1. Ch. 12 Therapeutic Modalities

2. Objectives Explain the use and effectiveness of physical modalities.
Describe the various thermal modalities and their applications.
Explain and describe the use of therapeutic ultrasound.
Explain and describe the use of electrical modalities.

3. Modalities
Various heating, cooling, and electrical methods of treatment used to promote healing
In order to be effective, modalities should be applied properly
Helps relieve pain, reduce swelling, decrease spasm, minimize time lost from sports

4. Cryotherapy Contraindications Always monitor athlete
Use of cooling agents
Ice packs
Ice massage
Cold whirlpool
Coldwater Compression
Always monitor athlete
Contraindications
Thermoregulatory problems
Sensory deficits
Hypersensitivity
Impaired circulation
Heart disease
Malignant tissue

5. Why ice? Effects Always use ice for acute injuries Vasoconstriction
Reduce tissue metabolism
Decrease nerve conduction velocity
Reduce muscle spasm
Always use ice for acute injuries

6. Ice Bag Easy to make, readily available, cheap No air should be in bag
May be wrapped on body
Reusable ice packs are better for clinical setting
Time: 20 minutes
May use thin barrier between ice and skin

7. Ice Massage Freeze water in a paper cup Reusable plastic cups
Ideal for tendonitis, shin splints
Time: 5-7 minutes

8. Cold Whirlpool Immersing body part in cold water (50°F-60°F)
Covers the whole body part
Athlete may move body part while receiving treatment
Time: 10 minutes

9. Cold Compression Unit
Many different units that provide cold and compression to shoulders, knees, and ankles
Some use a pump and some uses gravity
Time: minutes
Game ready: $4,500

10. Heating Agents Superficial and deep tissue heating Effects
Reduce pain
Increase range of motion
Muscle relaxation
Increased vasodilation
Only use with subacute or chronic injuries

11. Heat Packs Moist heat packs are kept in a hydrocollator
Water temp. 140°F to 194°F
Cover heat pack before placing on body
Should be warm but not burn
Time: minutes

12. Warm Whirlpool Immersing body part in warm water (95°F to 104°F)
Larger part of the body may be treated
Athlete may move during treatment
Time: minutes

13. Contrast Therapy Alternating hot and cold therapy
Used in subacute stage to reduce swelling, reduce pain, and increase range of motion

14. Ultrasound Deep heating modality High frequency sound wave
Can affect tissue up to 5 cm
Ideal for tendons, ligaments, and joint capsules
Time: 5-7 minutes

15. Ultrasound Effects Contraindications
Increased nerve conduction velocity
Increased extensibility of collagen rich structures
Increased blood flow
Tissue regeneration
Stimulating phagocytosis
Synthesis of collagen
Contraindications
Acute injuries
Ischemic areas
Anesthetic areas
Over cancerous tumors
Over active infections
Over spinal cord
Over fracture sites
Around eyes, heart, skull

16. Ultrasound Set-Up Transducer head: 1 cm², 5 cm², 10 cm²
Depends on availability and treatment area
Frequency: 1MHz for deep tissue, 3MHz for superficial
Continuous or pulsed setting (Duty Cycle)
Must use coupling agent
Move sound head at 2-4 cm/sec

17. Electrical Stimulation
Use of electrical currents to stimulate the muscle to cause contractions or spasms
Different types of currents
Different set-ups
Interferential
Pre-modulated

18. Electrical Stimulation
Effects
Increase range of motion
Increase muscle strength
Reeducation muscles
Improve muscle tone
Reduces muscle spasm
Control pain

19. Electrical Stimulation
Contraindications
Cardiac disability
Pacemaker
Pregnancy (over abdominal area)
Menstruation
Over cancerous lesions
Over sites of infection
Over exposed metal
Severe obesity
Epilepsy