermal effects to occur, the tissue temperature must be raised to a level of 104°F to 113°F for a minimum of five minutes. For the majority of thermal effects to occur, the tissue temperature must be raised to a level of 104°F to 113°F for a minimum of five minutes. Temperatures below this range will be ineffective. Temperatures below this range will be ineffective.

30 Acoustic Therapy: Ultrasound Non-thermal effects of ultrasound are cavitation and acoutsic microstreaming. Non-thermal effects of ultrasound are cavitation and acoutsic microstreaming.

31 Acoustic Therapy: Ultrasound Cavitation is the formation of gas-filled bubbles that expand and compress because of ultrasonically induced pressure changes in tissue fluids. Cavitation is the formation of gas-filled bubbles that expand and compress because of ultrasonically induced pressure changes in tissue fluids. Cavitation results in an increased flow in the fluid around these vibrating bubbles. Cavitation results in an increased flow in the fluid around these vibrating bubbles.

32 Acoustic Therapy: Ultrasound Microstreaming is the unidirectional movement of fluids along the boundaries of cell membranes resulting from the mechanical pressure wave in an ultrasonic field. Microstreaming is the unidirectional movement of fluids along the boundaries of cell membranes resulting from the mechanical pressure wave in an ultrasonic field. Microstreaming can alter cell membrane structure and function because of changes in cell membrane permeability to sodium and calcium ions important in the healing process. Microstreaming can alter cell membrane structure and function because of changes in cell membrane permeability to sodium and calcium ions important in the healing process. As long as the cell membrane is not damaged, microstreaming can be of therapeutic value in accelerating the healing process. As long as the cell membrane is not damaged, microstreaming can be of therapeutic value in accelerating the healing process.

33 Acoustic Therapy: Ultrasound The non-thermal effects of therapeutic ultrasound in the treatment of injured tissues may be as important as the thermal effects and perhaps are even more important. The non-thermal effects of therapeutic ultrasound in the treatment of injured tissues may be as important as the thermal effects and perhaps are even more important. The non-thermal effects of cavitation and microstreaming can be maximized while the thermal effects are minimized by using an intensity of 0.1 to 0.2 W/cm² with continuous ultrasound or 1.0 W/cm² at a duty cycle of 20 percent (pulsed). The non-thermal effects of cavitation and microstreaming can be maximized while the thermal effects are minimized by using an intensity of 0.1 to 0.2 W/cm² with continuous ultrasound or 1.0 W/cm² at a duty cycle of 20 percent (pulsed).

34 Acoustic Therapy: Ultrasound Ultrasound energy generated at a frequency of 1 MHz is transmitted through more superficial tissues and absorbed primarily in the deeper tissues at depths of 3 to 5 cm. Ultrasound energy generated at a frequency of 1 MHz is transmitted through more superficial tissues and absorbed primarily in the deeper tissues at depths of 3 to 5 cm. A 1 MHz frequency is most useful in individuals with high percent body fat and whenever the desired effects are in the deeper structures. A 1 MHz frequency is most useful in individuals with high percent body fat and whenever the desired effects are in the deeper structures. At a frequency of 3 MHz the energy is absorbed in the more superficial tissues with the depth of penetration between 1 and 2 cm. At a frequency of 3 MHz the energy is absorbed in the more superficial tissues with the depth of penetration between 1 and 2 cm.

35 Acoustic Therapy: Ultrasound 1 MHz 1 MHz Deeper Tissues 3 MHz 3 MHz Superficial Tissues

36 Acoustic Therapy: Ultrasound Frequency of Treatment Acute injuries require more frequent treatments over a shorter period of time (pulsed duty cycle). Acute injuries require more frequent treatments over a shorter period of time (pulsed duty cycle). Chronic conditions require fewer treatments over a longer period of time (continuous duty cycle). Chronic conditions require fewer treatments over a longer period of time (continuous duty cycle). Should begin as soon as possible after the injury (at least within 48 hours). Should begin as soon as possible after the injury (at least within 48 hours). Treatments should be limited to no more than 14 treatments then avoid ultra sound for two weeks. Treatments should be limited to no more than 14 treatments then avoid ultra sound for two weeks.

