1. Therapeutic Modalities

2. Introduction
Therapeutic modalities create an optimal environment for injury repair (DO NOT “CAUSE HEALING”)
Most common types of modalities
Cryotherapy (cold)
Thermotherapy (heat)
Massage
Electrical stimulation
Therapeutic ultrasound

3. Physiology Basics Vasodilation Vasoconstriction
Increased size of vascular structures
Means more oxygen to the tissue
Vasoconstriction
Decreased size of vascular structures
Useful for preserving compromised/injured cells/tissue

4. Physiology Basics Analgesia Metabolic rate Inflammation
Diminished/reduced sensation
Metabolic rate
Activity level of cells
Reducing MR can preserve cells damaged by injury
Inflammation
Series of events that hinder optimal function

5. Cryotherapy (Ice) Physiological effects Decreased local metabolic rate
Important in preventing secondary hypoxic injury
Decreased local blood flow
Vasoconstriction
Decreased presence of inflammation & the processes of inflammation

6. Cryotherapy (Ice) Physiological effects Reduced swelling
Decreased nerve conduction velocity
Analgesia- pain decreased

7. Cryotherapy (Ice) Indications Acute injuries After activity Swelling
Spasm
Pain
Mild burns

8. Cryotherapy (Ice) Contraindications Hunting response
Prolonged exposure to cold may lead to superficial vasodilation to protect cold bodypart
Raynaud’s phenomenon
Cold allergy

9. Cryotherapy (Ice) Application Ice massage 7-10 minutes
Excellent for muscle spasm and deep soreness

10. Cryotherapy (Ice) Application Ice bags, ice towels, or cold packs
15-20 minutes (no longer than 30)
If using packs, be sure to avoid direct contact to protect skin!
Cold whirlpool / ice immersion
5-15 minutes, degrees
Duration and temperature depends on surface area immersed

11. Thermotherapy (Heat) Physiological effects Increased local circulation
Vasodilation
Increased local metabolic rate
Increased collagen extensibility
Increased nerve conduction velocity
Analgesia

12. Thermotherapy (Heat) Indications Contraindications Sub-acute injury
Prior to activity
Reduce spasm/guarding
Contraindications
Acute injury
Impaired sensation

13. Thermotherapy (Heat) Application Warm whirlpool Contrast baths
Treat minutes (no longer than 30)
degrees
Contrast baths
Switch back and forth between hot and cold 3:1 or 4:1 to induce “vascular pumping action” from repeated vasodilation/vasoconstriction
Particularly useful for troublesome swelling or edema

14. Thermotherapy (Heat) Hydrocollator packs Treat 20 minutes
degrees
Will burn! Must pad with layered towels or covers!

15. Thermotherapy (Heat) Paraffin bath
Great for angular extremities (hands & feet)
degrees
Wash body part
Dip body part 4-5 times, then wrap in ice bag and towel
Treat minutes
Dispose of wax or return to bath for re-use
Do not use with open wounds

16. Massage Physiological effects Indications
Increased local blood flow (if done properly)
Increased venous/lymph return
Analgesia & sedative neurological effect
Indications
Sub-acute injury
Soreness
Persistent swelling

17. Massage Contraindications
Acute injury (may disturb clotting mechanism)
Fracture sites
Open wounds

18. Types of Therapeutic Massage
Effluerage
Petrissage
Tapotement
Vibration
Cross-friction

19. Effluerage Slow, rhythmic, soothing strokes toward the heart
One hand always in contact w/ patient
Use massage lotion or cream, gloves optional
Helps calm/soothe athlete
Encourages venous & lymph return

20. Petrissage Deeper “kneading” of large muscle masses
Stimulates local circulation
Eliminates muscle trigger points

21. Tapotement Percussion, cupping, or hacking of the large muscle groups
Typical “health-spa” massage
Invigorates- increases neural response
Increases local circulation

22. Vibration Rhythmic oscillations of larger muscle groups
Most often quads and hams
Physiologically speaking, we are not really certain of its effects
Perhaps largest benefit is psychological

23. Cross-friction Best empirically-supported technique
Increases local blood flow
Reduces sensation of pain
Accommodation
Useful in restoring full function & ROM
Typical treatment lasts 5 minutes

24. Electrical Stimulation
Many types available
Transcutaneous Electical Nerve Stimulation (TENS)
Useful for pain relief
Portable units are very affordable
Typically treat for 20 minutes

25. Electrical Stimulation
Many types available
Interferential quad polar (IFQP)
Uses four pads
Good for pain control
Premodulated Bipolar (PMBP)
Uses two pads
Good for pain control when IFQP not ideal (small body parts, etc)

26. Electrical Stimulation
Other types also available
Settings:
Higher frequencies tend to produce fast acting, comfortable treatment for acute injuries, while lower frequencies tend to elicit longer lasting relief for chronic injuries
Typical treatment lasts 15 minutes at intensity of comfort for patient

27. Therapeutic Ultrasound
Sound energy which results in deep heating to tissue
May penetrate up to 3-5 cm when administered a 1 MHz, up to 1-2 cm at 3 MHz.
Must keep ultrasound head moving to prevent burns
Typical treatment lasts 5-6 minutes at intensity of w/cm2