1. Therapeutic Modalities Chapter 6 or 7

2. Therapeutic Modalities  Indication: A condition that could benefit from a specific modality.  Contraindication: A condition that could be adversely affected if a particular modality is used.

3. Electromagnetic Spectrum  Electromagnetic Radiation  Electromagnetic Spectrum  Ionizing Range  Non-Ionizing Range

4. Ionizing Range  Energy readily alters the components of atoms.  Used for X-rays and Treating Cancer.  Not used by Athletic Trainers

5. Non-Ionizing Range  Ultraviolet- Superficial tissue treatment  Infrared-  Near Infrared- 5-10mm deep  Far Infrared- <2mm deep  Diathermy- Conversion

6. Transfer of Energy  Energy moves from an area of HIGH concentration to an area of LOW concentration.  Radiation  Conduction  Convection  Conversion  Evaporation

7. Radiation  When the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made.  Short-wave Diathermy  Microwave Diathermy

8. Conduction  Direct transfer of energy between two objects in physical contact with each other. Energy is transferred from the area of high temp. to the area of low temp.  Ice packs  Moist heat packs  Paraffin

9. Convection  Much like conduction, but the medium moves across the body causing variations.  Fluidotherapy  Whirlpools

10. Conversion  Changes other energy forms into Heat.  Ultrasound  Microwave  Liniments or Balms

11. Evaporation  Heat is absorbed by the liquid on the skins surface and cools the skin as it turns into a gaseous state.  Vapocoolant sprays  Alcohol

12. Factors Affecting Transfer of Energy  Density of Medium  Reflection  Refraction  Absorption  Law of Grotthus-Draper

13. Energy’s Effect on Tissue  Cosine law+/- 10ºF is acceptable  Inverse Square Law E=Es/D²  E= Resulting Energy  Es= Source Energy  D= Distance Squared

14. Cryotherapy  Heat Abstraction  Depth of 5cm can be cooled  Change in Temperature depends on:  Type of Agent  Temp. difference between agent and tissue  Amount of insulation  Thermal Conductivity  Limb circumference  Duration of application

15. Cryotherapy  Leads to vasoconstriction  Decreases tissue metabolism  Decreases tissue permeability  Decreases capillary permeability  Decreases pain  Decreases spasms  Analgesic relief of pain

16. Cryotherapy  Ideal Temperature 32-65°F  20-30 mins. (10-15 mins.) of treatment  30+ mins. If a towel is used  90 mins. Is the bodies rewarming period  Four progressive sensations  ColdBurningAchingAnalgesia

17. Types of Cryotherapy Applications  Cryokinetics  Ice Massage  Ice Packs  Cryocuffs  Ice Immersion (Whirlpool)  Contrast Bath  Commercial Gel and Chemical Packs

18. Types of Cryotherapy Applications cont.  Controlled Cold-Compression Units  Vapocoolant sprays

19. Cryotherapy  Indications  Acute or chronic pain, or muscle spasm  Acute inflammation  Post surgical pain or edema  Superficial first-degree burns  Facilitate mobilization  Relieve Pain  Decrease Muscle spasiticity

20. Cryotherapy  Contraindications  Hypersensitivity  Cold Allergy  Circulatory or sensory impairment  Reynaud’s disease  Hypertension  Open wounds  Cardiac or respiratory disorders  Nerve palsy  Arthritis

21. Thermotherapy  Increases circulation  Increases cellular metabolism  Produces analgesic or sedative effect  Helps resolve pain and muscle spasming  Vasodilatation:  Promotes Healing  Increases Oxygen concentration  Removes debris and waste products

22. Thermotherapy  Modes of use  Conduction  Convection  Radiation  Types of Applications  Whirlpools  Hot tubs  Jacuzzis  Moist heat packs  Paraffin baths  Ultrasound  Phonophoresis  Diathermy heat

23. Ultrasound  Indications  Increase deep tissue heat  Decrease inflammation  Decrease muscle spasms  Decrease pain  Increase extensibility of collagen tissue  Decrease pain of neuromas  Decrease joint adhesions  Treat myositis ossificans  Contraindications  Hemorrhage  Infection  Thrombophlebitis  Suspected malignancy  Impaired circulation or sensation  Stress fracture sites  Epiphyseal growth plates  Over the Eyes, Heart, Spine, or genitals

24. Ultrasound  Thermal effects  Non-thermal effects  Application of Ultrasound  1MHz 3-5cm of penetration  3MHz superficial tissues and tendons  Continuous- 100%  Pulsed- 10-50%

25. Phonophoresis  Ultrasound with drugs, used to increase absorption and penetration of drugs up to 5 or 6 cms  Anti-inflammatory’s  Cortisol  Dexamethasone  Salicylates  Analgesics  Lidocaine

26. Electrotherapy  Decrease pain  Increase blood flow  Increase Range of Motion  Increase muscle strength  Muscle re-education  Facilitate absorption of medicines

27. Electricity  Flows between two points  DC- Direct-current  Continuous one directional flow  Used for pain modulation or muscular contraction also produce ion movement  AC- Alternating-current  Continuous two directional flow of ions  Used for pain modulation or muscular contraction

28. Electrotherapy  Amplitude  Frequency  Pulse duration  Pulse charge  Electrode set-up  Polarity  Mode  Duty cycle  Duration of Treatment

29. Electrotherapy  TENS (transcutaneous Electrical Nerve Stimulation)  High-Voltage pulsed stimulation  Neuromuscular Electrical Stimulation  Interferential stimulation  Low-Intensity Stimulation  Galvanic Stimulation  Russian current  Faradic current  Iontophoresis

30. Massage  Effleurage  Petrissage  Tapotement  Vibration  Friction

31. Traction  Indications  Herniated disc  Spinal nerve impingement  Spinal nerve inflammation  Joint hypo-mobility  Narrowing of intervertebral foramen  Degenerative joint disease  Spondylolisthesis  Muscle spasm and guarding  Joint pain  Contraindications  Unstable vertebrae  Acute lumbage  Gross emphysema  S4 nerve root signs  Temperomandibular joint dysfunction  Patient discomfort

32. Drugs  Anti-inflammatory (NSAIDS)  Anti-pyretic  Analgesics