1. Chapter 17 Therapeutic Modalities

2. Various methods and agents used to manipulate circulation (blood flow) in the treatment of muscles and joints Purpose is to improve or restore an individual’s range of motion, regain strength, cope with pain, and engage in daily activities and athletic endeavors at an optimal performance level 2

3. Legal Implications Associated with Using Therapeutic Modalities Therapeutic modalities Provide great benefits in the rehabilitative process Must be used properly It is vital to understand some of the limitations that apply when working with therapeutic modalities. 3

4. Legal Implications Associated with Using Therapeutic Modalities Regulations concerning the use of therapeutic modalities vary from state to state. Check the specific laws of the state in which you will practice. Going beyond the scope of practice constitutes negligence. 4

5. Legal Implications Associated with Using Therapeutic Modalities It is essential to document all therapeutic treatments to ensure continuity of care and track treatment or outcomes. Documentation can be used as a part of a defense in a lawsuit. 5

6. Choosing a Modality There is a wide range of therapeutic modalities to choose from to achieve the best results. Athletic trainer must determine whether including exercise or various applications of heat, cold, and electrical or mechanical stimulation will be most effective 6

7. Choosing a Modality Factors to consider: Is it safe for use on this type of injury? Will use of this modality contribute significantly to the rehabilitation process and total recovery of the person? Is the person applying the modality trained and authorized to use it safely and efficiently? 7

8. Methods of Heat or Cold Transfer Thermotherapy Uses heat to increase the temperature of a body region in order to cause blood vessels to dilate, increasing blood flow to those tissues 8

9. Methods of Heat or Cold Transfer Cryotherapy Uses cold to reduce the temperature of body tissue in order to cause blood vessels to constrict, decreasing blood flow to the area and reducing pain, edema, and muscle spasms 9

10. Cooling or Heating the Body Conduction: A method of heat transfer by direct contact with another medium Examples: Heat packs or ice packs Convection: A method of heat transfer that takes place indirectly through a secondary conductive medium Examples: Fluid therapy, whirlpool baths 10

11. Cooling or Heating the Body Radiation: A method of heat transfer by or from its source to the surrounding environment in the form of waves or rays Examples: Infrared ultraviolet light, laser, or electrical stimulating modalities 11

12. Cooling or Heating the Body Conversion: A method of heat transfer that takes place through other forms of energy, such as sound, electricity or chemicals Examples: Ultrasound, diathermy, or heating/cooling ointments 12

13. Cooling or Heating the Body Evaporation : A method of heat transfer that takes place when a liquid is converted to a gas Examples: Perspiration or vapo-coolant sprays 13

14. Guidelines for Cryotherapy Never apply any form of cold on an open wound without a protective covering. Never apply any form of cold to anesthetized skin. Except for vapo-coolant sprays, do not apply cryotherapy to patients with decreased circulation, diabetes, or cardiac conditions. 14

15. Guides for Cryotherapy Monitor the patient for signs of cold allergy, or Raynaud’s phenomenon. To avoid further injury to the tissues, always monitor the time for which cryotherapy is applied; applications should not exceed 30 minutes. 15

16. Forms of Cryotherapy Ice packs Ice massage Vapo-coolant sprays Ice water immersion Whirlpool baths 16

17. Guidelines for Thermotherapy Never apply heat to an area where any loss of sensation exists; burns could occur without the client being aware of it. Never apply heat immediately after an injury. Never apply heat directly to the eyes or the genitalia. 17

18. Guidelines for Thermotherapy Never apply heat to the abdomen if there is a possibility that the patient is pregnant. Never apply any form of heat on an open wound, a burn, or over an area of malignancy. 18

19. Guidelines for Thermotherapy Do not use thermotherapy on patients with a history of reduced thermal regulation or diabetes. Always monitor the time for which thermotherapy is applied, and use appropriate padding or towels. 19

20. Forms of Thermotherapy Moist heat packs Fluidotherapy Paraffin bath 20

21. Electrical Modalities Use electricity to influence healing by stimulating the body tissues Used to speed the healing of tissues Penetrate deeper into the tissues than other modalities Among the most effective in terms of decreasing healing time 21

22. Electrical Modalities Low-voltage stimulation is used to increase blood flow of muscle contraction. High-voltage stimulation is used to help control pain. 22

23. Guidelines for Electrical Modalities Follow the physician’s or therapist’s orders for all electrical modalities. Make sure equipment works properly, is plugged in, and powered through a circuit served by a ground fault interrupter. Explain the procedure to the patient. Expose the area to be treated. 23

24. Guidelines for Electrical Modalities Cleanse the treatment area with soap and water or alcohol. Then, dry it thoroughly. Place electrode pads according to the manufacturer’s instructions. Follow the manufacturer’s instructions for use of all equipment. 24

25. Guidelines for Electrical Modalities Turn the treatment channel(s) off before carefully removing the adhesive electrodes from the patient’s skin. Leave the treatment area clean when finished. Follow the manufacturer’s instructions for cleaning and maintaining the unit. 25

26. Guidelines for Electrical Modalities Never use an electrical modality on an open wound. Do not use electrical modalities on a patient with a pacemaker without approval from a physician. Avoid high-fluid areas of the body. Avoid use over the carotid arteries. 26

27. Guidelines for Electrical Modalities Electrical modalities should never be used on the trunk of a pregnant patient. Stop the treatment if the procedure increases the patient’s pain. 27

28. Electrical Modalities Ultrasound therapy Electrical muscle stimulation (EMS) Galvanic stimulation Interferential stimulation (IFS) Iontophoresis Transcutaneous electrical nerve stimulation (TENS) 28

29. Electrical Modalities Diathermy Low-level laser 29

30. Mechanical Modalities Assist in healing by exerting pressure to the soft tissues, increasing circulation and/or distracting (pulling) bony structures This pressure can be applied manually or with a device. 30

31. Guidelines for Mechanical Modalities Follow the manufacturer’s instructions for use of all equipment. Frequent circulation checks of extremities are important when applying traction. Stop the treatment if the procedure increases the patient’s pain. 31

32. Types of Mechanical Modalities Intermittent compression Traction Massage therapy 32