Guideline in Physiotherapy Mod Ali Ties
-
Upload
wole-olaluwoye -
Category
Documents
-
view
220 -
download
0
Transcript of Guideline in Physiotherapy Mod Ali Ties
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 1/24
3PARAFFIN THERAPYCONTRAINDICATIONS
Paraffin should not be used over open wounds, abrasions, acute skin disorders, or wherethere is diminished sensation.METHODS OF PARAFFIN THERAPY APPLICATIONS
When constant heat is required for a long period, two or three hours, the application of theparaffin boot, properly insulated, gives excellent results either by direct or reflexapplication.
Dipping method: After washing and drying the extremity, dip the part in and out of the
bath quickly, allow time between dipping for congealing, dip again, and keep repeating
until the thickness of the paraffin is from 1/4 inch to 1/2 inch.
Depending upon the intended duration of the treatment, wrap the part in wax paper andinsulate all around with a towel.
When the treatment is completed, remove the paraffin and discard it
When dipping hands, keep fingers spread apart.
The part treated should now be massaged and passively exercised.
The entire treatment usually takes about 20 to 30 minutes.
Immersion method: For heat treatments of shorter duration, 10 to 30 minutes, use theimmersion method.
Dip the part in and out of the bath quickly so that a thin coating of paraffin congeals onthe
skin.
Repeat several times until the glove of paraffin is of sufficient thickness to allow the parttoremain in the bath with comfort.
Keep the part immersed from 20 to 30 minutes.
At the end of the treatment, remove the wax and discard it.
Brush on method: To apply paraffin bath heat treatment to parts of the body whichcannot beimmersed in the paraffin bath conveniently, paint the surface rapidly with a soft paintbrush.
When first applied, the paraffin will feel very warm, keep brushing until a thick coatingcovers the area
Allow it to remain for twenty to thirty minutes.
After removal, discard the wax.
The part treated should be massaged and passively exercised.
THERAPEUTIC ULTRASOUND THERAPEUTIC ULTRASOUND
Therapeutic ultrasound is that which is used for therapeutic (rather than diagnostic)purposesand is usually produced at 1 megacycle or 1 million cycles per second
US has replaced diathermy for many types of conditions because it is less timeconsumingand penetrates tissues well.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 2/24
There is less danger of burning
It takes only 8-10 minutes It is capable of penetrating 5 cm into the tissues.
Continuous US causes a thermal effect. The friction caused by the vibration within the
patient’s tissues will produce heat. Because US is transmitted by skin and fat, the heat can be directed to the deepermuscle layers
where it is needed.4PULSED ULTRASOUND
The energy is on for a short period of time, then off; alternating so that the "on time" ordutycycle is approximately5-50% of the total time.
The "off time" allow the tissues to disperse the heat created, thereby minimizing oreliminating the thermal effect.PULSED ULTRASOUND
With the 5% duty cycle, there is virtually no heating
With the50% duty cycle, some heating occurs.
Pulsating US is advantageous when the thermal effect may be detrimental.BIOLOGICAL EFFECTS
Inflammatory—increase fragility of lysosome membrane nd thus enhances the release of their contained enzymes which helps to clear the debris and allow next stage to occur.
Proliferative—fibroblast and myofibroblast may have ca++ ions driven to them by US.
Fibroblast are stimulated to produce collagen fibres to from scar and myofibroblast
contract
to pull the edges together.