37 Acoustic Therapy: Ultrasound Phonophoresis Phonophoresis Uses ultrasound to drive ions Uses ultrasound to drive ions

38 Acoustic Therapy: Ultrasound Indications Acute and post acute conditions (non-thermal) Acute and post acute conditions (non-thermal) Soft tissue healing and repair Soft tissue healing and repair Scar tissue Scar tissue Joint contracture Joint contracture Chronic inflammation Chronic inflammation Increased extensibility of collagen Increased extensibility of collagen Reduction of muscle spasm Reduction of muscle spasm Pain modulation Pain modulation Increase blood flow Increase blood flow Soft tissue repair Soft tissue repair Increase in protein synthesis Increase in protein synthesis Tissue regeneration Tissue regeneration Bone healing Bone healing Repair of non-union fractures Repair of non-union fractures Inflammation of myositis ossificans Inflammation of myositis ossificans Plantar warts Plantar warts Myofascial trigger points Myofascial trigger points

39 Acoustic Therapy: Ultrasound Contraindications Acute and post acute conditions (thermal) Acute and post acute conditions (thermal) Areas of decreased temperature sensation Areas of decreased temperature sensation Areas of decreased circulation Areas of decreased circulation Vascular insufficiency Vascular insufficiency Thrombophlebitis Thrombophlebitis Eyes Eyes Reproductive organs Reproductive organs Pelvis immediately following menses Pelvis immediately following menses Pregnancy Pregnancy Pacemaker Pacemaker Malignancy Malignancy Epiphyseal areas in young children Epiphyseal areas in young children Total joint replacement Total joint replacement Infection Infection

40 Electrotherapy: Electrical Stimulation Electricity is a form of energy that displays magnetic, chemical, mechanical, and thermal effects on tissue. Electricity is a form of energy that displays magnetic, chemical, mechanical, and thermal effects on tissue. It implies a flow of electrons between two points. It implies a flow of electrons between two points.

41 Electrotherapy: Electrical Stimulation All therapeutic electrical generators are transcutaneous electrical stimulators. All therapeutic electrical generators are transcutaneous electrical stimulators. The majority of these generators are used to stimulate peripheral nerves and are correctly called transcutaneous electrical nerve stimulators (TENS). The majority of these generators are used to stimulate peripheral nerves and are correctly called transcutaneous electrical nerve stimulators (TENS). Occassionally the terms neuromuscular electrical stimulator (NMES) or electrical muscle stimulator (EMS) are used; however, these terms are only appropriate when the electrical current is being used to stimulate muscle directly, as would be the case with denervated muscle in which peripheral nerves are not functioning. Occassionally the terms neuromuscular electrical stimulator (NMES) or electrical muscle stimulator (EMS) are used; however, these terms are only appropriate when the electrical current is being used to stimulate muscle directly, as would be the case with denervated muscle in which peripheral nerves are not functioning.

42 Electrotherapy: Electrical Stimulation Direct Current (DC current) Flows in one direction only from the positive pole to the negative pole. Flows in one direction only from the positive pole to the negative pole. Direct current may be used for pain modulation or muscle contraction or to produce ion movement. Direct current may be used for pain modulation or muscle contraction or to produce ion movement.

43 Electrotherapy: Electrical Stimulation Alternating Current (AC current) The direction of current flow reverses itself once during each cycle. The direction of current flow reverses itself once during each cycle. Alternating current may be used for pain modulation or muscle contraction. Alternating current may be used for pain modulation or muscle contraction.

44 Electrotherapy: Electrical Stimulation Pulsed Current Pulsed currents usually contain three or more pulses grouped together. Pulsed currents usually contain three or more pulses grouped together. These groups of pulses are interrupted for short periods of time and repeat themselves at regular interval. These groups of pulses are interrupted for short periods of time and repeat themselves at regular interval. Pulsed currents are used in interferential and so-called Russian currents (currents interfere with each other). Pulsed currents are used in interferential and so-called Russian currents (currents interfere with each other).

