Therapeutic Physical Modalities Chapter 12 Therapeutic Physical Modalities

Objectives Upon completion of this chapter, you should be able to: Explain the use and effectiveness of physical modalities Describe the various thermal modalities and their applications

Objectives (cont’d.) Upon completion of this chapter, you should be able to (cont’d.): Explain and describe the use of therapeutic ultrasound Explain and describe the use of electrical modalities

Therapeutic Physical Modalities Heating, cooling, and mechanical/electrical methods of treatment used on the human body Physical modalities Hot and cold treatments, therapeutic ultrasound, and various electrical modalities

Therapeutic Physical Modalities (cont’d.) Used along with other forms of treatment To relieve pain, reduce or retard swelling, decrease spasm, and promote healing Can minimize time lost from participation Used improperly, condition may worsen

Thermal Modalities Cryotherapy Use of cooling agents (e.g., cold packs, cold bucket baths, and ice massage) Most widely used therapy Acute Injury Responses include: initial vasoconstriction, reduction of tissue metabolism, decreased nerve conduction velocity, reduced muscle spasm, secondary vasodilatation, and increased in muscle strength If left on too long, counter effects may occur

Thermal Modalities (cont’d.) Ice packs Effective for local areas of concern Timing Elevate Quick and economical Plastic bags with ice cubes Gel packs Chemical-activated cold pack- careful of time, use towel

Thermal Modalities (cont’d.) Ice massage Used for localized problems (e.g., tennis elbow) Only takes about five minutes

Thermal Modalities (cont’d.) Cold water compression Cold and compression applied simultaneously Game Ready

Thermal Modalities (cont’d.) Ice baths Immersion in a bucket of ice water Allows complete, uniform coverage Some exercise movements may be performed 55-64 degrees

Thermal Modalities (cont’d.) Cold: 0-3 minutes Burning: 3-5 minutes Aching: 5-8 minutes Numbness: 8-10 minutes

Thermal Modalities (cont’d.) Contraindications/precautions Cryotherapy should be used with caution on persons who have: Thermoregulatory problems Sensory deficits Hypersensitivity to cold Impaired circulation Heart disease Malignant tissue

Thermal modalities (cont’d.) Reynaud’s Disease- feel numb and cold in response to cold stress Smaller arteries narrow constricting blood flow

Thermal Modalities (cont’d.) Heating agents Heat is applied superficially (skin deep), or with a modality capable of heating tissues up to a few inches beneath the skin Beneficial effects: Reduced pain Promotion of healing Increased range of motion Muscle relaxation

Thermal Modalities (cont’d.) Heating agents (cont’d.) Localized vigorous heating effects: Substantially increased vasodilatation Increased metabolic rate and capillary pressure and flow Clearance of metabolites Oxygenation of tissue

Thermal Modalities (cont’d.) Hydrocollator packs Moist hot packs used for superficial heating Kept warm in a heated stainless-steel container filled with hot water in the range of 60°C to 90°C (140 F to 190 F) Left in place for 10 to 20 minutes contradictions Burn

Thermal Modalities (cont’d.) Contraindications/precautions ATC must assess the condition and injury status Heat is not used until 48 to 72 hours after injury Heat dilates the vessels and could cause additional bleeding if healing is not adequate

Thermal Modalities (cont’d.) Contraindications/precautions (cont’d.) Heat should not be used: In acute states, with athletes who have impaired circulation, in areas of diminished sensation, or with athletes who may be heat intolerant

Thermal Modalities (cont’d.) Hydrotherapy Superficial heating Agitated, heated water in a whirlpool Larger area on an extremity can be treated Athlete can perform range-of-motion exercises 95-104 degrees

Thermal Modalities (cont’d.) Contrast therapy Alternating hot and cold water baths for specified time periods May be used in the subacute injury stage (48 to 72 hours after the injury incurs) Contraindications: impaired circulation resulting from diabetes, vascular disease, and tendency to hemorrhage

Thermal Modalities (cont’d.) Ultrasound Ultrasonic diathermy (“through heat”) Deep-heating modality Not recommended during acute injury stage DO NOT USE: fluid-filled cavities, eyes, heart, uterus, testes, growth plates, fx sites, artificial joints, herniated discs

Thermal Modalities (cont’d.) Ultrasound (cont’d.) Very high-frequency soundwave absorbed by tissues high in protein content Some absorbed by bone tissue, rest reflected off Continuous- transformed to deep heat Duty cycle 100% Pulsed- non-thermal effects shown to facilitate tissue repair Duty cycle 20-50%

Thermal Modalities (cont’d.) Ultrasound (cont’d.) Soundwave frequency humans can hear is 18,000- 20,000 cycles (waves) per second (called hertz (Hz)) Ultrasound either 1 million cycles/second (1 MHz) for deep structures Or 3 million cycles per second (3 MHz) for tissues under the skin

Thermal Modalities (cont’d.) Ultrasound (cont’d.) Vibrating synthetic crystal (1, 5, or 10 cm) Tx area 2x size of transducer head Cream or gel (coupling agent) medium used to penetrate skin

Therapeutic Electrical Modalities Pass electrical currents through skin into the body causing nerve tissue stimulation Use may be limited by law Two main categories: Electrical stimulation- produce muscle contractions and muscle facilitation by stimulating motor nerves Transcutaneous electrical nerve stimulation- reduce pn by stimulating sensory nerves

Therapeutic Electrical Modalities (cont’d.) Electrical stimulation therapy Effects include increasing ROM and muscle strength, reeducating muscles, improving muscle tone, controlling pain, wound healing, reducing Neuromuscular electrical stimulation is most common

Therapeutic Electrical Modalities (cont’d.) Transcutaneous electrical nerve stimulation Commonly applied with a portable unit for pain control Electric current is applied through a surface electrode pad that is in contact with the external skin surface

Therapeutic Electrical Modalities (cont’d.) Contraindications Electrical stimulation should not be used: Over the carotid sinus During pregnancy In individuals with pacemakers On people who are sensitive to electricity Any time active motion is contraindicated

Conclusion Appropriate selection and use of physical therapeutic modalities can have a dramatic beneficial effect The wrong selection can have an adverse effect Careful consideration of the nature and stage of the injury is mandatory