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Therapeutic Modalities

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Presentation on theme: "Therapeutic Modalities"— Presentation transcript:

1 Therapeutic Modalities
Sports Medicine 2 Lexington High School

2 Purpose Muscle Spasm/Pain Cycle~ injury causes muscle spasms that cause pain that causes muscle spasms Leads to decreased mobility Therapeutic Modalities used to stop cycle Misapplication can make injury worse

3 Choosing a Modality Is modality safe for this type of injury?
Will modality contribute significantly to rehab process and complete recovery? Is person applying modality trained to use it?

4 Heating and Cooling Means
Conduction~ heat transfer by direct contact with another medium. (hot or ice packs) Convection~ heat transfer by indirectly through secondary conductive medium. (air or liquid) Radiation~ heat transfer by or from its source to surrounding environment in form of waves or rays. (ultraviolet light)

5 Heating and Cooling Means
Conversion~ heat transfer that takes place through other forms of energy, such as sound, electricity or chemicals. (Ultrasound, diathermy) Evaporation~ heat transfer takes place when a liquid coverts into a gas. (perspiration)

6 Thermotherapy Treatments using heat
Increase the temperature of the body region to cause vasodilatation Increases blood flow to area Decreases pain and muscle spasms Increasing flexibility to tissues Comforting for most patients

7 Guidelines for Thermotherapy
Never apply to an area of decreased sensation Never apply directly after injury Never apply to eyes or genitalia Never apply to a pregnant belly Never apply over an open wound Do not apply on pts with hx of diabetes

8 Moist Heat Packs Indications Contraindications Chronic Pain/Tendonitis
Lg jt. Contractures Muscle Spasm Chronic edema Pre-heating to electrical stim tx Contraindications Existing fever Cardiac irregularities Decreased skin sensation Infections Active Bleeding Acute inflammatory conditions

9 Clinical Application Pack should be applied with several layers of towels or hot pack cover Hydrocollator water temp = 170 degrees Treatment time varies as indicated Never lie or sit on hot pack due to increase in burns

10 Typical Reactions to Hot Pack
Feel comfortable warmth Sensation of area relaxing No sensation of burning should be felt

11 Paraffin Bath Indications Contraindications Chronic Pain Muscle Spasms
Chronic Edema Chronic arthritis Soften calloused hands Contraindications Existing fever Infections Hypertension Acute inflammatory injuries Wet hands/fingers Open wounds

12 Clinical Application and Response
‘Glove hands’ with wax, frequent dip Follow individual manufacturer directions Feel comfortable warmth Feel sensation of relaxation No sensation of burning Feeling of slight oil on hands after removal of wax

13 Ultrasound High frequency sound wave converted to heat
Can reach depths of 3-5 cm Coupling mediums used to help sound waves penetrate the skin Sound head moved in slow, circular pattern with contact at all times

14 Ultrasound Two Types of Ultrasound Thermal Effects Mechanical Effects
↑ collagen elasticity ↓ Joint stiffness ↓ Pain and spasm ↑ Blood Flow Effects can last up to 1 hour after 5 minute tx. Mechanical Effects ↑ Nerve conduction Cell permeability altered from pressure changes Mineral deposits dissolved Micromassage Protein synthesis promoted

15 Ultrasound Depths of Ultrasound
1Mhz Frequency: depth of penetration = up to 5 cm 3Mhz Frequency: depth of penetration = 1-2 cm

16 Ultrasound Intensity (W/cm²) 1 Mhz 3 Mhz 0.5 .04º C .3º C 1 .2º C
Ultrasound Rate of Heating per Minute Intensity (W/cm²) 1 Mhz 3 Mhz 0.5 .04º C .3º C 1 .2º C .6º C 1.5 .9º C 2 .4º C 1.4º C

17 Ultrasound~ Suggested Uses
1Mhz for deep tissue 3Mhz for shallow tissue Treatment time should be 5-10 minutes depending on area being treated Ultrasound treatments not performed more than one time per day

18 Phonophoresis Combination of ultrasound and medication driven into the skin through sound waves Usually anti-inflammatory medication Time and technique same as regular ultrasound

19 Cryotherapy Treatments using Cold Decreases tissue temperature
Skin Color change from white to red Decrease in total blood flow Decrease in nerve conduction

20 Cryotherapy Treatment Length
Average minutes, once an hour Three phases of sensation: Cold sensation lasting 0-3 minutes Mild burning and aching lasting 2-7 minutes Relative numbness lasting 5-12 minutes

21 Guidelines for Cryotherapy
Use of a barrier, except in ice massage Never on anesthetize skin Never on open wounds Never on someone with desensitized skin Monitor for signs of Raynaud’s Phenomenon, condition in which the arteries and arterioles of an extremity constrict extensively. Causes extensive arterial blood flow.

