2. Therapeutic Physical Modalities
Chapter 12
Therapeutic Physical Modalities

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

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

12. 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

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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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
degrees

22. 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

23. 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

24. 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%

25. Thermal Modalities (cont’d.)
Ultrasound (cont’d.)
Soundwave frequency humans can hear is 18, ,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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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