Remodeling--- increase tensile strength of scar by affecting the directions, strength andelasticity of fibres.ULTRASOUND EFFECTS
Tissue temperature rise
Decreased nerve conduction velocity
Increased circulation
Increased tendon extensibility
Reduced adhesion formation
Decreased pain
Muscle relaxationULTRASOUND INDICATIONS
Neuromuscular, musculoskeletal disorders
Sprains and strains; adhesive capsulitis
Arthritic conditions - acute and chronic
Bursitis, tendinitis, including calcific tendinitis
Neuromas, scars, dupuytrens contracture
Plantar warts
Hematomas
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 3/24
AdhesionsPRECAUTIONS
Over heating of the cutaneous tissues may occur if
the intensity is set too high
Transducer is moved too slowly
Transducer surface is not kept parallel to the skin surfacePRECAUTIONS
Over heating of the periosteum may occur if:
~ The transducer is held too close to the bone
~ The intensity is set too high
~ The transducer is moved too slowly
5CONTRAINDICATIONS
Epiphysis of growing bones
Over reproductive organs
Over a gravid uterus
Over the heart
Over the eye; over anesthetic areas
Over ischemic areas; directly over the spinal column or brain
Over a fracture (until well healed)
Deep vein thrombosis
Arterial disease, hemophilia, malignancy
TB of the lungs or bone
Over the thoracic region of a patient with a pace makerAPPLICATION OF ULTRASOUND
Apply coupling medium to the part being treated and place the transducer against the
coupling medium. The unit should never be turned on without coupling medium because
the
crystal may over heat.
Keep the transducer moving slowly
Turn the intensity up to the desired level
Avoid bony prominences and keep the transducer parallel to the skin as possible
The patient may get a mild sense of warmth. If the patient gets too hot, oruncomfortable, thewattage should be reduced to a tolerable level
Treat for the desired timeUS IMMERSION METHOD
Good for treating hands, wrists, feet and elbows
Place the transducer and the treating part in a container of water
Keep the transducer moving slowly and within 1cm of the part being treated.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 4/24
Duration: acute 3-4 minutes; chronic 5-10 minutes
SHORT-WAVE DIATHERMY
Uses high frequency currents to heat the body tissues
The heat results from the resistance offered by the tissue to passage of the electric
current.
The patient's sensation is an important guide as the regulation of dosage, as it shouldproduceonly a mild comfortable sensation of warmth and not a sensation of heat
It is imperative that the sensory perception of the patient be normal in the use of diathermy.PRECAUTIONS
Remove metallic pins, buttons, and hair
Metallic objects must not contact the patient, as they will concentrate the heat and couldcause burns.
Pins, keys, jewelry, watches and buckles. TEN MAJOR EFFECTS
Thermal
Stimulation
Increased Blood flow
Hypotonicity6
Increase in visceral circulation
Endocrine changes
Oxidation
Phagocytosis
Detoxification
Increase in capillary pressureDOSAGE LEVEL I
For patients who have no appreciable specific pain or in the treatment of visceral
conditions, gradually increase temperature to where the patient just perceives a
comfortable yet distinct sensation of “velvety" warmth.
Dosage Level II
For patients who have pain, the temperature is increased to a point just below the levelof Dosage I.
The patient should perceive no detectable sensation of warmthGENERAL RULE
The more acute the condition to be treated, the less temperature elevation and theshorter thetreatment duration.ELECTRODE POSITIONS
The three common electrode positions are:
Transverse Longitudinal
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 5/24
CO-planar
GENERAL RULE
The thicker the body part to be treated, the greater should be the electrode -skin
distance,
which is provided by air spacing or towels
INDICATIONS
URI
Chronic osteoarthritis
ProstatitisCONTRAINDICATIONS
Over pregnant uterus
Over wet skin
Patients with pacemaker
Peptic ulcers
Rheumatoid
Malignancy
MICROWAVE DIATHERMY
The configuration of a pattern is determined and controlled by the distance that it isplacedfrom the patient and the shape of the reflector.
The power output of the microwave unit is adjusted in accordance with the size andshape of
the body part treated.
The smaller heat output of a microwave unit warms tissues in a much more local area.
7
There is little penetration into deeper organs.
Most of the effects of microwave radiation are due to heating of tissues by conversion.
The heat build up occurs mainly because of the resistance offered by tissue constituentstohigh frequency current, and a specific temperature distribution results within bodytissues.
Contact is not necessary, and smaller confinedareas can often be treated more effectively.
The field that can be heated at any one time is relatively small.
Microwave has little, if any effect on deep joints or visceraMICROWAVE DIATHERMY PRECAUTIONS
If vigorous heating effects are desired, the applicator must be brought close to thesurface of the skin.
The applicator should not be brought into contact with the skin.
Avoid sweat droplets forming on the skin that can be selectively heated.
During treatment near the head, the eyes should be shielded with special goggles.
