Therapeutic Modalities Chapter 6 or 7
Therapeutic Modalities
Chapter 6 or 7
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.
Electromagnetic Spectrum
Electromagnetic Radiation Electromagnetic Spectrum
Ionizing RangeNon-Ionizing Range
Ionizing Range
Energy readily alters the components of atoms. Used for X-rays and Treating Cancer. Not used by Athletic Trainers
Non-Ionizing Range
Ultraviolet- Superficial tissue treatment Infrared-
Near Infrared- 5-10mm deepFar Infrared- <2mm deep
Diathermy- Conversion
Transfer of Energy
Energy moves from an area of HIGH concentration to an area of LOW concentration.
Radiation Conduction Convection Conversion Evaporation
Radiation
When the surrounding environment is hotter that the body the radiant heat is absorbed. No-contact is made.
Short-wave Diathermy Microwave Diathermy
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
Convection
Much like conduction, but the medium moves across the body causing variations.
Fluidotherapy Whirlpools
Conversion
Changes other energy forms into Heat. Ultrasound Microwave Liniments or Balms
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
Factors Affecting Transfer of Energy
Density of Medium Reflection Refraction Absorption Law of Grotthus-Draper
Energy’s Effect on Tissue
Cosine law+/- 10ºF is acceptable Inverse Square Law E=Es/D²
E= Resulting EnergyEs= Source EnergyD= Distance Squared
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
Cryotherapy
Leads to vasoconstriction Decreases tissue metabolism Decreases tissue permeability Decreases capillary permeability Decreases pain Decreases spasms Analgesic relief of pain
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
Cold Burning Aching Analgesia
Types of Cryotherapy Applications
Cryokinetics Ice Massage Ice Packs Cryocuffs Ice Immersion (Whirlpool) Contrast Bath Commercial Gel and Chemical Packs
Types of Cryotherapy Applications cont.
Controlled Cold-Compression Units Vapocoolant sprays
Cryotherapy Indications
Acute or chronic pain, or muscle spasmAcute inflammationPost surgical pain or edemaSuperficial first-degree burnsFacilitate mobilizationRelieve PainDecrease Muscle spasiticity
Cryotherapy Contraindications
Hypersensitivity Cold Allergy Circulatory or sensory impairment Reynaud’s disease Hypertension Open wounds Cardiac or respiratory disorders Nerve palsy Arthritis
Thermotherapy Increases circulation Increases cellular metabolism Produces analgesic or sedative effect Helps resolve pain and muscle spasming Vasodilatation:
Promotes Healing Increases Oxygen concentrationRemoves debris and waste products
Thermotherapy Modes of use
Conduction Convection Radiation
Types of Applications Whirlpools Hot tubs Jacuzzis Moist heat packs
Paraffin baths Ultrasound Phonophoresis Diathermy heat
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
Ultrasound
Thermal effects Non-thermal effects Application of Ultrasound
1MHz 3-5cm of penetration3MHz superficial tissues and tendons
Continuous- 100% Pulsed- 10-50%
Phonophoresis Ultrasound with drugs, used to increase absorption
and penetration of drugs up to 5 or 6 cms Anti-inflammatory’s
CortisolDexamethasoneSalicylates
AnalgesicsLidocaine
Electrotherapy
Decrease pain Increase blood flow Increase Range of Motion Increase muscle strength Muscle re-education Facilitate absorption of medicines
Electricity Flows between two points DC- Direct-current
Continuous one directional flowUsed for pain modulation or muscular contraction also
produce ion movement AC- Alternating-current
Continuous two directional flow of ionsUsed for pain modulation or muscular contraction
Electrotherapy
Amplitude Frequency Pulse duration Pulse charge Electrode set-up Polarity Mode
Duty cycle Duration of Treatment
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
Massage
Effleurage Petrissage Tapotement Vibration Friction
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
Drugs
Anti-inflammatory (NSAIDS) Anti-pyretic Analgesics