45 Electrotherapy: Electrical Stimulation Duration Duration: 10 to 30 minutes Duration: 10 to 30 minutes Can be used with ice or heat Can be used with ice or heat

46 Electrotherapy: Electrical Stimulation High Voltage or Pulsed Indications Peripheral nerve injuries, Peripheral nerve injuries, Delaying denervation Delaying denervation delaying disuse atrophy delaying disuse atrophy Post-traumatic edema reduction Post-traumatic edema reduction Increase local blood circulation Increase local blood circulation Joint contracture prevention Joint contracture prevention Maintenance of range of motion Maintenance of range of motion Muscle strengthening Muscle strengthening Muscle spasm reduction Muscle spasm reduction Inhibitation of spasticity Inhibitation of spasticity Muscle re-education Muscle re-education Assist voluntary muscle function Assist voluntary muscle function Interferential Indications Acute pain Acute pain Chronic pain Chronic pain Muscle spasm Muscle spasm

47 Electrotherapy: Electrical Stimulation Contraindications Demand-type pacemakers Demand-type pacemakers Over pelvic or lumbar areas Over pelvic or lumbar areas During pregnancy During pregnancy Pain of central or unknown origin Pain of central or unknown origin Areas of particular sensitivity –carotid sinus –laryngeal muscles –pharyngeal muscles –upper thorax –temproal region –cancerous lesions –sites of infection

48 Electrotherapy: Electrical Stimulation Iontophoresis Iontophoresis Uses electrical current to drive ions Uses electrical current to drive ions

49 Massage Therapy Sports massage causes mechanical, physiological, and psychological responses.

50 Massage Therapy Mechanical Response Encourages venous and lymphatic drainage, mildly stretch superficial and scar tissue

51 Massage Therapy Physiological Response Reflex effects, relaxation, stimulation, and increased circulation

52 Massage Therapy Psychological Response The tactile system is one of the most sensitive systems in the human organism. Humans respond psychologically to being touched and is an important means for creating a bond of confidence between the athletic trainer and the athlete.

53 Massage Therapy Massage Strokes Effleurage Effleurage Petrissage Petrissage Tapotement Tapotement Vibration Vibration Deep Friction Deep Friction

54 Massage Therapy Effleurage Stroking; divided into light and deep methods. Stroking; divided into light and deep methods. Light stroking is designed primarily to be sedative. Light stroking is designed primarily to be sedative. It is also used in the early stages of injury treatment. It is also used in the early stages of injury treatment. Deep stroking is therapeutic compression of soft tissue, which encourages venous and lymphatic drainage. Deep stroking is therapeutic compression of soft tissue, which encourages venous and lymphatic drainage.

55 Massage Therapy Petrissage Petrissage Kneading; a technique adaptable primarily to loosen heavy tissue areas such as the trapezius, latissimus dorsi, or the triceps. Kneading; a technique adaptable primarily to loosen heavy tissue areas such as the trapezius, latissimus dorsi, or the triceps. Friction heat producing Friction heat producing Often used around joints and other areas where tissue is thin and is used on tissues that are especially unyielding such as scars, adhesions, muscle spasms, and fascia. Often used around joints and other areas where tissue is thin and is used on tissues that are especially unyielding such as scars, adhesions, muscle spasms, and fascia.

56 Massage Therapy Tapotement Tapotement Percussion; produces an invigorating and stimulating sensation. Percussion; produces an invigorating and stimulating sensation.

57 Massage Therapy Vibration Vibration Rapid shaking; rapid movement that produces a quivering or trembling effect. Rapid shaking; rapid movement that produces a quivering or trembling effect. It is used because of its ability to relax and soothe. It is used because of its ability to relax and soothe. Although vibration can be done manually, the machine vibrator is usually the preferred modality. Although vibration can be done manually, the machine vibrator is usually the preferred modality.

58 Massage Therapy Deep Friction Deep Friction Often precedes activity, restoring mobility to a muscle. Often precedes activity, restoring mobility to a muscle.

59 Massage Therapy Massage in sports is usually confined to a specific area and is seldom given to the full body. Massage in sports is usually confined to a specific area and is seldom given to the full body. The time required for giving an adequate and complete body massage is excessive in athletics. The time required for giving an adequate and complete body massage is excessive in athletics. It is not usually feasible to devote this much time to one athlete. It is not usually feasible to devote this much time to one athlete. Five minutes is usually all that is required for massaging a given area. Five minutes is usually all that is required for massaging a given area.


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