Watches must be kept away from the high frequency field,
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 6/24
Hearing aids must be placed at least 4 feet from the treatment field.
The director should be placed from 1-7 inches from the patient depending on the typethat isused. TREATMENT DURATION Treatment duration exceeding 2O minutes is inadvisable
INTERFERENTIAL THERAPY The name interferential therapy stems from the concept of two currents interfering with
each other The major problems with the standard low frequency currents lie with the resistance
offered by the skin and the relatively long pulse duration. Normal human skin has a veryhigh resistance to the passage of a low frequency current. When the skin resistance is high, a larger potential difference (voltage) has to beapplied to
the skin in order to achieve an adequate current flow in the tissues. The larger the applied voltage, the more likely it is that the stimulus will become
uncomfortable for the patient.
If the skin resistance is lowered, then a smaller applied voltage will be required toproduce agiven current flow in the tissues.
Little resistance is offered to a higher frequency alternating current
The net result is that if the applied current has a higher frequency, the skin resistance will
be
low, with all the advantages of a more comfortable and efficient stimulation. In addition,
the
higher frequencies will mean shorter pulse durations and this will lead to a more
comfortable stimulus
Problems arise, however, that in order to gain the advantages of lowered skin resistance,thefrequency of the current used needs to be approximately 4,000 Hz,
At this medium frequency the current is well outside the usual biological range of between0.1 and 200 Hz.
If however, two medium frequency sine waves are applied to the skin and tissues in suchaway that there is a difference in frequency between the two currents, then a rather
interesting
9
If the patient's condition is unchanged after one or two treatments, then the situationneedsre-assessing.
Assuming that the machine is working correctly and is applied properly, then poor resultsshould indicate possible change in electrode position and/or a change infrequency/intensity.INDICATIONS
Pain relief both acute and chronic
Reduction of edema
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 7/24
Re-education and strengthening of muscle.
Stimulation and improvement of circulation
General facilitation of healingINTERFERENTIAL THERAPY
I.F. can and should be combined with other modalities.
Combining treatments implies giving two different but complimentary treatments atdifferenttimes or in some instances at the same time (ice, moist heat)
Spinal Traction Definition
The application of a drawing or pulling force along the long axis of the spine in order to:
Stretch soft tissues
Separate joint surfaces
Separate bony fragments
DISTRACTION
A form of dislocation in which joint surfaces have been separated without rupture of thebinding ligaments and without displacementINVERSION
Turning upside-down or other reversal of the normal relation of a part
TYPES OF TRACTIONCONTINUOUS TRACTION
This particular form involves lightweight applied for prolonged periods of time.
It is generally accepted that this form is ineffective at producing separation because of theslight force used.
This type of traction is generally used to align and stabilize adjacent body parts whenthereare fractures and/or dislocations.CONTINUOUS TRACTION
An example of continuous spinal traction is the halo type device used following a fractureof the cervical spine.
It may also be used after certain surgical procedures such as spinal fusions.SUSTAINED (STATIC) TRACTION
Sustained traction applies a constant amount of force.
Sustained traction is used from only a few minutes to as long as 30 minutes
The shorter duration seen with static traction is coupled with a greater traction force thanthat10
seen with continuous traction.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 8/24
Static traction is used mostly for WD herniations and may be effectively applied in boththecervical and lumbar spine
Sustained traction is probably most helpful in the early phases of treatment when thereissignificant guarding and muscle spasm present.
As the patient's condition improves, intermittent traction may prove to be more helpful.
Home cervical traction units (over-the-door) devices are examples of sustained traction.
These devices use a traction force that ranges from 5 to 15 pounds
Although the forces probably are not great enough to create any significant separation,manypatients find these devices helpfulINTERMITTENT TRACTION
Utilizes a mechanical traction device that alternately applies traction and allowsrelaxationfor a time period of several minutes to one-half hour.
This allows intermittent stretch of soft tissues, joint separation and inhibition of the disc,
which can be beneficial for the treatment of soft tissue injuries, joint fixation, nerve root
compression, degenerative disc disease, or an acute or chronic herniated disc.
The application of different traction forces that are alternately applied and released(hold/rest).
