Injury Treatment Ms. Bowman
Jan 18, 2016
Injury Treatment
Ms. Bowman
Injury Treatment• 2 areas
o Therapeutic Modalitieso Therapeutic Exercise
Therapeutic Modalities
• Non-exercise treatment optionso Include the use of:
• Heat• Cold• Electrotherapy• Massage• Traction• Ultrasound• Compression
• Vocabularyo Indications-reasons/injuries where it is appropriate to use the modalityo Contraindications-reasons/injuries where it is inappropriate to use the
modality
Thermal Modalities• Transfer energy to or from the tissues; exchange
of energy based on a temperature gradient• Energy transferred through
o Conduction-between two objects that are touchingo Convection-movement of a medium (water, air)o Radiation-transfer without the use of a mediumo Conversion-energy changed to another form o Evaporation-liquid to gas state
Thermal Modalities• Cryotherapy-application of cold modalities
o Effects:• Vasoconstriction• Decreased rate of cell metabolism• Decreased production of cell waste• Reduction of inflammation• Decreased nerve conduction• Decreased pain• Decreased muscle spam• Decreased muscular force production
Thermal Modalitieso Indications:
• Acute injury or inflammation• Acute or chronic pain• Small, superficial, first-degree
burns• Postsurgical pain and edema• Use in conjunction with
rehabilitation exercises• Acute or chronic muscle spasms• neuralgia
o Contraindications:• Cardiac or respiratory
involvement• Uncovered open wounds• Circulatory insufficiency• Cold allergy/cold-induced
urticaria• Anesthetic skin• Advanced diabetes• Peripheral vascular disease• Raynaud’s phenomenon• Lupus
• Cryotherapy• Types:
o Ice bago Ice cupo Cold whirlpoolo Ice immersion
Thermal Modalities• Thermotherapy- application of superficial or deep
heating agentso Effects-
• Vasodilation• Increased rate of cell metabolism• Increased delivery of leukocytes• Increased capillary permeability• Increased venous and lymphatic drainage• Edema formation• Removal of metabolic wastes• Increased elasticity of collagen-rich tissues• Analgesia and sedation of nerves• Decreased muscle tone• Decreased muscle spasm• Decreased pain• Increased nerve conduction and velocity
Thermal Modalities• Indications:
o Subacute or chronic inflammatory conditions
o Reduction of subacute or chronic pain
o Subacute or chronic muscle spasm
o Decreased range of motiono Hematoma resolutiono Reduction of joint contractures
• Contraindications:o Acute injurieso Impaired circulationo Advanced arthritis (vigorous
heating)o Poor thermal regulationo Anesthetic areaso Neoplasmso thrombophlebitis
• Thermotherapyo Types:
• Superficial o Heat packo Warm whirlpoolo Warm immersiono Infrared lampso Paraffin baths
• Deep Heato Microwave diathermyo Shortwave diathermyo ultrasound
Deep Heating Agents• Therapeutic Ultrasound-deep-penetrating
modality capable of producing changes in tissue through both thermal and nonthermal mechanismso Uses acoustical energy
• Effectso Deep-heatingo Increase rate of tissue repairo Wound healingo Increased blood flowo Increased tissue extensibilityo Breakdown calcium depositso Reduction of paino Reduction of muscle spasmo Deliver medications
Deep Heating Agents• Ultrasound
o Continuous Output• Used for heating tissues
o Pulsed Output• Nonthermal effects
o The closer the duty cycle is to 100% the more thermal effects there are. The lower the duty cycle, the less thermal effects
Deep Heating Agents• Thermal Effects
o Increased sensory nerve conduction velocity
o Increased motor nerve conduction velocity
o Increased extensibility of collagen-rich structures
o Increased collagen depositiono Increased blood flowo Reduction of muscle spasmo Increased macrophage
activityo Enhanced adhesion of
leukocytes to damaged endothelial cells
• Nonthermal Effectso Increased cell membrane
permeabilityo Altered rates of diffusion across the
cell membraneo Increased vascular permeabilityo Secretion of cytokineso Increased blood flowo Increased fibroblastic activityo Stimulation of phagocytosiso Production of healthy granulation
tissueo Synthesis of proteino Synthesis of collageno Reduction of edemao Diffusion of ionso Tissue regenerationo Formation of stronger, more
deformable connective tissue
Deep Heating Agents• Contraindications
o Acute conditions (continuous) o Ischemic areaso Areas of impaired circulation/artery
diseaseo Over areas of deep vein thrombosiso Anesthetic areaso Over cancerous tumorso Over sites of active infection of sepsiso Over spinal cord or large nerve plexus
(high doses)o Exposed metal that penetrates skino Areas around eyes, heart, skull, or
genitalso Over the thorax (pacemaker)o Pregnancy when over pelvic or lumbar
areaso Over fracture site before healing is
completeo Stress fracture sites or sites of
osteoporosis o Over the pelvic of lumbar area in
menstruating patients
• Indicationso Joint contractureso Muscle spasmso Neuromao Scar tissueo Sympathetic nervous system
