Transcript Therapeutic Modalities

Therapeutic Modalities
Sports Medicine 2
Purpose
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Relieve Pain (Muscle Spasm/Pain
Cycle)~ injury causes muscle spasms
that cause pain that causes muscle
spasms
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Leads to decreased mobility, circulation
Reduce or slow swelling
Promote Healing
Choosing a Modality
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Is modality safe for this type of injury?
Will modality contribute significantly to
rehab process and complete recovery?
Is person applying modality trained to
use it?
Heating and Cooling
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Conduction~ heat transfer by direct contact
with another medium. (hot or ice packs)
Convection~ heat transfer by indirectly
through secondary conductive medium. (air
or liquid)
Radiation~ heat transfer by or from its
source to surrounding environment in form
of waves or rays. (ultraviolet light)
Heating and Cooling
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Conversion~ heat transfer that takes
place through other forms of energy,
such as sound, electricity or
chemicals. (Ultrasound, diathermy)
Evaporation~ heat transfer takes
place when a liquid coverts into a gas.
(perspiration)
Thermotherapy
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Treatments using heat
Increase the temperature of the body
region to cause vasodilatation
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Increases blood flow to area
Decreases pain and muscle spasms
Increasing flexibility to tissues
Comforting for most patients
Guidelines for Thermotherapy
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Never apply to an area of decreased
sensation
Never apply directly after injury
Never apply to eyes or genitalia
Never apply to a pregnant belly
Never apply over an open wound
Do not apply on pts with hx of diabetes
Moist Heat Packs
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Indications
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Chronic
Pain/Tendonitis
Lg jt. Contractures
Muscle Spasm
Chronic edema
Pre-heating to
electrical stim tx
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Contraindications
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Existing fever
Cardiac
irregularities
Decreased skin
sensation
Infections
Active Bleeding
Acute inflammatory
conditions
Clinical Application
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Pack should be applied with several
layers of towels or hot pack cover
Hydrocollator water temp = 170
degrees
Treatment time varies as indicated
Never lie or sit on hot pack due to
increase in burns
Typical Reactions to Hot Pack
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Feel comfortable warmth
Sensation of area relaxing
No sensation of burning should be felt
Paraffin Bath
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Indications
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Chronic Pain
Muscle Spasms
Chronic Edema
Chronic arthritis
Soften calloused
hands
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Contraindications
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Existing fever
Infections
Hypertension
Acute inflammatory
injuries
Wet hands/fingers
Open wounds
Clinical Application and
Response
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‘Glove hands’ with wax, frequent dip
Follow individual manufacturer directions
Feel comfortable warmth
Feel sensation of relaxation
No sensation of burning
Feeling of slight oil on hands after removal
of wax
Ultrasound
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High frequency sound wave converted
to heat
Can reach depths of 3-5 cm
Coupling mediums used to help sound
waves penetrate the skin
Sound head moved in slow, circular
pattern with contact at all times
Ultrasound
Two Types of Ultrasound
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Thermal Effects
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↑ collagen elasticity
↓ Joint stiffness
↓ Pain and spasm
↑ Blood Flow
Effects can last up to 1
hour after 5 minute tx.
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Mechanical Effects
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↑ Nerve conduction
Cell permeability
altered from pressure
changes
Mineral deposits
dissolved
Micromassage
Protein synthesis
promoted
Ultrasound
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Depths of Ultrasound
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1Mhz Frequency: depth of penetration =
up to 5 cm
3Mhz Frequency: depth of penetration =
1-2 cm
Ultrasound
Ultrasound Rate of Heating per Minute
Intensity
(W/cm²)
1 Mhz
3 Mhz
0.5
.04º C
.3º C
1
.2º C
.6º C
1.5
.3º C
.9º C
2
.4º C
1.4º C
Ultrasound~ Suggested Uses
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1Mhz for deep tissue
3Mhz for shallow tissue
Treatment time should be 5-10
minutes depending on area being
treated
Ultrasound treatments not performed
more than one time per day
Phonophoresis
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Combination of ultrasound and
medication driven into the skin through
sound waves
Usually anti-inflammatory medication
Time and technique same as regular
ultrasound
Cryotherapy
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Treatments using Cold
Decreases tissue temperature
Skin Color change from white to red
Decrease in total blood flow
Decrease in nerve conduction
Cryotherapy Treatment Length
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Average 15-20 minutes, once an hour
Three phases of sensation:
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Cold sensation lasting 0-3 minutes
Mild burning and aching lasting 3-5
minutes
Aching 5-8 minutes
Relative numbness lasting 8-10 minutes
Guidelines for Cryotherapy
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Use of a barrier, except in ice massage
Never on anesthetize skin
Never on open wounds
Never on someone with desensitized skin
Monitor for signs of Raynaud’s
Phenomenon, condition in which the
arteries and arterioles of an extremity
constrict extensively. Causes extensive
arterial blood flow.