In this form of traction a moderate force is applied for a period of time usually from 30 to60seconds.
This is referred to as the “hold time"
The moderate force is then reduced to a lesser traction force that is applied for a shorterperiod from 10 to 20 seconds - the “rest period"
The traction device alternates between the two different forces for the treatmentduration,thereby producing not only traction and separation, but also some degree of movement.
It is most often used for joint dysfunction and degenerative disc disease.
It can be used for disc protrusions with longer hold/'rest periods (60 seconds hold 20secondsrest).
MANUAL TRACTION
Traction applied manually by the doctor.
The traction forces usually are applied for a few seconds at a time and, typically, in arhythmic nature.
Although manual traction may often be beneficial by itself, it is often employed prior toothermechanical forms of traction in order to assess the patient's tolerance.
Patients who may be intolerant of manual traction probably will not respond well to moreaggressive forms of traction Manual traction may often provide relief for patients with cervical stiffness, discproblems,
headaches, and other conditions.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 9/24
The amount of traction applied may vary, depending upon the patient’s condition,the part of the spine being tractioned, and the strength of the doctor.
11POSITIONAL TRACTION
Involves placing the patient in a particular position to increase motion in a specificdirectionat a specific segment of the spine. Pillows, blocks, and sandbags may be used to accentuate the position and increasetraction.
These techniques are incorporated into many of the procedures used by McKenzie in hisextension protocols for LBP patients.GRAVITY LUMBAR TRACTION
This may be achieved by a variety of inversion apparatuses. The patient is secured by the ankles or thighs and allowed to invert in some degree up to90degrees.
The weight of the upper body is affected by gravity and allows traction of the spine,
especially of the lumbar segments.Flexion-Distraction This is achieved with a specialized table on which the patient is placed in a proneposition
with the ankles strapped to the caudal end of the table. The table is then unlocked, so that the lower half of the table is allowed to flex.
By placing cephalad and anterior pressure on the vertebra above the motionsegment being
treated, very specific distraction is applied to the motion segment involved Many tables can also rotate and/or sidebend they’re lower half, allowing even more
specifically therapeutic distraction to the segment. Traction is applied in an intermittent fashion, creating a pumping effect.
Flexion Distraction can be a very effective method for the treatment of acute andchronic
intervertebral disc protrusion (medial and lateral), facet syndrome, Spondylolisthesis,retrolisthesis, discogenic spondyloarthrosis, anterior or posterior innominate, and sacruminferiority. Cox, using the flexion-distraction technique, found in 43 cases of medial discprotrusion that
3 responded to this treatment:
In 57 cases of lateral disc protrusion, 55 responded to this treatment, alleviating theneed forsurgery.INTERSEGMENTAL
TRACTION Involves the application of mechanical rollers that move up and down vertically asthey track
longitudinally along the paraspinal structures. The tension, speed, and amount of travel of the rollers are modified to patientcomfort.
As they move, the rollers lift and separate the vertebral units and exert a mildtractioning effect.
This type of "traction" is more appropriately termed a form of Passive mobility ratherthan
traction. In addition to the application of the mechanical forces, many of the intersegmentaltraction
tables simultaneously incorporate the use of vibration and heat with the mobilization.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 10/24
The primary benefit of intersegmental traction is seen in patients who are stiff, tight,and
generally tense.12 This is a very gentle form of therapy that affects whole segments of the spine.
In addition to any mild effect that this procedure may have on the movement of the
spine, it is
very comfortable and relaxing.INTERSEGMENTAL TRACTION Intersegmental traction meets with high patient acceptance; consequently, it isoverused in
many practice situations As with all other forms of therapy, Intersegmental traction should be provided tothose
patients who will benefit from the procedure. It should not be a routine part of the treatment of every patient.
EFFECTS Suction: A subatmospheric pressure is created when two vertebrae are pulled apart,causing a
centripetal force on the disc. Distraction: The distance between the articular surfaces increases with sufficienttraction.
Ligamentous tautening: The anterior and posterior longitudinal ligaments arestretched,
causing further centripetal force on the disc.
Relaxation of the musculature: Cyriax reported EMG silence 3 minutes after continuoustraction. Widening of the IVF
Straightening of the spinal curves.