disorderso Trigger areaso Wartso Spasticityo Postacute reduction of myositis
ossificanso Acute inflammatory conditions
(pulsed)o Chronic inflammatory
conditions (pulsed or continuous)
Deep Heating AgentsTemperature Increases and Their Desired Effect
Classification of Ultrasound
Temperature Increase
Used for Thermal Effects
Mild 1ºC Mild inflammation, accelerating metabolic rate
Moderate 2°-3°C Decreasing muscle spasm, decreasing pain, increasing blood flow, reducing chronic inflammation
Vigorous 3°-4°C Tissue elongation, scar tissue reduction, inhibition of sympathetic activity
Deep Heating AgentsRate of Ultrasound Heating (temperature increase per minute)
Intensity Tissue Depth 1MHz 3MHz
0.5 0.04°C 0.3°C
1.0 0.2°C 0.6°C
1.5 0.3°C 0.9°C
2.0 0.4°C 1.4°C
Deep Heating Agents• Shortwave diathermy-uses high frequency
electromagnetic energy to produce deep heat within the tissueo Effects similar to thermal and nonthermal ultrasound
Deep Heating Agents• Effects
o Thermal-• Increased microvascular perfusion• Activation of fibroblast growth factors• Increased macrophage activity
o Nonthermal-• Heating of large area of tissue
o Heat retained 3 times longer than ultrasound
Deep Heating Agents• Contraindications
o Ischemiao Hemorrhageo Acute inflammation (thermal)o Metal within the output fieldo Pacemakero Presence of moistureo Moist dressing, adhesive tape,
skin creamso Skull (extreme caution)o Contact lenses must be
removed before application over head
o Pregnancy (over pelvis, abdomen, or lumbar)
o Menstruating females (over pelvis, abdomen, or lumbar)
o Unfused epiphyseal plates
• Indicationso Acute trauma (nonthermal)o Acute inflammation
(nonthermal)o Edema reduction
(nonthermal)o Subacute inflammationo Pain syndromeso Muscle spasmso Chronic inflammationo Increase blood flowo Stretching collagen-rich
tissues
Deep Heating AgentsPrecautions Against Metal Within the Field of Shortwave
Diathermy
In the Environment Near or On the Patient In the Patient
BedsTreatment tablesChairsWheelchairsMetal stoolsCPM UnitsSplintsBracesMedical instrumentsElectrical modalities
JewelryBody piercingsEarringsWatchesMetal in pockets (keys, etc.)Belt bucklesZippersMetal underwire brasHearing aids
Orthodontic bracesDental fillingsImplanted fixation devicesExternal fixation devicesMetal heart valvesArtificial jointsMetal IUDsBody piercingsCardiac pacemakersImplanted bone growth generatorsPhrenic pacers
Electrical Stimulation• Electrical stimulation-modality that utilizes
electrical currents• Electricity-force created by an imbalance in the
number of electrons at two points (poles)o Electrons flow in an attempt to equalize difference in charges—this
creates an electrical current• Negative pole-area of high electron concentration• Positive pole-area of low electron concentration
o Closed circuit-formed when a complete path is formed between the 2 poles
o Electrical Currents• Direct Current-uninterrupted, one directional flow of electrons; square
wave• Alternating Current-direction of flow changes from positive to
negative in a cyclical manner; no true positive or negative poles; electrons go back and forth between electrodes
• Pulsed Current-one direction of flow that is interrupted by periods of no current flow
Electrical Stimulation• Vocabulary
o Electrode leads-wires that conduct the current to and from the generator, electrodes, and patient
o Electrodes-introduce the current into the body; point where the electrode contacts the skin is where the electrons are converted into ions• When placed closer together, current flows superficially• When places farther apart, the deeper the current flows
Stimulation Levels
Subsensory
Between the point at which the output rises from zero to the point where the patient first receives an electrical sensation
Sensory Stimulation of only sensory nerves
Motor Stimulation that produces a visible muscle contraction
Noxious Stimulation of pain fibers
Electrical Stimulation• Contraindications
o Cardiac disabilityo Pacemakerso Pregnancy (over abdomen, pelvis,
and lumbar regions)o Menstruation (over abdomen,
pelvis, and lumbar regions)o Cancerous lesionso Sites of infectiono Exposed metal implantso Areas of nerve sensitivity
• Carotid sinus• Esophagus• Larynx• Pharynx• Around or on eyes• Upper thorax• Temporal region
o Severe obesityo Epilepsyo Electronic monitoring equipement
• Indicationso Controlling acute and chronic
paino Reducing edemao Reducing muscle spasmo Reducing joint contractureso Inhibiting muscle spasmso Minimizing disuse atrophyo Facilitation tissue healingo Facilitating muscle
reeducationo Facilitating fracture healing o Strengthening muscle
Electrical Stimulation• Types
o High-Voltage Pulsed Stimulationo Transcutaneous Electrical Nerve Stimulation (TENS)o Interferential Stimulationo Neuromuscular Electrical Stimulationo Iontoporesiso Microcurrent Electrical Stimulation
Mechanical and Light Modalities