Ice Packs
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Indications:
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Acute trauma
Acute Pain
Heat Illness
Muscle Fatigue
Spasms
Post-op Pain
Acute Edema
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Contraindications:
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Circulatory
insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to
cold
Raynaud’s Disease
Clinical Application of Ice Pack
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Directly to injured area
Frequency should be 20 minutes for
every waking hour in acute injuries
No longer than 20 minutes (veins
begin to vasodialate to warm body)
Used primarily for the first 48-72 hours
of an injury
Typical Response to Ice Pack
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Cold→Burning→Aching→Numbness
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Numbness takes from 3-7 minutes
Treatment usually satisfactory when
skin turns pink or red
Ice Massage
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Indications:
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Acute Trauma
Acute Pain
Muscle pain/spasm
Post-op pain
Heat Illness
Acute tendonitis
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Contraindications
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Circulatory
insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to
cold
Raynaud’s Disease
Clinical Application/
Responses
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Ice should have round edges
Continuous movement of ice to
prevent tissue freezing
5-10 minutes, 4-6 times a day
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Cold→Burning→Aching→Numbness
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Numbness takes from 3-7 minutes
Cold Whirlpool/Ice Immersion
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Indications:
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Acute Trauma
Acute Pain
Muscle pain/spasm
Post-op pain
Heat Illness
Acute tendonitis
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Contraindications
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Circulatory
insufficiency
Cardiac Problems
Open wounds
Anesthetic skin
Hypersensitivity to
cold
Raynaud’s Disease
Clinical Application
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Frequency of treatment is 20 minutes
Cool = 67º - 80º F . . Use for spasticity
Cold = 55º - 67º F . . Use for
inflammation and acute injury
Very Cold = 33º - 55º F . . Use for
acute injury and pain relief
Encourage athlete to work on ROM
while in the whirlpool or cold bath
Typical Reactions
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Athlete will usually be uncomfortable
and not want to do treatment
Cold→Burning→Aching→Numbness
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If water is constantly moving, athlete may
never achieve complete numbness
Contrast Bath
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Theory is that the cold vasoconstricts
the veins and the heat vasodialates
the veins creating a pumping motion to
push edema out of the area
Indications and Contraindications
same as those for Thermotherapy and
Cryotherapy
Clinical Application
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If swelling is anticipated end in cold
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Work to ending in hot
Hot water should be 95º-110º, and cold
water should be 55º-65º
Encourage athlete to work on increasing
ROM
Use a 2:3 ratio of cold to hot or hot to cold
Treatment should last between 20 and 30
minutes
Electric Modalities
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Use of electricity to influence healing
by stimulating the body tissues
Guidelines for Electrical
Modalities
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Follow all MD guidelines
Explain procedure to the patient
Expose and clean area to be treated
Place electrodes in appropriate place
Use equipment as prescribed
Never use on an open wound
Electrical Stimulation
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Effects:
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Management of pain through gate control
theory
Increase in deep blood flow and
lymphatic drainage
Slight increase in circulation
Muscle relaxation
Electrical Stimulation
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Indications:
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Pain
Edema
Spasm
Hematoma
Trigger Point
Early muscle reeducation
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Contraindications:
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Metabolic diseases
Children
Pacemaker
Tumor
Fever
Irritated skin
Clinical Application
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Follow MD recommendations for dosage
Treatment time should be 15-20 minutes
Each person has different levels that they
can tolerate, use the athlete as the guide
Athlete should feel a comfortable ‘moving’
tingling zone in the area around the
treatment pads
Iontophoresis
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Use of ions to penetrate medicine into the
injured area
1 cm penetration of medicinal ions
Numbing effect
Advantageous over Injectable:
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No chance of infection
No tissue trauma
Medication is only thing going through skin
Iontophoresis
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Indications:
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Trigger points
Tendonitis
Superficial
inflammatory
conditions
Plantar Warts
Myositis
Bursitis
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Contraindications:
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Superficial metal
implants
Pacemaker
Allergy to drug
being used
Acute injury
Anesthetic skin
Clinical Application
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Must have a prescription for use of
medicine
Follow MD guidelines for dosage
Must use appropriate medicines
Athlete should feel some pain relief
Athlete should not feel ‘hot pin’
sensation
Diathermy
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High frequency electrical current to
heat the body’s tissue
Bigger machines, not popular
Diathermy
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Indications:
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Chronic
sprains/strains
Limited ROM
Sub-acute
inflammations
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Contraindications:
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Acute inflammatory
injuries
Hemorrhages
Casts
Metal implants
Screws
Pregnant women
Clinical Application
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Sound heads placed around the area
being treated
Remove all metal from area
Cover the area with 2 layers of towels
Should feel like a ‘ray of sunshine’ on
the skin
Heats tissues to 104-112ºF at about 2
inches from skin’s surface