INDICATIONS
IVD protrusions
Facet syndrome
Nerve root compression Spondylolisthesis
Retrolisthesis
Discogenic spondyloarthrosis
Muscular spasm
Anterior or posterior innominate
Sacral inferiority
Early scoliosis
It should be borne in mind, that traction is usually not the only therapy used. As with
other
forms of therapy, when it is used the doctor should be alert to changes in the patient's
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 11/24
condition that warrant modification in treatment methods. It is particularly important to keep in mind the following rule.
- If treatment increases peripheral pain and/or symptoms, it should be discontinued untilboth the condition and the therapy have been re-evaluatedPRECAUTIONS To minimize any potential injury resulting from inappropriate use of traction (e.g..
too much
weight or improper patient position), traction should be initiated gently, withprogressivelyincreasing force and time as the patient condition warrants. Following the application of traction, a patient should be allowed a short rest periodbefore
resuming activities. It is not uncommon for patients to feel some pain relief during the application of traction, only
13to have the relief disappear at tile end of tile treatment session. It is suggested that the patient should be gradually returned to the upright positionto maintain
relief.CONTRAINDICATIONS
Structural disease secondary to tumor or infection Vascular compromise, hypertension, atherosclerosis, phlebitis, angina, and a historyof stroke
or transient ischemic attack.
Acute sprains, strains, and other musculoskeletal inflammatory processes.
Pregnancy
Instability
Osteoporosis and other bone-weakening conditions
Hiatal hernia
Ankle, knee or hip joint dysfunction
Patients with aortic aneurysms
Patients with active peptic ulcers
Patients who are claustrophobic
CERVICAL TRACTION Maximum separation of the cervical vertebrae occurs when the cervical spine is flexedto25 to
30 degrees except for the atlantoocccipital and atlantoaxial joints, which should betractionedwith a 0 degrees angle of pull.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 12/24
Research has shown that supine traction is superior to sitting traction.
It is particularly important that patients are able to relax
Consideration must be given to the effect of the traction device on the TMJ
In order to produce a desired effect the traction force must be great enough to effect
a
structural change at the spinal segment Much less force is required for the cervical region
CERVICAL TRACTION PROPER POUNDAGE Forces of25 to45 pounds are necessary to produce measurable changes in the
posterior
structures. The maximal force should not exceed 45 pounds
Forces of 120 pounds have been shown to be necessary to cause a disc rupture at theC5-C6
levelCERVICAL TRACTION PROPER POUNDAGE It has been shown that a traction force of only 10 pounds will produce a separation of the
atlantoaxial joints; consequently less force is necessary when the upper cervical spine isthetarget area.
For the safe and effective application of traction to the cervical spine:
It is suggested that the doctor begin with a traction force of between 10 and 15
pounds
If the patient improves, continue at the same poundage or increase poundage by 5-
pound
increments to a maximum of 45 pounds.CERVICAL TRACTION14PATIENT POSITION Positioning of the patient has a direct effect on the location of the traction effect:
If the head is allowed to lay on the table with the cervical spine in a neutral orextended
position, the traction will exert its maximal effect on the anterior intervertebral structuressuchas the IVD. When the objective is separation of the interbody joints, the patient should bepositioned in
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 13/24
such a neutral or extended position. If the head is maintained in a flexed, forward- bent position, the traction will exert itsmaximal
effect on the posterior structures, such as the facet articulations and the WF. When the objective is separation of the posterior articulations, the patient should bepositioned
with the neck in a flexed position. The greater angle of flexion, the lower in the cervical spine is the area affected by thetraction
force. The position of the head and neck can be adjusted to ensure that separation occurs atthe
desired location. This is most easily accomplished by communicating with the patient during the initial
application. The best position is the one that localizes the traction force in the area of pain.
CERVICAL TRACTION ANGLE OF PULL It is suggested that an angle of 0 to 15 degrees be used for the upper cervical spine.
The angle should be increased by 5-degree increments for each progressively lower
cervical segment Both the angle of pull and the position of the head have a similar effect in changingthe
location of the traction forces.CERVICAL TRACTION DURATION Traditionally, spinal traction is applied in 20-minute increments
Treatment times may vary depending on the nature of the condition, the type of equipment
used, and the response of the patient.