22 Ice Packs Indications: Contraindications: Acute trauma Acute Pain
Heat Illness Muscle Fatigue Spasms Post-op Pain Acute Edema Contraindications: Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

23 Clinical Application of Ice Pack
Directly to injured area Frequency should be 20 minutes for every waking hour in acute injuries No longer than 20 minutes (veins begin to vasodialate to warm body) Used primarily for the first hours of an injury

24 Typical Response to Ice Pack
Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes Treatment usually satisfactory when skin turns pink or red

25 Ice Massage Indications: Contraindications Acute Trauma Acute Pain
Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis Contraindications Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

26 Clinical Application/ Responses
Ice should have round edges Continuous movement of ice to prevent tissue freezing 5-10 minutes, 4-6 times a day Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes

27 Cold Whirlpool/Ice Immersion
Indications: Acute Trauma Acute Pain Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis Contraindications Circulatory insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to cold Raynaud’s Disease

28 Clinical Application Frequency of treatment is 20 minutes
Cool = 67º - 80º F . . Use for spasticity Cold = 55º - 67º F . . Use for inflammation and acute injury Very Cold = 33º - 55º F . . Use for acute injury and pain relief Encourage athlete to work on ROM while in the whirlpool or cold bath

29 Typical Reactions Athlete will usually be uncomfortable and not want to do treatment Cold→Burning→Aching→Numbness If water is constantly moving, athlete may never achieve complete numbness

30 Contrast Bath Theory is that the cold vasoconstricts the veins and the heat vasodialates the veins creating a pumping motion to push edema out of the area Indications and Contraindications same as those for Thermotherapy and Cryotherapy

31 Clinical Application If swelling is anticipated end in cold
Work to ending in hot Hot water should be 95º-110º, and cold water should be 55º-65º Encourage athlete to work on increasing ROM Use a 2:3 ratio of cold to hot or hot to cold Treatment should last between 20 and 30 minutes

32 Electric Modalities Use of electricity to influence healing by stimulating the body tissues

33 Guidelines for Electrical Modalities
Follow all MD guidelines Explain procedure to the patient Expose and clean area to be treated Place electrodes in appropriate place Use equipment as prescribed Never use on an open wound

34 Electrical Stimulation
Effects: Management of pain through gate control theory Increase in deep blood flow and lymphatic drainage Slight increase in circulation Muscle relaxation

35 Electrical Stimulation
Indications: Pain Edema Spasm Hematoma Trigger Point Early muscle re-education Contraindications: Metabolic diseases Children Pacemaker Tumor Fever Irritated skin

36 Clinical Application Follow MD recommendations for dosage
Treatment time should be minutes Each person has different levels that they can tolerate, use the athlete as the guide Athlete should feel a comfortable ‘moving’ tingling zone in the area around the treatment pads

37 Iontophoresis Use of ions to penetrate medicine into the injured area
1 cm penetration of medicinal ions Numbing effect Advantageous over Injectable: No chance of infection No tissue trauma Medication is only thing going through skin

38 Iontophoresis Indications: Contraindications: Trigger points
Tendonitis Superficial inflammatory conditions Plantar Warts Myositis Bursitis Contraindications: Superficial metal implants Pacemaker Allergy to drug being used Acute injury Anesthetic skin

39 Clinical Application Must have a prescription for use of medicine
Follow MD guidelines for dosage Must use appropriate medicines Athlete should feel some pain relief Athlete should not feel ‘hot pin’ sensation

40 Diathermy High frequency electrical current to heat the body’s tissue
Bigger machines, not popular

41 Diathermy Indications: Contraindications: Chronic sprains/strains
Limited ROM Sub-acute inflammations Contraindications: Acute inflammatory injuries Hemorrhages Casts Metal implants Screws Pregnant women

42 Clinical Application Sound heads placed around the area being treated
Remove all metal from area Cover the area with 2 layers of towels Should feel like a ‘ray of sunshine’ on the skin Heats tissues to ºF at about 2 inches from skin’s surface

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