Post on 27-Mar-2015
Therapeutic Modalities
Sports Medicine 2
Lexington High School
Purpose
Muscle Spasm/Pain Cycle~ injury causes muscle spasms that cause pain that causes muscle spasms Leads to decreased mobility
Therapeutic Modalities used to stop cycle
Misapplication can make injury worse
Choosing a Modality
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 Means
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 Means
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
Treatments using heat Increase the temperature of the body
region to cause vasodilatation Increases blood flow to area
Decreases pain and muscle spasms Increasing flexibility to tissues Comforting for most patients
Guidelines for Thermotherapy
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
Indications Chronic
Pain/Tendonitis Lg jt. Contractures Muscle Spasm Chronic edema Pre-heating to
electrical stim tx
Contraindications Existing fever Cardiac
irregularities Decreased skin
sensation Infections Active Bleeding Acute inflammatory
conditions
Clinical Application
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
Feel comfortable warmth Sensation of area relaxing No sensation of burning should be felt
Paraffin Bath
Indications Chronic Pain Muscle Spasms Chronic Edema Chronic arthritis Soften calloused
hands
Contraindications Existing fever Infections Hypertension Acute inflammatory
injuries Wet hands/fingers Open wounds
Clinical Application and Response
‘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
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
Thermal Effects ↑ collagen elasticity ↓ Joint stiffness ↓ Pain and spasm ↑ Blood Flow Effects can last up to 1
hour after 5 minute tx.
Mechanical Effects ↑ Nerve conduction Cell permeability
altered from pressure changes
Mineral deposits dissolved
Micromassage Protein synthesis
promoted
Two Types of Ultrasound
Ultrasound
Depths of Ultrasound 1Mhz Frequency: depth of penetration =
up to 5 cm 3Mhz Frequency: depth of penetration =
1-2 cm
Ultrasound
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 Rate of Heating per Minute
Ultrasound~ Suggested Uses
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
Combination of ultrasound and medication driven into the skin through sound waves
Usually anti-inflammatory medication Time and technique same as regular
ultrasound
Cryotherapy
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
Average 15-20 minutes, once an hour Three phases of sensation:
Cold sensation lasting 0-3 minutes Mild burning and aching lasting 2-7
minutes Relative numbness lasting 5-12 minutes
Guidelines for Cryotherapy
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
Indications: Acute trauma Acute Pain Heat Illness Muscle Fatigue Spasms Post-op Pain Acute Edema
Contraindications: Circulatory
insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to
cold Raynaud’s Disease
Clinical Application of Ice Pack
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
Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes
Treatment usually satisfactory when skin turns pink or red
Ice Massage
Indications: Acute Trauma Acute Pain Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis
Contraindications Circulatory
insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to
cold Raynaud’s Disease
Clinical Application/ Responses
Ice should have round edges Continuous movement of ice to
prevent tissue freezing 5-10 minutes, 4-6 times a day
Cold→Burning→Aching→Numbness Numbness takes from 3-7 minutes
Cold Whirlpool/Ice Immersion
Indications: Acute Trauma Acute Pain Muscle pain/spasm Post-op pain Heat Illness Acute tendonitis
Contraindications Circulatory
insufficiency Cardiac Problems Open wounds Anesthetic skin Hypersensitivity to
cold Raynaud’s Disease
Clinical Application
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
Athlete will usually be uncomfortable and not want to do treatment
Cold→Burning→Aching→Numbness If water is constantly moving, athlete may
never achieve complete numbness
Contrast Bath
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
If swelling is anticipated end in cold 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
Use of electricity to influence healing by stimulating the body tissues
Guidelines for Electrical Modalities
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
Effects: Management of pain through gate control
theory Increase in deep blood flow and
lymphatic drainage Slight increase in circulation Muscle relaxation
Electrical Stimulation
Indications: Pain Edema Spasm Hematoma Trigger Point Early muscle re-
education
Contraindications: Metabolic diseases Children Pacemaker Tumor Fever Irritated skin
Clinical Application
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
Use of ions to penetrate medicine into the injured area
1 cm penetration of medicinal ions Numbing effect Advantageous over Injectable:
No chance of infection No tissue trauma Medication is only thing going through skin
Iontophoresis
Indications: Trigger points Tendonitis Superficial
inflammatory conditions
Plantar Warts Myositis Bursitis
Contraindications: Superficial metal
implants Pacemaker Allergy to drug
being used Acute injury Anesthetic skin
Clinical Application
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
High frequency electrical current to heat the body’s tissue
Bigger machines, not popular
Diathermy
Indications: Chronic
sprains/strains Limited ROM Sub-acute
inflammations
Contraindications: Acute inflammatory
injuries Hemorrhages Casts Metal implants Screws Pregnant women
Clinical Application
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