CERVICAL TRACTION
TREATMENT FREQUENCY
As with other forms of therapy, spinal traction has a specific physiologic effect andshould beused when that effect is desired.
The application of sustained and intermittent traction is usually only warranted forrelativelyshort periods of time. Daily treatment is suggested for the first 3 days, followed by three times weekly for 2to 3
weeks
If traction is to be helpful, some relief should be seen within the first three to fivetreatments. Unlike other forms of traction, intersegmental traction may be warranted on acontinuing basis
in some patients. It should not, however, serve as a substitute for stretching and flexibility exercises,nor should
it be used as a standard procedure for all patients seen.LUMBAR TRACTION There is a great variation in the methods used to apply traction to the lumbar spine.
Traction node (sustained or intermittent) depends on both the disorder being treated and
on the
comfort of the patient.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 14/24
Disc protrusions usually are treated more effectively with sustained traction or withlonger
hold-rest periods of intermittent traction (60 seconds hold, 20 seconds rest). Joint dysfunction and degenerative disc disease usually respond to shorter hold-restperiods of intermittent traction (30 seconds hold, 10 seconds rest)
LUMBAR TRACTIONPROPER POUNDAGE Begin with approximately 50 pounds
If the patient improves, continue at the same poundage or increase poundage by 10-poundincrements to a maximum of 125 pounds. The patient position, whether prone or supine, and the amount of flexion orextension used
depend on the disorder being treated, on the experience of the doctor, on the comfort of thepatient, and on the type of equipment being used.LUMBAR TRACTION ANGLE OF PULL
To treat lumbar conditions the proper angle of pull is between 15 and 50 degrees
To affect the lower thoracic and upper lumbar segments (L1 -L3); the angle of pull mustbe15 to 30 degrees To affect the lower lumbar segments (L3-
L
5);the angle of pull must be 30-50 degrees. Hypolordosis of the lumbar spine should be treated with an angle of pull from 15 -30
degrees. Hyperlordosis should be treated with an angle of pull from 30 to 50 degrees.
The lower in the lumbar spine the traction is intended, the greater the angle of pull.
LOW VOLTAGE GALVANIC Galvanic current allows stimulation of deinervated muscle as well as the possibilityof driving ions into the tissues called iontophoresis. A galvanic current is a unidirectional (monophasic) current flowing for an indefinite
duration. Low frequency alternating currents are utilized because of the continued need for
electrical stimulation of atrophied muscle, especially for patients with CNS lesions. Low frequency alternating current: a current in which the direction of electron flow
changes at a rate between l and 2000 Hz.
Sine wave: a low frequency alternating current that takes the shape of a sine curve
Faradic current: a low frequency alternating current with 2 unequal phases
The iontophoresis effect is not frequently used.
LOW VOLTAGE THERAPY IONTOPHORESIS On the principle that like charges repel and opposites attract, ions of varioussubstances
are placed under their similar polarity electrode and driven through tissues by currentsusually less than 5 mA. Copper sulphate, sodium chloride, lidocaine and a corticosteroid
LOW VOLTAGE THERAPY
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 15/24
16EFFECTS
Contraction of innervated muscle
Pain relief
Edema reduction
LOW VOLTAGE THERAPYINDICATIONS Stimulation of weak and/or atrophied muscles
Nonsystemic edema
LOW VOLTAGE THERAPYCONTRAINDICATIONS
Through the brain, heart or eyes
Over bony prominences
Fractures
Skin lesions
Malignancy
Anesthetic areas
Over a gravid uterus
LOW VOLTAGE THERAPY APPLICATION Place pads firmly on treating parts; can use hot packs, cold packs, for combination
therapy.
Quadrapolar or bipolar technique may be used.
If unequal sized pads are used, the smaller pad will produce a greater effect.
A probe may be used for specific stimulation of motor points.
Set mode to: Pulse, if a gentle treatment is desired, to avoid further trauma or to
disperse
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 16/24
fluid. Set mode to: Surge, if a series of muscle contractions is desired (e.g. for muscle re-
education) Set mode to: Tetanize, if a tetanic contraction is desired to fatigue the muscle (e.g..for
muscle spasm or muscle tension)
Choose the pulse width, "on ramp" time, and/or "off ramp time.
Set the timer to desired time
Increase the intensity slowly to patient tolerance or until the desired muscle
contraction is
achieved. Treatment duration depends on the effect desired and the integrity of the musclebeing
stimulatedLOW VOLTAGE THERAPY
Dr. Kots of the Soviet Union has suggested the following times:
To increase circulation: 2 sec on, 2 sec off
To reduce spasm and pain: 12 sec on, S sec off
For strength, endurance, and velocity: 10 sec. on, 50 sec. off
17
TENS TENS should apply to any form of electrical stimulation that is applied via surface
electrodes. The term has been used for small portable stimulators that can be attached to thebelt or
clothing and used for various time periods for the relief of pain. In general the primary effect of TENS is the relief of pain.
Many health practitioners are finding TENS to be an effective, safe, noninvasive, and
cost effective method of treating acute, chronic and psychogenic pain of innumerableorigins. TENS INDICATIONS
Chronic pain
Acute pain
Intractable pain (TENS can provide adequate relief of pain secondary to malignancy.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 17/24
Results are best with trunk and extremity pain and worst with pelvic and perineal pain. Rehabilitation: The use of TENS for the reduction of pain during rehabilitation can
increase performance and shorten disability. Care must be taken to not allow the TENS to obliterate pain to the extent that thepatient
loses protective cues and overstresses the part being rehabilitated.
TENS CONTRAINDICATIONS
Pacemakers
Carotid nerve stimulation
Laryngeal stimulation
During pregnancy
TENS ELECTRODE PLACEMENT
Electrode placement is one of the most critical factors for the success of TENS
Directly over or around the painful site
Over trigger points
Over acupuncture points
Within a specific dermatome
At the site of the corresponding nerve root
TENS The most significant complication of TENS is local skin rashes produced by the
conduction gel or tape. There are no contraindications to 24-hour use of "high TENS". "Low" TENS, however,
should be used only 30-40 minutes at a time, as "Low TENS" causes muscle contractionandmay cause soreness if used for longer periods. Electrodes should be removed every day or two to clean the skin and inspect thearea.
SOFT TISSUE MANIPULATIONCertain manipulations of the soft tissues of the body; these manipulations are mosteffectively
performed with the hands, and are administered for the purpose of producing effects onthenervous and muscular systems and the local and general circulation of the blood andlymph.18EFFECTS
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 18/24
Mechanically assisting the flow of blood and lymph to increase circulation and reduce
edema
Maintenance of muscle flexibility and viability
Breaking up scar tissue, adhesions, and fibrosis
Sedation
Stimulation
CONTRAINDICATIONS
Acute circulatory disturbances
Acute inflammation
Malignancy
Edema secondary to heart decompensation, kidney disease, embolus, obstruction of
lymph
channels, thrombus Hyperesthesia of the skin
Communicable disease
SPECIFIC METHODSEffleurage - stroking motion and begin with light pressure and progress to heavierpressure as
tolerated and terminate with light pressure.Petrissage - Kneading or rolling motion, strokes are either in a centripetal direction or
transverse to the muscle fibers
Rolfing - is a deep massage that strives to separate the fascia between muscles Friction- is used
to break up superficial and/or deep adhesions of muscle or other soft tissues. No lotion isusedand small circular or linear strokes are used to loosen the tissue beneath the skin. Transverse friction - is a specific type of friction massage that is used to treat tendinitisor
tenosynovitis. It is performed perpendicular to the tendon sheath, causing the tendon toseparatefrom the sheath and slide through it more easily. Tapotement - includes tapping, slapping, cupping motions. It is useful for increasingcirculation
to an area and for postural drainage to increase the release of abnormal secretions from
the lungs.
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 19/24
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 20/24
19
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 21/24
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 22/24
20
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 23/24
8/4/2019 Guideline in Physiotherapy Mod Ali Ties
http://slidepdf.com/reader/full/guideline-in-physiotherapy-mod-ali-ties 24/24